Thromboprophylaxis in COVID‐19: Weight and severity adjusted intensified dosing

Background

Aims

Methods

Results

Conclusion

Venous Thromboembolism in Patients Discharged after COVID-19 Hospitalization

BACKGROUND

 Venous thromboembolism (VTE) is a frequent complication of COVID-19, so that the importance of adequate in-hospital thromboprophylaxis in patients hospitalized with COVID-19 is well established. However, the incidence of VTE after discharge and whether postdischarge thromboprophylaxis is beneficial and safe are unclear. In this prospective observational single-center study, we report the incidence of VTE 6 weeks after hospitalization and the use of postdischarge thromboprophylaxis.

METHODS

 Patients hospitalized with confirmed COVID-19 were invited to a multidisciplinary follow-up clinic 6 weeks after discharge. D-dimer and C-reactive protein were measured, and all patients were screened for deep vein thrombosis with venous duplex-ultrasound. Additionally, selected high-risk patients received computed tomography pulmonary angiogram or ventilation-perfusion (V/Q) scan to screen for incidental pulmonary embolism.

RESULTS

 Of 485 consecutive patients hospitalized from March through June 2020, 146 patients were analyzed, of which 39% had been admitted to the intensive care unit (ICU). Postdischarge thromboprophylaxis was prescribed in 28% of patients, but was used more frequently after ICU stay (61%) and in patients with higher maximal D-dimer and C-reactive protein levels during hospitalization. Six weeks after discharge, elevated D-dimer values were present in 32% of ward and 42% of ICU patients. Only one asymptomatic deep vein thrombosis (0.7%) and one symptomatic pulmonary embolism (0.7%) were diagnosed with systematic screening. No bleedings were reported.

CONCLUSION

 In patients who had been hospitalized with COVID-19, systematic screening for VTE 6 weeks after discharge revealed a low incidence of VTE. A strategy of selectively providing postdischarge thromboprophylaxis in high-risk patients seems safe and potentially effective.

Octreotide Acetate in Dominant Cystoid Macular Dystrophy

Purpose

Dominant cystoid macular degeneration (DCMD) is an autosomal dominant trait of cystoid macular edema with poor visual prognosis. Until now, no efficient treatments for DCMD have been reported. The authors evaluated a somatostatin-analogue (octreotide acetate) as treatment for DCMD.

Methods

The authors treated four patients with early DCMD by intramuscular longacting octreotide acetate, 20 mg every 4 weeks for 1 year. In addition to general ophthalmologic examination the authors performed fluorescein angiography (FA) before and after treatment.

Results

Seven out of eight eyes showed improvement on FA and stabilization of visual acuity.

Conclusions

Somatostatin-analogues may reduce cystoid edema in DCMD and may thus prevent disease-related visual loss.

Using Indirect Measurement Tasks to Assess the Self–Concept of Personality: A Systematic Review and Meta–Analyses

This systematic review presents the current state of research investigating the implicit self–concept of personality. First, we present results on meta–analyses estimating internal consistency, reliability coefficients, the implicit–explicit consistency and the single association predictive effect of implicit self–concept of personality measures. To do this, studies were aggregated over personality domains. Second, for each of the Five Factor personality domains, different aspects of construct validity and predictive validity are reviewed in a narrative way. Results show that implicit self–concept of personality measures are reliable, and there is evidence for the construct and predictive validity of these implicit measures, especially in the extraversion and agreeableness domains of personality. However, it must be kept in mind that clear evidence for publication bias was found for studies examining the single association predictive pattern. Finally, this systematic review identifies some achievable improvements that are needed in future research. Large cross–lab efforts are important in this respect. Moreover, the implicit self–concept of personality field must move from an ‘ad hoc’ to a ‘validation’ approach in developing new indirect measurement tasks. By adopting these research objectives, the information processing account of personality will increase its potential to become integrated into mainstream personality theory and research. Copyright © 2017 European Association of Personality Psychology

3D shapes of aryl(dihydro)naphthothiophenes: a comprehensive and structural study

Convenient access to new aryl(dihydro)naphthothiophenes is described using a common β-chloroacrolein derivative. Our strategy is based on the construction of a condensed thiophene ring prior to a Suzuki-Miyaura coupling and allowed installing various substituents at the molecular platform. The overall shapes of these architectures were confirmed by X-ray analyses and were in good agreement with theoretical calculations. It has been established that the relative orientation between all fragments that composed molecules within this series is strongly related to both steric and electronic factors. Contribution of these key parameters revealed to be crucial to rationalize attempts to prepare fluorenone and fluorene derivatives from aryl(dihydro)naphthothiophene platforms.

