[Consultation from centers of excellence in Dutch mental healthcare; the value for patient and specialist]. / Hoogspecialistische consultatie in de sggz; de waarde voor patiënt en specialist.

The consultation function of centers of excellence is still used to a limited extent. In this article we explain possibilities and contributions of highly specialized consultation to support standard mental healthcare by means of vignettes. Case descriptions from the consultation practice of four centers of excellence are presented. More intensive use of consultation options by mental health care providers can help improve the quality, efficiency and effectiveness of care.

[Substance use disorder in individuals with mild intellectual disabilities; collaboration needed]. / Verslaving bij mensen met een lichte verstandelijke beperking; versterk de zorgketen.

BACKGROUND: Individuals with a mild intellectual disability or borderline intellectual functioning (mbid) are at risk for psychiatric disorders, including addictive disorders. Treatment of these disorders is often complicated by co-morbidity, as well as caregiver's and practitioner's struggle to effectively help.
AIM: To provide guidelines for psychiatrists to organize and deliver treatment to patients with mbid and addiction.
METHOD: Based on a case study, we describe obstacles in the care for patients with mbid and addiction, and provide guidelines to overcome these.
RESULTS: The Netherlands are leading in providing proper care for patients with mbid and addiction. However, available treatment protocols are not widely implemented.
CONCLUSION: Staff needs to be trained in working with patients with mbid and addiction, and interagency collaboration needs to be put in place. This is a collective responsibility of addiction medicine, general psychiatry, and disability services.

Attentional bias in problematic drinkers with and without mild to borderline intellectual disability.

BACKGROUND: Problematic drinkers favour the processing of alcohol-related stimuli at the cost of other stimuli and also find it difficult to disengage their attention from these stimuli. This is indicative of an attentional bias towards alcohol. The goal of this study was to examine this bias in problematic drinkers with and without mild to borderline intellectual disability (MBID) using both eye tracking methodology and behavioural data (i.e. reaction time (RT) data). METHOD: Participants (N = 133) were divided into four groups based on (estimated) full scale intelligence quotient (IQ) and severity of alcohol use-related problems. The severity of substance use-related problems was assessed with the Alcohol Use Disorder Identification Test (AUDIT). The visual dot probe task was used to measure the attentional bias. We analysed both eye tracking data and behavioural data (i.e. RT data) of the visual dot probe task. RESULTS: Problematic drinkers were not more likely than light drinkers to direct their attention towards pictures of alcoholic beverages, did not look at these pictures longer than light drinkers and did also not respond faster than light drinkers to probes replacing pictures of alcoholic beverages. However, the strength of the attentional bias varied profusely. CONCLUSION: Taking the large variability in the strength of the attentional bias and the poor psychometric qualities of the measures into consideration, it is concluded that the use of these measures for clinical purposes is discouraged.

The addicted brain: cognitive biases in problematic drinkers with mild to borderline intellectual disability.

BACKGROUND: Substance use disorders (SUD) are associated with several neurobiological disruptions, including biases in attention and approach/avoidance behaviour. The aims of this study were to compare the strength of cognitive biases between light and problematic drinkers, to explore the role of IQ on the cognitive biases and to study the psychometric qualities of the measures. METHOD: Participants (N = 130) were divided into four groups based on IQ and severity of alcohol use-related problems: light (n = 28) and problematic drinkers (n = 25) with (sub)average IQ and light (n = 33) and problematic drinkers (n = 44) with mild to borderline intellectual disability (MBID). All participants performed the visual dot probe task and the approach avoidance task to measure the strength of cognitive biases. RESULTS: In contrast with the hypothesis, no cognitive biases were found in problematic drinkers. Full scale IQ nor level of craving influenced the strength of the cognitive biases in light and problematic drinkers, although IQ did influence task performance (i.e. large intra-individual, trial-to-trial variation in reaction time). The internal consistency of the visual dot probe task was good, whereas the internal consistency of the approach avoidance task was poor. CONCLUSION: Cognitive biases seem to vary within the group of problematic drinkers as a whole. The psychometric qualities of the measures are problematic, especially in relation to the intra-individual variability in reaction time found in participants with MBID. Until the implications of this variability on the validity of implicit measures and establishing bias scores are more clear, the use of these measures in individuals with MBID calls for scrutiny.