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Vollbehr NK, Stant AD, Hoenders HJR, Bartels-Velthuis AA, Nauta MH, Castelein S, Schroevers MJ, de Jong PJ, Ostafin BD. Cost-effectiveness of a mindful yoga intervention added to treatment as usual for young women with major depressive disorder versus treatment as usual only: Cost-effectiveness of yoga for young women with depression. Psychiatry Res 2024; 333:115692. [PMID: 38309011 DOI: 10.1016/j.psychres.2023.115692] [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: 04/25/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 02/05/2024]
Abstract
In a randomized controlled trial in the Netherlands, we studied the (cost)effectiveness of adding a mindful yoga intervention (MYI+TAU) to treatment as usual (TAU) for young women with major depressive disorder (MDD). In this paper, we present the results of the economic analyses. Societal costs and health outcomes were prospectively assessed during 15 months for all randomized participants (n = 171). Symptoms of depression (Depression Anxiety and Stress Scales; DASS) and quality adjusted life years (QALYs) were used as health outcomes in the economic analyses. Mean total societal costs during the 15 months of the study were €11.966 for the MYI+TAU group and €13.818 for the TAU group, differences in mean total societal costs were not statistically significant. Health outcomes (DASS and QALY) were slightly in favour of MYI+TAU, but differences between groups were not statistically significant. Combining costs and health outcomes in cost-effectiveness analyses indicated that MYI+TAU is likely to be cost-effective compared to TAU which was confirmed by sensitivity analyses. Although there were limitations in the cost-effectiveness analysis, findings from this study suggest that MYI+TAU warrants future attention for the potential to be cost-effective compared to TAU for young women with MDD.
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Affiliation(s)
- Nina K Vollbehr
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 80, 9725 AG, Groningen, the Netherlands; University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands.
| | | | - H J Rogier Hoenders
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 80, 9725 AG, Groningen, the Netherlands; University of Groningen, Faculty of Religion, Culture and Society, Groningen, the Netherlands
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research center, Groningen, the Netherlands
| | - Maaike H Nauta
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - Stynke Castelein
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 80, 9725 AG, Groningen, the Netherlands; University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands; Lentis Psychiatric Institute, Lentis Research, Groningen, the Netherlands
| | - Maya J Schroevers
- University of Groningen, University Medical Center Groningen, Faculty of Medical Sciences, Groningen, the Netherlands
| | - Peter J de Jong
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - Brian D Ostafin
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
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Vollbehr NK, Schmidt AT, Bartels-Velthuis AA, Ostafin BD, Hoenders HJR. The ethics of yoga in (mental) healthcare: Beyond the traditional Eightfold path. Complement Ther Med 2023; 77:102979. [PMID: 37640167 DOI: 10.1016/j.ctim.2023.102979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/13/2023] [Accepted: 08/25/2023] [Indexed: 08/31/2023] Open
Affiliation(s)
- Nina K Vollbehr
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Groningen, the Netherlands; University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands.
| | - Andreas T Schmidt
- University of Groningen, Faculty of Philosophy, Groningen, the Netherlands
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands
| | - Brian D Ostafin
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - H J Rogier Hoenders
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Groningen, the Netherlands; University of Groningen, Faculty of Religon, Culture and Society, Groningen, the Netherlands
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Spoelstra SK, Eijsink JJH, Hoenders HJR, Knegtering H. Maternal choline supplementation during pregnancy to promote mental health in offspring. Early Interv Psychiatry 2023. [PMID: 37038050 DOI: 10.1111/eip.13426] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/23/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
AIM There is increasing interest in the role of choline in brain development, including its possible role in promoting mental health and preventing mental illness. Choline is an essential micronutrient in fetal brain maturation. In more than 90% of pregnant women, choline intake has been found to be lower than the daily-recommended dose. The aim of this article is to review what is known about the effects of maternal choline supplementation on fetal brain development, early child development and mental health. METHODS A narrative review of the literature. RESULTS A limited number of studies suggest that maternal choline supplementation during pregnancy may enhance fetal brain development and improve early signs and symptoms that may predispose to mental illness. CONCLUSION The general low maternal choline intake during pregnancy, expected health benefits and low risks, make a plea for maternal choline supplementation to promote mental health. Choline supplementation may be especially important for pregnant women with a (family) history of severe mental illness and/or alcohol dependence.