[Ethical advice regarding the relationship between psychiatrists and the pharmaceutical industry]

BACKGROUND

The pharmaceutical industry is an important partner in mental health care.

AIM

To provide ethical advice that will help psychiatrists build a balanced relationship with the pharmaceutical industry.

METHOD

In this article we present the current advisory principles that have been developed by the Flemish Psychiatric Association (Vlaamse Vereniging voor Psychiatrie; VVP).

RESULTS

Not only do we give general advice that is relevant for all psychiatrists, but we also give advice that is applicable specifically to the psychiatrist-researcher, teachers and psychiatric trainees. Finally, we explain more fully how the VVP, as an organisation, deals with these issues.

CONCLUSION

It is important that the psychiatrists and the pharmaceutical industry deal with each other in a balanced and constructive manner, thereby stimulating progress in the field of psychiatry. For this purpose the VVP has formulated a number of ethical principles which, in our view, define the way in which psychiatrists should deal with the pharmaceutical industry.

[Sexuality in eating-disorder patients]

BACKGROUND

A link is suspected between eating disorders and dysfunctional sexuality. The grounds for this link are thought to be clinical, biological and psychological.

AIM

To find out from the literature what is known about sexuality in patients with eating disorders, to identify differences related to subtypes of the disorders and to ascertain whether sexuality can play a role in the diagnosis and treatment of various types of eating disorders.

METHOD

We studied the research literature with the help of PubMed.

RESULTS

Patients with eating disorders are more likely to have sexual problems; these include reduced libido, reduced sexual activity and sexual dissatisfaction. The distorted body image leads to the avoidance of sexual activity. Anorexia patients are more negative about sexuality and have a greater loss of libido than do bulimia patients, who experiment more with sex.

CONCLUSION

Patients with eating disorders experience sexual dysfunction, but there are clear differences between the various eating-disorder subtypes. It is advisable that, in the future, sexuality should be included in the outcome of research in eating disorders. This step will help researchers to evaluate the effect that treatment can have on the outcome of the eating disorder.

[The importance of movement-directed interventions in the multidisciplinary treatment of binge eating disorder: an overview]

BACKGROUND

More than three out of four persons with binge eating disorder do not get enough physical exercise.

AIM

To collect scientific evidence of the effects and benefits that movement and physical exercise can have on persons with a binge eating disorder.

METHOD

PubMed, PsychInfo, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Physiotherapy Evidence Database, the Dutch Journal of Psychiatry (Tijdschrift voor Psychiatrie), het Tijdschrift voor Vaktherapie and Actual Themata derived from psychomotor therapy were screened for the period January 1994 to August 2011. The methodological quality of the studies was determined on the basis of a checklist. Evidence for the effectiveness of the interventions was summarised by best-evidence synthesis.

RESULTS

Eight studies met the inclusion and exclusion criteria. Strong evidence was found for: 1) significant weight-loss after movement interventions; 2) fewer symptoms of depression after a combination of both movement and cognitive behavioural therapy (CBT) than after CBT on its own. There was only limited evidence for 1) the fact that the combination of movement and CBT leads to less eating disorder pathology than does CBT alone; 2) the beneficial effects of yoga on weight-loss as well as on the reduction of eating disorder pathology.There are indications that walking can be helpful in reducing of eating disorder pathology.

CONCLUSIONS

Activities involving movement and physical exercise deserve to play an important role in the multidisciplinary treatment of binge eating disorders.

[Eating disorders on the internet. A review of the quality of Dutch websites]

BACKGROUND

The internet is an important medium for people looking for health-related information. Since increasing numbers of people are now using the internet, it follows that more and more people are using the net to locate health-related information and services. In recent years more research has been done into the quality of health websites.

AIM

To study the quality of Dutch (-language) websites dealing with eating disorders and to produce a representative picture of the health information (in Dutch) available to the 'regular' internet user seeking information about eating disorders.

METHOD

We searched Dutch websites dealing with eating disorders using the Belgian-Dutch version of the Google search engine. We traced, visited, explored and classified websites using a classification system based on findings in the literature. Then we examined the quality of these websites by means of a self-made Scoring form for the Quality of Websites about Eating disorders (SQWE). We also assessed quality using the discern questionnaire, an instrument that has proved useful in earlier research.

RESULTS

Of the 141 websites that we located, 24 satisfied our selection criteria. "abbreviation" and discern showed the websites to be of variable quality. On the basis of the search terms we used, we did not find any pro anorexia nervosa or pro bulimia websites.

