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Bruijnen CJWH, Walvoort SJW, Dijkstra BAG, de Jong CAJ, Kessels RPC. The Course of Cognitive Performance during Inpatient Treatment in Patients with Alcohol Use Disorder with No, Mild or Major Neurocognitive Disorders. Alcohol Alcohol 2021; 56:89-100. [PMID: 33089302 PMCID: PMC7768622 DOI: 10.1093/alcalc/agaa100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 11/25/2022] Open
Abstract
Aims In patients with a history of chronic alcohol abuse, neurocognitive disorders (NCD) are not uncommon. The current study aimed to explore the course of cognitive performance, as measured by the Montreal Cognitive Assessment (MoCA), and everyday cognitive functioning, as measured by the Patient Competency Rating Scale (PCRS), in a large group of patients with alcohol use disorder (AUD) admitted to the Center of Excellence for Korsakov and Alcohol-related Cognitive Impairments. Methods A multiple time-series design was used, in which the MoCA was administered at three time points of assessment, and the PCRS was completed by both the patient and a clinician at two time points, all during clinical treatment. Results A total of 524 patients were included, 71 of whom were diagnosed with AUD only, 284 with AUD and mild NCD (ARCI) and 169 with AUD, major NCD and fulfilling criteria for Korsakoff’s syndrome (KS). Conclusions Cognitive performance improved for all three groups during treatment, sustained abstinence and recovery from AUD. A low memory performance on the MoCA without improvement over time was predictive for KS, while improvement on this domain did not differentiate between AUD and ARCI. Changes in overall cognitive performance and orientation in patients with KS were positively related to changes in everyday cognitive functioning.
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Affiliation(s)
- C J W H Bruijnen
- Center of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, 5800 Venray, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, 6500 Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6500 Nijmegen, The Netherlands
| | - S J W Walvoort
- Center of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, 5800 Venray, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, 6500 Nijmegen, The Netherlands
| | - B A G Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, 6500 Nijmegen, The Netherlands.,Novadic-Kentron, Addiction Care Center, 5260 Vught, The Netherlands
| | - C A J de Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, 6500 Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University, 6500 Nijmegen, The Netherlands
| | - R P C Kessels
- Center of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, 5800 Venray, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6500 Nijmegen, The Netherlands.,Department of Medical Psychology, Radboud University Medical Center, 6500 Nijmegen, The Netherlands
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de Weert-van Oene GH, de Jong CAJ. [Demoralisation in alcohol-dependent patients with co-occurring psychiatric disorders]. Tijdschr Psychiatr 2019; 61:84-91. [PMID: 30793268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Demoralisation is a multidimensional concept, with helplessness and hopelessness as its key elements. Many patients, both in somatic and in mental health care, suffer from demoralisation. In the process of recovery, remoralisation constitutes a first step.<br/> AIM: To investigate demoralisation in alcohol-dependent inpatients with co-occurring psychiatric disorders.<br/> METHOD: Included in this study were 159 alcohol-dependent inpatients admitted to clinics for dual diagnosis. Demoralisation was assessed at treatment entry and again one month later.<br/> RESULTS: A strong level of demoralisation was found, particularly in the co-occurrence of depression, anxiety and personality disorders. At treatment entry, 92% of patients was clinically demoralised and, one month later, this was 89%. In patients with co-occurring depression, mood and personality disorders, a significant decrease of demoralisation was found after one month, whereas in patients with developmental and psychotic disorders this was not the case. In 11% of patients there was clinically relevant improvement and in 7.5% there was clinically relevant deterioration; the latter mainly in patients with co-occurring developmental and psychotic disorders.<br/> CONCLUSION: At start of treatment, these alcohol-dependent patients were strongly demoralised, especially in the co-occurrence of psychiatric disorders. Although there was a significant improvement in demoralisation after one month of treatment, patients remained strongly demoralised. In one in ten patients there was clinically relevant remoralisation. As a first step in the process of recovery, clinicians should pay more attention to remoralisation. Targeted interventions, aimed at this specific population, are necessary.
