Publications by authors named "Frieda Matthys"

20 Publications

  • Page 1 of 1

[International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder].

Z Kinder Jugendpsychiatr Psychother 2021 Aug 16. Epub 2021 Aug 16.

Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für seelische Gesundheit, Mannheim, Deutschland.

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general ( = 4), risk of developing SUD ( = 3), screening and diagnosis ( = 7), psychosocial treatment ( = 5), pharmacological treatment ( = 11), and complementary treatments ( = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.
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http://dx.doi.org/10.1024/1422-4917/a000828DOI Listing
August 2021

Sexual Feelings Toward Clients in the Psychotherapeutic Relationship: The Taboo Revealed.

Qual Health Res 2021 04 6;31(5):999-1011. Epub 2021 Feb 6.

Vrije Universiteit Brussel, Brussels, Belgium.

Talking about sexual feelings toward clients is still difficult for many mental health professionals. This is unfortunate, because exploring and talking about these feelings with peers (especially senior ones) or supervisors can help professionals to recognize, acknowledge, accept, and handle these feelings well. This focus group study explores the various factors that contribute to psychotherapists' hesitancy to talk about these feelings. The analysis revealed two important impeding factors: the psychotherapists felt discomfortable and a safe environment was lacking. Young, less experienced psychotherapists and psychiatrists seemed to be most vulnerable. Furthermore, more profound sexual feelings were "disguised" in some cases by using a more acceptable narrative, such as " intimate feelings," which possibly also impeded acknowledgment and discussion of these feelings. These insights might help to open up the way for psychotherapists to explore and come forward with their sexual feelings and experiences.
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http://dx.doi.org/10.1177/1049732321990654DOI Listing
April 2021

[Recommendations for the screening, diagnosis and treatment of patients with comorbid attention deficit hyperactivity- and substance use disorder].

Psychiatr Hung 2020 ;35(4):435-447

Semmelweis Egyetem, Egeszsegtudomanyi Kar, Addiktologiai Tanszek, Budapest, Hungary, E-mail:

Among patients with substance use disorders (SUD), adult attention deficit hyperactivity disorder (ADHD) is one of the most frequently co-occuring disorder. Those SUD patients with comorbid ADHD show earlier onset of substance use, more severe SUD and poor treatment outcomes. Therefore, early recognition of ADHD is highly rele - vant within this patient population. The results of available screening instruments may lay the foundation of timely ADHD diagnosis. Considering the integrated treatment of patients with a dual ADHD+SUD diagnosis, the applica tion of combined pharmaco- and psychotherapy is recommended. Based on the evidence-and consensus-based suggestions, prescription of long-acting methylphenidate, extended-release amphetamines and atomoxetine with up-titration might be the best choice in the treatment of patients who are either unresponsive to standard dose or characterized by therapy resistance. The main purpose of this manuscript is to establish a standing-ground for the effective screening, diagnosis and treatment of ADHD+SUD patients.
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December 2020

Self-Reported Alcohol, Tobacco, and Cannabis Use during COVID-19 Lockdown Measures: Results from a Web-Based Survey.

Eur Addict Res 2020 22;26(6):309-315. Epub 2020 Sep 22.

Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.

Background: The outbreak of coronavirus disease 19 (COVID-19) has led to measures of social distancing and quarantine worldwide. This stressful period may lead to psychological problems, including increases in substance use.

Objective: To investigate changes in alcohol, tobacco, and cannabis consumption before and during COVID-19 lockdown and motives for these changes in substance use.

Method: A web-based survey was filled out by an unselected population during the social distancing measures of the COVID-19 pandemic in Belgium that assessed changes in alcohol, tobacco, and cannabis consumption in the period before and during the COVID-19 lockdown and also asked about reasons for change.

