[Railway suicide and the proximity of psychiatric hospitals: a scoping review]. / Spoorsuïcide en de aanwezigheid van psychiatrische ziekenhuizen: een scoping review.

BACKGROUND: The proximity of a psychiatric hospital to a railway infrastructure is a risk factor for railway suicide. Due to limited research results, no systematic reviews have extensively investigated the determinants of this association. AIM: Scoping review of the current scientific knowledge on the institutional, patient-related and rail- and environment-related determinants of rail suicide in proximity of psychiatric hospitals and of existing preventive measures taken by rail managers in Belgium and the Netherlands. METHOD: A literature search was conducted using the PubMed, Embase, Web of Science, and Scopus databases. Relevant policy documents were requested from railroad administrators. RESULTS: Residential patients with a severe psychiatric disorder are at increased risk of railway suicide. Poor continuity of care and various rail and environmental factors appear to be other relevant risk factors. The rail sector in Belgium and the Netherlands appears to take specific measures to prevent rail suicide in the hotspots located near psychiatric hospitals. CONCLUSION: Despite certain consistent findings about the population at risk for railway suicide, there is a clear need for more research concerning other possible determinants and the effectiveness of suicide prevention programs within a psychiatric context.

[The impact of high indoor temperatures on cognitive performance within the work setting: a systematic review]. / Hoge omgevingstemperatuur en cognitieve prestaties binnen werksetting: systematische review.

BACKGROUND: Workplace guidelines exclusively focus on the impact of high indoor temperatures on physical work. There are no concrete recommendations in this regard concerning mental work. AIM: To investigate to what extent high ambient temperatures can have an impact on cognitive performance within a work setting, which cognitive skills or tasks are impacted, and to what extent the results found can be transposed to the work setting of the psychiatrist. METHOD: A literature search was conducted using the PubMed, Embase, and Web of Science databases. RESULTS: A total of 17 studies were included. Although results were inconsistent, reaction time and processing speed appeared to be the most sensitive cognitive skills to elevated ambient temperatures. Higher cognitive functions such as logical and abstract reasoning were more resistant. The temperature range for optimal cognitive functioning generally appeared to be between 22°C and 24°C. CONCLUSION: Temperatures above 24°C can have a negative impact on cognitive performance within a work setting. Given that reaction speed and processing speed are particularly affected, this could possibly have an impact in the work setting of the psychiatrist when making crucial decisions. However, due to the limited ecological validity of the included studies, unequivocal conclusions remain difficult.

[Sustainability in Flemish and Dutch mental health care]. / Duurzaamheid in de Vlaamse en Nederlandse ggz.

BACKGROUND: The Flemish and Dutch (mental) health sectors cause greenhouse gas emissions and therefore will have to make an effort to reduce their climate impact. AIM: To assess whether differences can be found in the climate policies of Flemish and Dutch mental health institutions. METHOD: Descriptive research based on a sustainability questionnaire, in which concrete actions, objectives and ambitions in the field of sustainability were questioned at Flemish and Dutch mental health institutions. RESULTS: 59% and 38% of respectively the Flemish and Dutch institutions fully agreed that sustainability is a very important theme (with a main focus on sustainable energy transition and recycling in both regions). Statistically significant differences between both regions were only found with regard to fostering more sustainable commuting (stronger in Flanders; p < 0.0001). The climate impact of medicines and food, as well as investments in sustainable projects, received little attention. CONCLUSION: Although a substantial part of Flemish and Dutch mental health institutions consider sustainability (very) important, a systemic ‘transformation’ will be necessary to make them climate neutral.

[Somatic care in psychiatry : barriers perceived by patients and health professionals]. / Soins de santé somatiques en psychiatrie : barrières perçues par les patients et les professionnels de la santé.

Disparities in access to, use of and delivery of somatic health care contribute to widening gaps in morbidity and mortality between psychiatric patients and the general population. We conducted a qualitative semi-structured interview study with psychiatric patients and health professionals from different psychiatric care settings to understand these poor physical health outcomes. Optimal somatic follow-up of patients with severe mental illness seems to be hampered by (1) provider-related elements (attitude, training, experiences); (2) organisational aspects (equipment, infrastructure, staff, pharmacy, communication networks); (3) psychiatric patient-related elements and (4) financial barriers.There is an urgent need for integrated somatic and psychiatric health care systems and for cultural change. Psychiatrists and somatic health care providers continue to view the mental and physical health of their patients as mutually exclusive responsibilities. A range of system changes will improve the quality of somatic health care for these vulnerable patients.