CONCLUSION

The websites providing information in Dutch about eating disorders are of variable quality and, in accordance with previous research results, the site characteristics are not reliable predictors of the quality of the content. The SQWE and DISCERN instruments, however, do have the potential to distinguish between good quality and poor quality websites.

[Stigmatisation of psychiatric patients by general practitioners and medical students: a review of the literature]

BACKGROUND

In clinical practice general practitioners (GPS) and society tend to stigmatise patients with psychiatric problems.

AIM

To attempt to describe this stigmatisation by GPS and medical students on the basis of information given in the literature.

METHOD

We searched the literature via PubMed using mesh terms: 'family practice', 'physicians', 'family', 'mental disorder', 'attitude' and 'psychiatry' and the word 'stigma'. In addition, literature was supplied by experts and articles were located by the snowball method.

RESULTS

Stigmatisation constitutes a major obstacle in the psychiatric and somatic care that gps provide for patients with a psychiatric disorder. Although such patients have a higher somatic vulnerability as a result of their psychiatric problems, they receive fewer technical and exploratory investigations than other categories of patients. Medical students too have a negative attitude towards patients with a psychiatric disorder. More education and training could lead to less stigmatisation but the effect would probably be only temporary. Personal experience is the main factor that leads to greater empathy.

CONCLUSION

The literature suggests that psychiatric patients are victims of self-inflicted stigmatisation and stigmatisation by society and doctors. This leads to social exclusion and poorer healthcare. By tackling the problem of stigmatisation we could greatly improve the quality of life and healthcare for this group of patients.

Be kind to your eating disorder patients: the impact of positive and negative feedback on the explicit and implicit self-esteem of female patients with eating disorders

OBJECTIVE

Lack of self-esteem may play an important role in the development of eating disorders (ED). This study investigated the differential impact of positive and negative feedback on implicit and explicit self-esteem in women with an ED (N=25) as compared to women without an ED (N=29).

METHOD

False feedback (positive or negative) was given on participant's performance on a specifically developed intellectual test. Before and after the performance, explicit and implicit self-esteem was measured.

RESULTS

On the explicit measure ED patients reacted congruently with the nature of the feedback. On the implicit measure only ED patients responded to the positive feedback with an improvement of self-esteem, with no effect for negative feedback. The control group was unaffected by either feedback. Furthermore, no correlation was observed between the explicit and implicit measures, a finding suggesting that these measurements tap different constructs.

CONCLUSION

Positive feedback affects implicit self-esteem of female patients with eating disorders. The results underline the importance of positively approaching women with ED.

Graves' disease during immune reconstitution in HIV-infected patients treated with HAART

Autoimmune phenomena after immune recovery due to HAART are not frequently described. Recently we found 3 patients with Graves' disease after starting HAART, outnumbering the expected incidence; 13 patients have been reported in the literature up to the present time.A probable relation between immune restoration and development of Graves' disease might be suspected.

Assessing the additional impact of fitness training in depressed psychiatric patients receiving multifaceted treatment: a replicated single-subject design

PURPOSE

Exercise has been put forward as a therapeutic means for the treatment of clinical depression.

METHODS

In this study, 29 patients, all with diagnosed with mood disorder, completed daily measurements of depression and physical well-being during periods ranging from 77 to 436 days (M = 146.5). Fitness training was added to the treatment after a period and changes before (A-phase) and after (B-phase) the implementation of this training were the subject of investigation. Data were analysed by means of randomization tests with an AB-design and time-series analysis. Replication of the findings was investigated using Fisher's multiplicative method.

RESULTS

Adding fitness training to the treatment of clinical depression does not systematically lead to changes in self-reported feelings of depression on top of benefits that may be due to other treatments.

CONCLUSIONS

Since the present findings are not in agreement with previous studies, the absence of statistically significant changes in self-reported feelings of depression is discussed within the complexity of the 'exercise - depression' relationship in inpatient populations. These included the severity of their depression, the potential ceiling effect of a multifaceted treatment programme and the initial increase in depression due to the confrontational nature of the intervention.

[Disclosure of conflicts of interest in the Tijdschrift voor Psychiatrie]

Between March 2000 and December 2008 authors disclosed conflicts of interest in 9% of articles in the Tijdschrift voor Psychiatrie. For the same period, in the articles dealing with pharmaceuticals, the percentage of articles containing disclosures of conflict of interest was considerably higher, namely 24%. The policy of the journal with regard to the disclosure of conflicts of interest has helped to promote transparency. Further efforts are needed to encourage authors to disclose conflicts of interest.

[Are patients in randomised controlled trials of psychotherapy representative for clinical practice?]