Results: A total of 3,632 respondents (mean age 42.1 ± 14.6 years; 70% female) filled out the survey. Overall, respondents reported consuming more alcohol (d = 0.21) and smoking more cigarettes (d = 0.13) than before the COVID-19 pandemic (both p < 0.001), while no significant changes in the consumption of cannabis were noted. The odds of consuming more alcohol during the lockdown were associated with younger age (OR = 0.981, p < 0.001), more children at home (OR = 1.220, p < 0.001), non-healthcare workers (p < 0.001), and being technically unemployed related to COVID-19 (p = 0.037). The odds of smoking more cigarettes during the lockdown were associated with younger age (OR = 0.988, p = 0.027), current living situation (p < 0.001), lower education (p = 0.015), and working situation related to COVID-19 (p = 0.018). Boredom, lack of social contacts, loss of daily structure, reward after a hard-working day, loneliness, and conviviality were the main reasons for consuming more of the various substances.

Conclusions: During the lockdown, individuals consumed slightly more alcohol and smoked marginally more cigarettes compared to the period before the lockdown. Further research focussing on follow-up of individuals at risk may be useful to provide appropriate care in post-COVID times.
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http://dx.doi.org/10.1159/000510822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573904PMC
November 2020

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder.

Eur Addict Res 2020 7;26(4-5):223-232. Epub 2020 Jul 7.

Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Mannheim, Germany.

Background: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations.

Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience.

Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD.

Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion.

Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.
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http://dx.doi.org/10.1159/000508385DOI Listing
May 2021

Validity of the ADHD module of the Mini International Neuropsychiatric Interview PLUS for screening of adult ADHD in treatment seeking substance use disorder patients: ADHD screening with MINI-Plus.

Rev Psiquiatr Salud Ment (Engl Ed) 2020 Jun 16. Epub 2020 Jun 16.

Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address:

Objective: This study aims to assess the validity of the ADHD module of the Mini-International Neuropsychiatric Interview (MINI-Plus) in patients with substance use disorders (SUD), using the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) as the external criterion.

Method: A cross sectional international multi-center study in 10 countries was conducted in treatment seeking SUD patients. A sample of 1263 patients with both MINI-Plus and CAADID was analyzed to determine the psychometric properties of the MINI-Plus.

Results: According to the CAADID, 179 patients (14.2%) met criteria for adult ADHD, whereas according to the MINI-Plus 227 patients (18.0%) were identified as having adult ADHD. Sensitivity of the MINI-Plus ADHD module was 74%, specificity was 91%, positive predictive value was 60% and negative predictive value was 96%. Kappa was 0.60.

Conclusion: The MINI-Plus has acceptable criterion validity for the screening of adult ADHD in treatment seeking SUD patients.

Scientific Significance: On the basis of the results, The MINI-Plus may be used for the screening of ADHD in SUD patients.
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http://dx.doi.org/10.1016/j.rpsm.2020.04.013DOI Listing
June 2020

Psychotherapists' attitudes to intimate and informal behaviour towards clients.

Psychol Med 2021 Aug 18;51(11):1807-1813. Epub 2020 Mar 18.

Mental Health and Wellbeing Research Group (MENT), Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, 1090, Belgium.

Background: To avoid harming or exploiting a client, sexual and non-sexual dual relationship is generally considered as unacceptable in the psychotherapeutic relationship. However, little is known about what therapists themselves constitute as (un)acceptable intimate and informal behaviour (IIB).

Methods: A survey among psychotherapists in Flanders (Belgium) was conducted. Opinions about the acceptability of IIB were asked. Based on these opinions attitude groups could be determined.

Results: In total, 786 therapists completed and returned the questionnaire (response rate: 39.8%). Therapists could be divided into three attitude groups. Almost half of the therapists belonged to the 'rather restrictive group', a third to the 'rather socially permissive group' and a fifth to the 'rather sexually permissive group'. Being categorised as 'rather sexually permissive' is predominantly related to being male and non-heterosexual, whereas being 'rather restrictive' or 'rather socially permissive' is mainly due to the type of psychotherapy training. The 'rather sexually permissive' therapists more often found a client sexually attractive during the last year and fantasised more often about a romantic relationship with a client, but they did not more often started a sexual relationship.

