Background Yearly, almost six percent, which is more than 1,000.000 people, in the Netherlands receive mental health treatment, which usually improves their quality of life. Concurrently, mental healthcare professionals recognize clinically refractory cases in which improvement fails to occur, with severe ongoing burdens for patients. The Dutch Centre for Consultation and Expertise (CCE) is available to support such refractory cases. The Dutch government’s (financial) facilitation of consultation through the CCE is unique in the world. CCE consultations provide therefore unique insight into and an overview of refractory cases in mental health services. The objective of this study was to gain insight into the commonalities underlying the reasons for CCE consultations and the solutions proposed that play roles in (the reduction of) refractory cases for which consultation has been requested. Methods This descriptive study was conducted with quantitative and qualitative data from 472 CCE consultations in the Netherlands. Using descriptive statistics and thematic content analysis, four exemplary situations were distilled from the qualitative data. Results Most (83%) cases in the sample could be explained with four exemplary situations involving self-harm (24.2%), aggression (21.8%), self-neglect (24.4%), and socially unacceptable behavior (12.5%), respectively. Each situation could be characterized by a specific interaction pattern that unintentionally maintained or aggravated the situation. At the time of closure of the consultation applicants’ questions had been answered and their situations had improved in 60.4% of cases. Conclusions This study offers an overview of approaches that provided new perspectives for patients and professionals in many refractory cases in the Dutch mental health services.

BACKGROUND:Self-harming behavior is a frequent problem seen in patients admitted to a closed ward in a psychiatric hospital. Little is known about prevalence and characteristics of this behavior as well as the preceding triggering factors.AIM:To gain insights in the self-harming behavior of patients admitted to a closed ward in a psychiatric hospital.METHOD:From September 2019 till January 2021 was gathered information on self-harming incidents and aggressive behavior towards others or objects, of 27 patients admitted to the closed department of the Centre Intensive Treatment (Centrum Intensieve Behandeling).RESULTS:20 of 27 patients examined (74%) showed 470 incidents of self-harming behavior. Head banging (40.9%) and self-harming using straps/ropes (29.7%) occured most. Tension/stress as triggering factor was mentioned most (19.1%). Self-harming behavior occured more during evenings. Besides self-harm, a high degree of aggressive behavior towards others or objects was registered.CONCLUSION:This study delivers insights in self-harming behavior of patients admitted to closed psychiatric departments that can be used for prevention and treatment.

BACKGROUND Yearly, over 1.000.000 people receive mental health care treatment in the Netherlands. Treatment usually results in improvement in quality of life. Concurrently, each professional recognizes clinically refractory cases in which improvement fails to occur with severe ongoing burden for the client. In the Netherlands, for these clinically refractory cases the Centre of Consultation and Expertise (CCE) is available. The CCE is an independent nation-wide organisation offering free consultations to care providers. Therefore, CCE-consultations provide a unique insight in and overview of refractory cases. AIM Providing overview of and insight into backgrounds and themes that play a role in (the reduction of) refractory cases. METHOD Descriptive study of quantitative and qualitative data from 472 consultations in mental health care. RESULTS 83% of cases could be explained with 4 exemplary vignettes of refractoriness: self-harm, aggression, self-neglect and socially unacceptable behaviour. CONCLUSION Refractory cases result from an interaction pattern that unintentionally maintains or aggravates the situation. This study offers an overview of approaches that proved to be helpful in providing new perspective for clients and professionals in many therapy refractory cases in Dutch mental health care.

BACKGROUND: Since January 1,2012, nurse practitioners (np) working in mental health care are allowed to prescribe psychotropic medication. So far.there has been very little research on the results of this decision that now let nps share with doctors prescribing psychotropic drugs. AIM: To provide insight into how patients and psychiatrists experience the prescribing behaviours of nps and how nps themselves regard their extended role. METHOD: We performed an explorative study in which we used the data given in prescriptions written by nps, questionnaires exploring patientsu0027 experiences and semi-structured interviews with psychiatrists and nps. RESULTS: Between May 2014 and May 2015,13 nps wrote 3542 prescriptions for 565 unique patients. On the whole, patients, psychiatrists and nps expressed positive views on the prescribing of psychotropic medication by nps. CONCLUSION: Our research project confirms that the various stakeholders are satisfied with the prescribing practices of nps. A follow-up study is needed in order to ascertain whether there are qualitative differences between the prescriptions of nps and those of doctors.