BACKGROUND

In the debate about evidence-based psychotherapy it is often assumed that randomised controlled trials (RCT's) have a limited generalizable. Among the reasons for this assumption are the strict exclusion criteria which rule out patients with comorbidity or multiple diagnoses.

AIM

To investigate whether these strict exclusion criteria do effect the generalizable of RCT's.

METHOD

Narrative overview of the research literature on psychotherapy.

RESULTS

We found that the exclusion criteria infact have less effect than expected on the generalizable.

CONCLUSION

Most patients from clinical practice can indeed be included in a RCT. Recent RCT's also include many patients with comorbidity.

State anxiety and subjective well-being responses to acute bouts of aerobic exercise in patients with depressive and anxiety disorders

OBJECTIVE

Acute aerobic exercise is associated with a reduction in state anxiety and an improvement in subjective well-being. The objective of the present study was to contrast the effects of aerobic exercise at self-selected intensity versus prescribed intensity on state anxiety and subjective well-being (negative affect, positive well-being and fatigue) in patients with depressive and/or anxiety disorders. In addition, the potential impact of heart rate feedback was assessed.

METHODS

Nineteen men and 29 women performed three test conditions on a bicycle ergometer during 20 minutes: two tests at self-selected intensity; one with and another without heart rate feedback, and a third test at the prescribed intensity of 50% of the maximal heart rate reserve according to Karvonen. Tests were executed in random order. State anxiety and subjective well-being were evaluated using the state anxiety inventory and the subjective exercise experiences scale.

RESULTS

After 20 minutes cycling, patients showed significantly decreased state anxiety and negative affect in the three conditions. The magnitude of the reduction did not differ significantly between the three conditions. Only cycling at self-selected intensity enhanced positive well-being. Cycling at 50% of the maximal heart rate reserve decreased fatigue, whereas cycling at self-selected intensity increased fatigue.

CONCLUSIONS

The response in state anxiety and negative affect was unaffected by the type of aerobic exercise. Self-selected intensity influenced exercise-induced changes in positive well-being and fatigue in a positive and negative way, respectively.

[Psychoanalysis and cognitive behaviour therapy: in the past and in the future]

Some recent developments in psychoanalysis and cognitive behaviour therapy are reviewed. This is followed by some thoughts and comments on the directions in which these two disciplines are likely to develop in the future.

[Increase in the percentage of female authors in the international psychiatric literature since 1970]

BACKGROUND

The participation of women in medicine and psychiatry is increasing.

AIM

To find out whether this trend is also reflected in the international psychiatric literature.

METHOD

We took steps to discover the gender of the first and the last author as listed below the title of 290 articles sampled at random from three leading psychiatric journals published between 1970 and 2007. results Women turned out to be underrepresented as the first or last author of these psychiatric articles; this conclusion was also found to apply to the first and last authors who were medical authors. Whereas the proportion of female first authors had increased significantly since 1970 and had reached almost 50% in 2007, there had been no such increase as far as last authors were concerned.

CONCLUSION

In the psychiatric literature studied, the proportion of female first authors rose to almost 50%.

[Preliminary results of a focus-group-based research project on the problems of implementing evidence-based practice in Belgium (Flanders). Do psychiatrists differ from other health care practitioners?]

BACKGROUND

The impact of evidence-based practice (EBP) has increased substantially in recent years. However, health care practitioners are experiencing difficulties in implementing EBP.

AIM

The specific task was to find out what problems are encountered by Flemish (Belgian, Dutch-speaking) health care practitioners. method In order to explore this problem, we adopted a qualitative research strategy and set up 25 focus groups, 5 of which consisted solely of psychiatrists. results Psychiatrists shared with other health care disciplines some concerns about the characteristics of 'evidence' and about the influential role played by their 'partners' in the health care system, namely by government, commercial firms and patients. Psychiatrists perceived their discipline to be much more complex than other disciplines, particularly in areas such as research design, patients' problems, psychiatric diagnosis and therapeutic psychiatrist-patient relationships. The literature and the preliminary results of ongoing research revealed that other disciplines too are confronted with similar complexities.

CONCLUSION

There seems to be no justification for ruling out the possibility of implementing EBP on the basis of discipline-related barriers.

[De Clérambault syndrome. A case report and a review of the literature on the difference between primary and secondary erotomania]

This case report is about a female patient with an erotomanic delusion, who is convinced that a man is deeply in love with her. Because the specific course of primary erotomania and its response to treatment have been documented, the literature was studied to find out whether it distinguishes between primary and secondary erotomania. The search, however, showed that erotomania occurs so rarely and is defined in such ambiguous terms that it is impossible to divide these subtypes into two separate entities.

