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Heijerman-Holtgrefe AP, Huyser C, Bus M, Beljaars LPL, van de Griendt JMTM, Verdellen CWJ, Kan KJ, Zijlstra BJH, Lindauer RJL, Cath DC, Hoekstra PJ, Utens EMWJ. Tackle your Tics, a brief intensive group-based exposure treatment for young people with tics: results of a randomised controlled trial. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02410-0. [PMID: 38575665 DOI: 10.1007/s00787-024-02410-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 03/01/2024] [Indexed: 04/06/2024]
Abstract
Tics can have a serious impact on the quality of life of children and their families. Behavioural therapy is an evidence-based first line treatment for tic disorders. This randomised controlled trial studied the efficacy of a brief, condensed group-based programme for children with tics (Dutch Trial Registry NL8052, 27 September 2019). Tackle your Tics is a four-day group treatment, including exposure and response prevention and supporting components, delivered by therapists and 'experts by experience'. We collected outcome measures at baseline (T1), directly post-treatment (T2), and at three- and 6-months follow-up (T3, T4) including tic severity (primary outcome measure), tic-related impairment, quality of life, tic-related cognitions, emotional/behavioural functioning, family functioning, treatment satisfaction and adherence. Outcomes directly post-treatment improved in both the treatment group (n = 52) and waiting list (n = 54), but showed no statistically significant differences between the conditions (differential change over time T1-T2) on tic severity (Yale Global Tic Severity Scale), quality of life (Gilles de la Tourette Syndrome Quality of Life Scale), tic-related cognitions and family functioning. At longer term (T3), again no between-group difference was found on tic severity, but tic-related impairment, quality of life and emotional/behavioural functioning significantly improved in the treatment group compared to the waiting list. Mean treatment satisfaction scores were favourable for both children and parents. Directly posttreatment, Tackle your Tics showed no superior effect compared to waiting list. However, on longer term this brief four-day group treatment was effective in improving tic-related impairment, quality of life and emotional/behavioural functioning.
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Affiliation(s)
- A P Heijerman-Holtgrefe
- Academic Center for Child and Adolescent Psychiatry, Levvel, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Dutch Tourette Association, Haarlem, The Netherlands
| | - C Huyser
- Academic Center for Child and Adolescent Psychiatry, Levvel, Amsterdam, The Netherlands
| | - M Bus
- Academic Center for Child and Adolescent Psychiatry, Levvel, Amsterdam, The Netherlands
| | - L P L Beljaars
- Academic Center for Child and Adolescent Psychiatry, Levvel, Amsterdam, The Netherlands
- Dutch Tourette Association, Haarlem, The Netherlands
- Expertisecentrum Valora, Veldhoven, The Netherlands
| | | | - C W J Verdellen
- TicXperts, Heteren, The Netherlands
- PsyQ Nijmegen/Parnassia Group, Nijmegen, The Netherlands
| | - K J Kan
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - B J H Zijlstra
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - R J L Lindauer
- Academic Center for Child and Adolescent Psychiatry, Levvel, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - D C Cath
- Department of Specialized Training, GGZ Drenthe, Assen, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P J Hoekstra
- Department of Child and Adolescent Psychiatry and Accare Child Study Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E M W J Utens
- Academic Center for Child and Adolescent Psychiatry, Levvel, Amsterdam, The Netherlands.
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
- Department of Emotional Disorders, Levvel, Meibergdreef 5, Amsterdam, The Netherlands.
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2
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Kwee CMB, van der Flier FE, Duits P, van Balkom AJLM, Cath DC, Baas JMP. Effects of cannabidiol on fear conditioning in anxiety disorders: decreased threat expectation during retention, but no enhanced fear re-extinction. Psychopharmacology (Berl) 2024; 241:833-847. [PMID: 38044339 DOI: 10.1007/s00213-023-06512-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/10/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
RATIONALE Preclinical research suggests that pharmacologically elevating cannabinoid levels may attenuate fear memory expression and enhance fear extinction. OBJECTIVES We studied the effects of cannabidiol (CBD) on fear memory expression and fear re-extinction in 69 patients with panic disorder with agoraphobia or with social anxiety disorder. Moderation by sex, diagnosis, and serotonergic antidepressant (AD) use was explored. METHODS A cued fear conditioning paradigm was applied before the first treatment session with 300 mg CBD/placebo augmented exposure therapy. Study medication was administered orally preceding 8 weekly sessions. Fear acquisition and suboptimal extinction took place prior to the first medication ingestion (T0). After the first medication ingestion (T1), we investigated effects on fear memory expression at retention and fear re-extinction. Subjective fear, shock expectancy, skin conductance, and startle responses to conditioned (CS+) and safety stimulus (CS-) were measured. RESULTS Across the sample, CBD reduced shock expectancy at retention under low and ambiguous threat of shock, but fear re-extinction at T1 was unaffected by CBD. However, in AD users, re-extinction of subjective fear was impaired in the CBD condition compared to placebo. In female AD users, CBD interfered with safety learning measured with fear-potentiated startle. CONCLUSIONS The current findings provide no evidence for enhanced fear re-extinction by CBD. However, CBD acutely decreased threat expectation at retention, without affecting other indices of fear. More studies are needed to elucidate possible interactions with AD use and sex, as well as potential effects of CBD on threat expectancies.
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Affiliation(s)
- C M B Kwee
- Department of Experimental Psychology and Helmholtz Institute, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands.
- Altrecht Academic Anxiety Center, Utrecht, The Netherlands.
| | - F E van der Flier
- Department of Experimental Psychology and Helmholtz Institute, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
| | - P Duits
- Altrecht Academic Anxiety Center, Utrecht, The Netherlands
| | - A J L M van Balkom
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Centre and GGZ inGeest, Amsterdam, the Netherlands
| | - D C Cath
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Specialist Trainings, GGZ Drenthe, Assen, The Netherlands
| | - J M P Baas
- Department of Experimental Psychology and Helmholtz Institute, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
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3
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van de Griendt JMTM, van den Berg NME, Verdellen CWJ, Cath DC, Verbraak MJPM. Working Mechanisms of Exposure and Response Prevention in the Treatment of Tourette Syndrome and Tic Disorders Revisited: No Evidence for within-Session Habituation to Premonitory Urges. J Clin Med 2023; 12:7087. [PMID: 38002700 PMCID: PMC10672020 DOI: 10.3390/jcm12227087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/29/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Exposure and response prevention (ERP) has been shown to be an effective treatment for Tourette syndrome (TS) and chronic tic disorders (CTD). ERP is based on voluntary tic suppression in combination with prolonged exposure to premonitory urges preceding tics. A prevailing hypothesis of the working mechanism underlying ERP in tics is habituation to the premonitory urges as a result of prolonged exposure. However, results so far are equivocal. This study aims to further explore the relation between urges and ERP in tics, by investigating the course of premonitory urges during ERP sessions. METHODS Using a data-driven approach, within-session habituation to premonitory urge intensity was investigated. In total, 29 TS patients rated urge intensity at seven timepoints during ten 1 h ERP sessions. RESULTS/CONCLUSIONS Latent growth modeling showed an increase in urge intensity during the first 15 min of each session followed by a plateau in the remaining 45 min of the session. This does not support the idea of within-session habituation to premonitory urges as a working mechanism of ERP. Other potential underlying working mechanisms are discussed and should be tested in future research.
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Affiliation(s)
| | - Nelleke M. E. van den Berg
- Department of Psychology, Erasmus University Rotterdam, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands;
| | - Cara W. J. Verdellen
- PsyQ Nijmegen, Parnassia Group, Sint Annastraat 263, 6525 GR Nijmegen, The Netherlands;
| | - Daniëlle C. Cath
- Department of Psychiatry, University Medical Center Groningen, Rijksuniversiteit Groningen, 9700 AD Groningen, The Netherlands;
- GGZ Drenthe, Dennenweg 9, 9404 LA Assen, The Netherlands
| | - Marc J. P. M. Verbraak
- Behavioural Science Institute, Radboud University Nijmegen, Thomas van Aquinostraat 4, 6525 GD Nijmegen, The Netherlands;
- Pro Persona, Wolfheze 2, 6874 BE Wolfheze, The Netherlands
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4
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Groen SPN, Menninga MC, Cath DC, Smid GE. Let's talk about grief: Protocol of a study on the recognition and psychoeducation of prolonged grief disorder in outpatients with common mental disorders. Front Psychiatry 2022; 13:944233. [PMID: 36159934 PMCID: PMC9492871 DOI: 10.3389/fpsyt.2022.944233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/14/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recognition that the loss of a loved one may result in prolonged grief disorder (PGD) has gained broad attention recently. PGD may disturb daily functioning to such a degree that mental health treatment is required. Because PGD symptoms often resemble symptoms of common mental disorders (CMD) such as anxiety, depressive, and post-traumatic stress disorder, clinicians may not consider a PGD diagnosis. Moreover, cultural varieties in expression of PGD may complicate recognition. This study explores the prevalence of PGD among both natives and refugees with anxiety, depressive, or trauma- and/or stressor-related disorders as well as clinicians' awareness and knowledge of PGD symptoms. In addition, a psychoeducation module on PGD symptoms is developed through patient expert collaboration. METHODS Prevalence of PGD symptoms is investigated among 50 participants who are referred to outpatient clinics for anxiety, depression, or post-traumatic stress, using the Traumatic Grief Inventory-Self Report Plus (TGI-SR+) and the Bereavement and Grief-Cultural Formulation Interview (BG-CFI). Clinicians will be interviewed on knowledge (gaps) with respect to PGD symptoms. Finally, focus groups with patient experts are held to develop a psychoeducation module tailored to the patients' needs, norms and values. RESULTS This study will show prevalence of PGD among patients who are referred for anxiety, depression, and post-traumatic stress, awareness and knowledge of clinicians on PGD symptoms, and will offer patient expert informed psychoeducation. DISCUSSION Research on prevalence and recognition of PGD is vital. Study results of the prevalence of PGD will be compared to previous studies. Recognition of PGD as distinct disorder from CMDs requires clinicians' awareness of symptoms related to the loss of a loved one. Thereby, clinicians need to take cultural aspects related to death, bereavement and mourning into consideration. ETHICS AND DISSEMINATION The study protocol will be carried out in accordance with relevant guidelines and regulations. Exploratory research to assess the prevalence of PGD in patients suffering from CMDs will facilitate adequate diagnosis by increasing clinician's awareness of PGD symptoms. Tailored PGD psychoeducation, co-created by culturally diverse patient experts and clinicians will be made publicly available.
