Bram Dierckx

Fragile X syndrome (FXS) is a neurodevelopmental disorder that affects approximately 1 in 7,000 males and 1 in 11,000 females (Hunter et al., 2014). FXS is caused by an expanded CGG repeat in the f...

Aims: This study aimed to improve the understanding of lithium's safety profile by analysing the frequency and distribution of reported adverse drug reactions (ADRs) compared to second‐generation antipsychotics (SGAs). Methods: Individual case safety reports from VigiBase (1968–October 2023) involving individuals older than 2 years, with lithium or SGAs as a suspected or interacting drug, were included. Medical Dictionary for Regulatory Activities (MedDRA) was used for ADRs classification. Proportional reporting ratios (PRRs) with 95% confidence intervals were calculated across different age groups. Results: The lithium group contained 29 897 reported ADRs. Proportional reporting patterns varied across age groups. In children, lithium was associated with a higher proportion of renal, endocrine, gastrointestinal, skin and cardiac ADRs compared to SGAs. SGAs showed proportionally more ADRs in females, whereas lithium displayed fewer and more balanced sex‐related differences. Renal impairment accounted for a larger proportion of lithium‐related ADRs in older adults compared to children. For SGAs, type 2 diabetes and cardiovascular events showed higher proportional reporting in both younger and older adults than in children. In contrast, thyroid‐related ADRs with lithium and weight‐related ADRs with SGAs were proportionally more common in children. Conclusions: Renal, endocrine and gastrointestinal effects are observed in children using lithium, though serious outcomes like renal failure appear proportionally more often in older adults. SGAs also show age‐specific risk patterns, particularly metabolic and cardiovascular effects in adults. This emphasizes the ongoing need for individualized treatment and continued ADR monitoring and reporting to enhance the understanding of lithium's safety profile and support informed clinical decision‐making.

Objective: Bipolar disorder (BD) often emerges during mid‐adolescence and young adulthood, and leads to functional and social impairment, with a prevalence of 0.87% among Dutch youth. Lithium, the first‐line BD maintenance treatment, stabilizes mood, prevents suicide, and is well tolerated, yet its use has declined as long‐term second‐generation antipsychotics (SGAs) prescriptions increased. This study explores the prevalence, incidence, duration, prior and concurrent use of psychotropic medications, and dosage patterns of lithium dispensing in Dutch youth. Method: A retrospective cohort study using the Dutch community pharmacy‐based IADB.nl database included 567 youths (6–25 years), who were dispensed lithium between 2011 and 2022. Results: The yearly prevalence of lithium dispensing per 100,000 fluctuated between 30.3 in 2011 and 34.8 in 2022 ( p = 0.40), with the lowest prevalence in 6–12‐year‐olds and highest in 20–25‐year‐olds. Females had overall higher prevalence rates than males ( p = 0.03). Overall incidence rose from 7.9 to 9.3 ( p = 0.68). In 2011, incidence was 10.7 for both the 13–19 and 20–25 age groups. By 2022, this decreased to 4.2 in 13–19‐year‐olds and increased to 19.0 in 20–25‐year‐olds. Approximately 55% of individuals received other psychotropics before lithium, and 52% concurrently, with SGAs and antidepressants being most commonly dispensed. Conclusion: Despite lithium's efficacy and status as first‐line BD maintenance treatment, its dispensing in Dutch youth remains low compared to the BD prevalence. This may be due to misdiagnosis of BD and/or clinicians' reluctance to prescribe lithium, highlighting the need for improved diagnostics, clinician education, and further research into lithium's safety in youths.