Which elements in the treatment of eating disorders are necessary ‘ingredients’ in the recovery process?—A comparison between the patient's and therapist's view

BACKGROUND

Little is known about which therapeutic 'ingredients' in the treatment of eating disorders (anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED)) are needed for recovery. Remarkably, most studies on this topic have neglected the patient's view.

METHOD

In this study, a large sample of eating disorder patients (n = 132) was invited to evaluate which elements in the treatment they consider to be helpful and effective in their recovery process. These results were compared to the view of 49 eating disorder experts.

RESULTS

Following the patient's view, 'improving self-esteem', 'improving body experience' and 'learning problem solving skills', were considered as core elements in their treatment. No major differences were found between the different patient samples when comparing the patient's and therapist's view.

DISCUSSION

The findings suggest that therapists and patients share more or less the same view about the basic and effective elements in the treatment.

Psychomotor performance and sequence planning in anorexia nervosa before and after weight restoration

BACKGROUND

In the study of psychomotor performance in anorexia nervosa (AN), motor control has not been studied extensively. The present study explores sequence planning in a sample of AN patients.

METHOD

A group of 26 female restricting AN inpatients, aged 14 to 25, was compared with 24 healthy women matched for age and educational level. During the performance of a simple copying task, in which movement planning, but not working capacity, was challenged, the ease with which generally favored graphic production rules could be applied was manipulated. Computerized recordings of the drawing movements allowed detailed analyses of reaction and movement times and of drawing sequences. Fifteen patients were retested after weight restoration, as were 15 controls.

RESULTS

Copying patterns that normally elicit a conflict between preferred graphic production rules induced significantly less slowing in the reaction times of the anorexia nervosa patients than in the controls, both before and after weight restoration. There were no group differences as regards the consistency with which the implicit production rules were applied.

DISCUSSION

AN patients seem to show a fast response style combined with good sequence planning capacity.

The usefulness of experience sampling in understanding the urge to move in anorexia nervosa

BACKGROUND

Physical hyperactivity has often been described in anorexia nervosa (AN) patients but up until now in-depth research has been scarce. Experience sampling methodology (ESM), a structured diary technique assessing momentary mental state at random times during the day, may be useful in studying hyperactivity in AN.

METHODS

In two single case reports, ESM was used to investigate the variation across time of the urge to move in relation to potentially relevant eliciting conditions such as positive and negative emotions, weight preoccupation and attractiveness.

RESULTS

Frequency distribution of the involved variables indicated substantial individual differences between patients. While both patients' tendency to be hyperactive was positively related to their weight preoccupation and negative emotions, in only one patient, the urge to move turned out to be significantly related to (the absence of) positive emotions.

CONCLUSIONS

ESM can be useful to test whether general theories of psychopathology apply to specific patients, and it may be conceived as an individually tailored approach to self-monitoring. As such, it may guide the clinician to devise therapeutic interventions in particular patients.

[Obsessive compulsive disorder and the internet. An evaluation of Dutch-language websites and quality indicators]

BACKGROUND

The Internet is an important source of information about health matters. The quality of the information about Obsessive Compulsive Disorder (OCD) has not been investigated. Possible indicators of quality are the DISCERN rating tool, Google PageRank and cooperation from health care professionals.

AIM

To investigate the quality of the information given on Dutch-language websites relating to OCD and to determine whether the quality of the contents is correlated with site characteristics, scores on DISCERN and Google PageRank.

METHOD

We selected 27 Dutch-language websites via Google and Ixquick and investigated the correlation between the quality of the contents measured by 4 parameters and the presence of incorrect information, site characteristics, the DISCERN score and Google PageRank.

RESULTS

The quality of the information was generally poor. The only investigated site characteristic that was found to be associated with basic criteria relating to symptoms and diagnosis was the size of the site. The DISCERN score was significantly correlated with the quality of the information. The occurrence of incorrect information was independent of the quality of the content, site characteristics, Google PageRank and DISCERN scores.

CONCLUSION

The quality of Dutch-language websites on the subject of OCD is inadequate. Site characteristics and Google PageRank are not good predictors of the quality of information. The DISCERN rating tool is a potentially valuable indicator of content quality with regard to treatment options.

['Evidence-based medicine' in the Dutch and Flemish psychiatric, psychological and psychotherapeutic specialist literature: widely used?]

