Het nut van specialisatie? POH-GGZ, 02-02-2017 Jim van Os Nee het is depressie..ander zorgpad Nee het is psychose..ander zorgpad Nee het is verslaving.ander zorgpad Nee het is persoonlijkheid.ander zorgpad Nee het is autisme.ander zorgpad Het nut van specialisatie? Evidence-based practice: concept in crisis? DIAG1 DIAG2 DIAG3 DIAG4 DIAG5 Symptoms JAMA, 2010 Needs Treatments Hoeveel wetmatigheid onder de GGZ? Psychotherapie: verwondering van de Meta-analyticus Diagnose Zorgbehoefte Behandeling Prognose
Wat werkt: Relaties onder de behandeling CHIME: Ervaringskennis JAMA, 2010 CONNECTEDNESS; HOPE AND OPTIMISM; IDENTITY; MEANING IN LIFE; EMPOWERMENT..point to the need for a greater emphasis on assessment of strengths and support for self-narrative development, promoting the role of mental health systems in developing inclusive communities enabling access to peer support as well as providing retreats, and clinical interaction styles which promote empowerment and self-management. Leamey et al, 2011 Essentie van Weerbaarheid Gezondheid = Weerbaarheidsbevordering WHO, 1948 Huber, 2011 Sense Positief Verbinding of purpose affect Symptoombestrijding Je ding kunnen doen - ondanks uitdagingen Suggestie voor noodzaak van: 1. Kleinschaligheid HA + WMO 2. Relaties 3. Weerbaarheidsbevordering 4. (e)community De prevalentie is hoog. 45% 25%
Onder- en Overbehandeling Nieuwe GGZ OVERbehandeling ONDERbehandeling 1-op-1 GGZ Publieke GGZ ehealth 24% jaar prevalentie Zelfmanagement component ecommunities 1 op 1 zorg ehealth mhealth ecommunities mhealth 1 op 1 component 1 op 1 zorg Selfmanagement = Selfmonitoring Zelfmanagement = Empowerment Exercise sensitive Stress-reactive 24-hrs BP monitoring Preserved nocturnal dip JAMA, 2014
Experience Sampling Technology Situated Mood Phenotypes Ability to use natural rewards PsyMate I PsyMate II Positive Negative www.psymate.eu Stress sensitivity PA: Broaden & Build Theory NA TCA: Stress Sensitivity Reducing or Reward-Repairing? 70 Depressed Patients narrowing Mindfulness/AD attentional Imipramine Placebo Baseline: ESM, HAMD attention broadening Teasdale et al, 2002 NA Rewards PA Wichers et al, Neuropsychopharmacology, 2009 Week 6: ESM, HAMD Response contingent on change in reward Interventions at the HUB: MindMaastricht RCT effect negative activities on NA 0,25 0,2 0,15 0,1 0,05 0 change in stress-sensitivity in responders versus nonresponders after treatment (TCA or placebo) baseline week 6 χ2 = 0.27, B = 0.010, p = 0.6 χ2 = 10.1, B = 0.036, p = 0.001 Wichers et al, Neuropsychopharmacology, 2009 non-responders responders effect p ositive activities on PA 0,1 0,08 0,06 0,04 0,02 0-0,02 change in reward experience in responders versus non-responders after treatment (TCA or placebo) baseline week 6 non-responders responders Sample: 130 participants with mood disorders 6 days Experience Sampling Mindfulness Training Control Geschwind et al, J. Consulting & Clinical Psychology, 2011 6 days Experience Sampling FU 6 months FU 12 months
Daily Life Reward Intervention PA Persistence over Time Positive Emotions Positive Emotions Geschwind et al, J. Consulting & Clinical Psychology, 2011 Flow of Daily Life Geschwind et al, J. Consulting & Clinical Psychology, 2011 Flow of Daily Life Selfmonitoring-Feedback-Treatment Emotional resilience in depression: RCT Sample: 102 subjects with depression or residual symptoms PsyMate feedback TAU + PsyMate + feedback Baseline PsyMate Pseudo intervention TAU + PsyMate Control TAU Post PsyMate Depressive symptoms FU 1,2,3 & 6 months Lancet, 2011 Kramer, Simons, et al, World Psychiatry, 2014 Results REMOD PsyMate Intervention Trial 3 pijlers van Nieuwe GGZ Control PsyMate only PsyMate + feedback een visie op een visie op een visie op kennis middelen publieke GGZ Kramers et al, World Psychiatry, 2014
Key Concepten Fin Publieke GGZ = e/mhealth Transdiagnostische benadering Persoonlijke diagnostiek Behandeling: n=1 experiment Relationele component Fasegewijze weerbaarheidsbevordering