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Schellekens AFA, de Jong CAJ, Buitelaar JK, Verkes RJ. Co-morbid anxiety disorders predict early relapse after inpatient alcohol treatment. Eur Psychiatry 2014; 30:128-36. [PMID: 24630346 DOI: 10.1016/j.eurpsy.2013.08.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 08/13/2013] [Accepted: 08/22/2013] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Alcohol dependence and anxiety disorders often co-occur. Yet, the effect of co-morbid anxiety disorders on the alcohol relapse-risk after treatment is under debate. This study investigated the effect of co-morbid anxiety disorders on relapse rates in alcohol dependence. We hypothesized that co-morbid anxiety disorders would be particularly predictive for early relapse, but not late relapse. SUBJECTS AND METHODS In a prospective design, male alcohol dependent patients (n=189) were recruited from an inpatient detoxification clinic. Psychiatric diagnoses and personality traits were assessed using the Mini International Neuropsychiatric Interview for psychiatric disorders and the Temperament and Character Inventory. The addiction severity index was used to assess addiction severity and follow-up. RESULTS One year after detoxification, 81 patients (53%) relapsed and nine patients (7%) were deceased, due to alcohol related causes. Co-morbid anxiety disorder, marital status, addiction severity, in particular legal problems, and harm avoidance predicted relapse. Anxiety disorders specifically predicted early relapse. CONCLUSION Alcohol dependence is a severe mental disorder, with high relapse rates and high mortality. Alcohol dependent patients with co-morbid anxiety disorders are particularly prone to relapse during the first three months of treatment. These patients may therefore require additional medical and psychological attention.
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Affiliation(s)
- A F A Schellekens
- Radboud Medical Centre Nijmegen, Department of Psychiatry, 966, PO Box 9101, Reinier Postlaan 10, 6500 HB, Nijmegen, The Netherlands; Nijmegen Institute for Science Practitioners in Addiction (NISPA).
| | - C A J de Jong
- Nijmegen Institute for Science Practitioners in Addiction (NISPA)
| | - J K Buitelaar
- Radboud Medical Centre Nijmegen, Department of Psychiatry, 966, PO Box 9101, Reinier Postlaan 10, 6500 HB, Nijmegen, The Netherlands
| | - R J Verkes
- Department of Cognitive Neuroscience, University Medical Centre
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Carpentier PJ, Arias Vasquez A, Hoogman M, Onnink M, Kan CC, Kooij JJS, Makkinje R, Iskandar S, Kiemeney LA, de Jong CAJ, Franke B, Buitelaar JK. Shared and unique genetic contributions to attention deficit/hyperactivity disorder and substance use disorders: a pilot study of six candidate genes. Eur Neuropsychopharmacol 2013; 23:448-57. [PMID: 22841130 DOI: 10.1016/j.euroneuro.2012.07.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 06/01/2012] [Accepted: 07/09/2012] [Indexed: 11/16/2022]
Abstract
The shared genetic basis of attention deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) was explored by investigating the association of candidate risk factors in neurotransmitter genes with both disorders. One hundred seven methadone maintenance treatment patients, 36 having an ADHD diagnosis, 176 adult patients with ADHD without SUDs, and 500 healthy controls were genotyped for variants in the DRD4 (exon 3 VNTR), DRD5 (upstream VNTR), HTR1B (rs6296), DBH (rs2519152), COMT (rs4680; Val158Met), and OPRM1 (rs1799971; 118A>G) genes. Association with disease was tested using logistic regression models. This pilot study was adequately powered to detect larger genetic effects (OR≥2) of risk alleles with a low frequency. Compared to controls, ADHD patients (with and without SUDs) showed significantly increased frequency of the DBH (rs2519152: OR 1.73; CI 1.15-2.59; P=0.008) and the OPRM1 risk genotypes (rs1799971: OR 1.71; CI 1.17-2.50; P=0.006). The DBH risk genotype was associated with ADHD diagnosis, with the association strongest in the pure ADHD group. The OPRM1 risk genotype increased the risk for the combined ADHD and SUD phenotype. The present study strengthens the evidence for a shared genetic basis for ADHD and addiction. The association of OPRM1 with the ADHD and SUD combination could help to explain the contradictory results of previous studies. The power limitations of the study restrict the significance of these findings: replication in larger samples is warranted.
