Publications by authors named "Aartjan T F Beekman"

339 Publications

Insulin resistance as a marker for the immune-metabolic subtype of depression.

J Affect Disord 2021 Sep 1. Epub 2021 Sep 1.

Amsterdam UMC and GGZ inGeest, Dept. of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Postbus, 7075, 1007 MB, Amsterdam, the Netherlands.

Objective: Insulin resistance (IR), a marker of metabolic dysregulation and pro-inflammatory state, moderates the antidepressant treatment effect in patients with type 2 diabetes (T2D) and is therefore a potential marker for personalized treatment. Based on data from a light therapy trial (NTR4942), we aimed to evaluate whether 1) depression symptoms differ according to the level of IR, and 2) improvement of specific depression symptoms drive the positive effects of light therapy in those with higher IR.

Methods: This secondary analysis in 59 individuals with depression and T2D explored differences in depressive symptom profile (30-item Inventory of Depressive Symptomatology (IDS)) at baseline and in response to light therapy (versus placebo), between lower and higher IR individuals, using Likelihood Ratio tests and Linear-by-linear association. IR was measured using the gold standard, a hyperinsulinemic-euglycaemic clamp.

Results: At baseline, higher IR individuals reported more symptoms of irritability (p=0.024) anhedonia (no interest in people and activities: p=0.011; absence of pleasure and enjoyment: p=0.021), fatigue (fatigue: p=0.036; physical fatigue: p=0.035) and hypersomnia (p=0.029) relative to persons with lower IR, who reported more insomnia (nightly awakening: p=0.041; early morning awakening: p=0.012). Light therapy led to an improvement across IDS symptoms in higher IR individuals, while in lower IR individuals, light therapy improved early morning awakening (p=0.005) and interest in people and activities (p=0.015), but worsened mood (feeling sad: p=0.001; feeling irritable: p=0.002; interpersonal sensitivity: p=0.014).

Conclusions: Results add to the hypothesis of an immune-metabolic subtype of depression, and suggest that IR might be a promising focus for precision medicine.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jad.2021.08.151DOI Listing
September 2021

Evaluating feasibility and satisfaction of a group intervention for mild cognitive impairment in older age bipolar disorder: "Brain train".

Bipolar Disord 2021 Sep 17. Epub 2021 Sep 17.

GGZ inGeest, Amsterdam, the Netherlands.

To date, no remediation treatment is available aimed at improving cognitive functioning in patients with older age bipolar disorder (OABD). Our pilot intervention (Brain train) included cognitive training, physical exercise, and social encounter with peers for OABD and was positively evaluated by the participants. However, its feasibility was limited as few patients fulfilled the inclusion criteria of cognitive and social impairment and retaining the physical ability to walk for a minimum of 30 min. OABD patients with cognitive impairment are a vulnerable group for which it is most challenging to design interventions aimed at improving daily functioning.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/bdi.13126DOI Listing
September 2021

Psychosocial factors and cancer incidence (PSY-CA): Protocol for individual participant data meta-analyses.

Brain Behav 2021 Sep 2:e2340. Epub 2021 Sep 2.

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.

Objectives: Psychosocial factors have been hypothesized to increase the risk of cancer. This study aims (1) to test whether psychosocial factors (depression, anxiety, recent loss events, subjective social support, relationship status, general distress, and neuroticism) are associated with the incidence of any cancer (any, breast, lung, prostate, colorectal, smoking-related, and alcohol-related); (2) to test the interaction between psychosocial factors and factors related to cancer risk (smoking, alcohol use, weight, physical activity, sedentary behavior, sleep, age, sex, education, hormone replacement therapy, and menopausal status) with regard to the incidence of cancer; and (3) to test the mediating role of health behaviors (smoking, alcohol use, weight, physical activity, sedentary behavior, and sleep) in the relationship between psychosocial factors and the incidence of cancer.

Methods: The psychosocial factors and cancer incidence (PSY-CA) consortium was established involving experts in the field of (psycho-)oncology, methodology, and epidemiology. Using data collected in 18 cohorts (N = 617,355), a preplanned two-stage individual participant data (IPD) meta-analysis is proposed. Standardized analyses will be conducted on harmonized datasets for each cohort (stage 1), and meta-analyses will be performed on the risk estimates (stage 2).

Conclusion: PSY-CA aims to elucidate the relationship between psychosocial factors and cancer risk by addressing several shortcomings of prior meta-analyses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/brb3.2340DOI Listing
September 2021

The Montreal Cognitive Assessment (MoCA) with a double threshold: improving the MoCA for triaging patients in need of a neuropsychological assessment.

Int Psychogeriatr 2021 Aug 31:1-13. Epub 2021 Aug 31.

Department of Psychiatry, Amsterdam UMC, location VUmc and GGZ inGeest, Oldenaller 1, 1081 HJ, Amsterdam, The Netherlands.

Objectives: Diagnosis of patients suspected of mild dementia (MD) is a challenge and patient numbers continue to rise. A short test triaging patients in need of a neuropsychological assessment (NPA) is welcome. The Montreal cognitive assessment (MoCA) has high sensitivity at the original cutoff <26 for MD, but results in too many false-positive (FP) referrals in clinical practice (low specificity). A cutoff that finds all patients at high risk of MD without referring to many patients not (yet) in need of an NPA is needed. A difficulty is who is to be considered at risk, as definitions for disease (e.g. MD) do not always define health at the same time and thereby create subthreshold disorders.

Design: In this study, we compared different selection strategies to efficiently identify patients in need of an NPA. Using the MoCA with a double threshold tackles the dilemma of increasing the specificity without decreasing the sensitivity and creates the opportunity to distinguish the clinical (MD) and subclinical (MCI) state and hence to get their appropriate policy.

Setting/participants: Patients referred to old-age psychiatry suspected of cognitive impairment that could benefit from an NPA (n = 693).

Results: The optimal strategy was a two-stage selection process using the MoCA with a double threshold as an add-on after initial assessment. By selecting who is likely to have dementia and should be assessed further (MoCA<21), who should be discharged (≥26), and who's course should be monitored actively as they are at increased risk (21<26).

Conclusion: By using two cutoffs, the clinical value of the MoCA improved for triaging. A double-threshold MoCA not only gave the best results; accuracy, PPV, NPV, and reducing FP referrals by 65%, still correctly triaging most MD patients. It also identified most MCIs whose intermediate state justifies active monitoring.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1041610221000612DOI Listing
August 2021

Characteristics and Predictors of Educational and Occupational Disengagement Among Outpatient Youth With Borderline Personality Disorder.

J Pers Disord 2021 Aug 24:1-13. Epub 2021 Aug 24.

Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia.