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Affiliation(s)
- S K Spoelstra
- Department of addiction and mental health, Addiction Care Northern Netherlands, Groningen, The Netherlands
| | - J J H Eijsink
- Department of psychiatric emergencies, Lentis Mental Health Institution, Groningen, The Netherlands
| | - H J R Hoenders
- Centre for Integrative Psychiatry (CIP), Lentis Mental Health Institution in Groningen, Chair of the Dutch Consortium for Integrative Medicine and Health, Groningen, The Netherlands
| | - H Knegtering
- Lentis Mental Health Institution, University Medical Center, Rob Giel Research Center, Neuroimaging Center, University of Groningen, Groningen, The Netherlands
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Spoelstra SK, Eijsink JJH, Hoenders HJR, Knegtering H. [The influence of maternal choline supplementation on fetal brain development and the risk of psychotic symptoms]. Tijdschr Psychiatr 2023; 65:323-328. [PMID: 37434570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
BACKGROUND Choline is an essential micronutrient important for fetal brain development. Research suggests that maternal choline supplementation during pregnancy may reduce the risk of developing neuropsychiatric disorders such as psychosis in offspring. AIM To provide a narrative review of evidence from the literature for the possible prevention of neuropsychiatric problems such as psychosis by maternal choline supplementation. METHOD A narrative review of the literature obtained after searches in PubMed, Embase and PsycINFO. RESULTS Nutritional studies indicate that most pregnant women do not receive sufficient dietary choline. This may have adverse effects on fetal brain development. A total of 8 studies were identified; 4 animal and 4 clinical studies. Beneficial effects of maternal choline supplementation were found on fetal brain development, including cognitive and psychosocial functioning of children. No evidence of (serious) side effects was found. Due to the relatively short duration and limited size of the studies, no conclusions could be drawn about the role of maternal choline supplementation in the prevention of neuropsychiatric problems such as psychosis. CONCLUSION Maternal choline supplementation and/or a choline-rich diet during pregnancy should be further investigated because of evidence of beneficial effects on infant mental functioning, low cost and few side effects. There is no evidence that maternal choline supplementation can prevent psychotic symptoms in offspring.
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Vollbehr NK, Hoenders HJR, Bartels-Velthuis AA, Nauta MH, Castelein S, Schroevers MJ, Stant AD, Albers CJ, de Jong PJ, Ostafin BD. Mindful yoga intervention as add-on to treatment as usual for young women with major depressive disorder: Results from a randomized controlled trial. J Consult Clin Psychol 2022; 90:925-941. [PMID: 36701531 DOI: 10.1037/ccp0000777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the added value of a 9-week mindful yoga intervention (MYI) as add-on to treatment as usual (TAU) in reducing depression for young women (18-34 years) with major depressive disorder (MDD). METHOD Randomized controlled trial (RCT; n = 171) comparing TAU + MYI with TAU-only. Assessments were at baseline, postintervention, and at 6- and 12-month follow-up. Primary outcome measures were clinician-rated and self-reported symptoms of depression, together with a diagnostic interview to establish MDD diagnosis that was restricted to the baseline and 12-month follow-up assessments. Quality of life in various domains was assessed as secondary outcome measure. As potential mediators for treatment efficacy, we included self-report measures of rumination, self-criticism, self-compassion, intolerance of uncertainty, perceived body awareness and dispositional mindfulness, together with behavioral measures of attentional bias (AB) and depression-related self-associations. RESULTS Adding MYI to TAU did not lead to greater reduction of depression symptoms, lower rate of MDD diagnosis or increase in quality of life in various domains of functioning at post and follow-up assessments. There were no indirect effects through any of the potential mediators, with the exception of self-compassion. CONCLUSION Adding MYI to TAU appeared not more efficacious than TAU-only in reducing depression symptoms in young women. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Nina K Vollbehr
- Lentis Psychiatric Institute, Center for Integrative Psychiatry
| | | | | | - Maaike H Nauta
- Department of Clinical Psychology and Experimental Psychopathology
| | | | - Maya J Schroevers
- Department of Health Sciences, University Medical Center Groningen, University of Groningen
| | | | - Casper J Albers
- Department of Psychometrics and Statistics, University of Groningen
| | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen
| | - Brian D Ostafin
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen