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Affiliation(s)
- P J Carpentier
- Novadic-Kentron, Network for Addiction Treatment Services, Vught, The Netherlands; Reinier van Arkel groep, 's-Hertogenbosch, The Netherlands.
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de Weert-van Oene GH, Schellekens AFA, Dijkstra BAG, Kamal R, de Jong CAJ. [Detoxification of patients with GHB dependence]. Tijdschr Psychiatr 2013; 55:885-890. [PMID: 24242149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND A new detoxification method for GHB dependence was developed recently in the Netherlands. The method involves the use of pharmaceutical GHB. AIM To describe the characteristics of GHB dependent inpatients, the course of the detoxification process and patients' progress in the three months following inpatient detoxification. METHOD 229 GHB dependent patients were monitored during and after inpatient detoxification. Records were kept of the psychiatric symptoms, withdrawal symptoms and relapses. RESULTS The average age of the patients was 29 years; 69% of the patients were male. They reported severe symptoms of co-occurring depression and anxiety. Detoxification was successful in 86% of the patients and, on a whole, the procedure ran smoothly, without complications. However, within three months following detoxification two-thirds of the patients had relapsed and were again taking GHB. CONCLUSION Pharmaceutical GHB can be used as an alternative to the benzodiazepine method for detoxifying patients with GHB dependence. However, the high relapse rates following detoxification are of great concern.
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Joosten EAG, de Jong CAJ, de Weert-van Oene GH, Sensky T, van der Staak CPF. Shared decision-making reduces drug use and psychiatric severity in substance-dependent patients. Psychother Psychosom 2009; 78:245-53. [PMID: 19468259 DOI: 10.1159/000219524] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 09/29/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the last decades, shared decision-making (SDM) models have been developed to increase patient involvement in treatment decisions. The purpose of this study was to evaluate a SDM intervention (SDMI) for patients dependent on psychoactive substances in addiction health care programs. The intervention consisted of a structured procedure to reach a treatment agreement and comprised 5 sessions. METHODS Clinicians in 3 treatment centres in the Netherlands were randomly assigned to the SDMI or a standard procedure to reach a treatment agreement. RESULTS A total of 220 substance-dependent patients receiving inpatient treatment were randomised either to the intervention (n = 111) or control (n = 109) conditions. Reductions in primary substance use (F((1, 124)) = 248.38, p < 0.01) and addiction severity (F((8)) = 27.76, p < 0.01) were found in the total population. Significant change was found in the total population regarding patients' quality of life measured at baseline, exit and follow-up (F((2, 146)) = 5.66, p < 0.01). On the European Addiction Severity Index, SDMI showed significantly better improvements than standard decision-making regarding drug use (F((1, 164)) = 7.40, p < 0.01) and psychiatric problems (F((1, 164)) = 5.91, p = 0.02) at 3-month follow-up. CONCLUSION SDMI showed a significant add-on effect on top of a well-established 3-month inpatient intervention. SDMI offers an effective, structured, frequent and well-balanced intervention to carry out and evaluate a treatment agreement.
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Affiliation(s)
- E A G Joosten
- Novadic-Kentron, Network for Addiction Treatment Services, Vught, The Netherlands.
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Iskandar S, van Crevel R, Siregar IMP, Achmad TH, van der Ven AJAM, de Jong CAJ. Prevention and treatment of HIV addicted patients: a biopsychosocial approach. Acta Med Indones 2009; 41 Suppl 1:38-44. [PMID: 19920297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Injecting drug use is the main route of HIV transmission in many parts of Indonesia. Efforts to prevent HIV-transmission through injecting drug use mostly focus on subjects who actively inject. In scientific publications, the term 'injecting drug users' tends to be used without a clear definition and without specifying the pattern of drug use as current or former drug use, frequency, duration, type of injected drug(s) or context (e.g. imprisonment). Actually, injecting drug users (IDUs) have different drug use patterns, risk behavior, somatic co-morbidity, psychiatric co-morbidity, and psychosocial problems. In fact, these patients are suffering from addiction as a chronic brain disease in co-occurrence with somatic and psychiatric disorder and many social problems. Failing in addressing the problems comprehensively will lead to the failure of drug treatment. This is why addiction can be best studied and treated from a biopsychosocial perspective. Accordingly, treatment goals can be differentiated in crisis intervention, cure or recovery (detoxification, relapse prevention), and care or partial remission (stabilization and harm reduction). In summary, injecting drug use in Indonesia is not a single entity and patient oriented prevention and care for IDUs, especially focusing on their addiction, should be addressed to prevent the transmission of HIV/AIDS.