This study aimed to investigate predictors of vocational disengagement (referred to as Not in Employment, Education, or Training [NEET]) in young people with borderline personality disorder (BPD). The sample comprised 112 outpatients with a BPD diagnosis, aged 15-25 years, who participated in a randomized controlled trial (ANZCTR12610000100099). The proportion of participants who were NEET (39.3%) at study entry did not improve after 18 months and NEET status frequently changed. Therefore, multinomial regression analyses were used to study three groups: Non-NEET, NEET, and Unstable NEET status. NEET status was predicted by not achieving expected age-appropriate educational milestones, greater instability in identity, and emptiness. Greater instability in interpersonal relationships and identity predicted Unstable NEET status. The findings suggest that specific vocational interventions, that also incorporate a focus on interpersonal functioning, emptiness, and identity disturbance, are needed to improve functioning in youth with BPD, especially when educational milestones are not achieved.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1521/pedi_2021_35_534DOI Listing
August 2021

Characteristics and Predictors of Educational and Occupational Disengagement Among Outpatient Youth With Borderline Personality Disorder.

J Pers Disord 2021 Aug 24:1-13. Epub 2021 Aug 24.

Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia.

This study aimed to investigate predictors of vocational disengagement (referred to as Not in Employment, Education, or Training [NEET]) in young people with borderline personality disorder (BPD). The sample comprised 112 outpatients with a BPD diagnosis, aged 15-25 years, who participated in a randomized controlled trial (ANZCTR12610000100099). The proportion of participants who were NEET (39.3%) at study entry did not improve after 18 months and NEET status frequently changed. Therefore, multinomial regression analyses were used to study three groups: Non-NEET, NEET, and Unstable NEET status. NEET status was predicted by not achieving expected age-appropriate educational milestones, greater instability in identity, and emptiness. Greater instability in interpersonal relationships and identity predicted Unstable NEET status. The findings suggest that specific vocational interventions, that also incorporate a focus on interpersonal functioning, emptiness, and identity disturbance, are needed to improve functioning in youth with BPD, especially when educational milestones are not achieved.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1521/pedi_2021_35_534DOI Listing
August 2021

Exploratory Factor Analysis of Unusual Sexual Interests.

J Sex Med 2021 09 14;18(9):1615-1631. Epub 2021 Aug 14.

Department of Psychiatry, and GGZ inGeest, Amsterdam University Medical Centers, Free University Amsterdam, Amsterdam, the Netherlands.

Background: Unusual sexual interests are largely intercorrelated, yet not much is known about underlying patterns of clusters between various sexual interests.

Aim: To identify underlying clusters of unusual sexual interests using exploratory factor analysis.

Methods: We conducted exploratory factor analysis with self-reported interest in a wide variety of unusual sexual acts for an online, international sample (N = 669; 61% female), and for women and men separately. Factor regression weights were correlated to self-reported sex life satisfaction, sexual outlet, and psychiatric symptoms.

Outcomes: Participants rated the attractiveness of 50 unusual sexual activities, and reported on their sex life satisfaction (Arizona Sexual Experiences Scale), sexual outlet, and symptoms regarding ADHD (Adult ADHD Self-Report Screening Scale for DSM-5), depression, anxiety, and stress (Depression, Anxiety, and Stress Scale).

Results: We identified 5 factors of unusual sexual interests that were largely comparable for women and men: submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia (attraction to dirtiness or soiled things), and fetishism. For women, unusual sexual interests related to more psychiatric symptoms and higher sexual outlet, whereas this relation was less explicit for men.

Clinical Implications: Different factors of unusual sexual interests may serve different underlying functions or motivations, for instance related to sexual, and emotional regulation. A better understanding of the nature of unusual sexual interests is important to be able to influence sexual interests that are unwanted or cause damage to others.

Strengths & Limitations: Strength of this study include its anonymity, the avoidance of sexual orientation effects, and the possibility to indicate only a slight endorsement toward sexual items. Limitations include the sample's generalizability and the truthfulness of online responding.

Conclusion: Unusual sexual interests could be clustered into 5 factors that were largely comparable for women and men: submission/masochism, forbidden sexual activities, dominance/sadism, mysophilia, and fetishism. Schippers EE, Smid WJ, Huckelba AL, et al. Exploratory Factor Analysis of Unusual Sexual Interests. J Sex Med 2021;18:1615-1631.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsxm.2021.07.002DOI Listing
September 2021

The joint effects of clinically relevant depressive symptoms and cardiovascular risk factors on incident cardiovascular disease among older adults in the community.

J Psychosom Res 2021 Oct 16;149:110572. Epub 2021 Jul 16.

Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands. Electronic address:

Objective: To determine if there is a synergistic effect between clinically relevant depressive symptoms and cardiovascular risk factors that disproportionately increases the risk of cardiovascular disease (CVD) among older adults with depressive symptoms.

Methods: Data were obtained from the Longitudinal Aging Study Amsterdam, a longitudinal cohort study. N = 3091 respondents with up to seven years of follow-up were included. Incident CVD was based on self-report, medication use, general practitioners' diagnoses and causes of death. A score of ≥16 points on the Center for Epidemiological Studies Depression Scale indicated clinically relevant depressive symptoms. Risk factors included were sex, education, obesity, smoking, alcohol use, physical inactivity and diabetes mellitus. Data were analysed with Cox regression models. Measures of multiplicative and additive interaction were calculated to determine if the presence of both depressive symptoms and a risk factor amplified the risk of CVD.

Results: Of all participants, 12.6% had clinically relevant depressive symptoms and, after a median follow-up of six years, 15.7% developed CVD. Only the additive interaction between physical inactivity and depressive symptoms was statistically significant and explained 40.6% of the CVD risk among inactive persons with depressive symptoms.

Conclusion: In the general population, we did not detect synergistic effects for most risk factors. However, older adults with clinically relevant depressive symptoms and a physically inactive lifestyle appeared to be at a particularly high risk to develop CVD and may represent an important target for cardiovascular prevention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpsychores.2021.110572DOI Listing
October 2021

The association between plasma tryptophan catabolites and depression: The role of symptom profiles and inflammation.

Brain Behav Immun 2021 10 9;97:167-175. Epub 2021 Jul 9.

Department of Psychiatry, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam UMC/Vrije Universiteit, Amsterdam, The Netherlands.

Background: Tryptophan catabolites ("TRYCATs") produced by the kynurenine pathway (KP) may play a role in depression pathophysiology. Studies comparing TRYCATs levels in depressed subjects and controls provided mixed findings. We examined the association of TRYCATs levels with 1) the presence of Major Depressive Disorder (MDD), 2) depressive symptom profiles and 3) inflammatory markers.

Methods: The sample from the Netherlands Study of Depression and Anxiety included participants with current (n = 1100) or remitted (n = 753) MDD DSM-IV diagnosis and healthy controls (n = 642). Plasma levels of tryptophan (TRP), kynurenine (KYN), kynurenic acid (KynA), quinolinic acid (QA), C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor (TNF) were measured. Atypical/energy-related symptom (AES), melancholic symptom (MS) and anxious-distress symptom (ADS) profiles were derived from questionnaires.

