The Belgian medical world has acknowledged the diagnosis of transsexualism and accepted Sex Reassignment Surgery (SRS) as one of the steps in the treatment of choice since 1985. This prevalence and demographic study analyses data on all Belgian individuals who have undergone SRS since that year.

All (188) plastic surgeons as well as all gender teams (Antwerp, Bruges, Ghent, and Liège) in Belgium were sent demographic questionnaires to be completed for each of their transsexual patients.

The results show an overall prevalence of 1:12,900 for male-to-female and 1:33,800 for female-to-male transsexuals in Belgium. In Wallonia (the French-speaking region of Belgium) the prevalence is significantly lower than in Flanders (the Dutch-speaking region) and in Brussels (the bilingual capital region). In the total Belgian population the male/female sex ratio is 2.43:1, again with a substantial difference between Wallonia on the one hand and Flanders on the other.

While in Flanders and in Brussels the prevalence is comparable to that in other Western European countries, in Wallonia it is markedly lower. Transsexualism in Wallonia appears to be socially less acceptable: persons suffering from gender dysphoria in that part of Belgium encounter more problems accessing gender clinics and receiving treatment.

the Mini International Neuropsychiatric Interview (MINI) is a short diagnostic structured interview (DSI) designed to generate positive diagnosis for the main Diagnostic and Statistical Manual (DSM)-III-R/IV Axis I disorders and to explore the symptoms of Criterion A for Schizophrenia (Sc) to rule out the presence of Psychotic Disorders. The procedural validity of the MINI was investigated in psychiatric patients using the Composite International Diagnostic Interview (CIDI) as a gold standard in Europe and the Structured Clinical Interview for DSM-III-R (SCID-P)in the US. This paper presents the concordance and the reasons for discordance between the MINI and the CIDI for DSM-III-R Psychotic and Mood Disorders. No study had systematically analysed the sources of disagreement between DSI based on the same operational criteria in psychotic patients.

256 consecutively recruited psychiatric patients and 50 non-psychiatric subjects passed the MINI and the CIDI.

concordance was good for the presence of Major Depressive Episode (MDE), Manic Episode, Psychotic Disorders, syndromes or symptoms (0.65 to 0.82). Inconsistencies in evaluation of the disorder recency accounted for 25 to 40% of discordance for current diagnoses. Fifty-three percent of discordance for lifetime Manic Episode resulted from inconsistencies in the severity of the index episode. Fifty percent of discordance for the diagnosis of Psychotic Disorders was due to algorithmic differences between the two DSI.

the MINI yields reliable DSM-III-R diagnoses within a short time frame (22 minutes). Depending on the quantitative and the qualitative analyses of discrepancies between the MINI and the CIDI for Psychotic Disorders and Mood Episodes, we proposed and tested modifications leading to improvements in both interviews. The procedural validity of the modified MINI according to the modified CIDI was found to be very good.

In the past decades, the effects of problem-solving therapy (PST) for depression have been examined in several randomized controlled studies. However, until now no meta-analysis has tried to integrate the results of these studies.

We conducted a systematic literature search and identified 13 randomized studies examining the effects of PST, with a total of 1133 subjects. The quality of studies varied.

The mean standardized effect size was 0.34 in the fixed effects model and 0.83 in the random effects model, with very high heterogeneity. Subgroup analyses indicated significantly lower effects for individual interventions in studies with subjects who met criteria for major depression, studies in which intention-to-treat analyses were conducted instead of completers-only analyses, and studies with pill placebo and care-as-usual control groups. Heterogeneity was high, and the subgroup analyses did not result in clear indications of what caused this high heterogeneity. This indicates that PST has varying effects on depression, and that it is not known to date what determines whether PST has larger of smaller effects.

Although there is no doubt that PST can be an effective treatment for depression, more research is needed to ascertain the conditions and subjects in which these positive effects are realized.

– Studies have suggested that women with pregnancy anxiety may be at greater risk of postnatal depression (PND). However, due to the high comorbidity between anxiety and depressive disorders, this finding may be confounded by the association between prenatal depression and postnatal depression. The aim of the present prospective study was to assess whether anxiety disorder (AD) during pregnancy is an independent predictor of intensity of postnatal depressive symptoms.