Les disparités dans l'accès, l'utilisation et la prestation des soins de santé somatiques contribuent à creuser les écarts de morbidité et mortalité entre patients psychiatriques et la population générale. Nous avons mené une étude qualitative par entretiens semi-structurés auprès de patients psychiatriques et de professionnels de santé de différents lieux de soins psychiatriques afin de comprendre ces mauvais résultats en matière de santé physique. Le suivi somatique optimal des patients atteints d'une maladie mentale sévère semble entravé par des éléments : (1) liés aux prestataires de soins (attitude, formation, expériences); (2) en relation avec des aspects organisationnels (équipement, infrastructure, personnel, pharmacie, réseaux de communication); (3) inhérents aux caractéristiques des patients psychiatriques et (4) représentés par des obstacles financiers. Il est urgent de mettre en place des systèmes de soins de santé somatiques et psychiatriques intégrés et d'entamer un changement culturel. Les psychiatres et les prestataires de soins somatiques continuent de considérer la santé mentale et la santé physique de leurs patients comme des responsabilités mutuellement exclusives. Un changement de paradigme tendant vers une meilleure intégration permettra d'améliorer la qualité des soins de santé somatiques pour ces patients vulnérables.

[Between response and resistance: pseudo-resistance during treatment of major depressive disorder]. / Tussen respons en resistentie: pseudo­resistentie bij de behandeling van een depressieve stoornis.

BACKGROUND: Although the efficacy of antidepressants has been clearly established, 30-60% of patients with major depressive disorder (MDD) appear to have a poor response. However, many patients labeled with treatment-resistant depression actually have pseudo-resistance due to suboptimal approach. AIM: To provide an overview of the causes of pseudo-resistance, as well as the interventions to counteract it in patients with MDD. METHOD: A literature search was conducted using the PubMed, Embase, and Web of Science databases. RESULTS: The causes of pseudo-resistance can be multiple and can be attributed to both the clinician (inappropriate prescribing behavior, misdiagnosis or incomplete diagnosis) and the patient (ultra-fast metabolism, poor medication adherence, comorbidity). Advice and interventions to prevent pseudo-resistance must therefore be targeted to the clinician (knowledge of clinical guidelines, simplified dosage schedules, correct diagnosis, interventions to improve poor medication adherence), as well as the patient (personalized psychoeducation, social support, care management). CONCLUSION: Pseudo-resistance is a multifactorial phenomenon that requires complex intervention strategies. In addition to adequate treatment provided by the clinician, personalized psychoeducation, good patient support and intensive follow-up of, as well as open communication with the patient are also required.

[Effectiveness of anti-stigma interventions regarding severe mental illness: a systematic literature review]. / Effectiviteit van interventies tegen stigma van ernstige psychiatrische aandoeningen; systematisch literatuuroverzicht.

BACKGROUND: Stigma is one of the greatest challenges facing people with severe mental illness (smi) and can have profound psychological, social and professional consequences.
AIM: To systematically review the evidence of effectiveness of anti-stigma interventions (anti-stigma campaigns and specific interventions to reduce public stigma and self-stigma) for people with smi and to make recommendations for clinical practice.
METHOD: A systematic literature search for individual studies and reviews concerning the efficacy of interventions that reduce stigma for people with smi.
RESULTS: Anti-stigma interventions have small-to-medium effects. Although head-to-head comparisons do not show a clear advantage for educational or contact interventions, results suggest that the elements of contact, recovery and continuity (for public stigma) and psycho-education (for self-stigma) may yield the greatest effects. Due to the short follow-up period of most studies, there is limited evidence on the long-term effectiveness of these interventions. More specifically, it remains unknown whether these interventions lead to changes in actual behavior.
CONCLUSION: Anti-stigma interventions have limited effects on knowledge, attitudes and behavior. Several methodological shortcomings, as well as short follow-up periods in most studies, preclude making firm conclusions.

[Prolactin, antipsychotics and breast cancer: is there a connection?]. / Prolactine, antipsychotica en borstkanker: is er een verband?