Conclusions: Most therapists in Flanders are rather restrictive in their attitude to IIB, pointing to a high sense of morality. Having a rather sexually permissive attitude is predominantly related to more personal characteristics of the therapists, but these therapists did not start a sexual relationship more often.
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http://dx.doi.org/10.1017/S0033291720000513DOI Listing
August 2021

Points to consider regarding DSM alternatives.

Lancet Psychiatry 2019 11;6(11):894-895

Flemish Society for Psychiatry, Leuven, Belgium; Faculty of Medicine, University Hospital Brussel, Brussels, Belgium; Faculty of Medicine, Vrije Universiteit Brussel, Brussels, Belgium.

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http://dx.doi.org/10.1016/S2215-0366(19)30390-6DOI Listing
November 2019

Prevalence of metabolic syndrome and its associated risk factors in an African-Caribbean population with severe mental illness.

Psychiatry Res 2019 11 7;281:112558. Epub 2019 Sep 7.

Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.

This cross-sectional study aims to determine the prevalence of metabolic syndrome (MetS) in patients with severe mental illness (SMI) on a Caribbean island, Curaçao, using the modified National Cholesterol Education Program Adult Treatment Panel III criteria. Among 350 patients (240 men and 110 women) with a mean age of 51.9 years (S.D.=13.5) MetS prevalence was 37.4%, significantly higher in female patients (63.6%) compared to male patients (25.4%). Increased waist circumference was present in 51.1%, low HDL in 50.6%, hypertension in 49.4%, hyperglycemia in 28.6% and 25.7% had hypertriglyceridemia. Except for hypertriglyceridemia, all criteria were more prevalent in female patients. Binary logistic regression analysis indicated that female gender, outpatient treatment setting and the absence of substance use disorder were all significant predictors for MetS. Compared to data from the general population obtained by the 2013 National Health Survey Curaçao, this study showed significantly higher prevalence of diabetes and hypertension in patients with SMI. Moreover, female patients had the highest prevalence of diabetes (28.2%), obesity (50.0%) and increased waist circumference (88.2%). This study demonstrates that African-Caribbean patients with SMI are at high-risk for MetS, especially female patients. Our data suggest to focus on modifiable lifestyle risk factors, as promoting physical activity and healthy dietary habits.
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http://dx.doi.org/10.1016/j.psychres.2019.112558DOI Listing
November 2019

Diagnosis and treatment of patients with comorbid substance use disorder and adult attention-deficit and hyperactivity disorder: a review of recent publications.

Curr Opin Psychiatry 2019 07;32(4):300-306

Amsterdam Institute of Addiction Research (AIAR), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

Purpose Of Review: Attention-deficit and hyperactivity disorder (ADHD) often presents with comorbid substance use disorders (SUD). Due to similarities in key symptoms of both disorders and suboptimal efficacy of the available treatments, clinicians are faced with difficulties in the diagnosis and treatment of these patients with both disorders. This review addresses recent publications between 2017 and 2019 on the etiology, prevalence, diagnosis and treatment of co-occurring ADHD and SUD.

Recent Findings: ADHD is diagnosed in 15-20% of SUD patients, mostly as ADHD with combined (hyperactive/inattentive) presentation. Even during active substance use, screening with the Adult ADHD Self-Report Scale (ASRS) is useful to address whether further diagnostic evaluation is needed. After SUD treatment, the diagnosis of ADHD generally remains stable, but ADHD subtype presentations are not. Some evidence supports pharmacological treatment with long-acting stimulants in higher than usual dosages. Studies on psychological treatment remain scarce, but there are some promising findings on integrated cognitive behaviour therapy.