– The MATQUID cohort survey was conducted on pregnant women (n = 497) attending a state maternity hospital. Psychiatric status during pregnancy was assessed during the third trimester using a structured diagnostic interview. Intense postnatal depressive symptoms at 6 weeks post-partum were defined by a score >12 on the Edinburgh Postnatal Depression Scale (EPDS).

– Nearly one out of four women (24.1%) presented with at least one pregnancyAD, and 29 (5.8%) presented with a score >12 on the EPDS. After adjustment for presence of major depression during pregnancy and other confounding factors, women with pregnancy AD were nearly three times more likely to present with intense postnatal depressive symptoms (OR = 2.7, 95%CI 1.1-6.3, P = 0.03).

– Promoting the recognition and management of AD in pregnant women may be of interest for the prevention of postnatal depression.

(1) determine which antipsychotic side effects (SE) schizophrenic patients consider the most distressing during treatment with typical antipsychotics, (2) measure the impact of actual and past SE on patients' attitude toward antipsychotics and (3) assess the influence of both on adherence.

The 213 schizophrenics, treated with conventional antipsychotics, were recruited in two psychiatric hospitals in Hamburg. Subjects were assessed about type and severity of present and past side effects and their attitude and adherence to antipsychotic treatment.

The 82 (39%) patients presented present SE while 131 (61%) did not. Sexual dysfunctions (P<0.001), extrapyramidal (P<0.05) and psychic side effects (P<0.05) were rated as significantly subjectively more distressing than sedation or vegetative side effects. Patients presenting with present SE compared with patients without present SE had a significantly more negative general attitude toward antipsychotics (P<0.05), were more doubtful about their efficacy (P<0.01) and were less likely to encourage a relative to take such a medication in case of need (P<0.001). A regression analysis indicated that nonadherence was mainly influenced by negative general and efficacy attitudes toward antipsychotics and the experience of past or present antipsychotic side effects.

All antipsychotic side effects, present or past, can have a durable negative impact on patient's attitude toward antipsychotic treatment and adherence. Non-adherence is mainly determined, among other factors, by these negative attitudes, which are partly influenced by the experience of past or present antipsychotic-induced side effects.

Over the past several years there has been considerable interest in the relation between emotion dysregulation and non-suicidal self-injury (NSSI), particularly given that rates of NSSI have been increasing and NSSI is a critical risk factor for suicidal behavior. To date, however, no synthesis of empirical findings exists.

The present study presents a comprehensive meta-analytic review of the literature on the association between NSSI and emotion dysregulation. A total of 48 publications, including 49 independent samples, were included in this analysis.

Overall, a significant association was found between emotion dysregulation and NSSI (pooled OR = 3.03 [95% CI = 2.56–3.59]). This association was reduced but remained significant (OR = 2.40 [95% CI = 2.01–2.86]) after adjustment for publication bias. Emotion dysregulation subscales most strongly associated with NSSI included limited access to regulation strategies, non-acceptance of emotional responses, impulse control difficulties, and difficulties engaging goal-directed behavior. Lack of emotional awareness/clarity and cognitive aspects of dysregulation yielded weaker, yet significant, positive associations with NSSI.

Findings support the notion that greater emotion dysregulation is associated with higher risk for NSSI among individuals across settings, regardless of age or sex. Furthermore, findings reveal facets of dysregulation that may have unique implications for NSSI. This meta-analysis highlights the importance of better understanding emotion dysregulation as a treatment target for preventing NSSI.

Thirty-six OCD patients on maintenance treatment were evaluated using the Y-BOCS, SF-36, and DAS-S. Their SF-36 scores were compared to Spanish norms and to those obtained from U.S. OCD patients, schizophrenic outpatients, depressed outpatients, heroin dependents, patients on hemodialysis, and kidney transplant recipients.

Dysfunctions in metacognition have been reported in individuals with anxiety disorders. Although recent studies have examined metacognition in other disorders, how dysfunctional metacognition compares across disorders is not clear. This review aimed to ascertain the importance of dysfunctional metacognition in various psychopathologies, and to identify similarities and differences in metacognitive profiles across disorders.