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Kristoffersen AE, van der Werf ET, Stub T, Musial F, Wider B, Jong MC, Wode K, Danell JAB, Busch M, Hoenders HJR, Nordberg JH. Consultations with health care providers and use of self-management strategies for prevention and treatment of COVID-19 related symptoms. A population based cross-sectional study in Norway, Sweden and the Netherlands. Complement Ther Med 2022; 64:102792. [PMID: 34826590 PMCID: PMC8609665 DOI: 10.1016/j.ctim.2021.102792] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/14/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The present study was initiated to determine consultations with health care providers and use of self-management strategies for prevention or treatment of COVID-19 related symptoms in countries with a full lockdown (Norway), a partial lockdown (the Netherlands) and no lockdown (Sweden) during the first three months of the COVID-19 pandemic, and if such use correlates with worries of being infected by COVID-19 disease. DESIGN Data were collected in collaboration with Ipsos A/S in April-June 2020. An adapted version of the International Questionnaire to measure use of Complementary and Alternative Medicine (I-CAM-Q) was used with the categories "for prevention of COVID-19" and "to treat COVID-19-related symptoms" added. Data were collected among a representative sample in Norway, Sweden and the Netherlands using data assisted telephone interviews (Norway, n=990 and Sweden, n=500), and an online survey (the Netherlands, n=1004). Total response rate was 30%. RESULTS Very few consulted a health care provider with the intention to treat or prevent COVID-19 (1.2% and 1.0% respectively) with medical doctors mostly visited (1.0% and 0.9% respectively). Similarly, the use of self-management strategies to prevent or treat COVID-19 was low (3.4% and 0.2% respectively); most commonly used for prevention of COVID-19 were vitamins and minerals (2.8%). Consultations with health care providers and use of self-management strategies for prevention of COVID-19 were positively associated with worries of being infected with COVID-19. CONCLUSIONS The COVID-19 pandemic does not seem to have evoked a large-scale difference in behavior related to consultations with health care providers or the use of self-management strategies in any of the three countries.
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Affiliation(s)
- Agnete E Kristoffersen
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Esther T van der Werf
- Louis Bolk Institute, Bunnik, the Netherlands; The Consortium for Integrative Medicine and Health (CIZG), the Netherlands
| | - Trine Stub
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Frauke Musial
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Barbara Wider
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Miek C Jong
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kathrin Wode
- Regional Cancer Center Stockholm Gotland, Stockholm, Sweden; Department Radiation Sciences Umeå University, Umeå, Sweden; Department of Nursing, Umeå University, Umeå, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Martine Busch
- The Consortium for Integrative Medicine and Health (CIZG), the Netherlands; Van Praag Institute, Utrecht, the Netherlands
| | - H J Rogier Hoenders
- The Consortium for Integrative Medicine and Health (CIZG), the Netherlands; Center for Integrative Psychiatry, Lentis, Groningen, the Netherlands
| | - Johanna H Nordberg
- Regional Cancer Center Stockholm Gotland, Stockholm, Sweden; Karolinska Institutet, Department of Neurobiology, Care Sciences & Society, Divison of Nursing & Department of Physiology & Pharmacology, Stockholm, Sweden
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van Belkum SM, de Boer MK, Opmeer EM, Kortekaas R, Mulder T, Woonings F, Hoenders HJR, Kamphuis H, Aleman A, Schoevers RA. No antidepressant effects of low intensity transcranial pulsed electromagnetic fields for treatment resistant depression. J Affect Disord 2021; 294:679-685. [PMID: 34333176 DOI: 10.1016/j.jad.2021.07.087] [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: 01/24/2021] [Revised: 04/15/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Noninvasive neurostimulation with transcranial Pulsed Electromagnetic Fields (tPEMF) may be a promising method for treatment resistant depression (TRD). Studies shown substantial improvement of depressive symptoms in patients with TRD, but there is no information on long-term antidepressant effects. The aim of this study was to investigate the short- and long-term efficacy of tPEMF in participants with TRD. METHODS Eligible participants with TRD in this sham-controlled double-blind multicenter trial were randomly assigned to five weeks either daily active or sham tPEMF. Severity of depression and anxiety was assessed pre- and directly post-treatment and five and fifteen weeks post-treatment. Primary outcome was change on the 17-item Hamilton depression rating scale directly post-treatment. Secondary outcome was change on the Hamilton-17 during follow-up and change on the Inventory of Depressive Symptomatology Self-Report and the Beck Anxiety Index. RESULTS Of the 55 included participants, 50 completed the treatment protocol. Depressive symptoms improved over time in both groups. The improvement continued until the last follow-up measure. There was no difference in outcome between the active and the sham group on change in depression post-treatment or on any secondary measure. CONCLUSION Treatment with this type of active tPEMF was not superior to sham in patients with TRD. This is in contrast to a previous study using a similar design and power calculation, but a higher magnetic field strength, that reported improvement of depression after treatment with tPEMF compared to sham. An important limitation of our study was the fact that no different dosing regimens were tried.