Summary: Diagnosis and treatment of patients with comorbid ADHD and SUD remain challenging. As ADHD presentations can change during active treatment, an active follow-up is warranted to provide treatment to the individuals' personal strengths and weaknesses.
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http://dx.doi.org/10.1097/YCO.0000000000000513DOI Listing
July 2019

International Consensus Statement on Screening, Diagnosis and Treatment of Substance Use Disorder Patients with Comorbid Attention Deficit/Hyperactivity Disorder.

Eur Addict Res 2018 6;24(1):43-51. Epub 2018 Mar 6.

Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.

Adult attention deficit/hyperactivity disorder (ADHD) often co-occurs with substance use disorders (SUD) and is associated with early onset and more severe development of SUD and with reduced treatment effectiveness. Screening tools allow for a good recognition of possible ADHD in adults with SUD and should be used routinely, followed by an ADHD diagnostic process initiated as soon as possible. Simultaneous and integrated treatment of ADHD and SUD, using a combination of pharmaco- and psychotherapy, is recommended. Long-acting methylphenidate, extended-release amphetamines, and atomoxetine with up-titration to higher dosages may be considered in patients unresponsive to standard doses. This paper includes evidence- and consensus-based recommendations developed to provide guidance in the screening, diagnosis and treatment of patients with ADHD-SUD comorbidity.
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http://dx.doi.org/10.1159/000487767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986068PMC
September 2018

Accelerated HF-rTMS in the elderly depressed: A feasibility study.

Brain Stimul 2018 Jan - Feb;11(1):247-248. Epub 2017 Oct 31.

Department of Psychiatry and Medical Psychology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. Electronic address:

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http://dx.doi.org/10.1016/j.brs.2017.10.018DOI Listing
October 2017

Influence of Body Mass Index on Hair Ethyl Glucuronide Concentrations.

Alcohol Alcohol 2017 Jan 20;52(1):19-23. Epub 2016 Oct 20.

Laboratoire National de Santé, Service de Toxicologie, Dudelange, Luxembourg.

Aim: Analysis of ethyl glucuronide (EtG) concentrations in hair is increasingly used to estimate the consumption of alcohol of the prior months. Linear correlations between the amount of alcohol consumed and the concentration of EtG in hair have been reported, and several variables that may influence this correlation have been investigated: e.g. cosmetic hair treatments, gender influences or hair color. Here, we investigate the influence of body mass index (BMI) on this correlation.

Methods: A post hoc analysis on the influence of BMI on the relation between amounts of alcohol consumed and the measured EtG concentrations in hair in 199 participants.

Results: Our data show higher EtG concentrations in participants with high BMI (≥25) compared to participants with low BMI (<25) (P = 0.001) across a wide range of amounts of alcohol consumed.

Conclusions: We conclude that BMI should be taken into account when interpreting hair EtG concentrations.

Short Summary: Ethyl glucuronide concentrations in hair (hEtG) can be used to estimate the consumption of alcohol of the prior months. Body mass index (BMI) influences this relation and BMI should be taken into account when interpreting hEtG concentrations in participants with high BMI (≥25) compared to participants with low BMI (<25).
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http://dx.doi.org/10.1093/alcalc/agw079DOI Listing
January 2017

Development and Validation of Quality Indicators on Continuing Care for Patients With AUD: A Delphi Study.

Alcohol Alcohol 2016 Sep 5;51(5):555-61. Epub 2016 Jul 5.

Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33, Blok j, 3000 Leuven, Belgium

Aims: To develop indicators to assess quality of continuing care for persons with alcohol use disorder (AUD).

Methods: A guideline-based RAND-modified Delphi method was used to develop and validate indicators regarding the process and outcome of continuing care. We systematically searched for evidence-based guidelines and existing quality indicators. A multidisciplinary expert panel prioritized recommendations using a written questionnaire followed by a group discussion. Important recommendations were then translated to quality indicators. The panel subsequently selected indicators that were measurable and applicable in Belgium. In a final round the indicators face-validity was assessed.