Forty-seven studies were selected from 586 articles published between 1990 and August 2015, including a total sample of 3772 patients and 3376 healthy individuals. Studies that measured metacognition using the Meta-Cognitions Questionnaire (MCQ) and its variants were included. We conducted five meta-analyses including 49 to 55 effect sizes, comparing psychiatric patients to healthy individuals on respective metacognitive dimensions of the MCQ.

We found elevated metacognitive dysfunctions in patients, as a group, on all MCQ dimensions. Group effects were large and robust for the two negative beliefs (i.e., beliefs about the uncontrollability and danger of thoughts, and beliefs about the need to control thoughts), and moderate and unstable for the positive beliefs. Patients showed decreased cognitive confidence and heightened cognitive self-consciousness on moderate to large levels. Moderator analyses revealed that negative beliefs about uncontrollability and danger of thoughts were most prevalent in generalized anxiety disorder, whereas heightened cognitive self-consciousness was more characteristic in obsessive-compulsive disorder. Generalized anxiety disorder, obsessive-compulsive disorder and eating disorders manifested more similar metacognitive profiles than other disorders.

Our findings supported dysfunctional metacognition as common processes across psychopathologies, with certain dimensions being more prevalent in particular disorders.

To test the hypothesis that recent onset psychotic patients who use cannabis will have psychotic symptoms that are more severe and more persistent than those who do not use cannabis.

We carried out a 4-year follow-up study of a cohort of 119 patients with recent onset of psychosis. The patients were divided into four groups according to duration of cannabis use, taking index admission and follow-up as reference points.

Those subjects who persisted in the use of cannabis had more positive (but not negative) symptoms and a more continuous illness at follow-up.

The main limitations of the study were: the relatively small sample size, and that the excess of male subjects and the presence of cannabis induced psychosis could have a confusing impact on the interpretation of the results.

It is possible that psychotic patients who use cannabis are at a greater risk of a more continuous illness with more positive symptoms than those who do not.

Borderline personality disorder (BPD) is a highly prevalent, chronic condition. Because of its very problematic nature BPD is expected to be associated with substantial societal costs, although this has never been comprehensively assessed.

Estimate the societal cost of BPD in the Netherlands.

We used a prevalence-based bottom-up approach with a sample of 88 BPD patients who enrolled in a multicenter clinical trial comparing two kinds of outpatient psychotherapy. Costs were assessed by means of a structured interview, covering all healthcare costs, medication, informal care, productivity losses, and out-of-pocket expenses. Only BPD-related costs were included. All costs were expressed in Euros for the year 2000. A bootstrap procedure was performed to determine statistical uncertainty.

All patients had been diagnosed with BPD using DSM-IV criteria. Mean age was 30.5 years and 92% was female.

Based on a prevalence of 1.1% and an adult population of 11,990,942, we derived that there were 131,900 BPD patients in the Netherlands. Total bootstrapped yearly cost of illness was €2,222,763,789 (€1,372,412,403–€3,260,248,300), only 22% was healthcare-related. Costs per patient were €16,852.

Although healthcare costs of non-institutionalized Borderline patients might not be disproportionate, total societal costs are substantial.

Cognitive-behavioral therapy (CBT) is first choice of treatment for depressive symptoms and disorders in adolescents, however improvements are necessary because overall efficacy is low. Insights on CBT components and contextual and structural characteristics might increase the efficacy. The aim of our approach is to evaluate the efficacy of CBT for youth with depression and investigate the influence of specific components, contextual and structural factors that could improve effects.

A systematic review of randomized controlled trials was conducted, searches were undertaken in CINAHL, CENTRAL, EMBASE, MEDLINE/PubMed and PsycINFO. Outcomes were meta-analyzed and confidence in results was assessed using the GRADE-method. Meta-regression was used to pinpoint components or other factors that were associated with an in- or decrease of effects of CBT.

We included 31 trials with 4335 participants. Moderate-quality evidence was found for CBT reducing depressive symptoms at the end of treatment and at follow-up, and CBT as indicated prevention resulted in 63% less risk of being depressed at follow-up. CBT containing a combination of behavioral activation and challenging thoughts component (as part of cognitive restructuring) or the involvement of caregiver(s) in intervention were associated with better outcomes for youth on the long term.

There is evidence that CBT is effective for youth with a (subclinical) depression. Our analyses show that effects might improve when CBT contains the components behavioral activation and challenging thoughts and also when the caregiver(s) are involved. However, the influential effects of these three moderators should be further tested in RCTs.