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Affiliation(s)
- Sjoerd M van Belkum
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioral and Cognitive Neurosciences (BCN), Interdisciplinary Center Psychopathology of Emotion regulation (ICPE), the Netherlands.; University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands..
| | - Marrit K de Boer
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioral and Cognitive Neurosciences (BCN), Interdisciplinary Center Psychopathology of Emotion regulation (ICPE), the Netherlands
| | - Esther M Opmeer
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands
| | - Rudie Kortekaas
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands
| | - Tim Mulder
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands
| | | | | | - Hans Kamphuis
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioral and Cognitive Neurosciences (BCN), Interdisciplinary Center Psychopathology of Emotion regulation (ICPE), the Netherlands.; University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands.; GGZ Drenthe, the Netherlands,; Lentis, Center for Integrative Psychiatry, the Netherlands.; PsyQ Groningen, the Netherlands
| | - André Aleman
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, the Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Research School of Behavioral and Cognitive Neurosciences (BCN), Interdisciplinary Center Psychopathology of Emotion regulation (ICPE), the Netherlands
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van der Werf ET, Busch M, Jong MC, Hoenders HJR. Lifestyle changes during the first wave of the COVID-19 pandemic: a cross-sectional survey in the Netherlands. BMC Public Health 2021; 21:1226. [PMID: 34172042 PMCID: PMC8231077 DOI: 10.1186/s12889-021-11264-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During the Covid-19 pandemic the Dutch government implemented its so-called 'intelligent lockdown' in which people were urged to leave their homes as little as possible and work from home. This life changing event may have caused changes in lifestyle behaviour, an important factor in the onset and course of diseases. The overarching aim of this study is to determine life-style related changes during the first wave of the COVID-19 pandemic among a representative sample of the adult population in the Netherlands. METHODS Life-style related changes were studied among a random representative sample of the adult population in the Netherlands using an online survey conducted from 22 to 27 May 2020. Differences in COVID-19-related lifestyle changes between Complementary and Alternative Medicine (CAM) users and non-CAM users were determined. The survey included a modified version of the I-CAM-Q and 26 questions on lifestyle related measures, anxiety, and need for support to maintain lifestyle changes. RESULTS 1004 respondents were included in the study, aged between 18 and 88 years (50.7% females). Changes to a healthier lifestyle were observed in 19.3% of the population, mainly due to a change in diet habits, physical activity and relaxation, of whom 56.2% reported to be motivated to maintain this behaviour change in a post-COVID-19 era. Fewer respondents (12.3%) changed into an unhealthier lifestyle. Multivariable logistic regression analyses revealed that changing into a healthier lifestyle was positively associated with the variables 'Worried/Anxious getting COVID-19' (OR: 1.56, 95% C.I. 1.26-1.93), 'CAM use' (OR: 2.04, 95% C.I. 1.38-3.02) and 'stress in relation to financial situation' (OR: 1.89, 95% C.I. 1.30-2.74). 'Age' (OR 18-25: 1.00, OR 25-40: 0.55, 95% C.I. 0.31-0.96, OR 40-55:0.50 95% C.I. 0.28-0.87 OR 55+: 0.1095% C.I. 0.10-0.33), 'stress in relation to health' (OR: 2.52, 95% C.I. 1.64-3.86) and 'stress in relation to the balance work and home' (OR: 1.69, 95% C.I. 1.11-2.57) were found predicting the change into an unhealthier direction. CONCLUSION These findings suggest that the coronavirus crisis resulted in a healthier lifestyle in one part and, to a lesser extent, in an unhealthier lifestyle in another part of the Dutch population. Further studies are warranted to see whether this behavioural change is maintained over time, and how different lifestyle factors can affect the susceptibility for and the course of COVID-19.
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Affiliation(s)
- Esther T van der Werf
- Louis Bolk Institute, Bunnik, The Netherlands.
- Dutch Consortium for Integrative Medicine and Health (CIZG), Utrecht, The Netherlands.