Results: After adjustment for age, sex, education, smoking status, alcohol consumption and chronic diseases, no significant differences in TRYCATs were found comparing MDD cases versus controls. The MS profile was associated (q < 0.05) with lower KynA (β = -0.05), while AES was associated with higher KYN (β = 0.05), QA (β = 0.06) and TRP (β = 0.06). Inflammatory markers were associated with higher KYN (CRP β = 0.12, IL-6 β = 0.08, TNF β = 0.10) and QA (CRP β = 0.21, IL-6 β = 0.12, TNF β = 0.18). Significant differences against controls emerged after selecting MDD cases with high (top 30%) CRP (KYN d = 0.20, QA d = 0.33) and high TNF (KYN d = 0.24; QA d = 0.39).

Conclusions: TRYCATs levels were related to specific clinical and biological features, such as atypical symptoms or a proinflammatory status. Modulation of KP may potentially benefit a specific subset of depressed patients. Clinical studies should focus on patients with clear evidence of KP dysregulations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bbi.2021.07.007DOI Listing
October 2021

Discontinuity of psychiatric care for patients with schizophrenia, relation to previous psychiatric care and practice variation between providers: a retrospective longitudinal cohort study.

BMC Psychiatry 2021 06 29;21(1):319. Epub 2021 Jun 29.

Department Psychiatry Amsterdam University Medical Centre - location VUmc, Oldenaller 1, 1081 HJ, Amsterdam, The Netherlands.

Background: Patients with schizophrenia need continuous integrated healthcare, but many discontinue their treatment, often experiencing adverse outcomes. The first objective of this study is to assess whether patient characteristics or treatment history are associated with discontinuity of psychiatric elective care. The second objective is to assess whether practice variation between providers of psychiatric care contributes to discontinuity of elective care.

Methods: A large registry-based retrospective cohort of 9194 schizophrenia patients, who were included if they received elective psychiatric care in December 2014-January 2015. Logistic regression models were used to identify predictive factors of discontinuity of care. The dependent variable was the binary variable discontinuity of care in 2016. Potential independent predictive variables were: age, sex, urbanization, and treatment history in 2013-2014. Practice variation between providers was assessed, adjusting for the case mix of patients regarding their demographic and care utilization characteristics.

Results: 12.9% of the patients showed discontinuity of elective psychiatric care in the follow-up year 2016. The risk of discontinuity of care in 2016 was higher in younger patients (between age 18 and 26), patients with a history of receiving less elective psychiatric care, more acute psychiatric care, more quarters with elective psychiatric care without antipsychotic medication, or receiving no elective treatment at all. No evidence for practice variation between providers was found.

Conclusions: Our findings show that the pattern of previous care consumption is an important prognostic factor of future discontinuity of elective care. We propose that previous care consumption can be used to design strategies to improve treatment retention and focus resources on those most at risk of dropping out.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12888-021-03319-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244203PMC
June 2021

Steeling or sensitizing? A longitudinal examination of how ongoing accumulation of negative life events affects depressive symptoms in older adults.

J Gerontol B Psychol Sci Soc Sci 2021 Jun 25. Epub 2021 Jun 25.

Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands.

Objectives: To examine whether: 1) as people age, accumulation of negative events increases ('sensitizing') or decreases ('steeling') the detrimental effects of subsequent events on depressive symptoms, and 2) how particular psychosocial factors are associated with the strength of these steeling or sensitizing effects.

Method: We used data from six measurement waves from 2,069 adults aged 55-84 (M=68.0) at baseline in the Longitudinal Aging Study Amsterdam, the Netherlands. We included 18 different life events across the life course. Using hybrid multilevel models, we tested whether the effects of proximate life events (<3 years) on depressive symptoms (measured by the CES-D) were moderated by previous cumulative events (childhood until previous measurement wave). Additionally, we tested whether education, mastery, emotional support, neuroticism, having strong faith, and loneliness were associated with the strength of steeling/sensitizing effects.

Results: Cumulative and proximate life events were independently associated with more depressive symptoms. Interaction effects indicated that the more cumulative life events, the weaker the effects of recent life events, suggesting a 'steeling' effect. Unexpectedly, three-way interaction effects showed that higher mastery and lower neuroticism were associated with weaker steeling effects. These effects were predominantly attributable to within-person changes rather than to fixed between-person differences. Results from analyses with event severity scores were similar.

Conclusions: As a population, older adults appear to become more resilient against new stressors as they accumulate experience in dealing with negative life events. Findings on mastery tentatively suggest that accepting limits to one's own control over life circumstances may foster a steeling effect.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/geronb/gbab114DOI Listing
June 2021

Cognitive performance in older-age bipolar disorder: Investigating psychiatric characteristics, cardiovascular burden and psychotropic medication.

Acta Psychiatr Scand 2021 10 21;144(4):392-406. Epub 2021 Jul 21.

Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.

Objective: This study aimed to explore a large range of candidate determinants of cognitive performance in older-age bipolar disorder (OABD).

Methods: A cross-sectional study was performed in 172 BD patients aged ≥50 years. Demographics, psychiatric characteristics and psychotropic medication use were collected using self-report questionnaires and structured interviews. The presence of cardiovascular risk factors was determined by combining information from structured interviews, physical examination and laboratory assessments. Cognitive performance was investigated by an extensive neuropsychological assessment of 13 tests, covering the domains of attention, learning/ memory, verbal fluency and executive functioning. The average of 13 neuropsychological test Z-scores resulted in a composite cognitive score. A linear multiple regression model was created using forward selection with the composite cognitive score as outcome variable. Domain cognitive scores were used as secondary outcome variables.

Results: The final multivariable model (N = 125), which controlled for age and education level, included number of depressive episodes, number of (hypo)manic episodes, late onset, five or more psychiatric admissions, lifetime smoking, metabolic syndrome and current use of benzodiazepines. Together, these determinants explained 43.0% of the variance in composite cognitive score. Late onset and number of depressive episodes were significantly related to better cognitive performance whereas five or more psychiatric admissions and benzodiazepine use were significantly related to worse cognitive performance.

Conclusion: Psychiatric characteristics, cardiovascular risk and benzodiazepine use are related to cognitive performance in OABD. Cognitive variability in OABD thus seems multifactorial. Strategies aimed at improving cognition in BD should include cardiovascular risk management and minimizing benzodiazepine use.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/acps.13342DOI Listing
October 2021

Neural correlates of treatment effect and prediction of treatment outcome in patients with PTSD and comorbid personality disorder: study design.

Borderline Personal Disord Emot Dysregul 2021 May 5;8(1):13. Epub 2021 May 5.

Sinai Centrum, Amstelveen, The Netherlands.