Numerous treatment guidelines recommend that long-term use of benzodiazepines (BZD) should be avoided primarily due to development of tolerance and a risk for BZD dependence. Despite this, long-term BZD use remains a controversial subject in clinical patient care with “for and against” debates. However, there is no explicit understanding of what is meant by long-term BZD use in real world. The aim of this study was to assess different definitions, usage patterns, prevalence and other characteristics of long-term BZD use based on published register-based studies. Synthesis of these characteristics is essential to derive a meaningful definition of long-term BZD.

Systematic review of register-based studies on long-term BZD use published in 1994–2014.

Fourty-one studies met our predetermined inclusion criteria. The length of BZD use defined as “long-term” varied in these studies ranging from one month to several years. The most common definition was six months or longer during a year. The prevalence of long-term BZD use in the general population was estimated to be about 3%. The relative proportion of long-term BZD users (all definitions) in adult BZD users ranged from 6% to 76% (mean 24%; 95% CL 13–36%). The estimates were higher in studies only on the elderly (47%; 95% CL 31–64%). Long-term use involved typically steady treatment with low BZD doses. However, in elderly patients long-term BZD use and exceeding recommended doses was relatively common. Several characteristics associated with long-term use were found.

Long-term BZD use is common and a clinical reality. Uniform definitions for “long-term”, which is in line with population-based evidence, is needed to have more comparable results between studies. Our systematic review suggests that duration of BZD treatment over six months, the most common definition for long-term BZD use in the included studies. As also recommended previously, it is a useful starting point for further analyses on disadvantages but also potential advantages associated with long-term BZD use.

Prevention of psychosis has become a major objective of modern clinical psychiatry. An increasing number of new services have been established in Europe and in the world. The OASIS team has become an established model where clinical practice and research are fully integrated in the field of preventative interventions in psychosis.

Comprehensive analysis of different clinical and service measures describing the 2001–2011 implementation of the OASIS team.

Over the last decade, the OASIS team has received a total of 1102 referrals, mostly young males from ethnic minorities. After the assessment, 35% were diagnosed with an At Risk Mental State (ARMS) while 32% were already psychotic. Within the ARMS, 70% met the inclusion criteria for the attenuated psychotic symptoms subgroup, 1% met the inclusion criteria for the genetic deterioration syndrome, 9% met inclusion criteria for a brief and self-limited intermittent psychotic episode and the others met inclusion criteria for more than one subgroup. Most of them had at least one comorbid diagnosis, mainly relating to anxiety and depressive domains. The majority of the OASIS clients received cognitive behavioural therapy alone or in combination with antidepressants/antipsychotics. Over the 2-year follow-up time, 44 subjects (15.2%) developed a frank psychotic episode.

The OASIS service represents one of the largest and most established prodromal services in the world. The burden of research evidence and the translational impact produced on the clinical practice support the OASIS as a model for the development of similar services.

Clinical diagnosis has been shown to be unreliable compared to structured diagnostic schedules. However, clinicians rarely use structured diagnostic schedules due to concerns about the feasibility in clinical practice and about patient acceptance. Mini International Neuropsychiatric Schedule is a short diagnostic instrument validated against SCID and CIDI but its feasibility and patient acceptance has not been studied.

One hundred and eleven patients admitted to a partial program were administered Mini International Neuropsychiatric Schedule and the interview was timed. A short questionnaire was administered to assess patients’ views about the interview. For a subgroup of patients, diagnoses by both open interviews and Mini International Neuropsychiatric Interview (MINI) were available. These were compared to look for agreement in primary diagnoses and co-morbid conditions.

MINI took an average of 16.4 min to administer. Patients’ views of MINI were positive. It was considered comprehensive enough to cover all patient symptoms and at the same time not unduly lengthy. Patients were not bothered by the interview format. There was disagreement between MINI primary diagnosis and open diagnosis in 42% cases. In 33% the disagreement was of substantial clinical significance. MINI diagnosed more co-morbid conditions (average 2.05 compared to 0.5 in open interview).

MINI is a short diagnostic interview schedule that can be easily incorporated into routine clinical interviews. It has good acceptance by patients.