Gender-specific characteristics of alcohol use in community-dwelling older adults in Belgium.

OBJECTIVES: Gender has been identified as an important social determinant for health. This study investigates gender-specific characteristics for alcohol use (AU) among community-dwelling older adults. METHODS: This is a retrospective cross-sectional study in 1,406 community-dwelling older adults. We used standardized questionnaires to collect self-reported data on alcohol use behavior, mental health, drinking motives and resilience by using, respectively, the Alcohol Use Identification Test (AUDIT), the Brief Symptom Inventory (BSI), the Drinking Motives Questionnaire (DMQ), and the Connor-Davidson Resilience Scale (CD-RISC). Multiple linear regression was used to identify the joint contribution of those factors on AU. Hierarchical regression was used to investigate the influence of the interaction between gender and those factors on AU. RESULTS: Linear regression analyses showed different associations with AU in men and women. Hierarchical regression analyses showed that gender presented a two-way interaction effect with enhancement and anxiety variables related to AU. CONCLUSIONS: Different characteristics were found as predictors for AU among older men and women. CLINICAL IMPLICATIONS: Clinicians and health-care providers should be aware of these differences in order to provide tailored screening and intervention programs to reduce AU in older adults.

[Transcranial direct current stimulation in substance use disorders: an update]. / Transcraniële gelijkstroomstimulatie bij stoornissen in het gebruik van middelen: een update.

BACKGROUND: Existing treatments for substance use disorders are often subject to drop-out or relapse. Transcranial direct current stimulation (tDCS) possibly has a positive effect on this problem. AIM: To give an updated qualitative review of existing studies investigating the clinical effects of transcranial direct current stimulation for people with a substance use disorder, considering the many recently published studies. METHOD: Extensive literature search in the electronic database PubMed. We included 43 studies on top of the 7 studies already included in the previous review of Herremans and Baeken (2017) in this journal. RESULTS: The majority of the studies showed a positive effect of transcranial direct current stimulation on clinical measures as craving and abstinence. However, there was little uniformity in used protocols. CONCLUSION: Transcranial direct current stimulation can be an effective treatment for people with a substance use disorder. Optimal parameters need to be established to make the treatment maximally effective and adapted to the individual patient.

[Decision making and the future of mental capacity. Steps towards an uncertain future within the context of CRPD]. / Beslissingsbekwaamheid? Met het VN-verdrag Handicap naar een onzekere toekomst.

Background  Mental capacity, the criterion used today to determine who can make decisions independently, is under pressure from the United Nations Convention on the Rights of Persons with Disabilities. Aim  To outline the prevailing view, the view of the UN Convention and a middle ground. To formulate steps to apply the spirit of the UN Convention today. Method  Essay starting from the most relevant international human rights sources within the United Nations and the Council of Europe, supplemented by secondary literature on these sources. Results  The UN Convention abandons mental capacity as the criterion to determine whether a patient can make decisions autonomously. At the same time, it rejects any form of coercion applied directly or indirectly because of mental illness. Conclusion  The UN Convention does not offer a clear alternative, so the future is uncertain. Nevertheless, the important principles of the UN Convention should not be forgotten; they can already be implemented today by being aware of the role of human rights in mental health care, by placing the quality of decision-making at the center and by making less and more conscious use of coercion.

[How to understand the wokeness-paradox of multiple stigma in persons with mental vulnerabilities?] / De moeizame aansluiting van psychisch kwetsbare personen bij de wokeness-beweging.

Background  Prejudice, stigma and discrimination against people with mental health problems are largely responsible for their limited social participation. Joining the globalised wokeness movement could reduce the tendency of social injustice. Aim  To explore the reasons why people with mental health problems experience difficulties to integrate into the wokeness debate and to suggest possible solutions. Results  Intersectionality, persons with mental health problems often being part of different vulnerable minority groups, stress and public stigma, are the main reasons of the limited level of advocacy for this target group. Conclusion  The struggle against social injustice that mental vulnerable persons are victims of, remains unequal even in times of wokeness. A strategic, non-patronising cooperation between psychiatrists, patients, family members and interest groups in the media and in the public and political forum, could make it possible to join the international wokeness movement.

Resilience, depression and anxiety and hazardous alcohol use behaviour among community dwelling older adults.

INTRODUCTION: We examined the psychometric properties of the CD-RISC, including factor structure. Secondly, we examined if resilience factors moderate the association between negative affect and hazardous alcohol use. METHOD: The sample population consisted of 1,368 community-dwelling older adults. We used standardized questionnaires to collect self-reported data on alcohol use behaviour, depression and anxiety and resilience by using respectively the Alcohol Use Identification Test (AUDIT), the Brief Symptom Inventory (BSI) and the Connor-Davidson Resilience Scale (CD-RISC). RESULTS: Of the total sample (N 1.368), 80.1% reported using alcohol. The total sample and the drinking sample reported, respectively, a mean of 65.75 (SD 15.40) and 65.79 (SD 15.90) on the CD-RISC. Concerning the CD-RISC, exploratory factor analysis presents four factors of which three with a good reliability. Moderation analyses reflects that older adults with higher levels of resilient characteristics didn't report an association between negative affect and hazardous drinking. Alternatively, low resilient older adults did report an positive and significant association between negative affect and hazardous drinking. CONCLUSION: The CD-RISC appeared to be a reliable instrument, containing three factors. In our sample, high resilience moderated the association between negative affect and hazardous drinking and may serve as a buffer against hazardous drinking.