Background: Neural alterations related to treatment outcome in patients with both post-traumatic stress disorder (PTSD) and comorbid personality disorder are unknown. Here we describe the protocol for a neuroimaging study of treatment of patients with PTSD and comorbid borderline (BPD) or cluster C (CPD) personality disorder traits. Our specific aims are to 1) investigate treatment-induced neural alterations, 2) predict treatment outcome using structural and functional magnetic resonance imaging (MRI) and 3) study neural alterations associated with BPD and CPD in PTSD patients. We hypothesize that 1) all treatment conditions are associated with normalization of limbic and prefrontal brain activity and hyperconnectivity in resting-state brain networks, with additional normalization of task-related activation in emotion regulation brain areas in the patients who receive trauma-focused therapy and personality disorder treatment; 2) Baseline task-related activation, together with structural brain measures and clinical variables predict treatment outcome; 3) dysfunction in task-related activation and resting-state connectivity of emotion regulation areas is comparable in PTSD patients with BPD or CPD, with a hypoconnected central executive network in patients with PTSD+BPD.

Methods: We aim to include pre- and post-treatment 3 T-MRI scans in 40 patients with PTSD and (sub) clinical comorbid BPD or CPD. With an expected attrition rate of 50%, at least 80 patients will be scanned before treatment. MRI scans for 30 matched healthy controls will additionally be acquired. Patients with PTSD and BPD were randomized to either EMDR-only or EMDR combined with Dialectical Behaviour Therapy. Patients with PTSD and CPD were randomized to Imaginary Rescripting (ImRs) or to ImRs combined with Schema Focused Therapy. The scan protocol consists of a T1-weighted structural scan, resting state fMRI, task-based fMRI during an emotional face task and multi-shell diffusion weighted images. For data analysis, multivariate mixed-models, regression analyses and machine learning models will be used.

Discussion: This study is one of the first to use neuroimaging measures to predict and better understand treatment response in patients with PTSD and comorbid personality disorders. A heterogeneous, naturalistic sample will be included, ensuring generalizability to a broad group of treatment seeking PTSD patients.

Trial Registration: Clinical Trials, NCT03833453 & NCT03833531 . Retrospectively registered, February 2019.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40479-021-00156-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097786PMC
May 2021

Neural correlates of treatment effect and prediction of treatment outcome in patients with PTSD and comorbid personality disorder: study design.

Borderline Personal Disord Emot Dysregul 2021 May 5;8(1):13. Epub 2021 May 5.

Sinai Centrum, Amstelveen, The Netherlands.

Background: Neural alterations related to treatment outcome in patients with both post-traumatic stress disorder (PTSD) and comorbid personality disorder are unknown. Here we describe the protocol for a neuroimaging study of treatment of patients with PTSD and comorbid borderline (BPD) or cluster C (CPD) personality disorder traits. Our specific aims are to 1) investigate treatment-induced neural alterations, 2) predict treatment outcome using structural and functional magnetic resonance imaging (MRI) and 3) study neural alterations associated with BPD and CPD in PTSD patients. We hypothesize that 1) all treatment conditions are associated with normalization of limbic and prefrontal brain activity and hyperconnectivity in resting-state brain networks, with additional normalization of task-related activation in emotion regulation brain areas in the patients who receive trauma-focused therapy and personality disorder treatment; 2) Baseline task-related activation, together with structural brain measures and clinical variables predict treatment outcome; 3) dysfunction in task-related activation and resting-state connectivity of emotion regulation areas is comparable in PTSD patients with BPD or CPD, with a hypoconnected central executive network in patients with PTSD+BPD.

Methods: We aim to include pre- and post-treatment 3 T-MRI scans in 40 patients with PTSD and (sub) clinical comorbid BPD or CPD. With an expected attrition rate of 50%, at least 80 patients will be scanned before treatment. MRI scans for 30 matched healthy controls will additionally be acquired. Patients with PTSD and BPD were randomized to either EMDR-only or EMDR combined with Dialectical Behaviour Therapy. Patients with PTSD and CPD were randomized to Imaginary Rescripting (ImRs) or to ImRs combined with Schema Focused Therapy. The scan protocol consists of a T1-weighted structural scan, resting state fMRI, task-based fMRI during an emotional face task and multi-shell diffusion weighted images. For data analysis, multivariate mixed-models, regression analyses and machine learning models will be used.

Discussion: This study is one of the first to use neuroimaging measures to predict and better understand treatment response in patients with PTSD and comorbid personality disorders. A heterogeneous, naturalistic sample will be included, ensuring generalizability to a broad group of treatment seeking PTSD patients.

Trial Registration: Clinical Trials, NCT03833453 & NCT03833531 . Retrospectively registered, February 2019.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40479-021-00156-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097786PMC
May 2021

Clinical Efficacy and Cost-Effectiveness of Imagery Rescripting Only Compared to Imagery Rescripting and Schema Therapy in Adult Patients With PTSD and Comorbid Cluster C Personality Disorder: Study Design of a Randomized Controlled Trial.

Front Psychiatry 2021 19;12:633614. Epub 2021 Mar 19.

Sinai Centrum, Amstelveen, Netherlands.

Posttraumatic stress disorder (PTSD) is a serious and relatively common mental disorder causing a high burden of suffering. Whereas evidence-based treatments are available, dropout and non-response rates remain high. PTSD and Cluster C personality disorders (avoidant, dependent or obsessive-compulsive personality disorder; CPD) are highly comorbid and there is evidence for suboptimal treatment effects in this subgroup of patients. An integrated PTSD and CPD treatment may be needed to increase treatment efficacy. However, no studies directly comparing the efficacy of regular PTSD treatment and treatment tailored to PTSD and comorbid CPD are available. Whether integrated treatment is more effective than treatment focused on PTSD alone is important, since (1) no evidence-based guideline for PTSD and comorbid CPD treatment exists, and (2) treatment approaches to CPD are costly and time consuming. Present study design describes a randomized controlled trial (RCT) directly comparing trauma focused treatment with integrated trauma focused and personality focused treatment. An RCT with two parallel groups design will be used to compare the clinical efficacy and cost-effectiveness of "standalone" imagery rescripting ( = 63) with integrated imagery rescripting and schema therapy ( = 63). This trial is part of a larger research project on PTSD and personality disorders. Predictors, mediators and outcome variables are measured at regular intervals over the course of 18 months. The main outcome is PTSD severity at 12 months. Additionally, machine-learning techniques will be used to predict treatment outcome using biopsychosocial variables. This study protocol outlines the first RCT aimed at directly comparing the clinical efficacy and cost-effectiveness of imagery rescripting and integrated imagery rescripting and schema therapy for treatment seeking adult patients with PTSD and comorbid cluster C personality pathology. Additionally, biopsychosocial variables will be used to predict treatment outcome. As such, the trial adds to the development of an empirically informed and individualized treatment indication process. ClinicalTrials.gov, NCT03833531.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpsyt.2021.633614DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044980PMC
March 2021

An examination of reciprocal effects between cardiovascular morbidity, depressive symptoms and loneliness over time in a longitudinal cohort of Dutch older adults.

