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Hagen JM, Sutterland AL, Koeter MW, Lutter R, Cohen D, de Haan L. Advanced Glycation End Products in Recent-Onset Psychosis Indicate Early Onset of Cardiovascular Risk. J Clin Psychiatry 2019; 78:1395-1401. [PMID: 28445633 DOI: 10.4088/jcp.16m10972] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/01/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Profoundly increased mortality rates in schizophrenia, largely caused by a higher risk and earlier onset of cardiovascular disease, remain a major challenge. During the human lifespan, advanced glycation end products (AGEs) accumulate, and their concentration is strongly linked to cardiovascular mortality. AGE accumulation can be accelerated by several pathways, including oxidative stress. METHODS From March 2015 through January 2016, a case-control study including 111 patients with a recent-onset psychosis, 135 controls from a validation cohort, and 286 healthy controls was performed. Patients fulfilled the DSM-IV criteria for schizophrenia spectrum disorders with an illness duration shorter than 5 years. Main outcome parameters were skin autofluorescence levels of AGEs, controlled for age, gender, and smoking. Correlations of AGEs with cardiovascular risk factors and clinical variables were analyzed by hierarchical linear regression analyses. RESULTS An AGE measurement was possible in 77.4% of cases. AGEs were elevated by 15.1% in recent-onset psychosis compared to healthy controls (P < .001), corresponding to an increased accumulation of AGEs normally occurring in approximately 10 years. AGEs were not related to traditional risk factors. However, duration of illness (P = .008), duration of antipsychotic treatment (P = .009), and cumulative exposure to antipsychotics (P = .023) correlated with AGEs. CONCLUSIONS Patients with a recent onset of psychosis have increased AGE levels compared to healthy controls. These findings argue for an earlier implementation of treatment strategies aimed at preventing cardiovascular disease. Also, low-dose strategies of antipsychotics in schizophrenia could beneficially influence AGE levels.
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Affiliation(s)
- Julia M Hagen
- Department of Psychiatry, Early Psychosis Department, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Arjen L Sutterland
- Academic Medical Centre, Department of Psychiatry, Meibergdreef 5, Amsterdam 1105 AZ, The Netherlands. .,Department of Psychiatry, Early Psychosis Department, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten W Koeter
- Department of Psychiatry, Early Psychosis Department, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Rene Lutter
- Departments of Experimental Immunology and Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Dan Cohen
- Department of Community Mental Health, Mental Health Service North-Holland North, Heerhugowaard and Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Department, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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2
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Figueroa CA, Mocking RJT, Mahmoud GA, Koeter MW, Bockting CL, van der Does W, Ruhe HG, Schene AH. The measurement of cognitive reactivity to sad mood in patients remitted from major depressive disorder. Br J Clin Psychol 2018; 57:313-327. [PMID: 29488231 PMCID: PMC6099317 DOI: 10.1111/bjc.12175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 07/19/2017] [Revised: 01/31/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Cognitive reactivity (CR) to sad mood is a risk factor for major depressive disorder (MDD). CR is usually measured by assessing change on the Dysfunctional Attitudes Scale (DAS-change) after sad mood-induction. It has, however, been suggested that the versions of the DAS (A/B) are not interchangeable, impacting the reliability and validity of the change score. The Leiden Index of Depression Sensitivity-Revised (LEIDS-R) is an alternative self-report measure of CR. Studies examining the relationship between LEIDS-R and DAS-change have shown mixed results. We examined whether scores of these CR measures differed between remitted MDD and controls, the relationship between these CR measures, and the effect of order of DAS administration on DAS-change. DESIGN Cross-sectional design with two groups (remitted MDD and controls). METHODS Sixty-eight MDD patients remitted from ≥2 previous episodes, not taking antidepressants, and 43 never-depressed controls participated in a mood-induction and filled in the DAS-A/B in randomized order before and after mood-induction, and LEIDS-R separately. RESULTS LEIDS-R scores and pre-mood-induction DAS scores were significantly higher in remitted MDD than controls (p < .001, Cohen's d = 1.48; p = .001, Cohen's d = 0.66, respectively). DAS-change did not differ between these groups (p = .67, Cohen's d = 0.08). LEIDS-R correlated with DAS-change (r = .30, p = .042), but only in the group that filled in DAS-B before DAS-A. In remitted MDD, DAS-change was dependent on the order of DAS versions before and after mood-induction (10.6 ± 19.0 vs. -1.2 ± 10.5, for order B-A and A-B, respectively), with a significant group × order interaction (p = .012). CONCLUSIONS Existing DAS versions are not interchangeable, which compromises the usefulness of mood-inductions in clinical practice. The LEIDS-R seems a valid measure of cognitive vulnerability to depression. PRACTITIONER POINTS Clinical implications: Cognitive reactivity (CR) is a risk factor of depressive recurrence. The current measurement of CR, by assessing change on the Dysfunctional Attitudes Scale (DAS) after mood-induction, is not reliable. The Leiden Index Depression Sensitivity-Revised (LEIDS-R) is an alternative CR measure. In contrast to mood-induction, it reliably assesses depression vulnerability. The use of mood-inductions for clinical/research purposes is unnecessary. LIMITATIONS OF THE STUDY We were not able to examine the effect of previous treatment, which could have affected results as psychological treatments probably have differential effects on CR. Examining un-medicated patients may have led to selection of a sample not completely representative for the general MDD population. We did not administer both parallel versions of the DAS (A/B) before and after mood-induction. This might have provided better understanding of their differential sensitivity to change.
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Affiliation(s)
- Caroline A. Figueroa
- Department of PsychiatryProgram for Mood DisordersAcademic Medical CenterUniversity of AmsterdamThe Netherlands
- Department of PsychiatryWarneford HospitalUniversity of OxfordUK
| | - Roel J. T. Mocking
- Department of PsychiatryProgram for Mood DisordersAcademic Medical CenterUniversity of AmsterdamThe Netherlands
| | - Gelera A. Mahmoud
- Department of PsychiatryProgram for Mood DisordersAcademic Medical CenterUniversity of AmsterdamThe Netherlands
| | - Maarten W. Koeter
- Department of PsychiatryProgram for Mood DisordersAcademic Medical CenterUniversity of AmsterdamThe Netherlands
| | | | - Willem van der Does
- Department of PsychologyLeiden UniversityThe Netherlands
- Department of PsychiatryLeiden University Medical CenterThe Netherlands
| | - Henricus G. Ruhe
- Department of PsychiatryProgram for Mood DisordersAcademic Medical CenterUniversity of AmsterdamThe Netherlands
- Department of PsychiatryWarneford HospitalUniversity of OxfordUK
- Department of PsychiatryRadboud University Medical CenterNijmegenThe Netherlands
| | - Aart H. Schene
- Department of PsychiatryProgram for Mood DisordersAcademic Medical CenterUniversity of AmsterdamThe Netherlands
- Department of PsychiatryRadboud University Medical CenterNijmegenThe Netherlands
- Donders Institute for Brain, Cognition and BehaviorRadboud University NijmegenThe Netherlands
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van Emmerik-van Oortmerssen K, Vedel E, Kramer FJ, Koeter MW, Schoevers RA, van den Brink W. Diagnosing ADHD during active substance use: Feasible or flawed? Drug Alcohol Depend 2017; 180:371-375. [PMID: 28957778 DOI: 10.1016/j.drugalcdep.2017.07.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 03/27/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is highly prevalent in patients with a substance use disorder (SUD). Because of possible problems with validity, diagnostic assessment of ADHD is usually postponed until after a period of abstinence, which may jeopardize adequate and timely treatment. The aim of this study is to investigate how a diagnostic assessment of ADHD in patients who are actively using substances compares to the results of a second assessment after a period of full or partial abstinence. METHODS Prospective test-retest study in a SUD treatment center among 127 treatment seeking adult SUD patients with a comorbid diagnosis of adult ADHD. Conners' Adult ADHD Diagnostic Interview for DSM-IV was administered at intake and after four SUD treatment sessions. RESULTS The mean time interval between intake and retest assessment was 78days (SD=32; range 31-248). At the second ADHD assessment, substance use had decreased to about 50% of baseline consumption. Of the 127 patients with an initial diagnosis of ADHD, 121 patients (95.3%) still fulfilled DSM-IV adult ADHD criteria at re-diagnosis. Subtyping of ADHD was less stable (Cohen's Kappa=0.53). Agreement on the number of childhood and adult ADHD symptoms between both assessments was good (intraclass correlation coefficient of 0.69 and 0.65, respectively). Sensitivity analyses in subgroups of patients who were fully abstinent during the second assessment yielded very similar results. CONCLUSIONS These findings strongly suggest that a pragmatic approach, in which patients are evaluated for ADHD even when they are not (yet) abstinent, is feasible and justifiable.
