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BACKGROUND: The effectiveness of mental health care is currently monitored through routine quantitative symptom-driven measurements in most clinical settings. These measurements seem inadequate, especially for target groups with complex, multi-faceted problems. There is as yet no alternative method. AIM: 1. To describe why quantitative symptom-driven measurements are inadequate for measuring healthcare effectiveness; and 2. to introduce a new data platform that adjusts for socioeconomic and environmental factors to monitor the effectiveness of healthcare. METHOD: Overview of developments based on literature and introduction of a unique data platform. RESULTS: In the case of complex, multi-faced problems, such as in children with mild intellectual disability and comorbid psychopathology, mental health problems cannot be quantified, isolated, and individualized, i.e., decontextualized. To evaluate care for external benchmarking and scientific research, a shift is advised from measuring clinical symptoms within the treatment period to measuring longer-term group-level social functioning across multiple life domains, with a focus on socio-demographic differences. The Extramuraal LUMC Academisch Netwerk Gezond & Gelukkig Den Haag (ELAN-GGDH ; in English: Extramural LUMC Academic Network Healthy & Happy The Hague) data platform accomplishes this by combining mental health data with Statistics Netherlands microdata. CONCLUSION: The data platform could add value to external benchmarking and scientific research at group level.

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Background   Psychiatry is at the forefront of the emancipation of women as medical specialists. The share of women in the training of psychiatrists is high. In the labor market of the academia, however, there are indications of structural inequality. At university medical centers in the Netherlands 28% of the professors are female. How are women represented in the higher positions in academia in psychiatry? Aim   To explore how women are represented in the higher positions in psychiatric academia and what interventions can lead to a more equal labor market. Method   Information was obtained through universities and educational institutions on the current proportion of women in various positions in academic psychiatry. By searching the literature, interventions that can lead to a more equal labor market were investigated. Results   In psychiatry departments in the Netherlands 24% of the professors and 33% of the directors of psychiatric residency are female. Women are with 22% also a minority on editorial boards of scientific journals. Conclusion   In the higher academic positions in psychiatry, there is an unequal gender distribution. Culture change in combinations with policy changes can lead to a more equal labor market.

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Background  Of the total Dutch population, 25.7% has a migration background. The countries of origin, migration motives and time in the Netherlands are very diverse. Aim  To provide an overview of the cultural diversity within the psychiatry of different groups of people with a migration background, and to address the challenges and mental health care to these groups and the position of transcultural psychiatry in the Netherlands. Method  Based on integration of a narrative literature review (without a systematic search), own experiences and a fictitious case, we discuss the most important groups. This concerns the so-called guest workers as a specific group of first-generation migrants, second-generation migrants with their specific problems, and finally refugees and undocumented migrants with an accumulation of risk-increasing factors. Results  In addition to predisposition and migration factors, insufficient understanding of cultural context contributes to the psychiatric problems of first- and second-generation migrants. Refugees and undocumented migrants also have limited access to care. There is a reimbursement system in the Netherlands for undocumented migrants, through which they can also rely on care. By understanding cultural backgrounds, professionals can further improve their skills and communication in the field of intercultural psychiatry. Conclusion  Cultural diversity of patient groups demands additional attention to diagnosis and therapy.

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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.

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We saw a 60-year-old male veterinarian with a history of autism spectrum disorder, major depressive disorder, and suicidality. He had been treated with more than 15 psychotropic medications, was admitted to inpatient care several times, and attempted suicide once. His current complaints included a decline in social functioning, repetitive behaviour, sensory hypersensitivity, anxiety, low mood, anhedonia, lack of energy, and chronic suicidality. His last medication consisted of risperidone and valproic acid. Despite intensive treatment, he remained impaired by his complaints and could not return to work. After self-medication with ketamine, he reported that his depressive and suicidal complaints disappeared and that his autism-related complaints diminished. This case - together with previous clinical research - suggests that ketamine is likely to be effective against depression and suicidality, that ketamine is potentially effective against autism-related symptoms, and that increasing awareness of the beneficial effects of ketamine can lead to unsupervised, and therefore risky, use of ketamine as a form of self-medication.

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A newborn male presented with choanal atresia and minor dysmorphic facial features. At 4 years of age he showed delayed speech and language development. His mother had been treated with thiamazole for pre-existing hyperthyroidism during the first 3 months of pregnancy. It is possible that the maternal use of thiamazole caused the congenital anomalies. Embryopathy caused by maternal thiamazole use during pregnancy has been described several times before and is mainly characterised by choanal atresia, oesophageal atresia, minor dysmorphic facial features, growth retardation and delayed psychomotor development. Because the use of propylthiouracil during pregnancy has not been associated with similar effects, it is the treatment of choice for hyperthyroidism during pregnancy. For pregnant women or women who wish to become pregnant, thiamazole should be prescribed only ifpropylthiouracil cannot be used.

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