BACKGROUND: The use of antipsychotics can result in elevated prolactin levels or hyperprolactinemia. An increasing number of studies suggests that prolactin plays a role in mammary carcinogenesis, leading to concerns about a possible relationship between antipsychotics and breast cancer.
AIM: To provide an overview of recent literature regarding the relationship between prolactin, antipsychotics and breast cancer and an association between schizophrenia and breast cancer.
METHOD: We used PubMed to search for English- or Dutch-language articles concerning breast cancer risk (factors), prolactin, antipsychotics and schizophrenia.
RESULTS: Studies have not shown any causal link between antipsychotics and the development of breastcancer. Moreover, antipsychotic medication seems to have no influence on locally produced prolactin - which some experts believe plays a role in the tumor genesis - and certain antipsychotics actually provide protection against breast cancer. There are conflicting reports on the prevalence of breast cancer among patients with schizophrenia. Nevertheless, research has revealed that several well-known risk factors for breast cancer (such as an unhealthy lifestyle) are more prevalent in patients with schizophrenia.
CONCLUSION: There is no conclusive evidence that antipsychotic medication that raises prolactin levels increases the risk of breast cancer. Nevertheless, clinicians should always be cautious about prescribing antipsychotics for breast cancer patients. In our view, clinicians should always treat breast cancer risk factors as efficiently as possible, particularly when attending to patients who have schizophrenia.

Relationship between prolactin, breast cancer risk, and antipsychotics in patients with schizophrenia: a critical review.

OBJECTIVE: A recent meta-analysis showed that breast cancer probably is more common in female patients with schizophrenia than in the general population (effect size = 1.25, P < 0.05). Increasing experimental and epidemiological data have alerted researchers to the influence of prolactin (PRL) in mammary carcinogenesis. We therefore investigated the possible relationship between antipsychotic-induced hyperprolactinemia (HPRL) and breast cancer risk in female patients with schizophrenia. METHOD: A literature search (1950 until January 2015), using the MEDLINE database, was conducted for English-language published clinical trials to identify and synthesize data of the current state of knowledge concerning breast cancer risk (factors) in women with schizophrenia and its (their) relationship between HPRL and antipsychotic medication. RESULTS: Although an increasing body of evidence supports the involvement of PRL in breast carcinogenesis, results of human prospective studies are limited, equivocal, and correlative (with risk ratios ranging from 0.70 to 1.9 for premenopausal women and from 0.76 to 2.03 for postmenopausal women). Moreover, these studies equally do not take into account the local production of PRL in breast epithelium, although amplification or overexpression of the local autocrine/paracrine PRL loop may be a more important mechanism in tumorigenesis. Until now, there is also no conclusive evidence that antipsychotic medication can increase the risk of breast malignancy and mortality. CONCLUSION: Other breast risk factors than PRL, such as nulliparity, obesity, diabetes mellitus, and unhealthy lifestyle behaviours (alcohol dependence, smoking, low physical activity), probably are of greater relevance in individual breast cancer cases within the population of female patients with schizophrenia.

A meta-analysis of prevalence estimates and moderators of low bone mass in people with schizophrenia.

OBJECTIVE: To assess the prevalence and moderators of low bone mass, osteopenia and osteoporosis in schizophrenia patients. METHOD: Major electronic databases were searched from inception till December 2013 for studies reporting the prevalence of low bone mass (osteopenia + osteoporosis = primary outcome), osteopenia or osteoporosis in schizophrenia patients. Two independent authors completed methodological appraisal and extracted data. A random effects meta-analysis was utilized. RESULTS: Nineteen studies were included (n = 3038 with schizophrenia; 59.2% male; age 24.5-58.9 years). The overall prevalence of low bone mass was 51.7% (95% CI = 43.1-60.3%); 40.0% (CI = 34.7-45.4%) had osteopenia and 13.2% (CI = 7.8-21.6%) had osteoporosis. Compared with controls, schizophrenia patients had significantly increased risk of low bone mass (OR = 1.9, CI = 1.30-2.77, P < 0.001, n = 1872) and osteoporosis (OR = 2.86, CI = 1.27-6.42, P = 0.01, n = 1824), but not osteopenia (OR = 1.33, CI = 0.934-1.90, P = 0.1, n = 1862). In an exploratory regression analysis, older age (P = 0.004) moderated low bone mass, while older age (P < 0.0001) and male sex (P < 0.0001) moderated osteoporosis. The subgroup analyses demonstrated high heterogeneity, but low bone mass was less prevalent in North America (35.5%, CI = 26.6-45.2%) than Europe (53.6%, CI = 38.0-68.5%) and Asia (58.4%, CI = 48.4-67.7%), and in mixed in-/out-patients (32.9%, CI = 49.6-70.1%) vs. in-patients (60.3%, CI = 49.6-70.1%). CONCLUSION: Reduced bone mass (especially osteoporosis) is significantly more common in people with schizophrenia than controls.