Racism and mental health and the role of mental health professionals.

The concept of "race" and consequently of racism is not a recent phenomenon, although it had profound effects on the lives of populations over the last several hundred years. Using slaves and indentured labor from racial groups designated to be "the others," who was seen as inferior and thus did not deserve privileges, and who were often deprived of the right to life and basic needs as well as freedoms. Thus, creation of "the other" on the basis of physical characteristics and dehumanizing them became more prominent. Racism is significantly related to poor health, including mental health. The impact of racism in psychiatric research and clinical practice is not sufficiently investigated. Findings clearly show that the concept of "race" is genetically incorrect. Therefore, the implicit racism that underlies many established "scientific" paradigms need be changed. Furthermore, to overcome the internalized, interpersonal, and institutional racism, the impact of racism on health and on mental health must be an integral part of educational curricula, from undergraduate levels through continuing professional development, clinical work, and research. In awareness of the consequences of racism at all levels (micro, meso, and macro), recommendations for clinicians, policymakers, and researchers are worked out.

[Proactive psychiatry in addiction]. / Proactieve psychiatrie bij verslaving.

BACKGROUND: Most substance use disorders (SUD) emerge in adolescence and early adulthood. Early interventions in young people may reduce the risk and severity of SUD and other psychiatric disorders.
AIM: To provide suggestions for proactive psychiatry in addiction.
METHOD: Literature review.
RESULTS: Comorbidity, cumulative risks and self-regulation skills each play an important role in proactive psychiatry. Early universal prevention and intervention targeted at improving self-regulation reduces the risk of a broad array of psychiatric and social problems, including addiction.
CONCLUSION: In terms of broad prevention, much can be gained by widespread, consistent implementation and normalization of universal prevention at the pre- and elementary school level. Tijdschrift voor Psychiatrie 63(2021)2, 125-128.

[Adolescents with concurrent ADHD and substance use disorder; international consensus]. / Jongeren met een stoornis in het gebruik van middelen en ADHD: internationale consensus.

BACKGROUND: Substance use disorder (SUD) is common among youths with attention-deficit/hyperactivity disorder (ADHD). Co-morbid ADHD and SUD in youths complicates screening, diagnosis, and treatment of both disorders and is associated with worse treatment prognosis. Limited research in youths with SUD and co-morbid ADHD provides insufficient basis for firm recommendations. To offer clinicians some guidance on this topic, we present the results of an international consensus procedure. AIM: To summarize an international consensus on diagnosis and treatment of young people with comorbid ADHD and SUD. METHOD: In a modified Delphi-study, a multidisciplinary, international group of 55 experts strived to reach consensus on 37 recommendations. RESULTS: Consensus was reached on 36 recommendations. Routine screening of ADHD and/or SUD is important. For the treatment of co-morbid SUD and ADHD in youths, both psychosocial and pharmacological treatment should be considered. Psychosocial treatment should preferably consist of psychoeducation, motivational interviewing (MI), and cognitive behavioral therapy (CBT) focused on SUD or both disorders. Long-acting stimulants are recommended as first choice pharmacotherapy, preferably embedded in psychosocial treatment. Experts did not agree on the precondition that patients need to be abstinent before starting stimulant treatment. CONCLUSION: Clinicians and youths with co-morbid SUD and ADHD can use this international consensus to choose the best possible treatment.

[Tired of waiting: towards a joint approach of waiting times in Flemish mental health care]. / Genoeg gewacht: naar een gezamenlijke aanpak van wachttijden in de Vlaamse ggz.

BACKGROUND: Waiting times are an important barrier to timely obtaining appropriate mental health care in Flanders, but structural data is limited. AIM: To describe the waiting time problem in Flanders and propose some causal hypotheses and possible interventions. METHOD: An exploration of the available waiting time data, supplemented with literature and insights based on the results of some Flemish Centers for Mental Healthcare. RESULTS: Waiting times are especially problematic for subsidized outpatient care and care for children and youth, although the current data provide an incomplete picture. Besides capacity, important factors are the organization of the intake (e.g. assessment) and flow parameters (e.g. mean treatment duration - and intensity). CONCLUSION: Eliminating waiting lists is one of the greatest challenges for Flemish mental health care. There is a need to expand capacity as well as the smarter use of existing capacity and resources. A joint multi-level approach is required.

Microbiome and substances of abuse.