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Affiliation(s)
- Simon P N Groen
- De Evenaar Center for Transcultural Psychiatry Drenthe Mental Health Care, Beilen, Netherlands
| | - Marijke C Menninga
- De Evenaar Center for Transcultural Psychiatry Drenthe Mental Health Care, Beilen, Netherlands
| | - Daniëlle C Cath
- Department of Psychiatry, University Medical Center Groningen, Rob Giel Onderzoekscentrum, Groningen, Netherlands.,Drenthe Mental Health Care, Assen, Netherlands.,Department of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Geert E Smid
- Department of Humanist Chaplaincy Studies, University of Humanistic Studies, Utrecht, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands
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van Krugten FCW, Kaddouri M, Goorden M, van Balkom AJLM, Berretty EW, Cath DC, Hendriks GJ, Matthijssen SJMA, Visser HAD, van Vliet IM, Brouwer WBF, Hakkaart-van Roijen L. Development and psychometric evaluation of the Decision Tool Anxiety Disorders, OCD and PTSD (DTAOP): Facilitating the early detection of patients in need of highly specialized care. PLoS One 2021; 16:e0256384. [PMID: 34411200 PMCID: PMC8375980 DOI: 10.1371/journal.pone.0256384] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 08/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background Early identification of patients with an anxiety disorder, obsessive-compulsive disorder (OCD), or post-traumatic stress disorder (PTSD) in need of highly specialized care could facilitate the selection of the optimal initial treatment in these patients. This paper describes the development and psychometric evaluation of the Decision Tool Anxiety Disorders, OCD and PTSD (DTAOP), which aims to aid clinicians in the early identification of patients with an anxiety disorder, OCD, or PTSD in need of highly specialized mental healthcare. Methods A systematic literature review and a concept mapping procedure were carried out to inform the development of the DTAOP. To evaluate the psychometric properties of the DTAOP, a cross-sectional study in 454 patients with a DSM-IV-TR anxiety disorder was carried out. Feasibility was evaluated by the completion time and the content clarity of the DTAOP. Inter-rater reliability was assessed in a subsample of 87 patients. Spearman’s rank correlation coefficients between the DTAOP and EuroQol five-dimensional questionnaire (EQ-5D-5L) scores were computed to examine the convergent validity. Criterion validity was assessed against independent clinical judgments made by clinicians. Results The average time required to complete the eight-item DTAOP was 4.6 min and the total DTAOP was evaluated as clear in the majority (93%) of the evaluations. Krippendorff’s alpha estimates ranged from 0.427 to 0.839. Based on the qualitative feedback, item wording and instructions were improved. As hypothesized, the DTAOP correlated negatively with EQ-5D-5L scores. The area under the curve was 0.826 and the cut-off score of ≥4 optimized sensitivity (70%) and specificity (71%). Conclusions The DTAOP demonstrated excellent feasibility and good validity, but weak inter-rater reliability. Based on the qualitative feedback and reliability estimates, revisions and refinements of the wording and instructions were made, resulting in the final version of the DTAOP.
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Affiliation(s)
| | - Meriam Kaddouri
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maartje Goorden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anton J. L. M. van Balkom
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Academic Outpatient Clinic for Anxiety Disorders GGZ InGeest, Amsterdam, The Netherlands
| | - Ed W. Berretty
- Outpatient Clinic for Anxiety Disorders PsyQ, The Hague, The Netherlands
| | - Daniëlle C. Cath
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
- GGZ Drenthe Mental Health Institute, Assen, The Netherlands
| | - Gert-Jan Hendriks
- Overwaal, Center of Expertise for Anxiety, OCD, and PTSD, Institute for Integrated Mental Health Care Pro Persona, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suzy J. M. A. Matthijssen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Altrecht Academic Anxiety Center, Altrecht GGZ, Utrecht, The Netherlands
- RINO Groep, Utrecht, The Netherlands
| | - Henny A. D. Visser
- Marina de Wolfcentrum, Mental Health Care Institute GGZ Centraal, Ermelo, The Netherlands
| | - Irene M. van Vliet
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Werner B. F. Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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6
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van Passel B, Danner UN, Dingemans AE, Aarts E, Sternheim LC, Becker ES, van Elburg AA, van Furth EF, Hendriks GJ, Cath DC. Cognitive Remediation Therapy Does Not Enhance Treatment Effect in Obsessive-Compulsive Disorder and Anorexia Nervosa: A Randomized Controlled Trial. Psychother Psychosom 2021; 89:228-241. [PMID: 32074624 DOI: 10.1159/000505733] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Guideline-recommended therapies are moderately successful in the treatment of obsessive-compulsive disorder (OCD) and anorexia nervosa (AN), leaving room for improvement. Cognitive inflexibility, a common trait in both disorders, is likely to prevent patients from engaging in treatment and from fully benefiting from existing therapies. Cognitive remediation therapy (CRT) is a practical augmentation intervention aimed at ameliorating this impairing cognitive style prior to disorder-specific therapy. OBJECTIVE To compare the effectiveness of CRT and a control treatment that was not aimed at enhancing flexibility, named specialized attention therapy (SAT), as add-ons to treatment as usual (TAU). METHODS In a randomized controlled multicenter clinical trial, 71 adult patients with OCD and 61 with AN were randomized to ten twice-weekly sessions with either CRT or SAT, followed by TAU. Patients were evaluated at baseline, post-CRT/SAT, and after 6 and 12 months, with outcomes being quantified using the Yale-Brown Obsessive Compulsive Scale for OCD and the Eating Disorder Examination Questionnaire for AN. RESULTS Across study groups, most importantly CRT+TAU was not superior to control treatment (SAT)+TAU in reducing OCD and AN pathology. Contrary to expectations, SAT+TAU may have been more effective than CRT+TAU in patients being treated for OCD. CONCLUSIONS CRT did not enhance the effect of TAU for OCD and AN more than SAT. Unexpectedly, SAT, the control condition, may have had an augmentation effect on TAU in OCD patients. Although this latter finding may have been due to chance, the effect of SAT delivered as a pretreatment add-on intervention for adults with OCD and AN merits future efforts at replication.
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Affiliation(s)
- Boris van Passel
- Overwaal Center for Anxiety Disorders, OCD, and PTSD, Pro Persona Institute for Integrated Mental Health Care, Nijmegen, The Netherlands, .,Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands,
| | - Unna N Danner
- Altrecht Eating Disorders Rintveld, Zeist, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Alexandra E Dingemans
- Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands.,Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Emmeke Aarts
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | - Lot C Sternheim
- Altrecht Eating Disorders Rintveld, Zeist, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Eni S Becker
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Annemarie A van Elburg
- Altrecht Eating Disorders Rintveld, Zeist, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Eric F van Furth
- Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Gert-Jan Hendriks
- Overwaal Center for Anxiety Disorders, OCD, and PTSD, Pro Persona Institute for Integrated Mental Health Care, Nijmegen, The Netherlands.,Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands.,Radboud University Medical Center, Department of Psychiatry, Radboud University, Nijmegen, The Netherlands
| | - Daniëlle C Cath
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands.,Altrecht Academic Anxiety Center, Utrecht, The Netherlands.,GGz Drenthe, Department of Specialist Training, Rijksuniversiteit Groningen and University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
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7
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Quadackers DMC, Doornbos B, Cath DC. [Visual hallucinations, misidentification and reduplication of time: a sense of distorted reality due to a cerebral metastasis]. Tijdschr Psychiatr 2020; 62:1073-1079. [PMID: 33443761] [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: 06/12/2023]
Abstract
We describe a 66-year-old female patient with no prior psychiatric history who presented with an unusual psychotic state, largely in accordance with Fregoli syndrome (misidentification of people). Further, the patient suffered from reduplication of time, scenic hallucinations and psychotic perceptions. Symptoms were the result of a brain metastasis originating from a lung carcinoma. We describe the performed (additional) diagnostics and discuss how to differentiate between organic and functional psychosis, as well as the given psychiatric treatment. Finally, potential pathophysiological explanations are discussed that might explain the (reduction of) symptoms in the patient.
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Simoons M, Ruhé HG, van Roon EN, Schoevers RA, Bruggeman R, Cath DC, Muis D, Arends J, Doornbos B, Mulder H. Design and methods of the 'monitoring outcomes of psychiatric pharmacotherapy' (MOPHAR) monitoring program - a study protocol. BMC Health Serv Res 2019; 19:125. [PMID: 30764821 PMCID: PMC6376699 DOI: 10.1186/s12913-019-3951-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 02/07/2019] [Indexed: 11/20/2022] Open
Abstract
Background At many outpatient departments for psychiatry worldwide, standardized monitoring of the safety of prescribed psychotropic drugs is not routinely performed in daily clinical practice. Therefore it is unclear to which extent the drugs used by psychiatric outpatients are prescribed effectively and safely. These issues warrant structured monitoring of medication use, (pre-existing) co-morbidities, effectiveness and side effects during psychiatric outpatient treatment. Improvement of monitoring practices provides an opportunity to ensure that somatic complications and adverse drug effects are detected and dealt with in a timely manner. Structural support for data collection and follow-up tests seems essential for improvement of monitoring practices in psychiatric outpatients. The implementation of a structured somatic monitoring program as part of routine clinical practice, as we describe in this study protocol, may be a solution. Methods In order to address these issues, we developed the innovative program ‘Monitoring Outcomes of Psychiatric Pharmacotherapy (MOPHAR)’. MOPHAR is an infrastructure for implementation of standardized routine outcome monitoring (ROM; including standardized monitoring of treatment effect), monitoring of adverse psychotropic medication effects in psychiatric outpatients, encompassing both somatic adverse effects (e.g. metabolic disturbances) and subjective adverse effects (e.g. sedation or sexual side effects) and medication reconciliation. Discussion In the MOPHAR monitoring program, a nurse performs general and psychotropic drug-specific somatic screenings and provides the treating mental health care providers with more and better information on somatic monitoring for treatment decisions. Given our experience regarding implementation of the MOPHAR program, we expect that the MOPHAR program is feasible and beneficial for patients in any MHS organisation. This paper describes the objectives, target population, setting and the composition and roles of the treatment team. It also indicates what measurements are performed at which time points during outpatient treatment in the MOPHAR monitoring program, as well as the research aspects of this project. Trial registration MOPHAR research has been prospectively registered with the Netherlands Trial Register on 19th of November 2014. (NL4779). Electronic supplementary material The online version of this article (10.1186/s12913-019-3951-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mirjam Simoons
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands.,Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Pharmacy, Unit of Pharmacotherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Henricus G Ruhé
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
| | - Eric N van Roon
- Department of Pharmacy, Unit of Pharmacotherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands. .,Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, PO Box 888, 8901, BR, Leeuwarden, The Netherlands.