Most individuals with fragile X syndrome (FXS) exhibit symptoms of autism spectrum disorder (ASD), suggesting a substantial overlap in social cognitive profiles. This cross‐sectional study aimed to explore social cognitive abilities in children and adolescents with FXS in comparison with an age‐matched heterogeneous ASD group and typically developing (TD) peers. Key domains assessed included basic visual social attention towards faces, autonomic arousal in reaction to conflicting emotional information and Theory of Mind (ToM). Participants comprised 14 children with FXS, 24 with ASD and 19 TD controls, aged 6–18 years. Visual attention and implicit emotion recognition were measured using an emotional oddball paradigm using gaze behaviour and pupillometric analysis, and ToM was assessed with the NEPSY‐II neuropsychological test battery ToM subtest. Results indicated that children and adolescents with FXS directed their gaze less towards relevant social–emotional information (i.e., faces and especially eyes), compared with both the ASD and TD groups. Regarding implicit emotion recognition, the attentional disparity between the FXS group and the TD group was reduced when conflicting multisensory emotional information was presented, rather than congruent cues. Next, a diminished pupillary response to conflicting emotional information was found in the FXS group, as compared with the ASD group. Additionally, the FXS group showed difficulties with ToM, compared with the ASD and TD groups. These findings suggest that both deviations in basic and higher‐order social cognitive abilities may contribute to the social difficulties experienced by individuals with FXS and may partly account for the high incidence of ASD diagnoses in this population.

Background: University students are facing a multitude of challenges and an increase in mental health issues that affect their academic performance and overall well-being. In response, Erasmus University Rotterdam launched the Student Wellbeing Programme in 2019, offering comprehensive, tailored support through a stepped-care framework to enhance student success and well-being. One of the tools developed for students is ROOM to Grow, an anonymous and accessible preventative mental health app. Objective: This paper describes the process and outcomes of ROOM’s design and development, guided by the Centre for eHealth Research (CeHRes) road map and privacy-by-design principles, and highlights the lessons learned throughout this process. Methods: This paper describes the first 4 phases of the CeHRes Road map: contextual inquiry, value specification, design, and operationalization. It outlines the population (ie, stakeholders), methods (ie, literature reviews, expert groups, cognitive walkthroughs, interviews, experimental designs), and outcomes of each phase. Results: The most common mental health struggles among our target population were stress, anxiety symptoms, perfectionistic tendencies, and loneliness. Students often recognized these issues only once they became overwhelming. Regarding digital tools, students seek credible content specific to their experiences, as well as adaptable and intuitive systems; they are mindful of data privacy and aim to reduce their screen time. ROOM was developed to address the diverse needs and preferences of university students through a transdiagnostic approach to mental health. It targets emotion regulation (ER) skills and self-awareness, which underlie the mental health challenges experienced by our target users. ROOM comprises 26 brief exercises (ie, micro-interventions) that support the development and use of adaptive ER. The exercises incorporate techniques from various therapeutic approaches (ie, self-compassion, positive psychology, mindfulness, cognitive behavioral therapy, and acceptance and commitment therapy) to accommodate students’ diverse content preferences. To help students recognize their struggles earlier, ROOM includes a mood tracker and a self-assessment module with questionnaires that evaluate both traits (eg, perfectionistic tendencies) and states (eg, stress levels), providing personalized feedback. ROOM further implements an intelligent recommender system that connects users to relevant content, enhancing the tool’s personalization and responsiveness to users’ needs. As students aim to minimize screen time, ROOM’s goal is not prolonged app use but the application of ER skills in real life, supported by features that facilitate skill transfer into everyday settings. Finally, ROOM was developed within a “privacy-by-design” framework to address students’ privacy concerns, implementing strict privacy and security regulatory standards. Conclusions: Compromises were necessary to balance user needs, resource constraints, and privacy-by-design and security standards, often limiting ROOM’s interactivity. Other challenges included simplifying complex psychological concepts into brief formats, fostering interdisciplinary collaboration, balancing academic rigor with industry production pace, and operating with fixed resources while maintaining an iterative process. This paper may serve as a primer for designing transdiagnostic, adaptive mental health interventions for youth, blending therapeutic approaches and promoting skill transfer.