There is a growing amount of evidence showing a reciprocal relation between the gut microbiota and the brain. Substance use disorders (SUD), which are a major cause of preventable morbidity and mortality worldwide, have an influence on the gut microbiota and on the gut-brain axis. The communication between the microbiota and the brain exists through different pathways: (1) the immune response elicited by bacterial products, coupled with alterations of the intestinal barrier allowing these products to enter the bloodstream, (2) the direct and indirect effects of bacterial metabolites such as short chain fatty acids (SCFAs) or tryptophan on the brain, (3) and the hypothalamic-pituitary-adrenal (HPA) axis, whose peripheral afferents can be influenced by the microbiota, and can in turn activate microglia. Among substances of abuse, alcohol has been the subject of the greatest number of studies in this field. In some but not all patients suffering from alcohol-use-disorder (AUD), alcohol alters the composition of the gut microbiota and the permeability of the intestinal barrier, directly and through dysbiosis. It has also been well demonstrated that alcohol induces a peripheral inflammation; it is still unclear whether it induces a central inflammation, as there are contradictory results in human studies. In animal studies, it has been shown that neuroinflammation increases during alcohol withdrawal. Literature on opioids and stimulants is less numerous. Chronic morphine intake induces dysbiosis, increased intestinal permeability and a probable neuroinflammation, which could explain symptoms such as tolerance, hyperalgesia and deficit in reward behavior. Cocaine induces a dysbiosis and conversely the microbiome can modulate the behavioral response to stimulant drugs. Tobacco cessation is associated with an increase in microbiota diversity. Taken together, the findings of our narrative literature review suggest a bidirectional influence in the pathogenesis of substance use disorders.

Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries.

BACKGROUND: Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care. METHODS: The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions. RESULTS: We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures. CONCLUSIONS: We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.

[Perinatal mental health care for mothers with schizophrenia in Flanders; where are we still short?] / Perinatale geestelijke gezondheidszorg voor moeders met schizofrenie in Vlaanderen; wat kan er nog beter?

BACKGROUND: Only 0.8% of the admissions to our mother-baby unit are mothers with schizophrenia, while about half of the patients with schizophrenia become mothers. Mothers with schizophrenia are more likely to live in complex problematic settings and, thereby, more frequently lose custody of their children. Also, they experience stigma against their parenting skills. Literature research shows that they therefore avoid care. However, the inclusion of their role as a mother can contribute to recovery, giving meaning and social integration.
AIM: To initiate debate on responsible motherhood in women with schizophrenia with the aim of optimizing the Flemish care provision and give an incentive towards more scientific research.
METHOD: Consultation of the minimal psychiatric data (mpd) on our mother-baby unit. Narrative literature search using PubMed with a focus on schizophrenia in the peripartum.
RESULTS: Mothers who suffer from schizophrenia are more likely to experience difficulties in social cognition and sensitivity to their children. These problems can make the relationship between mother and baby more difficult. However, this does not exclude the possibility of developing a positive attachment relationship.
CONCLUSION: A persistent case manager-driven care model, which monitors the care for this vulnerable population and focuses on reinforcing the parenting qualities, looks promising. As a result, (shared) responsible motherhood could have a positive impact on their recovery.

Updated European Consensus Statement on diagnosis and treatment of adult ADHD.

Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness. Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated. Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated? Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.

[Somatic and pharmacological nurse care in 2b-teams in Flanders: a cross-sectional explorative study]. / Verpleegkundige somatische en farmacologische zorg binnen Vlaamse 2b-teams: een crosssectioneel verkennend onderzoek.

BACKGROUND: In the context of the Belgian mental health care reform (project 107), 2b-teams provide care to people with a serious mental illness (smi), a population encountering regular somatic comorbidity and limited compliance with medication. Team composition and care provided by these teams is rather unclear.
AIM: To consider the team composition and to focus on the nurses' role within Flemish 2b-teams. Also, seen from different disciplines involved, to determine the desired future nursing role.
METHOD: A structured interview was used to discover team characteristics and fidelity to the flexible assertive community treatment (fact) model in 12 Flemish 2b-teams. With a digital survey containing 16 questions we explored the actual and desired nursing care, according to 151 nurses and medical physicians.
RESULTS: Despite the difference in team size and composition, it was not found to be significant. Flemish team's fact model-fidelity was average. Actual care was restricted to psychosocial interventions. Regarding desired care, significant differences were found between physicians and nurses. Caregivers within outreach teams scored items significantly higher on desired care compared to actual care.
CONCLUSION: We conclude that the team composition of Flemish 2b-team varies, with an average fact model fidelity. Team care is restricted to psychosocial interventions, while more somatic and nursing care is desired.

[Personalised treatment of disorders in the use of alcohol and nicotine]. / Gepersonaliseerde behandeling bij stoornissen in het gebruik van alcohol en tabak.

BACKGROUND: There is an increasing interest in personalised treatment based on the individual characteristics of the patient in the field of addiction care. AIM: To summarise the present state of staging and profiling possibilities within addiction care. METHOD: A literature review highlighting the current scientific findings and proposing a theoretical model. RESULTS: There are currently an insufficient number of studies to allow for a fully data driven model. However, research identifying biomarkers is growing and some clinically implementable findings can be put forward. CONCLUSION: a personalised approach in addiction care holds promise. There is an urgent need for better and larger datasets to empirically support models aimed for clinical use.