Alles wat we niet weten kunnen we gebruiken voor goede zorg Prof. dr. Jim van Os, Maastricht UMC
Academisch = Verwondering The important thing in science is not so much to obtain new facts as to discover new ways of thinking about them. (William Lawrence Bragg)
Verwondering van… De bankier De hoge ambtenaar De filosoof De patiënt De wetenschapper
De professional
Verwondering van de Professional
Allen Frances, 2012
The making of disorders
Poor attention
Hearing voices
Are caused by:
ADHD Allen Frances, 2012
Schizophrenia
Verwondering: DSM Depression Anhedonia
Lack of appetite
Guilt Hopelessness
Insomnia Suicidality Low
mood Anergia Kendler, AJPsych, 2016
Worthless
SelfreLack of Anxiety appetite Hyper- ference CompulAnhedoactivity sions nia Influenc Pain Fear Guilt Hypere ObsesHopelessergia sions ness Voices Amnesia Panic Insomnia InattenIntruSuicidation sions lity HyperLow Worry Craving TOM mood ImpulsiWorthAvoidanvity less ce HypoHypoRuminaAnergia TOM mania tion DerealiDemoraParanoia sation lisation Depersonalisation
SelfreLack of Anxiety appetite Hyper- ference CompulAnhedoactivity sions nia Influenc Pain Fear Guilt Hypere ObsesHopelessergia sions ness Voices Amnesia Panic Insomnia InattenIntruSuicidation sions lity HyperLow Worry Craving TOM mood ImpulsiWorthAvoidanvity less ce HypoHypoRuminaAnergia TOM mania tion DerealiDemoraParanoia sation lisation Depersonalisation
SelfreLack of Anxiety appetite Hyper- ference CompulAnhedoactivity sions nia Influenc Pain Fear Guilt Hypere ObsesHopelessergia sions ness Voices Amnesia Panic Insomnia InattenIntruSuicidation sions lity HyperLow Worry Craving TOM mood ImpulsiWorthAvoidanvity less ce HypoHypoRuminaAnergia TOM mania tion DerealiDemoraParanoia sation lisation Depersonalisation
SelfreLack of Anxiety appetite Hyper- ference CompulAnhedoactivity sions nia Influenc Pain Fear Guilt Hypere ObsesHopelessergia sions ness Voices Amnesia Panic Insomnia InattenIntruSuicidation sions lity HyperLow Worry Craving TOM mood ImpulsiWorthAvoidanvity less ce HypoHypoRuminaAnergia TOM mania tion DerealiDemoraParanoia sation lisation Depersonalisation
Symptom Approach Works Better
Mental disorders as brain disease
Verwondering van de User-Filosoof
Niet weten is een vorm van weten
Verwondering van de Econoom
25%
25% jaar prevalentie eHealth
1-op-1 zorg
Explosie in ggz
2004
3.5%
2.4 miljard
2010
7.0%
6.0 miljard
Angst/Depressie behandeling: aanbod gedreven
Ieder aanbod creëert zijn eigen vraag
Verwondering van de hoge ambtenaar: De sectorale ontwikkeling
Reframing Health 1948
2011
Afwezigheid van
Vermogen tot
ziekte, symptomen of
aanpassing en eigen
handicap - volledig
regie, gegeven
welbevinden
uitdagingen
De Sector en het Leven
Symptoom bestrijding
Je ding kunnen doen
Een oceaan aan zinloosheid? …..de ervaring leert dat de gebruikelijke oplossingen ons vaak niet verder helpen. Daarvoor is de praktijk te weerbarstig en zijn de problemen te ingewikkeld. Te vaak gaat het “systematisch” fout. Mathieu Wagemans http://ontganiseren.nl/
Michel Serres
1.2 Miljoen Nederlanders
Tapering strips
We revealed a dysfunctional system that does not deliver the quality of treatment needed for recovery. Is this tolerable in the 21st century?
Wat patiënten willen Wonen Werken
Studeren Zich verhouden ‘Je ding doen’
Verwondering van de wetenschap JAMA, 2010
One Size Does not Fit All
Dodo effect: Simpel works as well as complex
Is Clozapine Superior?
Insufficient evidence exists on which antipsychotic is more efficacious for patients with treatment-resistant schizophrenia, and blinded RCTs-in contrast to unblinded, randomized effectiveness studies-provide little evidence of the superiority of clozapinecompared with other second-generation antipsychotics.
Placebo: Getting better all the time
JAMA Psychiatry, 2014
Effect of CBT for depression is falling
Johnson & Friborg, Psychological Bulletin, 2015
“Real” Placebo Efficacy of Maxalt mislabeled as placebo was not significantly different from the efficacy of placebo mislabeled as Maxalt.
Kam-Hansen et al, Sc Transl Med, 2014
How Does Placebo Work?
BMJ, 2011
Therapeutic Relationship JAMA, 2010
Recovery: CHIME CONNECTEDNESS; HOPE AND OPTIMISM; IDENTITY; MEANING IN LIFE; EMPOWERMENT
……..point to the need for a greater emphasis on assessment of strengths and support for selfnarrative 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
‘Integrated Care’ Large scale
Small scale
Innovatie zonder disruptie? Innovatie moet de default zijn, niet iets dat je er bij doet
Delespaul, Milo, Schalken, Boevink, Van Os
GGZ van Relaties: Communities
Wijk community
Online Community
Essentiële regiofuncties en Kennis Regiovoorziening + Kennis Centrum
neighbourhood community (100FTE) neighbourhood community (100FTE)
neighbourhood community (100FTE)
neighbourhood community (100FTE) neighbourhood community (100FTE)
neighbourhood community (100FTE)
neighbourhood community (100FTE)
neighbourhood community (100FTE)
neighbourhood community (100FTE)
neighbourhood community (100FTE)
neighbourhood community (100FTE)
Multideskundig Perspectief Professional
Diagnosticus
Betrokkene
Interventionist
Coach
Patiënt
Ervaringsdeskundig
Treatment = Activating Network Resources
Behandelen met tussenpozen (niet escalerend doorbehandelen)
Transdiagnostic Perspective COMMON MENTAL DISORDERS
SCHIZ
SzAFF
Psychosis
DEPR
ANX
POP
Social Economy
…de Nieuwe GGZ maakt het mogelijk dat deze ‘ingeplugd’ kunnen worden in het relevante onderdeel…
Treatment = Doctor in the Driving Seat
You
Your doctor
Treatment = You in the Driving Seat You
Your doctor
Treatment = You as Part of eCommunity
Twee Communities
Kijken vanuit verwondering naar de GGZ
Fin
