A Dutch Pre-DSM Attempt at Psychiatric Classification.

Considering the growing sense of ambivalence about the merits of the DSM, the time seems right for the re-evaluation of nosological attempts and efforts in the pre-DSM era. One example of these attempts is the CHAM system developed by the Dutch psychiatrist R.M. Silbermann (1932-1976). This system is intended as a simple classification with 20 "psychiatric states," which are classified based on the presence of one of 12 hierarchically arranged core symptoms or key characteristics, while all "hierarchically higher" symptoms are excluded without inference about the "hierarchically lower" symptoms. Its scientific evidence is, as yet, insufficiently substantiated. However, disqualifying the CHAM system as an outdated Dutch folklore is like throwing out the baby with the bathwater. The CHAM system emerges as clinically straightforward, didactically fruitful, and consistent with more modern initiatives in descriptive psychopathology. Studying pre-DSM attempts such as Silbermann's CHAM system can stimulate psychopathological thinking and serve as a source of inspiration for future phenomenological research in psychiatry.

Self-disturbance in schizophrenia: a phenomenological approach to better understand our patients.

A phenomenological approach explains the apparently unintelligible experiences of patients with schizophrenia as a disruption of the normal self-perception. Patients with schizophrenia suffer from a decline of "me," the background core of their experiences. Normally tacit experiences intrude into the forefront of their attention, and the sense that inner-world experiences are private diminishes. These patients lose the sense that they are the origin of their thoughts and actions; their self-evident network of meanings and a solid foundation of life disintegrate. Subsequently, their experiential world is transformed, alienated, intruded, and fragmented. In this article, a phenomenological investigation of the self-experiences and actions of 4 patients with schizophrenia is presented.

The guideline "consultation psychiatry" of the Netherlands Psychiatric Association.

BACKGROUND: In 2008, the Netherlands Psychiatric Association authorized a guideline "consultation psychiatry." AIM: To set a standard for psychiatric consultations in nonpsychiatric settings. The main objective of the guideline is to answer three questions: Is psychiatric consultation effective and, if so, which forms are most effective? How should a psychiatric consultations be performed? What increases adherence to recommendations given by the consulting psychiatrist? METHOD: Systematic literature review. RESULTS: Both in general practice and in hospital settings psychiatric consultation is effective. In primary care, the effectiveness of psychiatric consultation is almost exclusively studied in the setting of "collaborative care." Procedural guidance is given on how to perform a psychiatric consultation. In this guidance, psychiatric consultation is explicitly looked upon as a complex activity that requires a broad frame of reference and adequate medical and pharmacological expertise and experience and one that should be performed by doctors. Investing in a good relation with the general practitioner, and the use of a "consultation letter" increased efficacy in general practice. In the hospital setting, investing in liaison activities and an active psychiatric follow-up of consultations increased adherence to advice. CONCLUSION: Psychiatric consultations are effective and constitute a useful contribution to the patients' treatment. With setting a standard consultations will become more transparent and checkable. It is hoped that this will increase the quality of consultation psychiatry.