The expression 'evidence-based medicine' was first used in medical journals in the 1990's. Recent research has shown that the expression appears very frequently in international medical publications. Until recently, however, there were no research data concerning the frequency with which the expression is used in the titles and summaries in Dutch and Flemish specialist journals in the field of psychiatry, psychology and psychotherapy. In our systematic review of the Dutch and Flemish specialist medical literature published between 1990 and 2003 we found that the use of the expression increased markedly as from 1997.

Which factors do provoke binge eating? An exploratory study in eating disorder patients

OBJECTIVE

To study the different factors (external, emotional, cognitive, and physiological) which may trigger binge eating in eating disorder patients and to make a comparison of binge eating triggers in different eating disorder samples, i.e. anorexia nervosa bingeing-purging type and bulimia nervosa (BN).

METHOD

A total of 242 eating disorder patients filled out the Binge Eating Trigger Checklist (BETCH), a new screening device to evaluate the type of situations (and their experienced discomfort) which subjects identify as antecedents of a binge eating episode.

RESULTS

Eating disorder patients report a combination of negative emotions, physiological states (urge for sweets) and negative cognitions as most important antecedents for their bingeing episodes. External stimuli were only reported by a small number of patients and provoked significantly lower levels of discomfort. A comparison of binge eating triggers in bingeing anorexia nervosa patients and bulimic patients showed only a few significant differences.

CONCLUSIONS

Binge eating, as perceived and reported by eating disorder patients, seems to be provoked by a combination of different antecedents, both emotional, cognitive and physiological. Remarkably enough, binge eating triggers did not differ between bingeing anorectic patients and patients suffering from BN.

The predictive value of body mass index for the weight evolution in anorexia nervosa

BACKGROUND

Low body weight is considered to be an important risk factor for poor outcome in anorexia nervosa (AN).

OBJECTIVES

To study the relationship between body mass index (BMI) at the beginning of treatment and at follow-up. A BMI of 13 kg/m2 at admission was hypothesized as cut-off point for better versus worse evolution of weight after treatment.

METHOD

The BMI of 232 female AN inpatients was calculated at admission and after 6 months and 1 year.

RESULTS

An overall low correlation between BMI at admission and at 6 months (r = 0.27) and 1 year (r = 0.26) follow-up was found. A BMI value of 15 kg/m2 at admission was revealed as the best cut-off point for making predictions.

CONCLUSIONS

Patients with an admission BMI below 15 kg/m2 have a significantly greater chance to develop a lower BMI value at follow-up than those with a higher BMI.

Evaluation of cardio-respiratory fitness and perceived exertion for patients with depressive and anxiety disorders: a study on reliability

PURPOSE

The implementation of a physical reconditioning programme for patients with depressive and/or anxiety disorders requires a thorough evaluation of the physical fitness and the perceived exertion during exercise. This implies the use of reliable and clinically useful instruments. The present study examined the reliability of the Franz ergocycle test, as measure for cardio-respiratory fitness, and the Borg Category Ratio 10 Scale, as measure for subject-perceived exertion.

METHOD

Sixty-eight hospitalized patients performed test and re-test of the Franz ergocycle test and the Borg CR 10 Scale with a between interval of 1 week.

RESULTS

The Physical Work Capacity 130 and the Physical Work Capacity 150, determined by the Franz ergocycle test, had a proper to good test-re-test reliability (r ranged from 0.74 to 0.90). The Borg Category Ratio 10 Scale had a moderate reliability (r ranged from 0.42 to 0.82).

CONCLUSIONS

The Franz ergocycle test seems to be a reasonable reliable instrument for measuring physical work capacity of these patients. Possible explanations for the simply moderate reliability of the Borg Category Ratio 10 Scale could be the low level of physical activity prior to hospitalization, and the depressive and anxiety symptoms that might influence the perceived exertion.

Expressed Emotion in the Client-Professional Dyad

Summary: Background: This article reports on a study of the concurrent validity between the standard expressed emotion instrument, the Camberwell Family Interview (CFI), and two alternative EE measures, the Level of Expressed Emotion (LEE) and the Perceived Criticism Scale (PCS). Methods: The research sample consisted of 56 schizophrenic clients, who were residing in sheltered residences, and 56 professionals. Results: Based on the results of the correlation matrix between all the subscales of the instruments, a significantly positive relationship was found between the criticism scale of the CFI, the total score of the LEE, and the client version of the PCS. These correlations, however, were rather weak, which implies that the three instruments have little in common with each other. The professionals' version of the PCS does not appear to be an EE instrument. Conclusions: The results suggest that the CFI still remains the best instrument for assessing EE in a therapeutic relationship (between a professional and a client). If there is insufficient time to administer the CFI, then the client version of the PCS and the LEE can be used with the qualification that the PCS and LEE also measure other aspects and thus cannot completely replace the CFI. Nevertheless, the research indicates that asking the clients would seem to provide a better indication of the level of the professionals' criticism rather than asking the professionals themselves directly.