| | - Robert A Schoevers
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Centre, University of Groningen, University Medical Centre Groningen, University Centre for Psychiatry, Groningen, The Netherlands
| | - Daniëlle C Cath
- Department of Specialized Training, Psychiatric Hospital MHS Drenthe, Outpatient Clinics, Assen, The Netherlands
| | - Diny Muis
- Department of Specialized Training, Psychiatric Hospital MHS Drenthe, Outpatient Clinics, Assen, The Netherlands
| | - Johan Arends
- Department of Specialized Training, Psychiatric Hospital MHS Drenthe, Outpatient Clinics, Assen, The Netherlands
| | - Bennard Doornbos
- Department of Specialized Training, Psychiatric Hospital MHS Drenthe, Outpatient Clinics, Assen, The Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands.,Department of Specialized Training, Psychiatric Hospital MHS Drenthe, Outpatient Clinics, Assen, The Netherlands
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9
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Simoons M, Mulder H, Doornbos B, Raats PCC, Bruggeman R, Cath DC, Schoevers RA, Ruhé HG, van Roon EN. Metabolic Syndrome at an Outpatient Clinic for Bipolar Disorders: A Case for Systematic Somatic Monitoring. Psychiatr Serv 2019; 70:143-146. [PMID: 30526344 DOI: 10.1176/appi.ps.201800121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The primary objective of the study was to determine whether the Monitoring Outcomes of Psychiatric Pharmacotherapy (MOPHAR) program improved somatic monitoring practices at an outpatient clinic for bipolar disorders in the Netherlands. The secondary objective was to determine in MOPHAR the frequency of metabolic syndrome (compared with its measurability before MOPHAR) and treatment thereof. METHODS Frequencies of physical examinations and laboratory tests before (retrospectively) and after (prospectively) the active introduction of MOPHAR were compared among adult patients (N=155). RESULTS A median of three measurements (range 0-19) per patient were performed before MOPHAR, compared with 24 measurements (range 3-24) after MOPHAR (p<0.001). MOPHAR revealed somatic abnormalities previously unknown to treating physicians. Metabolic syndrome was present in 53% of patients; of these, 98% were not known to have metabolic syndrome before MOPHAR. CONCLUSIONS Introducing a monitoring program largely improved knowledge regarding metabolic abnormalities, which are frequently present among patients with bipolar disorder.
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Affiliation(s)
- Mirjam Simoons
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Bennard Doornbos
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Pascal C C Raats
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Richard Bruggeman
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Daniëlle C Cath
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Robert A Schoevers
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Henricus G Ruhé
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Eric N van Roon
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
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10
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van der Salm SMA, van der Meer JN, Cath DC, Groot PFC, van der Werf YD, Brouwers E, de Wit SJ, Coppens JC, Nederveen AJ, van Rootselaar AF, Tijssen MAJ. Distinctive tics suppression network in Gilles de la Tourette syndrome distinguished from suppression of natural urges using multimodal imaging. Neuroimage Clin 2018; 20:783-792. [PMID: 30268027 PMCID: PMC6169325 DOI: 10.1016/j.nicl.2018.09.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 08/19/2018] [Accepted: 09/16/2018] [Indexed: 02/07/2023]
Abstract
Background and objectives Gilles de la Tourette syndrome (GTS) is a neuropsychiatric disorder characterized by tics. A hallmark of GTS is the ability to voluntarily suppress tics. Our aim was to distinguish the neural circuits involved in the voluntary suppression of ocular tics in GTS patients from blink suppression in healthy subjects. Methods Fifteen GTS patients and 22 healthy control subjects were included in a multimodal study using eye-tracker recordings during functional MRI (fMRI). The ability to suppress tics/blinks was compared both on subjective (self-rating) and objective (eye-tracker) performance. For fMRI analysis we used a novel designed performance-adapted block design analysis of tic/blink suppression and release based on eye-tracker monitoring. Results We found that the subjective self-reported ability to suppress tics or blinks showed no significant correlation with objective task performance. In GTS during successful suppression of tics, the dorsal anterior cingulate cortex and associated limbic areas showed increased activation. During successful suppression of eye blinks in healthy subjects, the right ventrolateral prefrontal cortex and supplementary and cingulate motor areas showed increased activation. Conclusions These findings demonstrate that GTS patients use a characteristic limbic suppression strategy. In contrast, control subjects use the voluntary sensorimotor circuits and the classical ‘stop’ network to suppress natural urges. The employment of different neural suppression networks provides support for cognitive behavioral therapy in GTS. Neural networks of tic suppression are specific and differ from blink suppression. Tourette patients employ a limbic suppression strategy to suppress tics. Controls use sensorimotor circuits and ‘stop’ networks for blink suppression. Objective task performance is highly recommended during functional MRI of tics.
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Affiliation(s)
- Sandra M A van der Salm
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands; Stichting Epilepsie Instellingen Nederland (SEIN), Zwolle, the Netherlands
| | - Johan N van der Meer
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Daniëlle C Cath
- Department of Clinical & Health Psychology, University of Utrecht, GGz Drenthe, Department of Psychiatry, University Medical Center Groningen, the Netherlands
| | - Paul F C Groot
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ysbrand D van der Werf
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Eelke Brouwers
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Pediatrics/Child Neurology, Neuroscience Campus Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Stella J de Wit
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam and GGZ inGeest, Amsterdam, the Netherlands
| | - Joris C Coppens
- Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
| | - Aart J Nederveen
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anne-Fleur van Rootselaar
- Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; BIC: Brain Imaging Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marina A J Tijssen
- Department of Neurology, University Medical Centre Groningen, University of Groningen, the Netherlands.
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11
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Scholten WD, Batelaan NM, van Oppen P, Smit JH, Hoogendoorn AW, van Megen HJ, Cath DC, van Balkom AJ. The Efficacy of a Group CBT Relapse Prevention Program for Remitted Anxiety Disorder Patients Who Discontinue Antidepressant Medication: A Randomized Controlled Trial. Psychother Psychosom 2018; 87:240-242. [PMID: 29860251 PMCID: PMC6492611 DOI: 10.1159/000489498] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/23/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Willemijn D. Scholten
- Department of Psychiatry, GGZ ingest, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands,*Willemijn D. Scholten, Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, A.J. Ernststraat 1187, NL–1081 HL Amsterdam (The Netherlands), E-Mail
| | - Neeltje M. Batelaan
- Department of Psychiatry, GGZ ingest, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Patricia van Oppen
- Department of Psychiatry, GGZ ingest, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes H. Smit
- Department of Psychiatry, GGZ ingest, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Adriaan W. Hoogendoorn
- Department of Psychiatry, GGZ ingest, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Daniëlle C. Cath
- Altrecht Academic Anxiety Center, Utrecht, The Netherlands,GGZ Drenthe, Assen, The Netherlands,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands,Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Anton J.L.M. van Balkom
- Department of Psychiatry, GGZ ingest, Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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12
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van der Mheen M, Ter Mors LM, den Hout MAVAN, Cath DC. [Routine outcome monitoring in anxiety disorders: diagnosis-specific versus generic assessment instruments]. Tijdschr Psychiatr 2018; 60:11-19. [PMID: 29341052] [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: 06/07/2023]
Abstract
Mental health institutions increasingly utilise routine outcome monitoring (rom) in order to assess treatment effectiveness. It remains unclear which instruments are more sensitive to change with regard to rom in patients with an anxiety disorder: diagnosis-specific or generic instruments.<br/> AIM: To compare the sensitivity of diagnosis-specific versus generic rom-instruments in patients with an anxiety disorder.<br/> METHOD: 160 adults with an anxiety disorder received cognitive behavioural therapy at the Altrecht Academic Anxiety Centre. Approximately half of the population also received medication. Patients completed an assessment both before and after treatment. This consisted of two generic instruments (Outcome Questionnaire (oq-45) and Brief Symptom Inventory (bsi)) and two diagnosis-specific instruments, determined by the main diagnosis.<br/> RESULTS: The differences between pre- and post-treatment assessments were generally larger for the generic bsi and diagnosis-specific instruments than for the generic oq-45.<br/> CONCLUSION: When assessed after cognitive behavioural therapy, the (generic) bsi and diagnosis-specific instruments indicated larger progress than the oq-45. The bsi might be a relatively diagnosis-specific measure for anxiety disorders. when selecting an instrument for assessment, both the intended goal of treatment (symptom reduction or improvement in quality of life) and other reasons for assessment should be taken into consideration. The bsi or diagnosis-specific instruments are preferred if the goal is to assess the change in specific anxiety symptoms.
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13
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van der Salm SM, Cath DC, van Rootselaar AF, Koelman JH, de Haan RJ, Tijssen MA, Meynen G. Clinician and patient perceptions of free will in movement disorders: mind the gap. J Neurol Neurosurg Psychiatry 2017; 88:532-533. [PMID: 28285266 DOI: 10.1136/jnnp-2016-315152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/13/2017] [Accepted: 01/17/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Sandra Ma van der Salm
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Daniëlle C Cath
- Department of Clinical Psychology, University of Utrecht, Utrecht, The Netherlands.,GGZDrenthe, Department of Psychiatry, University Medical Center Groningen, The Netherlands
| | - Anne-Fleur van Rootselaar
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Johannes Htm Koelman
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Rob J de Haan
- Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands
| | - Marina Aj Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Gerben Meynen
- Department of Philosophy, Faculty of Humanities, VU University, Amsterdam, The Netherlands.,Department of Criminal Law, Tilburg Law School, Tilburg University, Tilburg, The Netherlands.,GGZ inGeest, Amsterdam, The Netherlands
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14
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Abstract
BACKGROUND Genetic-epidemiological studies that estimate the contributions of genetic factors to variation in tic symptoms are scarce. We estimated the extent to which genetic and environmental influences contribute to tics, employing various phenotypic definitions ranging between mild and severe symptomatology, in a large population-based adult twin-family sample. METHOD In an extended twin-family design, we analysed lifetime tic data reported by adult mono- and dizygotic twins (n = 8323) and their family members (n = 7164; parents and siblings) from 7311 families in the Netherlands Twin Register. We measured tics by the abbreviated version of the Schedule for Tourette and Other Behavioral Syndromes. Heritability was estimated by genetic structural equation modeling for four tic disorder definitions: three dichotomous and one trichotomous phenotype, characterized by increasingly strictly defined criteria. RESULTS Prevalence rates of the different tic disorders in our sample varied between 0.3 and 4.5% depending on tic disorder definition. Tic frequencies decreased with increasing age. Heritability estimates varied between 0.25 and 0.37, depending on phenotypic definitions. None of the phenotypes showed evidence of assortative mating, effects of shared environment or non-additive genetic effects. CONCLUSIONS Heritabilities of mild and severe tic phenotypes were estimated to be moderate. Overlapping confidence intervals of the heritability estimates suggest overlapping genetic liabilities between the various tic phenotypes. The most lenient phenotype (defined only by tic characteristics, excluding criteria B, C and D of DSM-IV) rendered sufficiently reliable heritability estimates. These findings have implications in phenotypic definitions for future genetic studies.
