EFPT Exchange: from Portugal to the Netherlands

EFPT Exchange Program is a short-term (2-6 weeks) observership for Psychiatry Trainees in Europe, established in 2011. It offers the opportunity to get acquainted with another mental health care system and different training programs, fostering international links among European trainees.

From 27th March to 7th April (2 weeks), I was placed in the Old Age Psychiatry Department of University Medical Center Groningen, under the supervision of Doctor W.H. van Zelst – Kwakkel and Doctor Aida Van de Poel – Mustafayeva.

Old Age Psychiatry is more than the simple application of general Psychiatry to the population aged over 65. It implies a mental shift, the need to follow a more sensitive and personalized medical practice, understanding the effect of coexistent physical illness with the normal ageing process. Considering the increasing life expectation of recent years, it is indeed a promising area for clinicians and researchers. Unfortunately, there is still lack of evidence for the treatment offered to older patients with mental disorders, and more basic and clinical research is needed.

During the period of internship, I had the opportunity to stay at the specialized ward, outpatient clinic and also to visit the liaison service. I mostly observed older patients with affective disorders (depression, anxiety and unexplained physical complaints), but also psychotic disorders. These mental disorders were very often comorbid with physical illnesses, including neurodegenerative disorders (such as Alzheimer’s disease) and other neurological disorders such as Parkinson’s and Huntington’s disorder. The Old Age Psychiatry Department promotes collaboration with internal medicine, geriatrics and neurology. I could also observe the main daily routines, attend multidisciplinary team meetings and participate in the clinical assessments of patients, where appropriated.

I also had the opportunity to attend the Electroconvulsive Therapy (ECT) Unit, under the supervision of Doctor Aida Van de Poel. ECT remains an important treatment for depressed geriatric patients with severe and/or treatment-resistant depression. In older patients, this medical procedure requires a careful assessment of potential benefits as well as potential risks (many of them related to anesthesia). I have also learned from conversations with Doctor Van Zelst, who is an expert in the field of psychoneurommunology and had developed several research projects about the post traumatic stress disorder in elderly patients.

This internship allowed me to have a general idea about Psychiatry Departments and health organization in Netherlands. Netherlands has an innovative mental health system and was one of the first countries to foster and promote old age psychiatry. The EU Commission Executive Agency for Health and Consumers (EAHC, 2011) has recently delivered a major report on the burden of mental disorders and inequalities in mental health in the Europe Union. Their report showed a lower prevalence of mental disorders in Netherlands (lifetime prevalence of 31.1%) than in Portugal (lifetime prevalence of 36.8%) and a smaller gender difference in terms of mental disorders in Netherlands when compared to Portugal. This difference could be perceived during my short internship period, and may have several causes, but is most likely to reflect complex socioeconomic and cultural factors.

This internship was also an opportunity to grow (not only professionally, but personally) to a much greater depth and expand my horizons by putting my psychiatric skills to work in this very different environment. Cultural variations do exist between Netherlands and Portugal – not to such a degree that we could properly appreciate culture-bound syndromes, for example, but it was possible to identify minor variations in how people communicate their symptoms and their distress.

As I had to rely many times on my nonverbal communications skills, I honestly think they improved during this internship. I have the general feeling I overcame linguistic and cultural challenges, learning not only knowledge, but experience. Even when we don’t share the same language with the patient, it is still possible to grasp a lot from him, as suffering and distress are often embodied in the appearance, posture, and affect.

Finally, I would like to mention Dr. Elena Melo and Dr. Michiel Over, who have helped me during the course of my internship.


Porto, 1st October 2017

Gustavo França, Medical Doctor, Psychiatry Trainee

Hospital de Magalhães Lemos, Porto, Portugal