J Affect Disord 2021 06 31;288:122-128. Epub 2021 Mar 31.

Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.

Background: Unidirectional studies suggest that the effects between cardiovascular disease, depressive symptoms and loneliness are reciprocal, but this has not been tested empirically. The aim was to study how cardiovascular morbidity, depressive symptoms and loneliness influence each other longitudinally.

Methods: Data from 2979 older adults from the Longitudinal Aging Study Amsterdam were analysed. Depressive symptoms (≥16 points on the Center for Epidemiologic Studies Depression Scale), loneliness (≥3 points on the De Jong Gierveld Loneliness Scale) and cardiovascular morbidity were measured five times during 13-year follow-up. With structural equation modelling, a full cross-lagged panel model was compared to nine nested models reflecting different sets of temporal effects.

Results: The best-fitting cross-lagged panel model showed reciprocal risk increasing effects between depressive symptoms and loneliness and a risk increasing effect of cardiovascular morbidity on depressive symptoms.

Limitations: A cross-lagged panel model has technical limitations, such as that the chosen time lag may not be appropriate for each effect. In addition, differential loss to follow-up and collider bias may have led to an underestimation of the effects.

Conclusions: Reciprocal effects tend to occur only between depressive symptoms and loneliness. Their interplay with cardiovascular morbidity seems more complex and mostly indirect, highlighting the potential of interventions to reduce depressive symptoms, loneliness and cardiovascular morbidity in concert to improve health at old age.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jad.2021.03.081DOI Listing
June 2021

Physical comorbidity in Older-Age Bipolar Disorder (OABD) compared to the general population - a 3-year longitudinal prospective cohort study.

J Affect Disord 2021 06 26;288:83-91. Epub 2021 Mar 26.

Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.

Background: The aim of this study was to examine the accumulation of chronic physical diseases in Older-Age Bipolar Disorder (OABD) as well as in individuals from the general aging population over a 3-year period.

Methods: This prospective longitudinal study compared 101 patients with OABD receiving outpatient care (DOBi cohort) with 2545 individuals from the general aging population (LASA cohort). The presence of eight major chronic diseases was asked at baseline and 3-year follow-up. Total number of diseases was the main outcome measure. Self-rated health (SRH, scale 1-5) was examined as a secondary outcome. Multilevel linear modelling of change was performed to estimate and test the observed change in both samples.

Results: At baseline, the number of chronic diseases was lower (b= -0.47, p<0.01) and self-rated health comparable (b=0.27, p=0.13) in DOBi than in LASA. Over 3 years the number of chronic diseases increased faster in DOBi than in LASA (b=0.51 versus b=0.35, p(interaction)=0.03). When corrected for employment, depressive symptoms, waist circumference, smoking, and alcohol use, this difference was no longer significant. SRH decreased faster in DOBi than in LASA (b=-0.24 versus b=-0.02, p(interaction)=0.04).

Limitations: Information on chronic diseases was collected using self-report.

Conclusions: A faster accumulation of chronic physical diseases and a faster decline in health perception was observed in OABD than in participants from the general population. The observed differences could partly be attributed to baseline differences in psychosocial, lifestyle, and health behaviour factors. Our findings urgently call for the use of integrated care in BD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jad.2021.03.057DOI Listing
June 2021

The Impact of Antipsychotic Formulations on Time to Medication Discontinuation in Patients with Schizophrenia: A Dutch Registry-Based Retrospective Cohort Study.

CNS Drugs 2021 04 10;35(4):451-460. Epub 2021 Apr 10.

Department of Psychiatry, Erasmus Medical Centre, Epidemiological and Social Psychiatric Research Institute, Rotterdam, the Netherlands.

Background: Many patients with schizophrenia discontinue antipsychotic medication, frequently with adverse outcomes. Although different antipsychotic formulations are associated with different times to discontinuation, not much is known about discontinuation rates with oral-weekly formulations. Such a formulation of penfluridol is available in both the Netherlands and several other countries.

Objectives: We aimed to investigate the impact of antipsychotic formulations on time to discontinuation, especially the oral-weekly formulation.

Methods: In a large, registry-based, retrospective cohort study from 1 January 2013 to 31 December 2016, we determined the time to medication discontinuation during the follow-up period with antipsychotic formulations, including oral-daily, oral-weekly, depot, or a combination of these. Patients with schizophrenia aged between 18 and 69 years were included and stratified according to the duration of recent antipsychotic use (taking the same formulation for ≤ 60 days or > 60 days before follow-up: short-term or long-term recent antipsychotic use). Medication discontinuation was defined as discontinuation of current antipsychotic formulation.

Results: Overall, 8257 patients were included for analyses, with 80% of patients discontinuing antipsychotic medication. Time to discontinuation was longer in those with long-term recent antipsychotic use before the follow-up period and longest for oral-daily formulations. Patterns for discontinuation of oral-weekly and depot formulations were similar, regardless of the duration of recent antipsychotic use before follow-up. More prior discontinuations were associated with shorter time to discontinuation.

Conclusions: Time to discontinuation differed considerably between formulations. The duration of recent antipsychotic use was a strong predictor of time to discontinuation. While oral-daily formulations had the longest time to discontinuation in the long-term recent antipsychotic use group, discontinuation trends were similar for oral-weekly and depot formulations. An oral-weekly formulation, whose administration route is noninvasive, might therefore be considered an alternative to depot formulations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40263-021-00802-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068711PMC
April 2021

Effects of dietary interventions on depressive symptom profiles: results from the MooDFOOD depression prevention study.

Psychol Med 2021 Apr 7:1-10. Epub 2021 Apr 7.

Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health Research Institute and Amsterdam Neuroscience, Amsterdam, The Netherlands.

Background: Dietary interventions did not prevent depression onset nor reduced depressive symptoms in a large multi-center randomized controlled depression prevention study (MooDFOOD) involving overweight adults with subsyndromal depressive symptoms. We conducted follow-up analyses to investigate whether dietary interventions differ in their effects on depressive symptom profiles (mood/cognition; somatic; atypical, energy-related).

Methods: Baseline, 3-, 6-, and 12-month follow-up data from MooDFOOD were used (n = 933). Participants received (1) placebo supplements, (2) food-related behavioral activation (F-BA) therapy with placebo supplements, (3) multi-nutrient supplements (omega-3 fatty acids and a multi-vitamin), or (4) F-BA therapy with multi-nutrient supplements. Depressive symptom profiles were based on the Inventory of Depressive Symptomatology.

Results: F-BA therapy was significantly associated with decreased severity of the somatic (B = -0.03, p = 0.014, d = -0.10) and energy-related (B = -0.08, p = 0.001, d = -0.13), but not with the mood/cognition symptom profile, whereas multi-nutrient supplementation was significantly associated with increased severity of the mood/cognition (B = 0.05, p = 0.022, d = 0.09) and the energy-related (B = 0.07, p = 0.002, d = 0.12) but not with the somatic symptom profile.