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Affiliation(s)
- N R Zilhão
- Department of Biological Psychology,Vrije Universiteit,Amsterdam,The Netherlands
| | - M C Olthof
- Department of Psychology,University of Amsterdam,The Netherlands
| | - D J A Smit
- Department of Biological Psychology,Vrije Universiteit,Amsterdam,The Netherlands
| | - D C Cath
- Department of Clinical Psychology,Utrecht University,The Netherlands
| | - L Ligthart
- Department of Biological Psychology,Vrije Universiteit,Amsterdam,The Netherlands
| | - C A Mathews
- Department of Psychiatry,University of Florida,Gainesville, FL,USA
| | - K Delucchi
- Department of Psychiatry,University of California,San Francisco, CA,USA
| | - D I Boomsma
- Department of Biological Psychology,Vrije Universiteit,Amsterdam,The Netherlands
| | - C V Dolan
- Department of Biological Psychology,Vrije Universiteit,Amsterdam,The Netherlands
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15
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van der Salm SMA, van Rootselaar AF, Cath DC, de Haan RJ, Koelman JHTM, Tijssen MAJ. Clinical decision-making in functional and hyperkinetic movement disorders. Neurology 2016; 88:118-123. [PMID: 27913700 DOI: 10.1212/wnl.0000000000003479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 09/06/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Functional or psychogenic movement disorders (FMD) present a diagnostic challenge. To diagnose FMD, clinicians must have experience with signs typical of FMD and distinguishing features from other hyperkinetic disorders. The aim of this study was to clarify the decision-making process of expert clinicians while diagnosing FMD, myoclonus, and tics. METHODS Thirty-nine movement disorders experts rated 60 patients using a standardized web-based survey resembling clinical practice. It provided 5 steps of incremental information: (1) visual first impression of the patient, (2) medical history, (3) neurologic examination on video, (4) the Bereitschaftspotential (BP), and (5) psychiatric evaluation. After full evaluation of each case, experts were asked which diagnostic step was decisive. In addition, interim switches in diagnosis after each informational step were calculated. RESULTS After full evaluation, the experts annotated the first impression of the patients as decisive in 18.5% of cases. Medical history was considered decisive in 33.3% of cases. Neurologic examination was considered decisive in 39.7%, the BP in 8%, and the psychiatric interview in 0.5% of cases. Most diagnostic switches occurred after addition of the medical history (34.5%). Addition of the neurologic examination led to 13.8% of diagnostic switches. The BP results led to diagnostic switches in 7.2% of cases. Psychiatric evaluation resulted in the lowest number of diagnostic switches (2.7% of cases). CONCLUSIONS Experts predominantly rely on clinical assessment to diagnose FMD. Importantly, ancillary tests do not determine the final diagnosis of this expert panel. In general, the experts infrequently changed their differential diagnosis.
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Affiliation(s)
- Sandra M A van der Salm
- From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., A.-F.v.R., J.H.T.M.K.) and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam; Altrecht Academic Anxiety Center and Department of Clinical & Health Psychology (D.C.C.), University of Utrecht; and Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Anne-Fleur van Rootselaar
- From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., A.-F.v.R., J.H.T.M.K.) and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam; Altrecht Academic Anxiety Center and Department of Clinical & Health Psychology (D.C.C.), University of Utrecht; and Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Daniëlle C Cath
- From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., A.-F.v.R., J.H.T.M.K.) and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam; Altrecht Academic Anxiety Center and Department of Clinical & Health Psychology (D.C.C.), University of Utrecht; and Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Rob J de Haan
- From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., A.-F.v.R., J.H.T.M.K.) and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam; Altrecht Academic Anxiety Center and Department of Clinical & Health Psychology (D.C.C.), University of Utrecht; and Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Johannes H T M Koelman
- From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., A.-F.v.R., J.H.T.M.K.) and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam; Altrecht Academic Anxiety Center and Department of Clinical & Health Psychology (D.C.C.), University of Utrecht; and Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Marina A J Tijssen
- From the Department of Neurology and Clinical Neurophysiology (S.M.A.v.d.S., A.-F.v.R., J.H.T.M.K.) and Clinical Research Unit (R.J.d.H.), Academic Medical Center, Amsterdam; Altrecht Academic Anxiety Center and Department of Clinical & Health Psychology (D.C.C.), University of Utrecht; and Department of Neurology (M.A.J.T.), University Medical Center Groningen, University of Groningen, the Netherlands.
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16
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Toffolo MBJ, van den Hout MA, Engelhard IM, Hooge ITC, Cath DC. Patients With Obsessive-Compulsive Disorder Check Excessively in Response to Mild Uncertainty. Behav Ther 2016; 47:550-9. [PMID: 27423170 DOI: 10.1016/j.beth.2016.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 04/08/2016] [Accepted: 04/12/2016] [Indexed: 02/08/2023]
Abstract
Patients with obsessive-compulsive disorder (OCD) not only respond to obsessions with perseverative checking, but also engage in more general checking, irrespective of their obsessive concerns. This study investigated whether general checking is specific to OCD and exacerbated when only mild uncertainty is induced. Thirty-one patients with OCD, 26 anxiety- and 31 healthy controls performed a visual search task with eye-tracking and indicated in 50 search displays whether a target was "present" or "absent". Target-present trials were unambiguous, whereas target-absent trials induced mild uncertainty, because participants had to rely on not overlooking the target. Checking behavior was measured by assessing search time and the number of fixations, measured with an eye-tracker. Results showed that in both target-present and target-absent trials patients with OCD searched longer and made more fixations than healthy and anxiety controls. However, the difference in checking behavior between patients with OCD and the control groups was larger in target-absent trials (where mild uncertainty was induced). Anxiety and healthy controls did not differ in checking behavior. Thus, mild uncertainty appears to specifically promote checking in patients with OCD, which has implications for treatment.
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17
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den Braber A, Zilhão NR, Fedko IO, Hottenga JJ, Pool R, Smit DJA, Cath DC, Boomsma DI. Obsessive-compulsive symptoms in a large population-based twin-family sample are predicted by clinically based polygenic scores and by genome-wide SNPs. Transl Psychiatry 2016; 6:e731. [PMID: 26859814 PMCID: PMC4872426 DOI: 10.1038/tp.2015.223] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/26/2015] [Accepted: 12/05/2015] [Indexed: 11/09/2022] Open
Abstract
Variation in obsessive-compulsive symptoms (OCS) has a heritable basis, with genetic association studies starting to yield the first suggestive findings. We contribute to insights into the genetic basis of OCS by performing an extensive series of genetic analyses in a homogeneous, population-based sample from the Netherlands. First, phenotypic and genetic longitudinal correlations over a 6-year period were estimated by modeling OCS data from twins and siblings. Second, polygenic risk scores (PRS) for 6931 subjects with genotype and OCS data were calculated based on meta-analysis results from IOCDF-GC, to investigate their predictive value. Third, the contribution of measured single nucleotide polymorphisms (SNPs) to the heritability was estimated using random-effects modeling. Last, we performed an exploratory genome-wide association study (GWAS) of OCS, testing for SNP- and for gene-based associations. Stability in OCS (test-retest correlation 0.63) was mainly explained by genetic stability. The PRS based on clinical samples predicted OCS in our population-based twin-family sample. SNP-based heritability was estimated at 14%. GWAS revealed one SNP (rs8100480), located within the MEF2BNB gene, associated with OCS (P=2.56 × 10(-8)). Additional gene-based testing resulted in four significantly associated genes, which are located in the same chromosomal region on chromosome 19p13.11: MEF2BNB, RFXANK, MEF2BNB-MEF2B and MEF2B. Thus, common genetic variants explained a significant proportion of OCS trait variation. Genes significantly associated with OCS are expressed in the brain and involved in development and control of immune system functions (RFXANK) and regulation of gene expression of muscle-specific genes (MEF2BNB). MEF2BNB also showed a suggestive association with OCD in an independent case-control study, suggesting a role for this gene in the development of OCS.
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Affiliation(s)
- A den Braber
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands,Alzheimer Center & Department of Neurology, VU University Medical Center and Neuroscience Campus, Amsterdam, The Netherlands,Department of Biological Psychology, VU University Amsterdam, van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. E-mail:
| | - N R Zilhão
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands,Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - I O Fedko
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - J-J Hottenga
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - R Pool
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - D J A Smit
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - D C Cath
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands,Altrecht Academic Anxiety Disorders Center, Utrecht, The Netherlands
| | - D I Boomsma
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
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Abstract
Functional jerks are among the most common functional movement disorders. The diagnosis of functional jerks is mainly based on neurologic examination revealing specific positive clinical signs. Differentiation from other jerky movements, such as tics, organic myoclonus, and primary paroxysmal dyskinesias, can be difficult. In support of a functional jerk are: acute onset in adulthood, precipitation by a physical event, variable, complex, and inconsistent phenomenology, suggestibility, distractibility, entrainment and a Bereitschaftspotential preceding the movement. Although functional jerks and tics share many similarities, characteristics differentiating tics from functional jerks are: urge preceding the tic, childhood onset, rostrocaudal development of the symptoms, a positive family history of tics, attention-deficit hyperactivity disorder or obsessive-compulsive symptoms, and response to dopamine antagonist medication. To differentiate functional jerks from organic myoclonus, localization of the movements can give direction. Further features in support of organic myoclonus include: insidious onset, simple and consistent phenomenology, and response to benzodiazepines or antiepileptic medication. Primary paroxysmal dyskinesias and functional jerks share a paroxysmal nature. Leading in the differentiation between the two are: a positive family history, in combination with video recordings revealing a consistent symptom pattern in primary paroxysmal dyskinesias. In this chapter functional jerks and their differential diagnoses will be discussed in terms of epidemiology, symptom characteristics, disease course, psychopathology, and supportive neurophysiologic tests.
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Affiliation(s)
- Y E M Dreissen
- Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands
| | - D C Cath
- Department of Clinical and Health Psychology, Utrecht University/Altrecht, Utrecht, The Netherlands
| | - M A J Tijssen
- Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands.
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van Velzen LS, de Wit SJ, Ćurĉić-Blake B, Cath DC, de Vries FE, Veltman DJ, van der Werf YD, van den Heuvel OA. Altered inhibition-related frontolimbic connectivity in obsessive-compulsive disorder. Hum Brain Mapp 2015; 36:4064-75. [PMID: 26183689 DOI: 10.1002/hbm.22898] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 06/09/2015] [Accepted: 06/24/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Recent studies have shown that response inhibition is impaired in patients with obsessive-compulsive disorder and their unaffected siblings, suggesting that these deficits may be considered a cognitive endophenotype of obsessive-compulsive disorder. Structural and functional neural correlates of altered response inhibition have been identified in patients and siblings. This study aims to examine the functional integrity of the response inhibition network in patients with obsessive-compulsive disorder and their unaffected siblings. METHODS Forty-one unmedicated patients with obsessive-compulsive disorder, 17 of their unaffected siblings and 37 healthy controls performed a stop signal task during functional magnetic resonance imaging. Psycho-physiological interaction analysis was used to examine functional connectivity between the following regions of interest: the bilateral inferior frontal gyri, presupplementary motor area, subthalamic nuclei, inferior parietal lobes, anterior cingulate cortex, and amygdala. We then used dynamic causal modeling to investigate the directionality of the networks involved. RESULTS Patients, and to a lesser extent also their unaffected siblings, show altered connectivity between the inferior frontal gyrus and the amygdala during response inhibition. The follow-up dynamic causal modeling suggests a bottom-up influence of the amygdala on the inferior frontal gyrus in healthy controls, whereas processing occurs top-down in patients with obsessive-compulsive, and in both directions in siblings. CONCLUSIONS Our findings suggest that amygdala activation in obsessive-compulsive disorder interferes differently with the task-related recruitment of the inhibition network, underscoring the role of limbic disturbances in cognitive dysfunctions in obsessive-compulsive disorder.