| | - Martine Busch
- Dutch Consortium for Integrative Medicine and Health (CIZG), Utrecht, The Netherlands
- Van Praag Institute, Utrecht, The Netherlands
| | - Miek C Jong
- National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Mid Sweden University, Department of Health Sciences, Sundsvall, Sweden
| | - H J Rogier Hoenders
- Dutch Consortium for Integrative Medicine and Health (CIZG), Utrecht, The Netherlands
- Center for Integrative Psychiatry (CIP), Lentis Mental Health Institution, Groningen, the Netherlands
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Vollbehr NK, Hoenders HJR, Bartels-Velthuis AA, Ostafin BD. Feasibility of a Manualized Mindful Yoga Intervention for Patients With Chronic Mood Disorders. J Psychiatr Pract 2021; 27:212-223. [PMID: 33939376 DOI: 10.1097/pra.0000000000000539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Chronic mood disorders pose an important mental health problem. Individuals with these disorders experience a significant impairment, often fail to seek help, and their illnesses frequently do not respond to treatment. It is therefore important to develop innovative and attractive treatments for these disorders. Mindful yoga represents a promising treatment approach. This pilot study tested the feasibility of a 9-week manualized mindful yoga intervention for patients with chronic mood disorders. Eleven patients receiving standard treatment were recruited to complete a 9-week mindful yoga intervention. Qualitative methods were used to assess patients' experiences of the intervention and quantitative methods were used to assess psychological distress and mechanisms that play a role in chronic mood disorders. Eight patients completed the intervention and rated the overall quality of the intervention with a mean score of 8.8 (range of 8 to 9, using a scale of 1 to 10). All participants reported a reduction in psychological distress and no adverse events. Among the mechanisms that play a role in chronic mood disorders, the most potentially promising effects from the intervention were found for worry, fear of depression and anxiety, rumination, and areas related to body awareness, such as trusting bodily experiences and not distracting from sensations of discomfort. A 9-week mindful yoga intervention appears to be a feasible and attractive treatment when added to treatment as usual for a group of patients with chronic mood disorders. A randomized controlled trial to study the effects of mindful yoga is recommended.
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Veling W, Lestestuiver B, Jongma M, Hoenders HJR, van Driel C. Virtual Reality Relaxation for Patients With a Psychiatric Disorder: Crossover Randomized Controlled Trial. J Med Internet Res 2021; 23:e17233. [PMID: 33448933 PMCID: PMC7846446 DOI: 10.2196/17233] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/29/2020] [Accepted: 08/25/2020] [Indexed: 01/02/2023] Open
Abstract
Background Virtual reality (VR) relaxation is a promising mental health intervention that may be an effective tool for stress reduction but has hardly been tested in clinical trials with psychiatric patients. We developed an easy-to-use VR self-management relaxation tool (VRelax) with immersive 360° nature videos and interactive animated elements. Objective To investigate the immediate effects of VR relaxation on negative and positive affective states and short-term effects on perceived stress and symptoms in patients with a psychiatric disorder, compared to standard relaxation exercises. Methods A randomized crossover trial was conducted in 50 patients receiving ambulatory treatment for anxiety, psychotic, depressive, or bipolar disorder. Participants were randomly assigned to start with VRelax or standard relaxation and used both interventions for 10 days at home. They completed 8 visual analog scales of momentary negative and positive affective states before and after each session. Global perceived stress and psychiatric symptoms were measured before and after both intervention periods. Treatment effects were analyzed with multilevel mixed model regression analyses and 2-way analysis of variance. Results Both VRelax and standard relaxation exercises led to a statistically significant immediate improvement of all negative and positive affective states. Compared to standard relaxation, VRelax resulted in a significantly greater reduction of total negative affective state (change 16.2% versus 21.2%; t1684=−2.02, 95% CI −18.70 to −0.28; P=.04). Specifically, VRelax had a stronger beneficial effect on momentary anxiety (t1684=−3.24, 95% CI −6.86 to −1.69), sadness (t1684=−2.32, 95% CI −6.51 to −0.55), and cheerfulness (t1684=2.35, 95% CI 0.51 to 5.75). There were no significant differences between short-term effects of the two treatments on global perceived stress and symptoms. Conclusions If the results of this trial are replicated and extended, VRelax may provide a much-needed, effective, easy-to-use self-management relaxation intervention to enhance psychiatric treatments. Trial Registration Netherlands Trial Register NTR7294; https://www.trialregister.nl/trial/7096
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Affiliation(s)
- Wim Veling
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,VRelax BV, Groningen, Netherlands
| | - Bart Lestestuiver
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | | | - Catheleine van Driel
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Hoenders HJR, Braam AW. [The role of spirituality in psychiatry: important but still unclear]. Tijdschr Psychiatr 2020; 62:955-959. [PMID: 33443746] [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
There is an increasing interest in spirituality in relation to psychiatry.<br/> AIM: Exploring the place and meaning of spirituality in mental healthcare.<br/> METHOD: A narrative review of recent developments and results of scientific studies.<br/> RESULTS: Spirituality is related to better (mental) health, wellbeing and longevity, but definitions and conceptualisation are still unclear. Clinical attention is recommended, including awareness of certain risks, but these are not systematically investigated in psychiatry.<br/> CONCLUSION: Spirituality seems to be an important lifestyle factor, that correlates positively with (mental) health, but there is a need for better definitions, conceptualisation and recommendations based on scientific research. A multidisciplinary guideline for psychiatry seems desirable.