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Affiliation(s)
- Katelijne van Emmerik-van Oortmerssen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands; Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arkin Mental Health and Addiction Treatment Center, Amsterdam, The Netherlands; Jellinek Substance Abuse Treatment Center, Amsterdam, The Netherlands.
| | - Ellen Vedel
- Arkin Mental Health and Addiction Treatment Center, Amsterdam, The Netherlands; Jellinek Substance Abuse Treatment Center, Amsterdam, The Netherlands
| | - Floor J Kramer
- Arkin Mental Health and Addiction Treatment Center, Amsterdam, The Netherlands; Jellinek Substance Abuse Treatment Center, Amsterdam, The Netherlands
| | - Maarten W Koeter
- Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Wim van den Brink
- Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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4
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Meijer JH, van Harten P, Meijer CJ, Koeter MW, Bruggeman R, Cahn W, Kahn RS, de Haan L. Association between olfactory identification and parkinsonism in patients with non-affective psychosis. Early Interv Psychiatry 2016; 10:404-10. [PMID: 25234230 DOI: 10.1111/eip.12183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/19/2013] [Accepted: 07/22/2014] [Indexed: 11/25/2022]
Abstract
AIM Olfactory identification deficits (OIDs) are seen in schizophrenia patients and individuals at increased risk for psychosis but its pathophysiology remains unclear. Although dopaminergic imbalance is known to lie at the core of schizophrenia symptomatology, its role in the development of OIDs has not been elucidated yet. This study investigated the association between OIDs and symptoms of parkinsonism as a derivative of dopaminergic functioning. METHODS In 320 patients diagnosed with non-affective psychosis, olfactory identification performance was assessed by means of the Sniffin' Sticks task. Level of parkinsonian symptoms was assessed by means of the Unified Parkinson's Disease Rating Scale (UPDRS-III). By means of multiple linear regression with bootstrapping, the association between UPDRS and Sniffin' Sticks score was investigated while correcting for potential confounders. A Bonferroni corrected P-value of 0.007 was used. RESULTS Higher UPDRS scores significantly predicted worse olfactory identification in patients with non-affective psychosis with an unadjusted b = -0.07 (95% CI -0.10 to -0.04) and an adjusted b = -0.04 (95% CI -0.07 to -0.01). CONCLUSION Results provide preliminary evidence that the same vulnerability may underlie the development of parkinsonism and OIDs in patients with non-affective psychosis. Further investigation should evaluate the clinical value of OIDs as a marker of dopaminergic vulnerability that may predict psychosis.