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Affiliation(s)
- Laura S van Velzen
- Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
- Neuroscience Campus Amsterdam (NCA), Amsterdam, the Netherlands
| | - Stella J de Wit
- Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
- Neuroscience Campus Amsterdam (NCA), Amsterdam, the Netherlands
- Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, the Netherlands
| | - Branislava Ćurĉić-Blake
- Department of Neuroscience, Neuroimaging Center, University Medical Centre Groningen, Groningen, the Netherlands
| | - Daniëlle C Cath
- Altrecht Academic Anxiety Center, Utrecht, the Netherlands
- Division of Clinical and Health Psychology, Utrecht University, Utrecht, the Netherlands
| | - Froukje E de Vries
- Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
- Neuroscience Campus Amsterdam (NCA), Amsterdam, the Netherlands
- Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, the Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
- Neuroscience Campus Amsterdam (NCA), Amsterdam, the Netherlands
| | - Ysbrand D van der Werf
- Neuroscience Campus Amsterdam (NCA), Amsterdam, the Netherlands
- Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, the Netherlands
- Netherlands Institute for Neuroscience, Netherlands Academy of Sciences, Amsterdam, the Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands
- Neuroscience Campus Amsterdam (NCA), Amsterdam, the Netherlands
- Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, the Netherlands
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20
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Abstract
BACKGROUND Until recently, hoarding was considered an obsessive-compulsive symptom (OCS). However, current evidence suggests that these two phenotypes may be clinically, and perhaps etiologically, distinct. Both hoarding and OCS have a genetic etiology, but the degree of unique and shared genetic contributions to these phenotypes has not been well studied. METHOD Prevalence rates were assessed for hoarding and OCS in a sample of adult twin pairs (n = 7906 twins) and their family members from The Netherlands Twin Register (total sample = 15,914). Using Mplus, genetic analyses using liability threshold models were conducted for both phenotypes, for their co-morbidity, and for specific hoarding symptoms (cluttering, discarding and acquiring). RESULTS Of the total sample, 6.7% met criteria for clinically significant hoarding; endorsement of all three hoarding symptoms was > or = 79%. Men had slightly higher rates than women. Also, 5.7% met criteria for clinically significant OCS; rates were similar in males and females. Genetic factors accounted for 36% of the variance for hoarding and 40% of the variance for OCS. The genetic correlation between hoarding and OCS was 0.10. There was no evidence of sex-specific genetic contributions for hoarding or OCS. There was evidence for a genetic contribution to all hoarding symptom subtypes. Only cluttering showed evidence of a contribution from the shared environment. CONCLUSIONS OCS and hoarding are common in this population-based sample, have prevalence rates similar to those previously reported, and show significant heritability. Genetic factors contributed to the co-morbidity of both traits, although the genetic correlation between them was low.
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Affiliation(s)
- C A Mathews
- Department of Psychiatry,University of California San Francisco,San Francisco, CA,USA
| | - K Delucchi
- Department of Psychiatry,University of California San Francisco,San Francisco, CA,USA
| | - D C Cath
- Department of Clinical and Health Psychology,Utrecht University and Altrecht Academic Anxiety Disorders Center,Utrecht,the Netherlands
| | - G Willemsen
- Department of Biological Psychology,VU University,Amsterdam, Amsterdam,the Netherlands
| | - D I Boomsma
- Department of Biological Psychology,VU University,Amsterdam, Amsterdam,the Netherlands
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21
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van der Salm SMA, de Haan RJ, Cath DC, van Rootselaar AF, Tijssen MAJ. The eye of the beholder: inter-rater agreement among experts on psychogenic jerky movement disorders. J Neurol Neurosurg Psychiatry 2013; 84:742-7. [PMID: 23412076 DOI: 10.1136/jnnp-2012-304113] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The current criteria for conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders rely on the assumption that neurological disorders can be distinguished from conversion disorders through clinical assessment. This study aims to assess inter-rater agreement among clinicians with experience in the diagnosis of various hyperkinetic jerky movements, including psychogenic jerks. METHODS 60 patients with psychogenic jerks, myoclonus or tics were rated by international experts using a standardised survey resembling daily clinical practice. The survey included the following diagnostic steps: a short video offering a visual impression of the patients and their jerky movements, medical history, neurological examination (on video), additional investigations and the findings of a standardised psychiatric interview. The diagnosis and diagnostic certainty were scored after each step. RESULTS After all clinical information was given, moderate inter-rater agreement was reached (κ=0.56±0.1) with absolute agreement (100%) of experts on the diagnosis in 12 (20%) patients and reasonable agreement (>75%) in 43 (72%) patients. Psychiatric evaluation did not contribute to inter-rater agreement or diagnostic certainty. CONCLUSIONS Our findings illustrate the fact that experienced movement disorder specialists moderately agree on the clinical diagnosis of jerky movements. Clinical assessment, especially by a team of clinicians in challenging individual cases, might improve diagnostic agreement.
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Affiliation(s)
- Sandra M A van der Salm
- Department of Neurology AB 51, University Medical Centre Groningen (UMCG), PO Box 30.001, Groningen 9700 RB, The Netherlands.
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Abstract
AbstractGenetic factors have historically been thought of as important in the development of obsessive–compulsive disorder (OCD). For the estimation of the relative importance of genetic and environmental factors, twin studies are an obvious approach. Twin studies of OCD have a long history, starting in 1929. In this review, over 70 years of twin research of OCD is presented, using four different approaches that represent the steps in the twin research of OCD from past to present. These steps include (1) case-studies of twins with OCD from the old literature; (2) twin studies of OCD using Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria; (3) twin studies of OCD using a dimensional approach, comparing resemblances in monozygotic and dizygotic twins; and (4) twin studies of OCD using a dimensional approach, analyzing the data with Structural Equation Modeling. It is concluded that only the studies using the last method have convincingly shown that, in children, obsessive–compulsive (OC) symptoms are heritable, with genetic influences in the range of 45% to 65%. In adults, studies are suggestive for a genetic influence on OC symptoms, ranging from 27% to 47%, but a large twin study using a bio- metrical approach with continuous data is still needed to provide conclusive evidence. Strategies for future twin studies of OCD are discussed.
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van Balkom AJLM, Oosterbaan DB, Batelaan N, Cath DC, Hendriks GJ, van Megen HJGM, Schruers K, Spijker J, van der Wee N, van Vliet IM. [The characterisation of anxiety disorders: staging and profiling based on common sense]. Tijdschr Psychiatr 2012; 54:935-940. [PMID: 23138620] [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: 06/01/2023]
Abstract
BACKGROUND Clinicians need to be well informed about staging and profiling so that they can divide patients with anxiety disorders into groups according to the phase and severity of their illness. The group to which the patient is assigned determines the types of treatment he or she receives. AIM To investigate ways in which clinicians can be helped to apply staging and profiling procedures to patients with anxiety disorders. METHOD We searched the literature for articles about the staging and profiling of anxiety disorders. RESULTS There seems to be practically no literature relating to the staging and profiling of anxiety disorders. However, in daily practice clinicians do attempt to classify their patients and use forms of staging when deciding on special types of treatment for their patients and when assessing the length of treatment required. The revised Dutch guidelines on anxiety disorders include a generalised form of staging, called ‘stepped care’. These revisions have been made on the basis of consensus decisions reached by the guideline committee. CONCLUSION The revised guidelines on anxiety disorders assist clinicians with the application of staging in their daily practice. However, because of the lack of scientific data, our article closes with the presentation of a research agenda.
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van den Heuvel OA, Mataix-Cols D, Zwitser G, Cath DC, van der Werf YD, Groenewegen HJ, van Balkom AJLM, Veltman DJ. Common limbic and frontal-striatal disturbances in patients with obsessive compulsive disorder, panic disorder and hypochondriasis. Psychol Med 2011; 41:2399-2410. [PMID: 21557892 DOI: 10.1017/s0033291711000535] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Direct comparisons of brain function between obsessive compulsive disorder (OCD) and other anxiety or OCD spectrum disorders are rare. This study aimed to investigate the specificity of altered frontal-striatal and limbic activations during planning in OCD, a prototypical anxiety disorder (panic disorder) and a putative OCD spectrum disorder (hypochondriasis). METHOD The Tower of London task, a 'frontal-striatal' task, was used during functional magnetic resonance imaging measurements in 50 unmedicated patients, diagnosed with OCD (n=22), panic disorder (n=14) or hypochondriasis (n=14), and in 22 healthy subjects. Blood oxygen level-dependent (BOLD) signal changes were calculated for contrasts of interest (planning versus baseline and task load effects). Moreover, correlations between BOLD responses and both task performance and state anxiety were analysed. RESULTS Overall, patients showed a decreased recruitment of the precuneus, caudate nucleus, globus pallidus and thalamus, compared with healthy controls. There were no statistically significant differences in brain activation between the three patient groups. State anxiety was negatively correlated with dorsal frontal-striatal activation. Task performance was positively correlated with dorsal frontal-striatal recruitment and negatively correlated with limbic and ventral frontal-striatal recruitment. Multiple regression models showed that adequate task performance was best explained by independent contributions from dorsolateral prefrontal cortex (positive correlation) and amygdala (negative correlation), even after controlling for state anxiety. CONCLUSIONS Patients with OCD, panic disorder and hypochondriasis share similar alterations in frontal-striatal brain regions during a planning task, presumably partly related to increased limbic activation.
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Affiliation(s)
- O A van den Heuvel
- Department of Psychiatry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
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Fibbe LA, Cath DC, van Balkom AJLM. [Obsessive compulsive disorder with tics: a new subtype?]. Tijdschr Psychiatr 2011; 53:275-285. [PMID: 21538297] [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: 05/30/2023]
Abstract
BACKGROUND Obsessive compulsive disorder (OCD) is a heterogeneous disorder. With the help of phenomenological research, attempts are being made to create more homogeneous subtypes. AIM To search the literature in order to compare the symptoms of OCD patients with tics and without tics, and thereby determine whether OCD with tics can be distinguished clinically from OCD without tics. METHOD Search terms were used in conjunction with PubMed and Psychinfo in order to locate studies in which OCD patients without tics were compared with OCD patients with tics. RESULTS In the 26 studies found in our search 872 OCD patients out of a total of 2801 OCD patients (i.e. 31%) had a comorbid tic disorder. OCD patients with tics displayed similarities and differences at symptom level. OCD patients with tics were associated with male gender and early age of onset. Tic-like symptoms such as touching, twitching, repeating, symmetry behavior and rubbing were seen more frequently in OCD patients with tics. OCD patients without tics more often displayed contamination obsessions and engaged in compulsive washing. On the other hand, the obsessions of patients with tics and without tics were very similar. The goal-directedness of compulsions differed between OCD patients with tics and those without tics. By analogy with 'the premonitory urges' that often precede tics, OCD patients with tics more often reported 'just-right' perceptions prior to their compulsions. OCD patients without tics more often reported anxiety prior to their compulsions. Compulsions seemed to be aimed at reducing tension and feelings of anxiety. CONCLUSION On the basis of the clinical symptoms OCD with tics does seem to be a subtype of OCD. However further research is needed into the aetiology, effective treatment and the course of the disorder before OCD with tics can be accepted conclusively as a subtype of OCD.