Conclusions: Differentiating depressive symptom profiles indicated that food-related behavioral interventions are most beneficial to alleviate somatic symptoms and symptoms of the atypical, energy-related profile linked to an immuno-metabolic form of depression, although effect sizes were small. Multi-nutrient supplements are not indicated to reduce depressive symptom profiles. These findings show that attention to clinical heterogeneity in depression is of importance when studying dietary interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S0033291721000337DOI Listing
April 2021

Cohort profile of the longitudinal Netherlands Study of Depression and Anxiety (NESDA) on etiology, course and consequences of depressive and anxiety disorders.

J Affect Disord 2021 05 17;287:69-77. Epub 2021 Mar 17.

Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit, and GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands (Oldenaller 1, 1081 HJ Amsterdam, The Netherlands).

Introduction: The Netherlands Study of Depression and Anxiety (NESDA, www.nesda.nl) is a longitudinal, multi-site, naturalistic, case-control cohort study set up to examine the etiology, course and consequences of depressive and anxiety disorders. This paper presents a cohort profile of NESDA.

Methods And Results: The NESDA sample recruited initially 2329 persons with a remitted or current DSM-IV based depressive (major depressive disorder, dysthymia) and/or anxiety disorder (panic disorder, social phobia, agoraphobia, generalized anxiety disorder), 367 of their siblings and 652 healthy controls, yielding a total of 3348 participants. Half-day face-to-face assessments of participants started in 2004 and since then have been repeated six times over a period of 9 years. A 13-year follow-up assessment is ongoing, at what time we also recruit offspring of participants. Retention rates are generally high, ranging from 87.1% (after 2 years) to 69.4% (after 9 years). Psychiatric diagnostic interviews have been administered at all face-to-face assessments, as was monitoring of clinical characteristics, psychosocial functioning and somatic health. Assessed etiological factors include e.g. early and current environmental risk factors, psychological vulnerability and resilience factors as well as (neuro)biology through hypothesis-driven biomarker assessments, genome-wide and large-scale '-omics' assessments, and neuroimaging assessments.

Limitations: The naturalistic design allows research into course and consequences of affective disorders but is limited in treatment response interpretation.

Conclusions: NESDA provides a strong research infrastructure for research into depressive and/or anxiety disorders. Its data have been used for many scientific papers describing either NESDA-based analyses or joint collaborative consortia-projects, and are in principle available to researchers outside the NESDA consortium.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jad.2021.03.026DOI Listing
May 2021

Posttraumatic stress disorder and loneliness are associated over time: A longitudinal study on PTSD symptoms and loneliness, among older adults.

Psychiatry Res 2021 05 2;299:113846. Epub 2021 Mar 2.

Department of Psychology, Maynooth University, Kildare, Ireland.

Loneliness has a pernicious effect on mental health in later life and is likely to have a bidirectional relationship with psychopathology. However, longitudinal research examining loneliness and posttraumatic stress symptoms among older adults is scarce. This study aimed to examine the longitudinal relationship between different types of loneliness (social and emotional) and posttraumatic stress symptoms. Using two waves of an older adult sample (n = 1,276) from the Longitudinal Aging Study Amsterdam (LASA), this longitudinal relationship was examined using a multivariate two wave-latent change score (2W-LCS) model. There were significant, however, very small increases in both posttraumatic stress symptoms and emotional loneliness over time, whereas, average social loneliness scores did not significantly increase/decrease over time. Changes in both social (β = .16) and emotional loneliness (β = .15) were associated with small changes in posttraumatic stress symptoms, consistent with the existence of a longitudinal association between the constructs, net of covariate effects. Results provide evidence of the existence of a longitudinal association between subtypes of loneliness and posttraumatic stress symptoms, among older adults. Results have implications for clinicians who should identify individuals at risk of developing posttraumatic stress symptoms, and for the theory of both posttraumatic stress disorder and loneliness.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.psychres.2021.113846DOI Listing
May 2021

Police Encounters, Agitation, Diagnosis, and Employment Predict Psychiatric Hospitalisation of Intensive Home Treatment Patients During a Psychiatric Crisis.

Front Psychiatry 2021 5;12:602912. Epub 2021 Feb 5.

Department of Research, Arkin Institute for Mental Health Care, Amsterdam, Netherlands.

This study aims to determine factors associated with psychiatric hospitalisation of patients treated for an acute psychiatric crisis who had access to intensive home treatment (IHT). This study was performed using data from a randomised controlled trial. Interviews, digital health records and eight internationally validated questionnaires were used to collect data from patients on the verge of an acute psychiatric crisis enrolled from two mental health organisations. Thirty-eight factors were assigned to seven risk domains. The seven domains are "sociodemographic", "social engagement", "diagnosis and psychopathology", "aggression", "substance use", "mental health services" and "quality of life". Multiple logistic regression analysis (MLRA) was conducted to assess how much pseudo variance in hospitalisation these seven domains explained. Forward MLRA was used to identify individual risk factors associated with hospitalisation. Risks were expressed in terms of relative risk (RR) and absolute risk difference (ARD). Data from 183 participants were used. The mean age of the participants was 40.03 (SD 12.71), 57.4% was female, 78.9% was born in the Netherlands and 51.4% was employed. The range of explained variance for the domains related to "psychopathology and care" was between 0.34 and 0.08. The "aggression" domain explained the highest proportion ( = 0.34) of the variance in hospitalisation. "Quality of life" had the lowest explained proportion of variance ( = 0.05). The forward MLRA identified four predictive factors for hospitalisation: previous contact with the police or judiciary (OR = 7.55, 95% CI = 1.10-51.63; ARD = 0.24; RR = 1.47), agitation (OR = 2.80, 95% CI = 1.02-7.72; ARD = 0.22; RR = 1.36), schizophrenia spectrum and other psychotic disorders (OR = 22.22, 95% CI = 1.74-284.54; ARD = 0.31; RR = 1.50) and employment status (OR = 0.10, 95% CI = 0.01-0.63; ARD = -0.28; RR = 0.66). IHT teams should be aware of patients who have histories of encounters with the police/judiciary or were agitated at outset of treatment. As those patients benefit less from IHT due to the higher risk of hospitalisation. Moreover, type of diagnoses and employment status play an important role in predicting hospitalisation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpsyt.2021.602912DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901988PMC
February 2021

Depressive and anxiety disorders in concert-A synthesis of findings on comorbidity in the NESDA study.

J Affect Disord 2021 04 5;284:85-97. Epub 2021 Feb 5.

Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, The Netherlands & GGZ inGeest Specialized Mental Health Care, Research and Innovation, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Research and Innovation, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands. Electronic address:

Background: Comorbidity of depressive and anxiety disorders is common and remains incompletely comprehended. This paper summarizes findings from the Netherlands Study of Depression and Anxiety (NESDA) regarding prevalence, temporal sequence, course and longitudinal patterns; sociodemographic, vulnerability and neurobiological indicators; and functional, somatic and mental health indicators of comorbidity.

Methods: Narrative synthesis of earlier NESDA based papers on comorbidity (n=76).

Results: Comorbidity was the rule in over three-quarter of subjects with depressive and/or anxiety disorders, most often preceded by an anxiety disorder. Higher severity and chronicity characterized a poorer comorbidity course. Over time, transitions between depressive and anxiety disorders were common. Consistent comorbidity risk indicators in subjects with depressive and anxiety disorders were childhood trauma, neuroticism and early age of onset. Psychological vulnerabilities, such as trait avoidance tendencies, were more pronounced in comorbid than in single disorders. In general, there were few differences in biological markers and neuroimaging findings between persons with comorbid versus single disorders. Most functional, somatic, and other mental health indicators, ranging from disability to cardiovascular and psychiatric multimorbidity, were highest in comorbid disorders.

Limitations: The observational design of NESDA limits causal inference. Attrition was higher in comorbid relative to single disorders.

Conclusions: As compared to single disorders, persons with comorbid depressive and anxiety disorders were characterized by more psychosocial risk determinants, more somatic and other psychiatric morbidities, more functional impairments, and poorer outcome. These results justify specific attention for comorbidity of depressive and anxiety disorders, particularly in treatment settings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jad.2021.02.004DOI Listing
April 2021

The long-lasting impact of childhood trauma on adult chronic physical disorders.

J Psychiatr Res 2021 04 27;136:87-94. Epub 2021 Jan 27.

GGZinGeest, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands; Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1105, 1081, HV, the Netherlands. Electronic address:

Background: It is unclear if childhood trauma (CT) is an independent risk factor of adult chronic physical disorders or whether its impact is (also) due to underlying poorer mental health.

Methods: Data were obtained from baseline measurements among 13,489 respondents of the Netherlands Mental Health Survey and Incidence Study-1 and -2, cohort studies of the Dutch general population aged 18-64 years. We used a childhood trauma questionnaire measuring emotional, psychological, physical or sexual trauma before the age of 16. Lifetime mood, anxiety and substance use disorders were assessed with the Composite International Diagnostic Interview version 1.1 and 3.0. A standard self-report checklist was used to assess a broad range of chronic physical disorders treated by a medical doctor in the previous 12 months.

Results: Respondents with a history of CT (N = 4054) suffered significantly more often from digestive (OR: 1.89-2.95), musculoskeletal (OR: 1.21-1.75) and respiratory disorders (OR: 1.39-1.91) and migraine (OR: 1.42-1.66). We found indirect associations between CT and digestive, musculoskeletal and respiratory disorders through lifetime mood (54%, 52% and 48% respectively), anxiety (44%, 55% and 44% respectively) and substance use disorders (33%, 23% and 38% respectively). Mood (69%) and anxiety disorders (67%) also impacted the relationship with migraine.

Conclusions: CT predicts the development of adult physical disorders, even after controlling for sociodemographic and lifestyle factors. This association is substantially influenced by mental health disorders. Treatment programs for CT should include interventions aimed at enhancing both mental and physical health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpsychires.2021.01.031DOI Listing
April 2021

Transient Cognitive Impairment and White Matter Hyperintensities in Severely Depressed Older Patients Treated With Electroconvulsive Therapy.

Am J Geriatr Psychiatry 2021 Nov 8;29(11):1117-1128. Epub 2021 Jan 8.

GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands.

Background: Although electroconvulsive therapy (ECT) is a safe and effective treatment for patients with severe late life depression (LLD), transient cognitive impairment can be a reason to discontinue the treatment. The aim of the current study was to evaluate the association between structural brain characteristics and general cognitive function during and after ECT.

Methods: A total of 80 patients with LLD from the prospective naturalistic follow-up Mood Disorders in Elderly treated with Electroconvulsive Therapy study were examined. Magnetic resonance imaging scans were acquired before ECT. Overall brain morphology (white and grey matter) was evaluated using visual rating scales. Cognitive functioning before, during, and after ECT was measured using the Mini Mental State Examination (MMSE). A linear mixed-model analysis was performed to analyze the association between structural brain alterations and cognitive functioning over time.

Results: Patients with moderate to severe white matter hyperintensities (WMH) showed significantly lower MMSE scores than patients without severe WMH (F(1,75.54) = 5.42, p = 0.02) before, during, and post-ECT, however their trajectory of cognitive functioning was similar as no time × WMH interaction effect was observed (F(4,65.85) = 1.9, p = 0.25). Transient cognitive impairment was not associated with medial temporal or global cortical atrophy (MTA, GCA).

Conclusion: All patients showed a significant drop in cognitive functioning during ECT, which however recovered above baseline levels post-ECT and remained stable until at least 6 months post-ECT, independently of severity of WMH, GCA, or MTA. Therefore, clinicians should not be reluctant to start or continue ECT in patients with severe structural brain alterations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jagp.2020.12.028DOI Listing
November 2021

The effects of intensive home treatment on self-efficacy in patients recovering from a psychiatric crisis.

Int J Ment Health Syst 2021 Jan 6;15(1). Epub 2021 Jan 6.

Department of Research, Arkin Mental Health Care, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands.

Background: This study evaluated whether providing intensive home treatment (IHT) to patients experiencing a psychiatric crisis has more effect on self-efficacy when compared to care as usual (CAU). Self-efficacy is a psychological concept closely related to one of the aims of IHT. Additionally, differential effects on self-efficacy among patients with different mental disorders and associations between self-efficacy and symptomatic recovery or quality of life were examined.

Methods: Data stem from a Zelen double consent randomised controlled trial (RCT), which assesses the effects of IHT compared to CAU on patients who experienced a psychiatric crisis. Data were collected at baseline, 6 and 26 weeks follow-up. Self-efficacy was measured using the Mental Health Confidence Scale. The 5-dimensional EuroQol instrument and the Brief Psychiatric Rating Scale (BPRS) were used to measure quality of life and symptomatic recovery, respectively. We used linear mixed modelling to estimate the associations with self-efficacy.

Results: Data of 142 participants were used. Overall, no difference between IHT and CAU was found with respect to self-efficacy (B = - 0.08, SE = 0.15, p = 0.57), and self-efficacy did not change over the period of 26 weeks (B = - 0.01, SE = 0.12, t (103.95) = - 0.06, p = 0.95). However, differential effects on self-efficacy over time were found for patients with different mental disorders (F(8, 219.33) = 3.75, p < 0.001). Additionally, self-efficacy was strongly associated with symptomatic recovery (total BPRS B = - 0.10, SE = 0.02, p < 0.00) and quality of life (B = 0.14, SE = 0.01, p < 0.001).