Results: We extracted 69 recommendations from 06 guidelines and 17 relevant quality indicators. Of all, 13 indicators remained after 03 written rounds and 02 group discussions.

Conclusions: This study describes a systematic approach to develop and validate quality indicators for continuing care for AUD. The final set of selected indicators consisted of 10 process and 03 outcome indicators. As the level of evidence of effective continuing care components is very low further development of the indicators is recommended.

Short Summary: This study describes a systematic approach to develop and validate quality indicators for continuing care for AUD. The proposed set of indicators consisted of 10 process and 03 outcome indicators. As the level of evidence of effective continuing care components is very low further development of the indicators is recommended.
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http://dx.doi.org/10.1093/alcalc/agw044DOI Listing
September 2016

Accelerated HF-rTMS Protocol has a Rate-Dependent Effect on dACC Activation in Alcohol-Dependent Patients: An Open-Label Feasibility Study.

Alcohol Clin Exp Res 2016 Jan;40(1):196-205

Department of Psychiatry, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.

Background: The application of accelerated high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) could be a potential treatment option for alcohol-dependent patients and may result in a faster clinical response. In this open-label HF-rTMS feasibility study, we wanted to replicate previous findings of baseline brain activation as a predictor of relapse, and to evaluate how this intervention influences the relapse neurocircuit of "treatment-seeking" alcohol-dependent patients, by means of functional magnetic resonance imaging (fMRI) cue-exposure paradigms. Because relapsing patients have a diminished resilience of the emotion regulation/cognitive control system, before HF-rTMS treatment, we expected lower neuronal activation of especially the ventromedial prefrontal cortex and anterior cingulate cortex (ACC) during the presentation of alcohol-related cues in these patients. The relapse neurocircuit should be modified after accelerated HF-rTMS treatment, only in those patients who did not relapse.

Methods: After being administered a single sham-controlled HF-rTMS session (20 Hz to 110% motor threshold), 19 alcohol-dependent patients received an accelerated HF-rTMS protocol, consisting of 14 right dorsolateral prefrontal cortical sessions spread over 3 days. Before and after stimulation, during fMRI patients were confronted with a block and an event-related alcoholic cue-exposure paradigm. Relapse was defined as the consumption of any amount of alcohol within 4 weeks after the stimulation. A region of interest analysis was performed to evaluate how HF-rTMS exerts its effect.

Results: After 4 weeks, 13 of 19 patients had already consumed alcohol. When abstainers were compared to patients who had relapsed, we found higher dorsal ACC (dACC) activation at baseline, but only during the blocked cue-exposure paradigm. The effects of HF-rTMS on dACC blood oxygen level-dependent response were negatively correlated with the baseline dACC activation. Due to susceptibility artifacts located at the ventral cortical aspects in 6 of our participants, reliable data were only obtained for the ACC.

Conclusions: Our data indicate that higher baseline dACC activation may serve as a protective mechanism regarding relapse. For the first time, it is demonstrated that accelerated HF-rTMS treatment influences dACC activation in a rate-dependent manner: the lower the baseline dACC activation, the more dACC activity was increased after HF-rTMS treatment.
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http://dx.doi.org/10.1111/acer.12937DOI Listing
January 2016

The Impact of Accelerated Right Prefrontal High-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) on Cue-Reactivity: An fMRI Study on Craving in Recently Detoxified Alcohol-Dependent Patients.

PLoS One 2015 21;10(8):e0136182. Epub 2015 Aug 21.

Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium; Department of Psychiatry and Medical Psychology, Ghent University, Universitair Ziekenhuis Gent, Ghent, Belgium.