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van Grootheest DS, van den Berg SM, Cath DC, Willemsen G, Boomsma DI. Marital resemblance for obsessive-compulsive, anxious and depressive symptoms in a population-based sample. Psychol Med 2008; 38:1731-1740. [PMID: 18304384 DOI: 10.1017/s0033291708003024] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Resemblance between spouses can be due to phenotypic assortment, social homogamy and/or marital interaction. A significant degree of assortment can have consequences for the genetic architecture of a population. We examined the existence and cause(s) of assortment for obsessive-compulsive (OC), anxious and depressive symptoms in a population-based twin-family sample. METHOD OC, anxious and depressive symptoms were measured in around 1400 twin-spouse pairs and >850 parent pairs. Correlations of twins and their spouse, twin and co-twin's spouse, spouses of both twins and parents of twins were obtained to consider phenotypic assortment versus social homogamy as possible causes of marital resemblance. The association of length of relationship with marital resemblance was also investigated. Finally, we examined whether within-trait or cross-trait processes play a primarily role in marital resemblance. RESULTS Small but significant within-trait correlations of between 0.1 and 0.2 were seen for spouse similarity in OC, anxious and depressive symptoms. Cross-correlations were significant but lower. There was no correlation between length of relationship and marital resemblance. From the pattern of correlations for twin-spouse, co-twin-spouse and spouses of both twins, phenotypic assortment could not be distinguished from social homogamy. Both within- and cross-assortment processes play a role in marital resemblance. CONCLUSIONS Small within- and across-trait correlations exist for OC, anxious and depressive symptoms. No evidence for marital interaction was found. Spouse correlations are small, which makes it difficult to distinguish between social homogamy and phenotypic assortment. It is unlikely that correlations of this size will have a large impact on genetic studies.
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Affiliation(s)
- D S van Grootheest
- Department of Biological Psychology, VU University, Amsterdam, The Netherlands.
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Abstract
BACKGROUND The association between life events and anxious depression might be due to causality or to gene-environment correlation. We examined unidirectional and reciprocal causality and a gene-environment correlation model, in which genes that influence the vulnerability for anxious depression also increase the risk of exposure to life events. The effect of genes that influence environmental exposure might be mediated through personality and we therefore also examined the association between life events and personality (neuroticism and extraversion). METHOD Information on life events, anxious depression, neuroticism and extraversion was collected in 5782 monozygotic (MZ) and dizygotic (DZ) twins who participated in a longitudinal survey study of the Netherlands Twin Register. To examine causality, data were analysed longitudinally. To examine gene-environment correlation, the co-twin control method was used. RESULTS Anxious depression and, to a lesser extent, neuroticism scores increased after exposure to life events. Anxious depression and neuroticism also predicted the experience of life events. Prospectively, extraversion was not associated with life events. Anxious depression, neuroticism and extraversion scores did not differ between the non-exposed subjects of MZ and DZ twin pairs and unrelated subjects discordant for life events. CONCLUSIONS Our findings suggest that reciprocal causation explains the relationship between life events and anxious depression and between life events and neuroticism. Extraversion is not related to life events. No evidence was found for gene-environment correlation, i.e. the genes that influence anxious depression, neuroticism or extraversion do not overlap with the genes that increase the risk of exposure to life events.
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Affiliation(s)
- C M Middeldorp
- Department of Biological Psychology, Vrije Universiteit, Van der Boechorststraat 1, Amsterdam, The Netherlands.
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van Grootheest DS, van den Heuvel OA, Cath DC, van Oppen P, van Balkom AJLM. [Obsessive-compulsive disorder]. Ned Tijdschr Geneeskd 2008; 152:2325-2329. [PMID: 19024062] [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: 05/27/2023]
Abstract
Obsessive-compulsive disorder is a complex psychiatric disorder characterised by obsessions and/or compulsions. Obsessive-compulsive disorder has a relatively high prevalence and is a highly disabling disease. The disorder is associated with shame, which causes long delays in accessing treatment. Obsessive-compulsive disorder is caused by a complex interplay between genetic and environmental factors. Effective treatments exist in the form of either pharmacotherapy--clomipramine or selective serotonin reuptake inhibitors--or cognitive behaviour therapy.
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Affiliation(s)
- D S van Grootheest
- Vrije Universiteit, afd. Biologische Psychologie, Van der Boechorststraat 1, 1081 BT Amsterdam.
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Cath DC, Meynen G, de Jonge JL, van Balkom AJLM. [Antipsychotics in the treatment of Tourette disorder: a review]. Tijdschr Psychiatr 2008; 50:593-602. [PMID: 18785106] [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: 05/26/2023]
Abstract
BACKGROUND Gilles de la Tourette syndrome (GTS) is a neuropsychiatric disorder, characterised by the presence of multiple motor and vocal tics. Some GTS patients need pharmacological treatment. Patients who have a moderate to severe tic syndrome are usually treated with antipsychotics. AIM To provide a literature review of the use of typical and atypical antipsychotics as well as dopamine agonists in patients with GTS. METHOD Publications in the Medline database from 1970 onwards were used, as well as literature references from books and book chapters. The following search terms were used: 'treatment', 'psychopharmaca', 'psychopharmacological treatment', 'medication', 'antipsychotics', 'D2 antagonists', 'D2 agonists' and 'atypical antipsychotics'. results A few controlled short-term studies had been performed on haloperidol, pimozide, risperidone and pergolide. These agents all appeared to be effective in the short term, with risperidone showing fewest side-effects. CONCLUSION Surprisingly few controlled studies have been performed on antipsychotics in GTS. Future studies should focus on what the second step should be in the case of treatment-resistant patients, on comparisons between drug therapy and behavioural therapy and on identifying predictors of drug response.
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Affiliation(s)
- D C Cath
- GGZ Buitenamstel en VU Medisch Centrum, Amsterdam.
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Van Grootheest DS, Cath DC, Beekman AT, Boomsma DI. Genetic and environmental influences on obsessive-compulsive symptoms in adults: a population-based twin-family study. Psychol Med 2007; 37:1635-1644. [PMID: 17592667 DOI: 10.1017/s0033291707000980] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The contribution of genetic factors to obsessive-compulsive (OC) symptoms has not been examined using a large population-based sample of adults. Furthermore, the extent to which there are qualitative and quantitative differences in genetic architecture between men and women with OC symptoms has not been elucidated. METHOD We obtained the Young Adult Self Report Obsessive-Compulsive Scale (YASR-OCS) from a group of 5893 monozygotic (MZ) and dizygotic (DZ) twins, and 1304 additional siblings from the population-based Netherlands Twin Register. Structural equation modelling was used to decompose the variation in OC behaviour into genetic and environmental components and analyse quantitative and qualitative sex differences. RESULTS Familial resemblance was the same for DZ twins and non-twin siblings, which means that there was no evidence for a special twin environment. The same genetic risk factors for OC behaviour were expressed in men and women. Depending on the choice of fit index, we found small (39% for men and 50% for women) or no sex differences (47% for both men and women) in heritability. The remaining variance in liability was due to individual-specific environment. CONCLUSIONS OC behaviour showed a moderate heritability. At most, small quantitative sex differences were found in the genetic architecture of OC behaviour, and no qualitative sex differences.
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van Grootheest DS, Bartels M, Cath DC, Beekman AT, Hudziak JJ, Boomsma DI. Genetic and environmental contributions underlying stability in childhood obsessive-compulsive behavior. Biol Psychiatry 2007; 61:308-15. [PMID: 16950209 DOI: 10.1016/j.biopsych.2006.05.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Revised: 05/24/2006] [Accepted: 05/31/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the stability of obsessive-compulsive (OC) behavior during childhood. The objective of this study is to determine the developmental stability of pediatric OC behavior and the genetic and environmental influences on stability in a large population-based twin sample. METHODS Maternal and paternal ratings on the 8-item Obsessive Compulsive Scale of the Child Behavior Checklist (CBCL-OCS) on Dutch mono- and dizygotic twin pairs from 8083 families were collected at ages 7, 10, and 12 years. Using a longitudinal twin design, stability of OC behavior and genetic and environmental influences on stability were determined. Using cutoff criteria, persistent, resilient, and new onset cases were identified in this sample. RESULTS OC behavior assessed by the CBCL-OCS showed a moderate stability with phenotypic correlations of around .50 for boys and for girls. Stability of OC behavior was influenced by genetic factors, by environmental factors shared by children growing up in the same family, and by non-shared environmental factors. Stability for OCS was lower when categorical data were analyzed than when quantitative definitions were used. CONCLUSIONS OC behavior is moderately stable in childhood. Stability of OC behavior is influenced by genetic, shared, and non-shared environmental factors.
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Remijnse PL, Nielen MMA, van Balkom AJLM, Cath DC, van Oppen P, Uylings HBM, Veltman DJ. Reduced orbitofrontal-striatal activity on a reversal learning task in obsessive-compulsive disorder. ACTA ACUST UNITED AC 2006; 63:1225-36. [PMID: 17088503 DOI: 10.1001/archpsyc.63.11.1225] [Citation(s) in RCA: 269] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT The orbitofrontal cortex (OFC)-striatal circuit, which is important for motivational behavior, is assumed to be involved in the pathophysiology of obsessive-compulsive disorder (OCD) according to current neurobiological models of this disorder. However, the engagement of this neural loop in OCD has not been tested directly in a cognitive activation imaging paradigm so far. OBJECTIVE To determine whether the OFC and the ventral striatum show abnormal neural activity in OCD during cognitive challenge. DESIGN A reversal learning task was employed in 20 patients with OCD who were not receiving medication and 27 healthy controls during an event-related functional magnetic resonance imaging experiment using a scanning sequence sensitive to OFC signal. This design allowed investigation of the neural correlates of reward and punishment receipt as well as of "affective switching," ie, altering behavior on reversing reinforcement contingencies. RESULTS Patients with OCD exhibited an impaired task end result reflected by a reduced number of correct responses relative to control subjects but showed adequate behavior on receipt of punishment and with regard to affective switching. On reward outcome, patients showed decreased responsiveness in right medial and lateral OFC as well as in the right caudate nucleus (border zone ventral striatum) when compared with controls. During affective switching, patients recruited the left posterior OFC, bilateral insular cortex, bilateral dorsolateral, and bilateral anterior prefrontal cortex to a lesser extent than control subjects. No areas were found for which patients exhibited increased activity relative to controls, and no differential activations were observed for punishment in a direct group comparison. CONCLUSIONS These data show behavioral impairments accompanied by aberrant OFC-striatal and dorsal prefrontal activity in OCD on a reversal learning task that addresses this circuit's function. These findings not only confirm previous reports of dorsal prefrontal dysfunction in OCD but also provide evidence for the involvement of the OFC-striatal loop in the pathophysiology of OCD.
