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Dr Jules Tielens - A new Language for Psychosis

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Jules Tielens is a Psychiatrist. His interest has always been on the treatment of people with schizophrenia and severe personality disorders as well as the development of alternative perspectives and a new language in respect to psychosis. He gives frequent workshops and lectures on this subject in addition to work as a psychiatrist at the care farm Bij Bram.

From 1998 to 2010 he was Psychiatrist to the Rehabteam; outreach care for psychotic homeless people in Amsterdam, and he was a Psychiatrist in Early Intervention Psychoses at the Amsterdam Medical Centre. Between 2011-2016 he worked at The Brewery, a centre for recovery of Psychosis in Amsterdam. As of 2018 he has been working as a Psychiatrist at the care farm Bij Bram (at Bram’s place)

Jules has authored 2 books in the Netherlands –

"Assertive in Care" and "In conversation with Psychosis".

Published in: Health & Medicine
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Dr Jules Tielens - A new Language for Psychosis

  1. 1. De Brouwerij Hoogte Kadijk 61hs 1018 BE Amsterdam Tel: 088 - 020 1350 Fax: 088 - 020 1351
  2. 2. DSM IV-TR: schizophrenia and other psychotic ilnesses • A majority of individuals with schizophrenia have poor insight regarding the fact that they have a psychotic illness. Evidence suggests that poor insight is a manifestation of the illness rather than a coping strategy. It may be comparable to the lack of awareness of neurological deficits seen in stroke, termed anosognosia. This symptom predisposes the individual to non-compliance with treatment and has been found to be predictive of higher relapse rates, increased number of involuntary hospital admissions, poorer psychosocial functioning, and a poorer course of illness Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, APA, 2000
  3. 3. When anosognosia: • The patient will not trust the doctor • No conventional psycho-education! • Go around (our medical) insight of sickness. • Connective Talking Technique.
  4. 4. Minister Luns and psychosis
  5. 5. ‘The Dutch are always right, but seldom relevant’.  (English Minister of Foreign affairs to our minister of Foreigns affairs. What is a psychosis?
  6. 6. A psychosis is: • A serious and long-lasting problem in interpretation (of non-verbal information). • A serious problem of perception/hallucination. • Some cognitive deficits. – Filter en flexibility – Face recognition – Tone recognition – Problems with abstractions • Apathy (negative symptoms).
  7. 7. A psychosis is: A disturbance in information processing.
  8. 8. In Gesprek met Psychose, 2012
  9. 9. We are a social species
  10. 10. The circle of destruction Psychosi s Isolation Loneliness Los of trust and self-efficacy Bad prognisis of outcome Social malfuctioning In Gesprek met Psychose, 2012
  11. 11. What is motivating?
  12. 12. Anosognosia: ‘No motivation without connection’ ‘No treatment without motivation’ Connection  Motivation  Treatment
  13. 13. The conversation
  14. 14. Reflective listening Start like a detective! In Gesprek met Psychose, 2012
  15. 15. The Brewery Center for Connection
  16. 16. View of the patient on psychosis? 'Not me bro!' Ok than….. I have problems with burn-out, hypersensitivity, social isolation, demotivation, study problems, concentration, too much weight, nothing to do, no hobbies, housing, partner-relations, relations with friends, etc…
  17. 17. So what will be our focus? Burn-out, hypersensitivity, social isolation, demotivation, study problems, concentration, too much weight, nothing to do, no hobbies, housing, partner-relations, relations with friends!!!!
  18. 18. What is de Brouwerij? A cooperation of 1.Excellent professionals 2.Clients (members) 3.Family members 4.Volunteers
  19. 19. Professionals do: • Assertive (seduce to) care • Connective Talking Therapy • Prepared for a longlasting relationship with the patient • Shared decision making • Make extensive use of the volunteers
  20. 20. Health
  21. 21. with..
  22. 22. by all members & almost 30 volunteers
  23. 23. …next to treatment by a team of highly skilled craftsmen….. Community mental health nurses, home care nurses, psychologists, social worker, legal expert, psychiatrists…
  24. 24. Wat doen de vrijwilligers? • Daily lunch • Twice a week diner • Yoga with Pim • Courses in communication styles • Holidays, going out • Guitarlesson with Dominik • Madstudies • Michaja, Sacha at the telephone • Running with Johanne • Fitness with Bert and Jules • Welcome by Frans en Ajay • Young Ones with Bert and Marije • Artclub with Riek • Improvisationtheater by Alessandra • Blogging with Evelyne • Aikido with Jan Nothing for nothing!
  25. 25. Continuity of care • Handling of crisis at home • Trans-mural treatment when hospitalized • partial recovery: no transferal but low maintenance membership at the Brewery by: – Peer to peer – Support by family and volunteers
  26. 26. Current care for psychosis
  27. 27. Nieuwe psychosezorg
  28. 28. Inloop Ambulante outreachende zorg Sociaal contact Scholing Sport Lunchgroep Muziekles Werk Mantelzorg ondersteuning Bibliotheek /kenniscentrum Dagbesteding Yoga Ei-complex Windroos Sens catering Loenatix Waterheuvel de Prael enz… Ypsilon Anoiksis Werkgevers via Ypsilon familienetwerk Werkgevers in de buurt Sportschool en zwembad in de buurt Vrijwilligers Vrijwilligers Vrijwilligers Vrijwilligers Vrijwilligers Vrijwilligers
  29. 29. And… • Advise by telephone until 10 PM • If necessary prolonged treatment in the weekend • Peer to peer (USA inspiration) and ‘union of members' • Family is very welcome • In future: – Collaboration with entrepreneurs in the neighborhood – Entrepreneurs in the building – Flexible workplaces for members in the Brewery
  30. 30. The Brouwerij Effect • Honos en Mansa scores • Client and familymember Evaluation iROC based questionnaire (measuring recovery)” • Days of hospilization (during MT and the years before MT) • Costs per day • Costs for society and client • DBC minutes (time spend with client) Quality of treatment Relevance to society Cohort N = 42: patiënts > 3 years in treatment at bij MT A.Galli, J.A.E. Tielens, J. van Os sept 2016
  31. 31. N = 42 >3 DBC years in treatment ( 2012 t/m 2015 ) 0 200 400 600 800 1000 1200 1400 1600 1800 Vóór MT TijdensMT Aantalopnamedagenover3jaar Gedwongen Vrijwillig * p = 0.053 Het Brouwerij Effect Resultaten opnames A.Galli, J.A.E. Tielens, J. van Os sept 2016
  32. 32. Het Brouwerij Effect Resultaten DBC minuten N = 42 0 1000 2000 3000 4000 5000 6000 7000 Jaar 1 Jaar 2 Jaar 3 gemiddeldeDBCminuten *** p < 0.001 A.Galli, J.A.E. Tielens, J. van Os sept 2016 N = 42 >3 DBC years in treatment ( 2012 t/m 2015 )
  33. 33. De Brouwerij Hoogte Kadijk 61hs 1018 BE Amsterdam Tel: 088 - 020 1350 Fax: 088 - 020 1351 molemanntielens.amsterdam@molemann.nl

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