Improvements in physical fitness of non-psychotic psychiatric patients following psychomotor therapy programs

AIM

To investigate the changes in physical fitness after participation in 1 of 2 psychomotor therapy programs in a sample group of non-psychotic psychiatric patients.

METHODS

EXPERIMENTAL DESIGN

randomized controlled parallel group trial with follow-up measures after 8 weeks and after 16 weeks.

SETTING

3 treatment units of a university psychiatric hospital in Belgium.

PATIENTS

141 (51 males, 90 females) patients with severe depressive and/or anxious symptoms, and/or personality disorders.

INTERVENTIONS

patients followed a personalized psychomotor fitness program (PF), consisting of aerobic and resistance training, or a general program of psychomotor therapy (GPMT), consisting of different forms of physical exercises and relaxation training.

MEASURES

the maximum dynamic strength, the strength endurance and physical work capacity at 60% and 80% of the estimated maximal heart rate reserve.

RESULTS

After 8 weeks it was observed that the PF group enhanced in all parameters of cardio-respiratory as well as muscular fitness; the GPMT group had improved in 7 out of the 9 muscular fitness measurements. At the end of the 16 weeks, both groups had shown an improvement in all of the muscular fitness parameters, but only the PF group had increased in cardio-respiratory fitness.

CONCLUSION

In order to improve both muscular and cardio-respiratory fitness in these patients, a balanced personalized training program, which includes aerobic and resistance training, is necessary during a period of at least 8 weeks. The less specific GPMT, when followed for a period of 16 weeks, is sufficient for improving muscular fitness and for maintaining cardio-respiratory fitness.

The effectiveness of two psychomotor therapy programmes on physical fitness and physical self-concept in nonpsychotic psychiatric patients: a randomized controlled trial

OBJECTIVE

To compare the changes in cardiorespiratory and muscular fitness, and the changes in physical self-concept after participation in one of two psychomotor therapy programmes in a sample group of psychiatric patients. To study the relationship between the changes in physical fitness and the changes in physical self-concept.

DESIGN

Randomized controlled parallel-group trial with repeated measures.

SETTING

Three treatment units of a university psychiatric hospital in Belgium.

SUBJECTS

One hundred and ninety-nine patients with severe symptoms of depression and/or anxiety, and/or personality disorders.

INTERVENTIONS

A general programme of psychomotor therapy, consisting of different forms of physical exercises and relaxation training, and a personalized psychomotor fitness programme, consisting of aerobic and resistance training. These programmes were followed three times a week for a period of 16 weeks.

OUTCOME MEASURES

The maximum dynamic strength, the strength endurance, physical work capacity at 60% and 80% of the estimated maximal heart rate reserve, and the physical self-concept by means of the Dutch version of the Physical Self-Perception Profile.

RESULTS

After eight weeks, both groups exhibited an improvement in muscular fitness (both p-values < 0.0001), but only the psychomotor fitness group had improved in cardiorespiratory fitness (p < 0.01). After 16 weeks, the patients in the general programme of psychomotor therapy had not increased in cardiorespiratory fitness. At the end of the 16-week programmes, both groups showed a more positive physical self-concept (p from 0.01 to < 0.0001). However, these improvements were not related to the progress in physical fitness.

CONCLUSIONS

The main difference in the effectiveness of the two programmes was the increase in cardiorespiratory fitness in the psychomotor fitness group. The gains in fitness did not play an essential role in the enhancement of physical self-concept.

Expressed emotion in the client-professional caregiver dyad: are symptoms, coping strategies and personality related?

OBJECTIVE

The aim of this study was to investigate whether the characteristics of residents and professional caregivers are associated with the professionals' expressed emotion (EE).

METHOD

Fifty-six residents in sheltered living who suffer from schizophrenia or a related psychotic disorder and their professional caregivers were enlisted. Standardised validated instruments were used to measure EE, the residents' social functioning, symptoms and social network size, and the professional caregivers' coping strategies and personality.

RESULTS

There was strong evidence that high EE was associated with the residents' age, poorer social functioning and smaller network sizes. There was no significant relationship between EE and the residents' symptoms except for excitement. Concerning the professional caregivers, high EE professionals were less open than their low EE colleagues and had a lower education level.

CONCLUSION

The residents' social functioning is an important correlate of the EE index.

