BACKGROUND:The professional reality of psychiatrists is complex and dynamic, requiring continual adjustments in the way the professional role is enacted. AIM:To develop a conceptual framework for professional development in light of this need for ongoing professional adaptation. METHOD:Literature review and conceptual analysis. RESULTS:Professional adaptive capacity is manifested in the iterative progression through an adaptive cycle in which individuals develop proficiency in professional meta-competencies. CONCLUSION:Training in professional meta-competencies deserves attention in psychiatric residency training; the national training curriculum in The Netherlands provides opportunities to incorporate this focus.
BACKGROUND:To emphasize recovery from the very start of treatment, the recovery-oriented intake (ROI) was developed in Dutch mental health care. This approach places additional focus on the personal domain, alongside the usual attention to biological, psychological, and social factors. The question is whether this translates into intake documentation. AIM:To compare ROI with intake as usual (IAU) regarding attention to abovementioned domains of mental health, the degree of integration into a case formulation, and the quality and focus of treatment goals. METHOD:In a retrospective file study, 60 intake reports (30 ROI, 30 IAU) were assessed using validated scales for level of detail per domain, integration of information, and quality of treatment goals. RESULTS:ROI and IAU reports contained a similar level of detail for biological, psychological, and social domains. The personal domain appeared more often in ROI, though usually in isolation. Contrary to expectations, integration was rated higher in ROI. The quality of treatment goals did not differ significantly, but ROI goals more often addressed personal growth and symptoms (26,7% vs 6,7%), whereas IAU goals were more often limited to symptoms (36,7% vs 16,7%). CONCLUSION:ROI provides more attention to the personal domain and shows greater integration, without reducing attention to other domains. Strengths are often mentioned in isolation, and social goals remain limited.
BACKGROUND:Clinical care for adults with eating disorders in the Netherlands is under pressure due to limited capacity and long waiting times. Insight into bed capacity, occupancy, and waiting lists in specialized clinics and medical-psychiatric units (MPUs) is lacking. AIM:To gain insight into clinical capacity in eating disorder care in the Netherlands METHOD: A nationwide telephone survey was conducted among 8 clinics and 31 MPUs. Data on capacity, occupancy, waiting lists, and admission criteria were collected between August 26 and September 9, 2025. RESULTS:The clinics had 115 beds, with 103 occupied and 103 patients waiting. Length of stay ranged from months to longer. Some applied BMI thresholds: compulsory care was limited. MPUs had 40-45 beds, 25 occupied, and 20 waiting. Care ranged from acute somatic interventions to structured weight restoration and compulsory care. CONCLUSION:Severe capacity problems, long waiting times, varying admission criteria, and limited compulsory care highlight the urgent need for expansion of capacity, national coordination and stronger collaboration.
BACKGROUND:Professional anxieties in psychiatric practice are often insufficiently recognized and infrequently discussed, despite their potentially significant impact on the quality of care. AIM:To examine these less visible forms of anxiety and their influence on professional functioning. METHOD:A narrative review based on relevant literature and clinical observations from psychotherapeutic practice. RESULTS:A typology of five categories of professional anxiety is identified: fear of making mistakes, fear of powerlessness, fear of aggression, system-related fears, and existential anxiety. These anxieties appear closely intertwined with defensive medicine, professional isolation, and an increased risk of burnout – factors that generally do not contribute to patient safety. CONCLUSION:Articulating and discussing professional uncertainty is essential for fostering an environment of psychological safety. A layered approach – at the individual, team, and organizational levels – is necessary to acknowledge these anxieties without pathologizing them.
BACKGROUND:Sleep problems and stress are common among adults with autism and can affect physical activity, daily functioning, and quality of life. This study explores the relationships between perceived stress, sleep, and physical activity in adults with autism. AIM:To examine whether there is a reciprocal relationship between perceived stress, physical activity, and sleep in adults with autism. METHOD:Seventeen adults with autism participated in a cohort study using experience sampling. Perceived stress levels were measured four times a day for 28 days via the Stress Autism Mate (SAM) app. Sleep and physical activity, expressed as the number of steps, were measured with a smartwatch (Fitbit Sense). RESULTS:Findings show substantial differences between individuals in how sleep, physical activity, and perceived stress are related. No consistent effect was found of sleep on stress the next day, nor of stress on sleep quality the following night. For some participants, better sleep was linked to lower stress, while others showed no relationship or the opposite pattern. Better sleep was significantly associated with higher physical activity the next day, whereas step count did not significantly affect stress. CONCLUSION:These results highlight the complexity and variability of sleep, physical activity, and perceived stress interactions in adults with autism, emphasizing the need for personalized interventions. Further research should explore the interplay between perceived stress, activity, and sleep to guide individualized care.