Objective: The Youth Act, implemented by the Dutch government in 2015, aimed to provide more efficient, coherent, and cost-effective care tailored to the specific needs of children, while also reducing medicalization. Between 2003 and 2013, there was a four-fold increase in methylphenidate prescriptions among Dutch children aged 4 to 18 years. However, the impact of the Youth Act on the ADHD medication dispensing remains unassessed. This study investigated changes in ADHD medication dispensing patterns among Dutch youth following the implementation of the Youth Act. Method: A before-after retrospective cohort study was conducted using data from the Dutch community pharmacy-based IADB.nl database among 137,684 youths aged 0–19 years using ADHD medication between 2010 and 2022. Results: A significant decrease in overall ADHD medication dispensing prevalence rates per thousand youths was observed in 2022 compared to 2015 (35.2 vs. 45.7, p < 0.001). Methylphenidate accounted for approximately 87% of all ADHD medication dispensing. Incidence rates decreased significantly among children aged 7–12 from 2015 to 2022 (9 vs. 7.3, p < 0.001), while incidence rates increased significantly in adolescent youths (4 vs. 4.8, p = 0.008), particularly among adolescent females (3.5 vs. 5.3, p < 0.001). Females had lower prevalence rates and shorter durations of ADHD medication use compared to males, with no difference in daily dose observed. Conclusion: ADHD medication dispensing among Dutch youth declined following the 2015 implementation of the Youth Act. However, other factors such as the DSM-5 revision, COVID-19, and medication shortages likely contributed to this decrease, suggesting a multifactorial explanation for the observed changes in ADHD medication dispensing.

Background: Fatigue is a common and debilitating side effect of chronic diseases, significantly impacting patients’ quality of life. While physical exercise and psychological treatments have been shown to reduce fatigue, patients often struggle with adherence to these interventions in clinical practice. Game-based eHealth interventions are believed to address adherence issues by making the intervention more accessible and engaging. Objective: This study aims to compile empirical evidence on game-based eHealth interventions for fatigue in individuals with chronic diseases and to evaluate their effectiveness in alleviating fatigue. Methods: A comprehensive literature search was performed across Embase, MEDLINE ALL, PsycINFO, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar in August 2021. Study characteristics and outcomes from the included studies were extracted, and a random-effects meta-analysis was conducted. Sensitivity and subgroup analyses were performed to identify sources of heterogeneity. Results: Of 1742 studies identified, 17 were included in the meta-analysis. These studies covered 5 different chronic diseases: multiple sclerosis (n=10), cancer (n=3), renal disease (n=2), stroke (n=1), and Parkinson disease (n=1). All but 1 study used exergaming interventions. The meta-analysis revealed a significant moderate effect size in reducing fatigue favoring the experimental interventions (standardized mean difference [SMD] –0.65, 95% CI –1.09 to –0.21, P=.003) compared with control conditions consisting of conventional care and no care. However, heterogeneity was high (I2=85.87%). Subgroup analyses were conducted for the 2 most prevalent diseases. The effect size for the multiple sclerosis subgroup showed a trend in favor of eHealth interventions (SMD –0.47, 95% CI –0.95 to 0.01, P=.05, I2=63.10%), but was not significant for the cancer group (SMD 0.61, 95% CI –0.36 to 1.58, P=.22). Balance exercises appeared particularly effective in reducing fatigue (SMD –1.19, 95% CI –1.95 to –0.42, P=.002). Conclusions: Game-based eHealth interventions appear effective in reducing fatigue in individuals with chronic diseases. Further research is needed to reinforce these findings and explore their impact on specific diseases. Additionally, there is a lack of investigation into interventions beyond exergaming within the field of game-based learning.