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Affiliation(s)
- Shelly Iskandar
- Department of Psychiatric, Faculty of Medicine, Padjajaran University/Hasan Sadikin Hospital. Jl. Pasirkaliki no. 190, Bandung 40151, Indonesia.
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Joosten EAG, DeFuentes-Merillas L, de Weert GH, Sensky T, van der Staak CPF, de Jong CAJ. Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychother Psychosom 2008; 77:219-26. [PMID: 18418028 DOI: 10.1159/000126073] [Citation(s) in RCA: 654] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In the last decade, the clinician-patient relationship has become more of a partnership. There is growing interest in shared decision-making (SDM) in which the clinician and patient go through all phases of the decision-making process together, share treatment preferences, and reach an agreement on treatment choice. The purpose of this review is to determine the extent, quality, and consistency of the evidence about the effectiveness of SDM. METHOD This is a systematic review of randomised controlled trials (RCTs) comparing SDM interventions with non-SDM interventions. Eleven RCTs met the required criteria, and were included in this review. RESULTS The methodological quality of the studies included in this review was high overall. Five RCTs showed no difference between SDM and control, one RCT showed no short-term effects but showed positive longer-term effects, and five RCTs reported a positive effect of SDM on outcome measures. The two studies included of people with mental healthcare problems reported a positive effect of SDM. CONCLUSIONS Despite the considerable interest in applying SDM clinically, little research regarding its effectiveness has been done to date. It has been argued that SDM is particularly suitable for long-term decisions, especially in the context of a chronic illness, and when the intervention contains more than one session. Our results show that under such circumstances, SDM can be an effective method of reaching a treatment agreement. Evidence for the effectiveness of SDM in the context of other types of decisions, or in general, is still inconclusive. Future studies of SDM should probably focus on long-term decisions.
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Affiliation(s)
- E A G Joosten
- Novadic-Kentron, Network for Addiction Treatment Services, St-Oedenrode, The Netherlands.
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Dumont GJH, Wezenberg E, Valkenberg MMGJ, de Jong CAJ, Buitelaar JK, van Gerven JMA, Verkes RJ. Acute neuropsychological effects of MDMA and ethanol (co-)administration in healthy volunteers. Psychopharmacology (Berl) 2008; 197:465-74. [PMID: 18305926 PMCID: PMC2270918 DOI: 10.1007/s00213-007-1056-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 12/19/2007] [Indexed: 10/27/2022]
Abstract
RATIONALE In Western societies, a considerable percentage of young people expose themselves to 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy"). Commonly, ecstasy is used in combination with other substances, in particular alcohol (ethanol). MDMA induces both arousing as well as hallucinogenic effects, whereas ethanol is a general central nervous system depressant. OBJECTIVE The aim of the present study is to assess the acute effects of single and co-administration of MDMA and ethanol on executive, memory, psychomotor, visuomotor, visuospatial and attention function, as well as on subjective experience. MATERIALS AND METHODS We performed a four-way, double-blind, randomised, crossover, placebo-controlled study in 16 healthy volunteers (nine male, seven female) between the ages of 18-29. MDMA was given orally (100 mg) and blood alcohol concentration was maintained at 0.6 per thousand by an ethanol infusion regime. RESULTS Co-administration of MDMA and ethanol was well tolerated and did not show greater impairment of performance compared to the single-drug conditions. Impaired memory function was consistently observed after all drug conditions, whereas impairment of psychomotor function and attention was less consistent across drug conditions. CONCLUSIONS Co-administration of MDMA and ethanol did not exacerbate the effects of either drug alone. Although the impairment of performance by all drug conditions was relatively moderate, all induced significant impairment of cognitive function.