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Abstract
Responses to evidence-based interventions for depression are divergent: Some patients benefit more than others during treatment and some do not benefit at all or even deteriorate. Tailoring interventions to the individual may improve outcomes. However, such personalization of evidence-based treatment in depression requires investigation of individual outcomes and the individual trajectories towards these outcomes. This theoretical paper provides a critical reflection on individual outcomes of depression treatment. First, it is argued that outcomes should be broadened, from a focus on mainly depressive symptomatology to recovery in different domains. It is acknowledged that recovery from depression reflects a personal journey that differs from person to person. Second, outcome measures should be lengthened beyond the acute treatment phase, taking a lifetime perspective on depression. The challenge then is to discover which trajectories of what measures during what interventions result in personalized sustainable recovery and for whom. Routine outcome monitoring systems may be used to inform this quest towards assessment of personalized sustainable therapeutic outcomes. Adaptations to broaden and lengthen measurements in routine outcome monitoring systems are proposed to identify predictors of personalized sustainable recovery. Routine outcome monitoring systems may eventually be used to implement personalized treatments for depression that result in personalized sustainable recovery.
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Affiliation(s)
- Christien Slofstra
- Lentis Research, Groningen, Hereweg 80, 9700 AB Groningen, The Netherlands
| | - Sanne H Booij
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 76, 9700 AB Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, CC72, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - H J Rogier Hoenders
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 76, 9700 AB Groningen, The Netherlands
| | - Stynke Castelein
- Lentis Research, Groningen, Hereweg 80, 9700 AB Groningen, The Netherlands.,Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 76, 9700 AB Groningen, The Netherlands.,University of Groningen, Faculty of Behavioral and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
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Vollbehr NK, Bartels-Velthuis AA, Nauta MH, Castelein S, Steenhuis LA, Hoenders HJR, Ostafin BD. Hatha yoga for acute, chronic and/or treatment-resistant mood and anxiety disorders: A systematic review and meta-analysis. PLoS One 2018; 13:e0204925. [PMID: 30273409 PMCID: PMC6166972 DOI: 10.1371/journal.pone.0204925] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/17/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The aim of this study was to systematically investigate the effectiveness of hatha yoga in treating acute, chronic and/or treatment-resistant mood and anxiety disorders. METHODS Medline, Cochrane Library, Current Controlled Trials, Clinical Trials.gov, NHR Centre for Reviews and Dissemination, PsycINFO and CINAHL were searched through June 2018. Randomized controlled trials with patients with mood and anxiety disorders were included. Main outcomes were continuous measures of severity of mood and anxiety symptoms. Cohen's d was calculated as a measure of effect size. Meta-analyses using a random effects model was applied to estimate direct comparisons between yoga and control conditions for depression and anxiety outcomes. Publication bias was visually inspected using funnel plots. RESULTS Eighteen studies were found, fourteen in acute patients and four in chronic patients. Most studies were of low quality. For depression outcomes, hatha yoga did not show a significant effect when compared to treatment as usual, an overall effect size of Cohen's d -0.64 (95% CI = -1.41, 0.13) or to all active control groups, Cohen's d -0.13 (95% CI = -0.49, 0.22). A sub-analysis showed that yoga had a significant effect on the reduction of depression compared to psychoeducation control groups, Cohen's d -0.52 (95% CI = -0.96, -0.08) but not to other active control groups, Cohen's d 0.28 (95% CI = -0.07, 0.63) For studies using a follow-up of six months or more, hatha yoga had no effect on the reduction of depression compared to active control groups, Cohen's d -0.14 (95% CI = -0.60, 0.33). Regarding anxiety, hatha yoga had no significant effect when compared to active control groups, Cohen's d -0.09 (95% CI = -0.47, 0.30). The I2 and Q-statistic revealed heterogeneity amongst comparisons. Qualitative analyses suggest some promise of hatha yoga for chronic populations. CONCLUSIONS The ability to draw firm conclusions is limited by the notable heterogeneity and low quality of most of the included studies. With this caveat in mind, the results of the current meta-analysis suggest that hatha yoga does not have effects on acute, chronic and/or treatment-resistant mood and anxiety disorders compared to treatment as usual or active control groups. However, when compared to psychoeducation, hatha yoga showed more reductions in depression. It is clear that more high-quality studies are needed to advance the field.