BACKGROUND University students are facing a multitude of challenges and an increase in mental health issues that affect their academic performance and overall well-being. In response, Erasmus University Rotterdam launched the Student Wellbeing Programme in 2019, offering comprehensive, tailored support through a stepped-care framework to enhance student success and well-being. One of the tools developed for students is ROOM to Grow, an anonymous and accessible preventative mental health app. OBJECTIVE This paper describes the process and outcomes of ROOM’s design and development, guided by the Centre for eHealth Research (CeHRes) road map and privacy-by-design principles, and highlights the lessons learned throughout this process. METHODS This paper describes the first 4 phases of the CeHRes Road map: contextual inquiry, value specification, design, and operationalization. It outlines the population (ie, stakeholders), methods (ie, literature reviews, expert groups, cognitive walkthroughs, interviews, experimental designs), and outcomes of each phase. RESULTS The most common mental health struggles among our target population were stress, anxiety symptoms, perfectionistic tendencies, and loneliness. Students often recognized these issues only once they became overwhelming. Regarding digital tools, students seek credible content specific to their experiences, as well as adaptable and intuitive systems; they are mindful of data privacy and aim to reduce their screen time. ROOM was developed to address the diverse needs and preferences of university students through a transdiagnostic approach to mental health. It targets emotion regulation (ER) skills and self-awareness, which underlie the mental health challenges experienced by our target users. ROOM comprises 26 brief exercises (ie, micro-interventions) that support the development and use of adaptive ER. The exercises incorporate techniques from various therapeutic approaches (ie, self-compassion, positive psychology, mindfulness, cognitive behavioral therapy, and acceptance and commitment therapy) to accommodate students’ diverse content preferences. To help students recognize their struggles earlier, ROOM includes a mood tracker and a self-assessment module with questionnaires that evaluate both traits (eg, perfectionistic tendencies) and states (eg, stress levels), providing personalized feedback. ROOM further implements an intelligent recommender system that connects users to relevant content, enhancing the tool’s personalization and responsiveness to users’ needs. As students aim to minimize screen time, ROOM’s goal is not prolonged app use but the application of ER skills in real life, supported by features that facilitate skill transfer into everyday settings. Finally, ROOM was developed within a “privacy-by-design” framework to address students’ privacy concerns, implementing strict privacy and security regulatory standards. CONCLUSIONS Compromises were necessary to balance user needs, resource constraints, and privacy-by-design and security standards, often limiting ROOM’s interactivity. Other challenges included simplifying complex psychological concepts into brief formats, fostering interdisciplinary collaboration, balancing academic rigor with industry production pace, and operating with fixed resources while maintaining an iterative process. This paper may serve as a primer for designing transdiagnostic, adaptive mental health interventions for youth, blending therapeutic approaches and promoting skill transfer.

BACKGROUND Fatigue is a common and debilitating side effect of chronic diseases, significantly impacting patients’ quality of life. While physical exercise and psychological treatments have been shown to reduce fatigue, patients often struggle with adherence to these interventions in clinical practice. Game-based eHealth interventions are believed to address adherence issues by making the intervention more accessible and engaging. OBJECTIVE This study aims to compile empirical evidence on game-based eHealth interventions for fatigue in individuals with chronic diseases and to evaluate their effectiveness in alleviating fatigue. METHODS A comprehensive literature search was performed across Embase, MEDLINE ALL, PsycINFO, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar in August 2021. Study characteristics and outcomes from the included studies were extracted, and a random-effects meta-analysis was conducted. Sensitivity and subgroup analyses were performed to identify sources of heterogeneity. RESULTS Of 1742 studies identified, 17 were included in the meta-analysis. These studies covered 5 different chronic diseases: multiple sclerosis (n=10), cancer (n=3), renal disease (n=2), stroke (n=1), and Parkinson disease (n=1). All but 1 study used exergaming interventions. The meta-analysis revealed a significant moderate effect size in reducing fatigue favoring the experimental interventions (standardized mean difference [SMD] –0.65, 95% CI –1.09 to –0.21, P=.003) compared with control conditions consisting of conventional care and no care. However, heterogeneity was high (I2=85.87%). Subgroup analyses were conducted for the 2 most prevalent diseases. The effect size for the multiple sclerosis subgroup showed a trend in favor of eHealth interventions (SMD –0.47, 95% CI –0.95 to 0.01, P=.05, I2=63.10%), but was not significant for the cancer group (SMD 0.61, 95% CI –0.36 to 1.58, P=.22). Balance exercises appeared particularly effective in reducing fatigue (SMD –1.19, 95% CI –1.95 to –0.42, P=.002). CONCLUSIONS Game-based eHealth interventions appear effective in reducing fatigue in individuals with chronic diseases. Further research is needed to reinforce these findings and explore their impact on specific diseases. Additionally, there is a lack of investigation into interventions beyond exergaming within the field of game-based learning.