In alcohol-dependent patients craving is a difficult-to-treat phenomenon. It has been suggested that high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) may have beneficial effects. However, exactly how this application exerts its effect on the underlying craving neurocircuit is currently unclear. In an effort to induce alcohol craving and to maximize detection of HF-rTMS effects to cue-induced alcohol craving, patients were exposed to a block and event-related alcohol cue-reactivity paradigm while being scanned with fMRI. Hence, we assessed the effect of right dorsolateral prefrontal cortex (DLPFC) stimulation on cue-induced and general alcohol craving, and the related craving neurocircuit. Twenty-six recently detoxified alcohol-dependent patients were included. First, we evaluated the impact of one sham-controlled stimulation session. Second, we examined the effect of accelerated right DLPFC HF-rTMS treatment: here patients received 15 sessions in an open label accelerated design, spread over 4 consecutive days. General craving significantly decreased after 15 active HF-rTMS sessions. However, cue-induced alcohol craving was not altered. Our brain imaging results did not show that the cue-exposure affected the underlying craving neurocircuit after both one and fifteen active HF-rTMS sessions. Yet, brain activation changes after one and 15 HF-rTMS sessions, respectively, were observed in regions associated with the extended reward system and the default mode network, but only during the presentation of the event-related paradigm. Our findings indicate that accelerated HF-rTMS applied to the right DLPFC does not manifestly affect the craving neurocircuit during an alcohol-related cue-exposure, but instead it may influence the attentional network.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136182PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546410PMC
May 2016

Causal attribution in individuals with subclinical and clinical autism spectrum disorder: An fMRI study.

Soc Neurosci 2016 11;11(3):264-76. Epub 2015 Aug 11.

a Department of Psychology , Vrije Universiteit Brussel , Brussels , Belgium.

This neuroimaging study compares brain activation during causal attribution to three different attribution loci (i.e., self, another person, and situation) across a typical population without (N = 20) or with subclinical autism spectrum symptoms (N = 18) and a clinical population with autism spectrum disorder (ASD; N = 11). While they underwent fMRI, all participants read short sentences describing positive and negative behaviors and thoughts of another person directed toward the participant (i.e., "you"). Participants were then asked to attribute these behaviors to themselves, the other person, or the situation. Behavioral measures revealed self-serving attributions (i.e., attributing positive events to the self, while attributing negative events externally from the self) in all three participant groups. Neural measures revealed a great deal of shared activation across the three attribution loci and across the three participant groups in the temporo-parietal junction, the posterior superior sulcus, and the precuneus. Comparison between groups revealed more widespread activation in both subclinical and clinical ASD participants, which may be indicative of the extraneural resources these participants invest to compensate their impairments.
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http://dx.doi.org/10.1080/17470919.2015.1074104DOI Listing
December 2016

Barriers to implementation of treatment guidelines for ADHD in adults with substance use disorder.

J Dual Diagn 2014 ;10(3):130-8

a Department Psychiatry, Vrije Universiteit Brussel (VUB) , University Hospital, Brussels and MSOC Free Clinic , Antwerp , Belgium.

Objective: Attention deficit hyperactivity disorder (ADHD) is common among adult patients with a substance use disorder, yet often goes undetected. This is a qualitative study to explore implementation barriers to a guideline developed in Belgium for the recognition and treatment of ADHD in adult patients with substance use disorder and to gain a better understanding of the strategies to overcome these barriers.

Methods: Focus groups were conducted with caregivers and patients to explore experiences with comorbid substance use disorder and ADHD. The barriers reported in these focus groups became the subject of further study in focus groups with addiction professionals (physicians, psychiatrists, and psychologists) who had tried the guideline and with psychiatrists specializing in addiction but without experience with ADHD.

Results: Our analysis revealed a number of barriers to the implementation of this guideline, including lack of information from the family, pressure from patients and caregivers to make an ADHD diagnosis, and the potential for abuse of ADHD medication. Furthermore, diagnostic instruments for ADHD have not been validated in people with substance use disorder. Although patients with ADHD are usually treated in an outpatient setting, patients with ADHD comorbid with substance use disorder are difficult to identify in an outpatient setting for various reasons. Finally, there is a lack of specific ADHD expertise in substance use treatment organizations.