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Affiliation(s)
- Nina K. Vollbehr
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Groningen, the Netherlands
- University of Groningen, Faculty of Behavioral and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - Agna A. Bartels-Velthuis
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands
| | - Maaike H. Nauta
- University of Groningen, Faculty of Behavioral and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - Stynke Castelein
- University of Groningen, Faculty of Behavioral and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
- Lentis Psychiatric Institute, Lentis Research, Groningen, the Netherlands
| | - Laura A. Steenhuis
- University of Groningen, Faculty of Behavioral and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - H. J. Rogier Hoenders
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Groningen, the Netherlands
| | - Brian D. Ostafin
- University of Groningen, Faculty of Behavioral and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
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Groen RN, de Clercq NC, Nieuwdorp M, Hoenders HJR, Groen AK. Gut microbiota, metabolism and psychopathology: A critical review and novel perspectives. Crit Rev Clin Lab Sci 2018; 55:283-293. [PMID: 29673295 DOI: 10.1080/10408363.2018.1463507] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Psychiatric disorders are often associated with metabolic comorbidities. However, the mechanisms through which metabolic and psychiatric disorders are connected remain unclear. Pre-clinical studies in rodents indicate that the bidirectional signaling between the intestine and the brain, the so-called microbiome-gut-brain axis, plays an important role in the regulation of both metabolism and behavior. The gut microbiome produces a vast number of metabolites that may be transported into the host and play a part in homeostatic control of metabolism as well as brain function. In addition to short chain fatty acids, many of these metabolites have been identified in recent years. To what extent both microbiota and their products control human metabolism and behavior is a subject of intense investigation. In this review, we will discuss the most recent findings concerning alterations in the gut microbiota as a possible pathophysiological factor for the co-occurrence of metabolic comorbidities in psychiatric disorders.
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Affiliation(s)
- Robin N Groen
- a Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Nicolien C de Clercq
- b Department of Internal and Vascular Medicine , Academic Medical Center , Amsterdam , The Netherlands
| | - Max Nieuwdorp
- b Department of Internal and Vascular Medicine , Academic Medical Center , Amsterdam , The Netherlands.,c Department of Internal Medicine, VUmc Diabetes Center , Free University Medical Center , Amsterdam , The Netherlands.,d Wallenberg Laboratory , University of Gothenburg , Gothenburg , Sweden
| | | | - Albert K Groen
- b Department of Internal and Vascular Medicine , Academic Medical Center , Amsterdam , The Netherlands.,c Department of Internal Medicine, VUmc Diabetes Center , Free University Medical Center , Amsterdam , The Netherlands.,f Department of Pediatrics , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
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Bouwmans MEJ, Bos EH, Hoenders HJR, Oldehinkel AJ, de Jonge P. Sleep quality predicts positive and negative affect but not vice versa. An electronic diary study in depressed and healthy individuals. J Affect Disord 2017; 207:260-267. [PMID: 27736737 DOI: 10.1016/j.jad.2016.09.046] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 04/20/2016] [Revised: 08/30/2016] [Accepted: 09/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The exact nature of the complex relationship between sleep and affect has remained unclear. This study investigated the temporal order of change in sleep and affect in participants with and without depression. METHODS 27 depressed patients and 27 pair-matched healthy controls assessed their sleep in the morning and their affect 3 times a day for 30 consecutive days in their natural environment. Daily sleep quality and average positive affect (PA) and negative affect (NA) were used to examine whether changes in sleep quality preceded or followed changes in PA and NA, and whether this was different for patients and healthy controls. Second, presumptive mediating factors were investigated. We hypothesized that fatigue mediated the effect of changes in sleep quality on subsequent PA/NA, and that rumination mediated the effect of changes in PA/NA on subsequent sleep quality. RESULTS Multilevel models showed that changes in sleep quality predicted changes in PA (B=0.08, p<0.001) and NA (B=-0.06, p<0.001), but not the other way around (PA: B=0.03, p=0.70, NA: B=-0.05, p=0.60). Fatigue was found to be a significant mediator of the relationship between sleep quality and PA (Indirect Effect=0.03, p<0.001), and between sleep quality and NA (Indirect Effect=-0.02, p=0.01). Rumination was not investigated because of non-significant associations between PA/NA and sleep quality. The associations were not different for patients and controls. LIMITATIONS The analyses were restricted to self-reported sleep quality, and conclusions about causality could not be drawn. CONCLUSIONS Improvements in sleep quality predicted improvements in affect the following day, partly mediated by fatigue. Treatment of sleep symptoms would benefit affect in clinical care and beyond.