Conclusions: Although self-efficacy was associated with symptomatic recovery and quality of life, IHT does not have a supplementary effect on self-efficacy when compared to CAU. This result raises the question whether, and how, crisis care could be adapted to enhance self-efficacy, keeping in mind the development of self-efficacy in depressive, bipolar, personality, and schizophrenia spectrum and other psychotic disorders. The findings should be considered with some caution. This study lacked sufficient power to test small changes in self-efficacy and some mental disorders had a small sample size. Trial registration This trial is registered at Trialregister.nl, number NL6020.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13033-020-00426-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789166PMC
January 2021

Prevalence of hormone-related mood disorder symptoms in women with ADHD.

J Psychiatr Res 2021 01 3;133:10-15. Epub 2020 Dec 3.

PsyQ Program and Expertise Center Adult ADHD, The Hague, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Dept. of Psychiatry, Amsterdam, the Netherlands.

This is the first study to assess the prevalence of symptoms of premenstrual dysphoric disorder (PMDD), episodes of postpartum depression symptoms (PPD) after first childbirth, and climacteric mood symptoms in Attention-Deficit/Hyperactivity Disorder (ADHD). 209 consecutive women (18-71 years) with ADHD completed the PMDD chapter of the Neuropsychiatric Interview Plus version 5.0.0 to assess PMDD, the Edinburgh Postnatal Depression Scale to assess PPD, and the Greene Climacteric Scale to assess climacteric symptoms. Comorbid psychiatric disorders, medication use, and chronobiological sleep characteristics were also assessed. The prevalence of PMDD and PPD were high in ADHD, compared to the general population. PMDD symptoms were associated with less use of contraceptives. Antidepressants were associated with more PMDD symptoms. The following GCS scores were significant increased: anxiety, depression, and sexual dysfunction, vasomotor and somatic complaints. No significant differences were found in sleep characteristics or current comorbidity between the groups with and without PPD or PMDD, or increased climacteric scores. The prevalences of PMDD, PPD and climacteric scores were high in women with ADHD. This is the first study in women with ADHD that suggests that female ADHD patients suffer from significant PMDD symptoms, experience PPD during the first child birth, and experience more severe climacteric symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpsychires.2020.12.005DOI Listing
January 2021

Prevalence of hormone-related mood disorder symptoms in women with ADHD.

J Psychiatr Res 2021 01 3;133:10-15. Epub 2020 Dec 3.

PsyQ Program and Expertise Center Adult ADHD, The Hague, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Dept. of Psychiatry, Amsterdam, the Netherlands.

This is the first study to assess the prevalence of symptoms of premenstrual dysphoric disorder (PMDD), episodes of postpartum depression symptoms (PPD) after first childbirth, and climacteric mood symptoms in Attention-Deficit/Hyperactivity Disorder (ADHD). 209 consecutive women (18-71 years) with ADHD completed the PMDD chapter of the Neuropsychiatric Interview Plus version 5.0.0 to assess PMDD, the Edinburgh Postnatal Depression Scale to assess PPD, and the Greene Climacteric Scale to assess climacteric symptoms. Comorbid psychiatric disorders, medication use, and chronobiological sleep characteristics were also assessed. The prevalence of PMDD and PPD were high in ADHD, compared to the general population. PMDD symptoms were associated with less use of contraceptives. Antidepressants were associated with more PMDD symptoms. The following GCS scores were significant increased: anxiety, depression, and sexual dysfunction, vasomotor and somatic complaints. No significant differences were found in sleep characteristics or current comorbidity between the groups with and without PPD or PMDD, or increased climacteric scores. The prevalences of PMDD, PPD and climacteric scores were high in women with ADHD. This is the first study in women with ADHD that suggests that female ADHD patients suffer from significant PMDD symptoms, experience PPD during the first child birth, and experience more severe climacteric symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpsychires.2020.12.005DOI Listing
January 2021

Prevalence of hormone-related mood disorder symptoms in women with ADHD.

J Psychiatr Res 2021 01 3;133:10-15. Epub 2020 Dec 3.

PsyQ Program and Expertise Center Adult ADHD, The Hague, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Dept. of Psychiatry, Amsterdam, the Netherlands.

This is the first study to assess the prevalence of symptoms of premenstrual dysphoric disorder (PMDD), episodes of postpartum depression symptoms (PPD) after first childbirth, and climacteric mood symptoms in Attention-Deficit/Hyperactivity Disorder (ADHD). 209 consecutive women (18-71 years) with ADHD completed the PMDD chapter of the Neuropsychiatric Interview Plus version 5.0.0 to assess PMDD, the Edinburgh Postnatal Depression Scale to assess PPD, and the Greene Climacteric Scale to assess climacteric symptoms. Comorbid psychiatric disorders, medication use, and chronobiological sleep characteristics were also assessed. The prevalence of PMDD and PPD were high in ADHD, compared to the general population. PMDD symptoms were associated with less use of contraceptives. Antidepressants were associated with more PMDD symptoms. The following GCS scores were significant increased: anxiety, depression, and sexual dysfunction, vasomotor and somatic complaints. No significant differences were found in sleep characteristics or current comorbidity between the groups with and without PPD or PMDD, or increased climacteric scores. The prevalences of PMDD, PPD and climacteric scores were high in women with ADHD. This is the first study in women with ADHD that suggests that female ADHD patients suffer from significant PMDD symptoms, experience PPD during the first child birth, and experience more severe climacteric symptoms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpsychires.2020.12.005DOI Listing
January 2021

Clinical management of emotions in patients with cancer: introducing the approach "emotional support and case finding".

Transl Behav Med 2020 12;10(6):1399-1405

Department of Medical Oncology, Radboud UMC, Nijmegen, the Netherlands.

The current approach to the management of emotions in patients with cancer is "distress screening and referral for the provision of psychosocial care." Although this approach may have certain beneficial effects, screening and referral programs have shown a limited effect on patient psychological well-being. We argue that this limited effect is due to a mismatch between patient needs and the provision of care, and that a fundamental reconceptualization of the clinical management of emotions in patients with cancer is needed. We describe the rationale and characteristics of "emotional support and case finding" as the approach to the management of emotions in patients with cancer. The two main principles of the approach are: (1) Emotional support: (a) The treating team, consisting of doctors, nurses, and allied health staff, is responsive to the emotional needs of patients with cancer and provides emotional support. (b) The treating team provides information on external sources of emotional support. (2) Case finding: The treating team identifies patients in need of mental health care by means of case finding, and provides a referral to mental health care as indicated. We present a novel perspective on how to organize the clinical management of emotions in patients with cancer. This is intended to contribute to a fruitful discussion and to inform an innovative research agenda on how to manage emotions in patients with cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/tbm/ibaa115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796719PMC
December 2020
-->