In-patient treatment of borderline personality disorder: convergences and divergences between a psychoanalytical and a cognitive-behavioral approach

For more than 20 years, patients with borderline personality disorder have been treated as in-patients in the UC St-Jozef in Kortenberg, Belgium. The majority of these patients were treated in a psychoanalytical or a behavior therapy ward. During these years, the treatment programs of these wards were gradually adjusted to the challenges provided by these patients. In this paper, we will describe the process of change that both wards have experienced. We will highlight similarities and differences between the approaches that are the result of an evolution over years. In both approaches, there is a strong emphasis on training and support for staff. While the psychoanalytical ward uses a group approach, the behavior therapy ward evolves towards a more individualized treatment.

Expressed emotion

Expressed emotion (EE) refers to the quality of the emotional climate between a relative and a family member with a serious psychiatric disorder. Well-established, it has proven to be a reliable predictor of the relapse rate of psychiatric patients. In this article, the Camberwell Family Interview (CFI), the standard instrument, and 11 alternative EE measures will be presented and discussed with regard to their psychometric properties. It is concluded that the CFI remains the best instrument for assessing the quality of the relationship.

Expressed emotion in staff-patient relationships: the professionals' and residents' perspectives

BACKGROUND

Expressed emotion (EE) is a well-established, important predictor of the relapse rate of patients suffering from schizophrenia and other severe psychiatric disorders. EE measures the quality of the social interaction between a patient and his most important (in)formal caregiver. The aim of this study was to investigate the quality of the relationship in the staff-patient dyad as measured by the concept of EE.

METHODS

EE was assessed using the Camberwell Family Interview (CFI, professionals) and the Perceived Criticism Scale (PCS, residents and professionals form) in a sample of 56 professional caregivers and their residents in nine sheltered living facilities in Flanders.

RESULTS

Depending on the instrument, high EE was found to exist in one out of six (CFI) or one out of three (PCS) relationships. There was a significant positive correlation between the resident PCS and the critical comment scale of the CFI.

CONCLUSIONS

The results of this study support the hypothesis that high levels of EE exist in some staff-resident relationships, which are mainly manifest as frequent critical comments and the presence of hostility. Emotional overinvolvement appears to be exceptional. Compared with the PCS, the CFI provides the most information about the quality of the relationship.

The Care Perception Questionnaire

Summary: Major changes have taken place over the last decade in the mental health care services in Belgium as well as in the rest of Europe. To track these developments, Shepherd and colleagues developed an instrument to assess the degree of perceived accomplishment of 11 key areas in such care. This instrument was translated and adapted as the Care Perception Questionnaire. In clinical settings the instrument can be a good tool for exploring the perspective of patients and professionals regarding the 11 key areas. However, for research purposes it is not practical to work with the 28 separate items or with the 11 key areas. The goal of this study is to reduce the 11 key areas to a smaller number of scales with good psychometric properties and with relevance to clinical practice. Using principal-component analysis by means of promax rotation and scale construction, we developed four statistically reliable and meaningful scales: (1) support in social relations and practical aid, (2) treatment and monitoring of the course of the illness, (3) information and insight, and (4) coordination and continuity of care. The relevance of the findings for clinical work and for research is discussed.

Body experience in eating disorders before and after treatment: a follow-up study

Since body dissatisfaction is an essential part of anorexia/bulimia nervosa, we wanted to assess the patients' body experience before and after intensive treatment. Body experience was studied in 290 eating disorder patients, admitted to a specialised unit, after six months and again after one year using the Body Attitude Test (BAT), the Eating Disorder Inventory (EDI), and the Eating Disorder Evaluation Scale (EDES). The clearly negative body experience of eating disorder patients evolved in a positive way after therapy and this improvement lasted for up to one year after admission. EDI scores and Body Mass Index at the time of admission appeared to be the strongest predictors of the total BAT score at follow-up. Although body dissatisfaction can be quite persistent in eating disorders, intensive treatment can substantially improve the patients' body experience.

Implicit and explicit memory for shape, body weight, and food-related words in patients with anorexia nervosa and nondieting controls

Twelve patients with anorexia nervosa and 12 control participants watched a series of 64 words. There were 4 word types: anorexia related, positive, negative, and neutral. The last 3 types were anorexia unrelated. Anorexia-related words had the same affective valence as the neutral control words. Next, the participants completed an explicit memory test (cued recall) and an implicit memory test (word stem completion). Results showed a strong explicit memory bias for anorexia-related words for patients with anorexia nervosa but not for nondieting controls. There was no evidence for a similar bias in implicit memory. Results are discussed in the context of cognitive biases in psychopathology.