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Affiliation(s)
- Mara E J Bouwmans
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands.
| | - Elisabeth H Bos
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | | | - Albertine J Oldehinkel
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - Peter de Jonge
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
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Hoenders HJR, Booij SH, Knegtering H, van den Brink H. [Mindfulness training for psychiatrists in residency: a pilot study]. Tijdschr Psychiatr 2016; 58:809-813. [PMID: 27868176] [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: 06/06/2023]
Abstract
Medical students and psychiatrists in residency run a high risk for burnout. Furthermore, while at medical school, students seem to experience a reduction in empathy; this seems to be linked to a high level of stress. Interventions based on mindfulness training appear to reduce stress and increase empathy in medical students. Trainees in psychiatric residency might also benefit from mindfulness training.<br/> AIM: To assess the effects that a mindfulness course has on perceived stress and empathy in psychiatrists in residency.<br/> METHOD: In this pilot study 13 trainees in psychiatric residency participated in an eight-week course in mindfulness. Before and after the training, 11 of the participants completed questionnaires relating to their empathy, perceived stress and mindfulness.<br/> RESULTS: Participants reported experiencing considerably more empathy after their course than before it. Perceived stress also diminished, but not significantly.<br/> CONCLUSION: The results support our suggestion that mindfulness training can be a valuable part of the curriculum for trainees in psychiatric residency.
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Hoenders HJR, Bos EH, de Jong JTVM, de Jonge P. Temporal dynamics of symptom and treatment variables in a lifestyle-oriented approach to anxiety disorder: a single-subject time-series analysis. Psychother Psychosom 2012; 81:253-5. [PMID: 22678230 DOI: 10.1159/000335928] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 12/15/2011] [Indexed: 11/19/2022]
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Hoenders HJR, Appelo MT, van den Brink H, Hartogs BMA, Berger CJJ. [Protocol for complementary and alternative medicine within the Dutch mental health services]. Tijdschr Psychiatr 2010; 52:343-348. [PMID: 20458681] [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: 05/29/2023]
Abstract
Complementary and alternative medicine (CAM) is the subject of heated debate. There are many prejudices for and against CAM. At the centre for Integrative Psychiatry (CIP) of Lentis CAM is offered alongside conventional treatments, but under strict conditions. Because of the controversy surrounding CAM and the potential health risks involved, the CIP in Lentis has formulated a protocol for CAM which is presented in this article.
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Hoenders HJR, Appelo MT, Milders CFA. [Complementary and alternative medicine and psychiatry: opinions of patients and psychiatrists]. Tijdschr Psychiatr 2006; 48:733-7. [PMID: 17007479] [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: 05/12/2023]
Abstract
All over the world people are becoming increasingly interested in complementary and alternative medicine (CAM). Some would like CAM to be integrated into conventional medicine, others are strongly opposed to its integration. We distributed printed questionnaires in order to discover the views of patients and psychiatrists on CAM and to obtain information about the extent to which people actually use CAM. Patients often turn to CAM and are generally satisfied with the results and many support integration. Psychiatrists underestimate the number of times that patients use CAM. They are reluctant to support the integration of alternative medicine but are less opposed to the integration of complementary medicine. Patients and psychiatrists want more information about CAM. Asking the patients whether they use CAM seems desirable.
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Hoenders HJR, Wilterdink J. [Delirium in a 73-year-old man after many years of unwise use of betahistine]. Ned Tijdschr Geneeskd 2004; 148:2338-41. [PMID: 15587054] [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: 05/01/2023]
Abstract
A 73-year-old man was admitted because of delirium that had already persisted for 5 days. The physical examination and extensive tests did not reveal any somatic pathology. The only drug he used was betahistine, taken for several years because of supposed Ménière's disease. After withdrawal of betahistine and treatment with haloperidol the patient recovered completely within a few days. A new delirium was induced when, after discharge from the hospital, betahistine was restarted because of dizziness. There was again a complete remission after betahistine was stopped and haloperidol was restarted. Betahistine is not known to induce delirium, but an investigation in side-effects databases did reveal several cases in which delirium might have been present, even though the term was not actually used. In this case, delirium was possibly caused by the combination of an elevated betahistine plasma level and a damaged blood-brain barrier due to cerebral infarctions, which were revealed by CT and MRI.
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Affiliation(s)
- H J R Hoenders
- Martini Ziekenhuis, afd. Consultatieve Psychiatrie, Postbus 30.033, 9700 RM Groningen.
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