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Affiliation(s)
- Peter L Remijnse
- Department of Psychiatry, VU University Medical Center, Graduate School of Neurosciences, and Outpatient Academic Clinic for Anxiety Disorders, GGZ Buitenamstel, Amsterdam, the Netherlands.
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Verkerk AJMH, Cath DC, van der Linde HC, Both J, Heutink P, Breedveld G, Aulchenko YS, Oostra BA. Genetic and clinical analysis of a large Dutch Gilles de la Tourette family. Mol Psychiatry 2006; 11:954-64. [PMID: 16894393 DOI: 10.1038/sj.mp.4001877] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gilles de la Tourette syndrome is a complex neuropsychiatric disorder, which becomes evident in childhood between the ages of 2 and 15 years. Tourette syndrome is defined by the occurrence of a large range and variable number of unwanted repetitive simple or complex motor and vocal tics that start in childhood and follow a waxing and waning course. A major gene for this syndrome has not yet been identified, probably owing to both genetic and phenotypic heterogeneity of this disease. This article describes the clinical evaluation of patients and family members in a large Dutch Gilles de la Tourette Syndrome pedigree and the decisions encountered with respect to phenotyping. The importance of an accurate definition of the Tourette phenotype is discussed, which is highly important for reliable genetic linkage and association studies. Subsequent linkage analysis resulted in three linkage peaks on different chromosomes 3q, 9q, and 13q. Multipoint analysis resulted in a single linkage peak with logarithm of odds score 2.55 with marker D3S1311 on chromosome 3q.
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Affiliation(s)
- A J M H Verkerk
- Department of Bioinformatics, Erasmus Medical Center, Rotterdam, The Netherlands.
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Abstract
Genetic factors have historically been thought of as important in the development of obsessive-compulsive disorder (OCD). For the estimation of the relative importance of genetic and environmental factors, twin studies are an obvious approach. Twin studies of OCD have a long history, starting in 1929. In this review, over 70 years of twin research of OCD is presented, using four different approaches that represent the steps in the twin research of OCD from past to present. These steps include (1) case-studies of twins with OCD from the old literature; (2) twin studies of OCD using Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria; (3) twin studies of OCD using a dimensional approach, comparing resemblances in monozygotic and dizygotic twins; and (4) twin studies of OCD using a dimensional approach, analyzing the data with Structural Equation Modeling. It is concluded that only the studies using the last method have convincingly shown that, in children, obsessive-compulsive (OC) symptoms are heritable, with genetic influences in the range of 45% to 65%. In adults, studies are suggestive for a genetic influence on OC symptoms, ranging from 27% to 47%, but a large twin study using a biometrical approach with continuous data is still needed to provide conclusive evidence. Strategies for future twin studies of OCD are discussed.
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Braam AW, Visser S, Cath DC, Hoogendijk WJG. Investigation of the syndrome of apotemnophilia and course of a cognitive-behavioural therapy. Psychopathology 2006; 39:32-7. [PMID: 16282717 DOI: 10.1159/000089661] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Accepted: 03/01/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND The syndrome of apotemnophilia, body integrity or amputee identity disorder, is defined as the desire for amputation of a healthy limb, and may be accompanied by behaviour of pretending to be an amputee and sometimes, but not necessarily, by sexual arousal. SAMPLING AND METHODS A case history is presented of a 35-year-old man who was referred because of his desire for amputation of his left leg, without sexual connotations. The course of a combined cognitive behavioural psychotherapy with SSRI treatment is described. RESULTS Symptoms showed considerable similarity with obsessive-compulsive disorder, and some similarity with body dysmorphic disorder according to DSM-IV, but the core symptom seemed to be strongly connected with a sense of identity. Treatment with a selective serotonin re-uptake inhibitor decreased levels of distress only. The effects of cognitive restructuring of the psychotherapy were limited, whereas the behavioural elements substantially reduced the behaviour of pretending to be an amputee. CONCLUSIONS The rare syndrome of apotemnophilia raises unresolved questions of classification. Psychotic disorders should be ruled out carefully. The model designed in the current cognitive behavioural approach may serve as a starting point for further development of intervention protocols for this rare disorder.
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Affiliation(s)
- Arjan W Braam
- Institute of Extramural Medicine (EMGO), Amsterdam, The Netherlands.
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Middeldorp CM, Cath DC, Van Dyck R, Boomsma DI. The co-morbidity of anxiety and depression in the perspective of genetic epidemiology. A review of twin and family studies. Psychol Med 2005; 35:611-624. [PMID: 15918338 DOI: 10.1017/s003329170400412x] [Citation(s) in RCA: 212] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Co-morbidity within anxiety disorders, and between anxiety disorders and depression, is common. According to the theory of Gray and McNaughton, this co-morbidity is caused by recursive interconnections linking the brain regions involved in fear, anxiety and panic and by heritable personality traits such as neuroticism. In other words, co-morbidity can be explained by one disorder being an epiphenomenon of the other and by a partly shared genetic etiology. The aim of this paper is to evaluate the theory of Gray and McNaughton using the results of genetic epidemiological studies. METHOD Twenty-three twin studies and 12 family studies on co-morbidity are reviewed. To compare the outcomes systematically, genetic and environmental correlations between disorders are calculated for the twin studies and the results from the family studies are summarized according to the method of Klein and Riso. RESULTS Twin studies show that co-morbidity within anxiety disorders and between anxiety disorders and depression is explained by a shared genetic vulnerability for both disorders. Some family studies support this conclusion, but others suggest that co-morbidity is due to one disorder being an epiphenomenon of the other. CONCLUSIONS Discrepancies between the twin and family studies seem partly due to differences in used methodology. The theory of Gray and McNaughton that neuroticism is a shared risk factor for anxiety and depression is supported. Further research should reveal the role of recursive interconnections linking brain regions. A model is proposed to simultaneously investigate the influence of neuroticism and recursive interconnections on co-morbidity.
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Affiliation(s)
- C M Middeldorp
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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Abstract
BACKGROUND Research on risk factors for burnout has mainly focused on circumstances at work and on personal characteristics. The aim of this study was to investigate whether burnout clusters within families and, if so, whether this is due to genetic influences or to environmental factors shared by family members. Finally, we tried to identify specific risk factors for burnout. METHOD In 2707 twins, 736 of their siblings and 575 of their spouses from a population-based twin-family sample, burnout was measured using a self-report questionnaire. Correlations in burnout scores were obtained for monozygotic and dizygotic twin pairs and sibling pairs conditional on the pairs' sex. Correlations for twins and their spouses were derived conditional on the length of the relationship. RESULTS In the final model, correlations of the monozygotic and dizygotic twin pairs and sibling pairs were significantly different from zero, but not significantly different from each other. The correlation was estimated at 0.22. The correlation between spouses was also significant. This was mainly due to the group with a relationship longer than 5 years in which the correlation was 0.24. Burnout scores were higher in subjects whose parents had a high level of education. CONCLUSIONS There is familial clustering for burnout due to environmental factors shared by family members, explaining 22 % of the variance. Genetic factors do not seem to be of importance. The significant correlation between spouses supports the conclusion that common environment plays a role in burnout. A high parental education is one of the familial risk factors.
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Affiliation(s)
- C M Middeldorp
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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Denys DA, Cath DC. [The inheritance of obsessive-compulsive disorders]. Ned Tijdschr Geneeskd 2003; 147:2166-9. [PMID: 14626833] [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: 04/27/2023]
Abstract
Obsessive-compulsive disorder is a chronic psychiatric disorder characterised by obsessions and/or compulsions. Genetic research into obsessive-compulsive disorder is significantly limited by the difficulty in clearly defining the disease. There are only a few good studies and the populations investigated are small. Family and twin studies have provided evidence for a genetic component in obsessive-compulsive disorders. Segregation analyses suggest Mendelian inheritance of a dominant allele. In addition to one gene with a major effect, genes with smaller effects also play a role.
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Affiliation(s)
- D A Denys
- Universitair Medisch Centrum Utrecht, Rudolf Magnus Instituut voor Neurowetenschappen, afd. Psychiatrie, Postbus 85.500, 3508 GA Utrecht.
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Cath DC, Spinhoven P, Landman AD, van Kempen GM. Psychopathology and personality characteristics in relation to blood serotonin in Tourette's syndrome and obsessive-compulsive disorder. J Psychopharmacol 2001; 15:111-9. [PMID: 11448084 DOI: 10.1177/026988110101500208] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Family studies suggest an interrelationship between Gilles de la Tourette Syndrome (GTS) and some forms of obsessive-compulsive disorder (OCD). Some authors consider GTS to be part of a serotonergically mediated cluster of OCD spectrum disorders. The present study was undertaken to compare measures of psychopathology, personality and blood serotonin between GTS and OCD (without tics), and to investigate whether an OCD spectrum hypothesis is supported for GTS. Fifteen GTS without OCD subjects, 21 tic with (+) OCD subjects, 15 OCD without tic subjects and 26 controls (all without serotonergic medication) were evaluated with self-rated and clinician-rated measures of psychopathology and personality. Whole blood serotonin (5-HT) and platelet monoamine oxidase activity (MAO) was measured, and Spearman's correlations were calculated between whole blood 5-HT, MAO and rating scale scores within the entire sample and within subgroups. There were main effects of OCD on anxiety, obsessive-compulsive, neuroticism and extraversion scores. There were main effects of tics on depression, obsessive-compulsive, trait anxiety and neuroticism scores, and on platelet MAO. There were interaction effects on platelet MAO, 5-HT, Yale-Brown Obsessive-Compulsive Rating Scale severity, trait anxiety and Eysenck Personality Questionnaire neuroticism scores. Platelet MAO activity was elevated in tic-free OCD subjects when compared to tic + OCD, GTS without OCD and controls. Whole blood 5-HT was lowered in tic + OCD patients in comparison to GTS without OCD and tic-free OCD subjects. Whole blood 5-HT and obsessive-compulsive severity were negatively correlated within OCD without tic patients and MAO and Leyton Obsessive Inventory scores were negatively related within GTS without OCD patients. The biochemical data of this study suggest that in tic + OCD and in tic-free OCD patients, 5-HT dysregulations play a role, but not necessarily in pure GTS. Serotonergic dysregulations within tic + OCD and tic-free OCD patients are distinct, suggesting differences in underlying pathophysiology. The finding that obsessions and compulsions can be associated with either 5-HT hypofunctionality or hyperfunctionality reveals a major weakness in the OCD spectrum theory, i.e. that the associations between obsessive-compulsive behaviours and 5-HT abnormalities are less specific than suggested by the original obsessive-compulsive spectrum model.