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Affiliation(s)
- G. J. H. Dumont
- Unit for Clinical Psychopharmacology and Neuropsychiatry (UCPN), Department of Psychiatry, University Medical Centre St Radboud, Nijmegen, The Netherlands ,University Medical Centre Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - E. Wezenberg
- Unit for Clinical Psychopharmacology and Neuropsychiatry (UCPN), Department of Psychiatry, University Medical Centre St Radboud, Nijmegen, The Netherlands
| | - M. M. G. J. Valkenberg
- Unit for Clinical Psychopharmacology and Neuropsychiatry (UCPN), Department of Psychiatry, University Medical Centre St Radboud, Nijmegen, The Netherlands
| | - C. A. J. de Jong
- Nijmegen Institute for Science Practitioners in Addiction, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - J. K. Buitelaar
- Unit for Clinical Psychopharmacology and Neuropsychiatry (UCPN), Department of Psychiatry, University Medical Centre St Radboud, Nijmegen, The Netherlands
| | | | - R. J. Verkes
- Unit for Clinical Psychopharmacology and Neuropsychiatry (UCPN), Department of Psychiatry, University Medical Centre St Radboud, Nijmegen, The Netherlands
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Abstract
In this study, we examined the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) profiles of 324 Dutch patients with eating disorders at an eating disorder day treatment program. We studied the MMPI-2 profiles in 5 diagnostic eating disorder groups. All diagnostic subgroups showed high mean elevations of the T scores on the same 6 or 7 scales. Remarkable similarities existed between the mean profile configurations. The MMPI-2 distinguished especially in that patients with restricting anorexia nervosa scored lower on one Validity scale (F), two Clinical scales (1 and 2) and several Supplementary and Content scales of the MMPI-2 compared to the other groups. Only on the validity Scale L did they score higher. The MMPI-2 also distinguished patients with the bulimia nervosa purging type who scored higher on Scale 9 and different on several Content and Supplementary scales. We discuss results with regard to other studies of MMPI (Hathaway & McKinley, 1983) and MMPI-2 profiles of women with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified in inpatient and outpatient settings.
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Affiliation(s)
- Cecile C Exterkate
- Amarum, Specialist Centre for Eating Disorders, Zutphen, The Netherlands.
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Abstract
This paper focuses on exploring the association between the patient's perception of his own interpersonal behaviour on the one hand, and that of the therapist's behaviour and of helping alliance on the other hand. A cross-sectional study was conducted, including 83 patients from substance dependence programs in The Netherlands. They completed the Helping Alliance Questionnaire (HAQ) and the Interpersonal Check List (ICL). Results indicate that the patient's perception of the therapeutic alliance, and his perception of his own and of the therapist's interpersonal behaviour are three separate domains, each playing their role in the context of the therapeutic relationship. Helping Alliance scores are predicted by both the patient's (complaisance) and the therapist's interpersonal behaviour (dominance). We conclude that patient's cognitions about himself and about his therapist do contribute significantly to the perception of the therapeutic relationship. Limitations to the study are discussed, as well as some clinical implications.
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Affiliation(s)
- G H De Weert-Van Oene
- Julius Center for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands.
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Verbon H, de Jong CAJ. [Psychosis during and after disulfiram use]. Ned Tijdschr Geneeskd 2002; 146:571-3. [PMID: 11938582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
A 47-year-old man was registered for treatment of his alcohol abuse problem. Disulfiram was administered as part of the treatment, the intake of which was supervised by his wife. During the treatment with disulfiram and two weeks after the withdrawal of this treatment he developed a psychosis. He stated that he had not taken alcohol. During the second psychotic period he was successfully treated with antipsychotic drugs. Afterwards it was discovered that his family history was positive for schizophrenia; it is therefore possible that the patient was more vulnerable for a psychosis due to disulfiram use. Although a psychotic reaction during and after disulfiram therapy is not common, it should nonetheless be taken into consideration when prescribing the drug.
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Affiliation(s)
- H Verbon
- Novadic, Netwerk voor verslavingszorg, Schijndelseweg 46, 5491 TB Sint-Oedenrode
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