The effects of novel and newly approved antipsychotics on serum prolactin levels: a comprehensive review.

Since the 1970s, clinicians have increasingly become more familiar with hyperprolactinemia (HPRL) as a common adverse effect of antipsychotic medication, which remains the cornerstone of pharmacological treatment for patients with schizophrenia. Although treatment with second-generation antipsychotics (SGAs) as a group is, compared with use of the first-generation antipsychotics, associated with lower prolactin (PRL) plasma levels, the detailed effects on plasma PRL levels for each of these compounds in reports often remain incomplete or inaccurate. Moreover, at this moment, no review has been published about the effect of the newly approved antipsychotics asenapine, iloperidone and lurasidone on PRL levels. The objective of this review is to describe PRL physiology; PRL measurement; diagnosis, causes, consequences and mechanisms of HPRL; incidence figures of (new-onset) HPRL with SGAs and newly approved antipsychotics in adolescent and adult patients; and revisit lingering questions regarding this hormone. A literature search, using the MEDLINE database (1966-December 2013), was conducted to identify relevant publications to report on the state of the art of HPRL and to summarize the available evidence with respect to the propensity of the SGAs and the newly approved antipsychotics to elevate PRL levels. Our review shows that although HPRL usually is defined as a sustained level of PRL above the laboratory upper limit of normal, limit values show some degree of variability in clinical reports, making the interpretation and comparison of data across studies difficult. Moreover, many reports do not provide much or any data detailing the measurement of PRL. Although the highest rates of HPRL are consistently reported in association with amisulpride, risperidone and paliperidone, while aripiprazole and quetiapine have the most favorable profile with respect to this outcome, all SGAs can induce PRL elevations, especially at the beginning of treatment, and have the potential to cause new-onset HPRL. Considering the PRL-elevating propensity of the newly approved antipsychotics, evidence seems to indicate these agents have a PRL profile comparable to that of clozapine (asenapine and iloperidone), ziprasidone and olanzapine (lurasidone). PRL elevations with antipsychotic medication generally are dose dependant. However, antipsychotics having a high potential for PRL elevation (amisulpride, risperidone and paliperidone) can have a profound impact on PRL levels even at relatively low doses, while PRL levels with antipsychotics having a minimal effect on PRL, in most cases, can remain unchanged (quetiapine) or reduce (aripiprazole) over all dosages. Although tolerance and decreases in PRL values after long-term administration of PRL-elevating antipsychotics can occur, the elevations, in most cases, remain above the upper limit of normal. PRL profiles of antipsychotics in children and adolescents seem to be the same as in adults. The hyperprolactinemic effects of antipsychotic medication are mostly correlated with their affinity for dopamine D2 receptors at the level of the anterior pituitary lactotrophs (and probably other neurotransmitter mechanisms) and their blood-brain barrier penetrating capability. Even though antipsychotics are the most common cause of pharmacologically induced HPRL, recent research has shown that HPRL can be pre-existing in a substantial portion of antipsychotic-naïve patients with first-episode psychosis or at-risk mental state.

Psychological impact of the announcement of a fetal abnormality on pregnant women and on professionals.

The psychological impact of the announcement of a fetal abnormality after ultrasound examinations is examined in relation to the building up of the mother-child attachment. It represents the "psychological cost" of such techniques. Understanding the subjective experience of the patients could increase the effectiveness of clinical practice. We have assumed that the relationship between parents and professionals is a critical element that contributes to the establishment of an emotional link between the mother and her child. Pregnant women, mothers, and professionals were approached for interviews and by questionnaires including anamnestic data, opinions, and projective methods. The results showed that the women with fetopathy were less centered on themselves during the pregnancy. Long-term effects were found to be important. In pregnant women, ultrasound examination was experienced with satisfaction even if some ambivalence remained. In mothers with an impaired child, ultrasound examination was viewed as a technique with low reliability. Professionals reported not having preparation in making such an announcement. We concluded that a need exists for better management of the modalities of ultrasound examinations. Many parents have expressed their need for psychological support.