BACKGROUND:The therapeutic relationship is an important predictor of the effectiveness of psychotherapy. Within this relationship, the balance between distance and closeness plays a crucial role. However, within child psychiatry, little is known about the conceptual scope and clinical interpretation of these concepts. AIM:To investigate how child and adolescent psychiatrists, in their contact with minors, give meaning to distance and closeness in the therapeutic relationship and what considerations they make in clinical practice. METHOD:In this qualitative study, semi-structured interviews with ten child psychiatrists explored various perspectives that describe the experience of distance and closeness in clinical practice. Thematic analysis identified meaningful patterns and themes from the interviews. RESULTS:The following themes emerge: 1. Space, time and availability as regulators of distance and closeness; 2. Physical contact: the tension between providing good care and maintaining professional boundaries; 3. Emotional involvement as a source of professional tension; 4. Personal and professional identity in the therapeutic relationship; 5. The doctor as a human being; 6. Professional role and clinical assignment as a framework for establishing distance and closeness. CONCLUSION:Distance and closeness take shape in various ways in the therapeutic relationship with children and adolescents. Child psychiatrists seek an appropriate balance in their own way. This article offers an initial thematic framework to support further dialogue and research.
BACKGROUND:The centenary of Frantz Fanon’s birth in 2025 sparked renewed attention to his work. In recent years, his reception has shifted noticeably: from Fanon as a political activist to Fanon as a psychiatrist. AIM:To offer a concise exploration of the historical significance and contemporary relevance of Fanon’s psychiatric writings, and to help make this body of work more accessible to a Dutch-speaking readership. METHOD:A reflective discussion based on a literature review of both the primary and recent secondary literature, including a recent narrative literature review on Fanon via PubMed. RESULTS:The renewed engagement with Fanon’s psychiatric writing provides a more accurate understanding of his role in the decolonization of psychiatry and sheds light on his radically innovative clinical practice as a psychiatrist. CONCLUSION:Although formal decolonization largely lies behind us, Fanon remains a vital point of reference for social and transcultural psychiatry. His work continues to issue a postcolonial challenge to the broader psychiatric field: it calls for culturally sensitive care and reminds psychiatry of its societal responsibility to confront institutional racism.
BACKGROUND:Highly specialized consultation is a promising intervention for improving the treatment for mental disorders. AIM:To model the impact of consultation for eating disorders (EDs). METHOD:An explorative economic impact analysis was conducted in 2024-2025, utilizing data on patients who had been in treatment for more than two years within specialized secondary care for EDs as their primary diagnosis (anorexia nervosa, bulimia nervosa, binge eating disorder). These data were used to model the effects of consultation for EDs. Sensitivity analyses were performed to evaluate the robustness of the findings across different estimated parameter values. RESULTS:Across all five care pathways, consultation for EDs was effective in: 1. reducing the burden of disease for patients, work absenteeism and direct mental healthcare costs and 2. enhancing the patient flow in mental healthcare. CONCLUSION:Consultation for EDs is a potentially promising intervention with both clinical and systemic benefits. Therefore, the Centres of Excellence for Eating Disorders aim to further investigate and implement consultation for EDs, in order to make knowledge accessible and contribute to the provision of appropriate care for patients with EDs.
BACKGROUND:Mental suffering lies at the heart of psychiatric practice but is often approached as a disorder, defect, or symptom – thereby eclipsing the lived experience itself. AIM:To explore how mental suffering can be re-understood as a human experience in context, and what this implies for clinical attitude. METHOD:Reflective essay based on literature, philosophical analysis, and clinical experience. RESULTS:Mental suffering does not appear as a brain defect but as a disruption of human coherence -embodied, affective, relational, and temporal. It emerges when the natural continuity between past, present, and future falters, and a person temporarily loses their orientation in the world. Suffering is contextually embedded – in body, biography, relationships, and society – and may manifest as powerful, coercive, or opaque. Not all suffering is transparent or meaningful, yet each instance calls for presence and understanding. The clinical encounter becomes a shared hermeneutic space where experiential and professional knowledge complement and correct each other. CONCLUSION:Mental suffering calls not for repair but for recognition; not for reduction but for presence and dialogue. A clinical stance grounded in listening, resonance, and co-bearability – understanding rather than explaining – creates room for the restoration of coherence, meaning, and humanity.