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Affiliation(s)
- D C Cath
- GGZ Buitenamstel Outpatient Services, Location Lassusstraat, Amsterdam, The Netherlands.
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Cath DC, Spinhoven P, van Woerkom TC, van de Wetering BJ, Hoogduin CA, Landman AD, Roos RA, Rooijmans HG. Gilles de la Tourette's syndrome with and without obsessive-compulsive disorder compared with obsessive-compulsive disorder without tics: which symptoms discriminate? J Nerv Ment Dis 2001; 189:219-28. [PMID: 11339317 DOI: 10.1097/00005053-200104000-00003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Stereotyped repetitive behaviors occur in Gilles de la Tourette's Syndrome (GTS) and obsessive-compulsive disorder (OCD). The present study was undertaken to compare the distribution of obsessive-compulsive and Tourette-related impulsive behaviors in GTS with (+) OCD, GTS without (-) OCD, tic-free OCD, and control subjects. Fourteen GTS + OCD, 18 GTS-OCD, 21 OCD-tic, and 29 control subjects were evaluated using a semistructured interview designed to assess GTS and OCD-related repetitive behaviors. Each reported item was evaluated on the presence of anxiety and goal-directedness. This information was subsequently used to define whether the repetitive behavior was an (anxiety-related) obsession or compulsion, or a (non-anxiety-related) OC-like behavior, impulsion. GTS + OCD subjects reported more overall Tourette-related impulsions than OCD-tic subjects, i.e., more mental play, echophenomena, and touching behaviors but similar frequencies of typical obsessive-compulsive behaviors. Further, GTS + OCD subjects exhibited more overall repetitive behaviors than GTS-OCD subjects, i.e., more Tourette-related impulsions as well as more obsessive-compulsive behaviors. The distribution of symptoms is similar in GTS with and without OCD, and differs from tic-free OCD. These differences suggest that GTS with OCD constitutes a form of GTS, not of OCD, although the possibility that GTS + OCD patients constitute a subgroup distinct from GTS and from OCD can not be excluded by this phenomenological study. Specific non-anxiety-related impulsions seem to discriminate between GTS and OCD-tic individuals. These impulsions possibly reflect differences in underlying mechanisms between GTS and OCD-tics.
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Affiliation(s)
- D C Cath
- Department of Psychiatry, GGZ Buitenamstel Outpatient Services, Amsterdam, The Netherlands
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Cath DC, Spinhoven P, Hoogduin CA, Landman AD, van Woerkom TC, van de Wetering BJ, Roos RA, Rooijmans HG. Repetitive behaviors in Tourette's syndrome and OCD with and without tics: what are the differences? Psychiatry Res 2001; 101:171-85. [PMID: 11286820 DOI: 10.1016/s0165-1781(01)00219-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Gilles de la Tourette Syndrome (GTS) and obsessive-compulsive disorder (OCD) share obsessive-compulsive phenomena. The aims of this study were to compare the OC symptom distribution between GTS and OCD and to investigate whether a subdivision of these phenomena into obsessions, compulsions and 'impulsions' is useful in distinguishing GTS and OCD patients. Thirty-two GTS, 31 OCD (10 with tics, 21 without tics) and 29 control subjects were studied using the Leiden repetitive behaviors semi-structured interview to assess GTS as well as OCD-related behaviors. Each reported repetitive thought or action was evaluated on the presence of anxiety and on goal-directedness. This information was used to define whether the behavior was an obsession, compulsion, or 'impulsion'. Both the GTS and OCD study groups showed higher scores than control subjects on rating scales measuring depression, OC behavior and anxiety. In GTS, Y-BOCS severity scores and trait anxiety were lower than in the OCD groups. Furthermore, GTS patients differed from OCD patients in the distribution of symptoms. Aggressive repetitive thoughts, contamination worries and washing behaviors were reported more frequently by tic-free OCD, while mental play, echophenomena, touching and (self)-injurious behaviors were reported more frequently by GTS. OCD individuals with tics were intermediate, but closer to tic-free OCD. GTS individuals reported significantly more 'impulsions' and fewer obsessions and compulsions than OCD individuals with and without tics. Factor analysis revealed three factors accounting for 44% of the variance, resulting in an 'impulsive' factor related to GTS, a 'compulsive' factor related to OCD and an 'obsessive' factor related to tic-free OCD. In conclusion, OCD individuals reported more anxiety and goal-directedness associated with their behaviors than did GTS subjects. The distinction between obsessions, compulsions and impulsions is of importance in identifying Tourette-related vs. non-Tourette-related repetitions.
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Affiliation(s)
- D C Cath
- Department of Psychiatry, GGZ Buitenamstel Outpatient Services, Lassusstraat 2, 1075 GV, Amsterdam, The Netherlands.
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Cath DC, Spinhoven P, van de Wetering BJ, Hoogduin CA, Landman AD, van Woerkom TC, Roos RA, Rooijmans HG. The relationship between types and severity of repetitive behaviors in Gilles de la Tourette's disorder and obsessive-compulsive disorder. J Clin Psychiatry 2000; 61:505-13. [PMID: 10937609 DOI: 10.4088/jcp.v61n0708] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study investigated which categories of obsessive-compulsive and Tourette-related behaviors in Gilles de la Tourette's disorder and obsessive-compulsive disorder (OCD) without tics are experienced as most severe across the study groups and what the differences are in symptom distribution between the study groups. METHOD Fourteen subjects with both Tourette's disorder and OCD, 18 subjects with Tourette's only, 21 subjects with OCD (no tics), and 29 control subjects were studied using a semistructured interview designed to equally assess Tourette- and OCD-related behaviors according to DSM-III-R criteria. Each reported repetitive behavior was evaluated on the presence of anxiety and on goal-directedness. Anxiety-related items were categorized as obsessions or compulsions and non-anxiety-related items as impulsions. Severity of each reported item was assessed with respect to time per day consumed and amount of distress and interference induced by the item. Following these criteria, each reported item was classified as a symptom, a subthreshold symptom, or just as being present. RESULTS Across the study groups, obsessions were experienced as more severe than (Tourette-related) impulsions and compulsions. Within the study groups, patients with both Tourette's disorder and OCD reported more symptomatic Tourette-related impulsions, such as mental play, echophenomena, and impulsive or self-injurious behaviors; less overall symptomatic obsessions; and less symptomatic washing than patients with OCD (no tics). The differences among individuals with Tourette's with or without OCD reflected differences in symptom severity rather than differences in symptom distribution. CONCLUSION Obsessions are more time consuming, distressing, and interfering than compulsions and impulsions. Furthermore, the symptomatic repetitive behaviors were distributed differently among patients with both Tourette's disorder and OCD and patients with OCD (no tics). Patients with Tourette's and OCD are phenomenologically more similar to Tourette's than to OCD. These differences possibly represent differences in underlying pathophysiology between Tourette's and tic-free OCD.
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Affiliation(s)
- D C Cath
- Department of Psychiatry, Psychiatric Center Amsterdam, The Netherlands.
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Cath DC, Gijsman HJ, Schoemaker RC, van Griensven JM, Troost N, van Kempen GM, Cohen AF. The effect of m-CPP on tics and obsessive-compulsive phenomena in Gilles de la Tourette syndrome. Psychopharmacology (Berl) 1999; 144:137-43. [PMID: 10394994 DOI: 10.1007/s002130050986] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
RATIONALE Family genetic and phenomenological studies support an interrelationship between Gilles de la Tourette syndrome (GTS) and obsessive-compulsive disorder (OCD). Some authors consider GTS as part of a serotonergically mediated cluster of OCD spectrum disorders. OBJECTIVE To study serotonergic mechanisms in GTS, the effect of the relatively selective 5-HT2c agonist meta-chlorophenylpiperazine (m-CPP) was assessed. METHODS We studied the behavioural effects of m-CPP on tics, obsessions, compulsions and impulsions of GTS. Twelve medication-free GTS patients (ten men, two women) were included in a single dose 0.5 mg/kg oral m-CPP challenge study with a double-blinded placebo-controlled cross-over design. Global symptom scores, target symptom scores as well as biochemical measures were followed up to 24 h after baseline. RESULTS While m-CPP caused a significant rise in plasma cortisol and prolactin levels, no significant effects were found on the tics, obsessions and compulsions. Impulsions showed a trend to ameliorate. CONCLUSIONS This study does not support a predominant role for 5-HT on the tics in GTS. The trend of impulsions to ameliorate after m-CPP can be interpreted as circumstantial support for impulsivity-related 5-HT hypofunctionality in GTS. However, the large variability of m-CPP plasma concentrations found in this study casts doubts upon the reliability of m-CPP as a probe for challenge studies.
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Affiliation(s)
- D C Cath
- Psychiatric Hospital Amsterdam Outpatient Clinic, The Netherlands.
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Abstract
Studies in Great-Britain and the USA have established the prevalence of 'age disorientation', defined as a discrepancy between true and subjective age of five years or more, as approximately 25% in the population of long-stay patients with a diagnosis of schizophrenia. We examined all schizophrenic patients in long-stay wards of three mental hospitals and found a prevalence of 6% (95% CI: 0.9-10.6%). We have no definitive explanation for this finding. 'Age disorientation' may be the result of an interaction between a serious form of the illness and poor psychosocial treatment.
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Affiliation(s)
- J P Selten
- Rosenburg Psychiatric Hospital, The Hague, The Netherlands
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Cath DC, van de Wetering BJ, van Woerkom TC, Hoogduin CA, Roos RA, Rooijmans HG. Mental play in Gilles de la Tourette's syndrome and obsessive-compulsive disorder. Br J Psychiatry 1992; 161:542-5. [PMID: 1393343 DOI: 10.1192/bjp.161.4.542] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A new phenomenon, found only in Gilles de la Tourette (GTS) patients, and which we have called 'mental play', is described. It was compared with the phenomenon of counting, which occurred in both GTS and obsessive-compulsive patients. In the GTS patients both mental play and counting were best characterised as playful impulsions. In contrast to the GTS patients, the counting of the obsessive-compulsive patients was in line with their obsessive-compulsive behaviour. These findings suggest that repetitive symptoms in GTS patients, even when they share superficial similarities with obsessive-compulsive symptoms, should not be diagnosed automatically as obsessive-compulsive.
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Affiliation(s)
- D C Cath
- Psychiatric Hospital Endegeest, Oegstgeest, The Netherlands
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van de Wetering BJ, Cath DC, Roos RA, van Woerkom TC, Hoogduin CA, Minderaa RB. [Tics in Gilles de la Tourette syndrome]. Ned Tijdschr Geneeskd 1992; 136:1644-7. [PMID: 1407104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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