Conclusions: Despite the availability of an approved guideline for recognizing and treating adult ADHD in patients with a substance use disorder, underdiagnosis and inadequate treatment still persist. As in general substance use treatment, medication only plays a supportive role in the treatment of substance use disorder with comorbid ADHD. An integrated approach and further improvements in the competence of practitioners may help to reduce the resistance to diagnosing ADHD in substance use treatment centers. Practitioners who specialize in addiction medicine and therapists without medical education view the problem from different perspectives and therefore each group needs specific information and training. Targeted interventions need to be developed to keep these patients in treatment.
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http://dx.doi.org/10.1080/15504263.2014.926691DOI Listing
July 2015

Continuing care for patients with alcohol use disorders: a systematic review.

Drug Alcohol Depend 2014 Feb 14;135:9-21. Epub 2013 Nov 14.

Academic Center for General Practice, Department of Public health and Primary Care, Katholieke Universiteit Leuven, Kapucijnenvoer 33, blok j, bus 7001, 3000 Leuven, Belgium.

Background: A chronic care perspective should be adopted in the treatment of patients with alcohol use disorders (AUDs). Initial treatment in a more intense psychiatric care setting should be followed by continuing care. This systematic review aims to identify effective continuing care interventions for patients with AUDs.

Methods: Electronic databases were searched up to February 2013 (MEDLINE, EMBASE, CENTRAL, CINAHL and PsycINFO) to identify RCTs studying continuing care interventions for patients with AUDs. Study selection and quality appraisal was done independently by two reviewers. Drinking and treatment engagement outcomes were considered. Relative risks and mean differences were calculated with 95% confidence intervals. A statistical pooling of results was planned.

Results: 20 trials out of 15,235 identified studies met the inclusion criteria. Only six were evaluated as methodologically strong enough and included for further analysis. Interventions ranged from telephone calls and nurse follow-up to various forms of individual or couples counseling. Four trials suggested that supplementing usual continuing care with an active intervention empowering the patient, could be beneficial to drinking outcomes. Effect sizes were limited and not consistent across all outcomes. Because of heterogeneity in the interventions and outcome measures, a meta-analysis could not be performed.

Conclusion: For the treatment of a disease with such devastating consequences, it is remarkable how few high quality studies are available. Adding an active intervention to usual continuing care seems to improve treatment outcomes. We propose an integrated care program with different elements from the selected studies and discuss implications for further research.
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http://dx.doi.org/10.1016/j.drugalcdep.2013.10.030DOI Listing
February 2014

[Summary of the practice guideline for the diagnosis and treatment of ADHD in adolescents and adults with addictions].

Ned Tijdschr Geneeskd 2013 ;157(24):A6025

Vrije Universiteit Brussel, UZ Brussel, afd. Psychiatrie, Brussel, België.

Various guidelines are available for the diagnosis and treatment of ADHD in adults, but not for patients with ADHD and a comorbid substance use disorder (SUD). In 2010, the Addiction Medicine Working Party, a division of the VAD (Verenigingvoor Alcohol- en andere Drugproblemen/Association for Alcohol and other Drug Problems) developed a practice guideline on how, when and by whom ADHD can be diagnosed in patients with an addiction, and how these patients should be treated. Given the high prevalence of ADHD in treatment-seeking SUD patients and the availability of valid screening instruments, all SUD patients should be screened for ADHD as soon as their drug use has stabilized. Acquiring information from external sources as well as clinical observation and questionnaires are important tools for the establishment of the diagnosis of ADHD. Integrated treatment primarily includes psycho-education, coaching and cognitive behavioural therapy in addition to pharmacotherapy. Evidence-based treatments for addiction may also be effective in patients with concomitant ADHD, provided the methods are adapted to the limitations that are associated with this condition.
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August 2013
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