BACKGROUND:Since January 1, 2012, nurse practitioners (NP) working in mental health care are allowed to prescribe psychotropic medication. So far, there has been very little research on the results of this decision that now let NPS share with doctors prescribing psychotropic drugs.AIM:To provide insight into how patients and psychiatrists experience the prescribing behaviours of NPS and how NPS themselves regard their extended role.METHOD:We performed an explorative study in which we used the data given in prescriptions written by NPS, questionnaires exploring patients' experiences and semi-structured interviews with psychiatrists and NPS.RESULTS:Between May 2014 and May 2015, 13 NPS wrote 3542 prescriptions for 565 unique patients. On the whole, patients, psychiatrists and NPS expressed positive views on the prescribing of psychotropic medication by NPS.CONCLUSION:Our research project confirms that the various stakeholders are satisfied with the prescribing practices of NPS. A follow-up study is needed in order to ascertain whether there are qualitative differences between the prescriptions of NPS and those of doctors.

This literature review was carried out to examine the effects of user involvement in shared decision-making processes and the methods/tools available to psychiatric nurses to measure and encourage user involvement. A systematic literature review was then used in this study. Many studies indicate that an increased involvement of service users leads to better care, better treatment compliance, improved health outcomes and higher levels of patient satisfaction. The tools and methods described are designed to measure the ability to participate, the process of implementation and the evaluation of healthcare services. An adequate instrument to measure user involvement will be necessary to underpin the positive effects. Although care providers have a statutory duty to help shape user involvement, and the tools required are available, care providers are still insufficiently inclined to take up this duty.

In mammals, ornithine decarboxylase (ODC) activity is highest during periods of rapid cellular growth and development, and the normal pattern of ODC activity during this period is sensitive to chemical and drug exposure. The industrial solvent ethylene glycol monomethyl ether (EGME) is teratogenic to rats and mice, with the heart being particularly sensitive. Basal ODC activity and ODC activity following an isoproterenol challenge were used to assess heart function in 3-, 9-, 16- and 22-day-old offspring from dams treated with 25 mg/kg EGME by gavage on days 7-13 or 13-19 of gestation. Reproductive outcome was not affected by EGME and none of the offspring had gross physical abnormalities. Gestation length was prolonged by both EGME treatments, but the increase was statistically significant only in the group treated on days 7-13 gestation. ODC activity per mg protein was greatest in 3-day-old rats and dropped off sharply during the following 3 weeks. In 3-day-old rats exposed on days 7-13 of gestation, ODC activity was 54% of that found in controls. ODC activity was comparable to that in controls in 3-day-old rats exposed on days 13-19 of gestation. Isoproterenol increased ODC activity in all groups, but additional functional abnormalities were not revealed by the isoproterenol challenge.

Methods for the biological monitoring of aromatic hydrocarbons and their metabolites in the human blood and urine are reviewed. For the determination of the unchanged aromatic hydrocarbon in blood, gas chromatographic head-space analysis is recommended. The metabolites can be monitored by photometric, thin-layer chromatographic, high-performance liquid chromatographic and gas chromatographic methods. For the assessment of health risks caused by aromatic hydrocarbons, reference values and occupational limit values, expressed as biological tolerance values and biological exposure indices, have to be considered.

The widely used industrial solvent ethylene glycol monomethyl ether (EGME) is teratogenic to rats and mice, inducing a variety of heart and major vessel abnormalities. In the present study, electrocardiography was used to evaluate heart function in day 20 rat (Sprague-Dawley) fetuses from mothers treated on gestation days 7-13 (sperm = day 1) with 0, 25, or 50 mg/kg EGME by gavage in 10 ml/kg water. The increased incidence of fetuses with cardiovascular malformations (primarily right ductus arteriosus and ventricular septal defect) and abnormal electrocardiograms (EKG) was dose dependent. The most prevalent EKG abnormality was a prolonged QRS wave. Mean QRS intervals were not significantly increased by EGME exposure, but there were significantly more litters in the 50-mg/kg EGME group that had one or more fetuses with QRS complexes of 40 msec or longer. The enhanced duration and the appearance of the aberrant QRS's suggested the presence of an intraventricular conduction delay in these fetuses. Heart rate and other EKG characteristics such as the P wave or P-R and Q-T intervals were not significantly affected by exposure to EGME. There did not appear to be an association between abnormal EKG's and fetal heart dysmorphology.