BACKGROUND:In recent years, a growing number of young people have requested medical aid in dying (MAID) on the basis of psychiatric suffering. This development has raised concern within the mental health care sector and has contributed to a broader societal debate. AIM:To address the following question: what can mental health care professionals do in response to a MAID request from a young person? METHOD:In this essay, a group of youth mental health experts examines the issue from multiple perspectives and formulates recommendations for a practical framework to support health care professionals who are confronted in clinical practice with a young person – and their relatives – requesting MAID. RESULTS:MAID requests from young people based on psychiatric suffering are even more complex than those made by adults. We recommend that clinicians adopt a basic attitude of ‘not now’. This approach entails taking the wish for MAID seriously and exploring it carefully, without acting on it immediately. Instead, we advocate a strategy of slowing down and enduring. CONCLUSION:In this essay, we present a ‘not now’ conceptual framework for responding to MAID requests from young people on the grounds of psychiatric suffering. In addition to this approach, it is essential that high-quality, accessible and humane care is available to young people making a MAID request, as well as to their relatives.
We describe the case of a 39-year-old man who was admitted due to suicidal behaviour and substance abuse. During the course of the admission, several psychiatric diagnoses were considered. It later became evident that the patient had been using anabolic-androgenic substances (AAS) heavily and over a prolonged period until shortly before admission. Based on the available literature, we discuss the epidemiology, patterns of use, mechanisms of action and psychological implications of AAS. Furthermore, we highlight how AAS use can complicate the differential diagnosis. To date, there is no consensus on the required abstinence period before conducting psychodiagnostic assessment. Based on current evidence, we outline several guiding considerations that may assist clinicians in the psychodiagnostic evaluation and treatment of patients with known AAS misuse.
We describe an extraordinary case of a 76-year-old man who suddenly did not recognize his house as his own. This clinical phenomenon, a ‘reduplicative paramnesia’, turned out to be the consequence of a stroke in the anterior nuclei of the right thalamus. Reduplicative paramnesia, a delusional misidentification disorder, is often the consequence of a neurological disease and therefore a neuropsychiatric phenomenon par excellence. Through this case we further discuss the clinical elements and neuroanatomical mechanisms that underlie this phenomenon.
BACKGROUND:Religion, spirituality and meaning making (RSM) are an important aspect of psychological health. Consequently, it is also important in child and adolescent psychiatry to engage with issues related to RSM. However, little is known about the perspective of care providers in child and adolescent psychiatry on RSM, and about the way in which this is practiced. AIM:To explore care providers’ perspectives on the importance of RSM, their ability to discuss it, and the practice. METHOD:A self-report questionnaire on the perceived importance and competencies at RSM was completed by 220 of the 737 child and adolescent psychiatry care providers (30%). RESULTS:Although 90% of respondents indicated that they found RSM important in their therapy and feel capable of discussing it, only 10% regularly discussed RSM during intake. Barriers included a lack of knowledge of the people to refer to (for 72% of respondents), a lack of knowledge about RSM (55%), the perception of not being responsible for RSM (30%), and a lack of time (25%). CONCLUSION:Discussing RSM in diagnosis and treatment is experienced as relevant by care providers in child and adolescent psychiatry. In practice RSM is not mentioned so often. Based on this research, it is recommended to equip care providers in the field of RSM.
BACKGROUND:In the Netherlands the Health of the Nation Outcome Scale (HoNOS) has been used for over 20 years, but norms for the HoNOS have not been updated since 2004. AIM:To establish metropolitan HoNOS norm scores for patients with a severe mental illness (SMI) in various types of care. METHOD:Anonymized data from a large cohort (n = 7566) from the years 2012-2021 of patients with SMI in acute clinical care (n = 4309), long-term clinical care (n = 822) and in care at flexible assertive community treatment (FACT; n = 2435) were used to establish norms for the index (total) score as well as the scores for clinically meaningful and serious problem areas. RESULTS:There were significant differences in HoNOS scores between the three types of care: patients in acute clinical care had higher scores, long-term clinical care patients scored intermediate, and FACT patients had lower scores. Legal status did not influence the HoNOS score in a meaningful way. Norm tables with raw scores, normalised T-scores and percentile scores were created. CONCLUSION:The new norms enable clinicians to estimate the severity of psychopathology and level of functioning in individual patients compared to appropriate reference groups.