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Affiliation(s)
- Julia H Meijer
- Academic Medical Center, Academic Psychiatric Centre, Department of Early Psychosis, University of Amsterdam, Amsterdam, The Netherlands.
| | - Peter van Harten
- Psychiatric Centre GGZ Centraal, Amersfoort, The Netherlands.,Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
| | - Carin J Meijer
- Academic Medical Center, Academic Psychiatric Centre, Department of Early Psychosis, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten W Koeter
- Academic Medical Center, Academic Psychiatric Centre, Department of Early Psychosis, University of Amsterdam, Amsterdam, The Netherlands
| | - Richard Bruggeman
- Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wiepke Cahn
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - René S Kahn
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L de Haan
- Academic Medical Center, Academic Psychiatric Centre, Department of Early Psychosis, University of Amsterdam, Amsterdam, The Netherlands
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5
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Niesink RJM, Rigter S, Koeter MW, Brunt TM. Potency trends of Δ9-tetrahydrocannabinol, cannabidiol and cannabinol in cannabis in the Netherlands: 2005-15. Addiction 2015; 110:1941-50. [PMID: 26234170 DOI: 10.1111/add.13082] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [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: 02/03/2015] [Revised: 04/04/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS Between 2000 and 2005 the average percentage of Δ(9) -tetrahydrocannabinol (THC) in marijuana as sold in Dutch coffeeshops has increased substantially; the potency of domestic products (Nederwiet and Nederhasj) has particularly increased. In contrast with imported marijuana, Nederwiet hardly contained any cannabidiol (CBD), a cannabinoid that is thought to offset some of the adverse effects of THC. In 2005, the THC content in Nederwiet was significantly lower than in 2004. This study investigates the further decrease or increase of cannabinoids in these cannabis products. METHODS From 2005 to 2015 five different cannabis products were bought anonymously in 50 coffeeshops that were selected randomly each year from all coffeeshops in the Netherlands. A total of 2126 cannabis samples were bought, consisting of 664 Nederwiet samples (most popular), 537 Nederwiet samples (supposed strongest varieties), 183 imported herbal cannabis samples, 140 samples of cannabis resin made of Nederwiet and 602 samples of imported cannabis resin. All samples were analysed chemically for their THC, CBD and cannabinol (CBN) content. RESULTS Between 2005 and 2015, the mean potencies of the most popular and the strongest Nederwiet and of imported cannabis resin were 16.0±4.0%, 17.0±3,9% and 16.5±6.3%, respectively. Imported herbal cannabis (6.5±3.5%) and cannabis resin made from Nederwiet (30.2±16.4%) contained, respectively, less (β=-10.0, P<0.001) and more (β=13.7, P<0.001) THC than imported cannabis resin. Linear regression models were used to study the trends in THC of the different cannabis products over time. A marginal, but significant (P<0.001), overall decline of THC per year of 0.22% was found in all cannabis products. However, no significant difference was found between the five products in the THC linear trajectories across time. Of all the cannabis products, only imported cannabis resin contained a relatively high CBD/THC ratio (median 0.42). CONCLUSION The average tetrahydrocannabinol (THC) content of the most popular herbal cannabis products in the Netherlands has decreased slightly since 2005. The popular Nederwiet type still has a relatively high THC to cannabidiol ratio.
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Affiliation(s)
- Raymond J M Niesink
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.,Faculty of Management, Science and Technology, School of Science, Open University of the Netherlands, Heerlen, the Netherlands
| | - Sander Rigter
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Maarten W Koeter
- Academic Medical Center, Department of Psychiatry, Amsterdam, the Netherlands
| | - Tibor M Brunt
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.,Academic Medical Center, Department of Psychiatry, Amsterdam, the Netherlands
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6
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Figueroa CA, Ruhé HG, Koeter MW, Spinhoven P, Van der Does W, Bockting CL, Schene AH. Cognitive reactivity versus dysfunctional cognitions and the prediction of relapse in recurrent major depressive disorder. J Clin Psychiatry 2015; 76:e1306-12. [PMID: 26528654 DOI: 10.4088/jcp.14m09268] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 11/06/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Major depressive disorder (MDD) is a burdensome disease that has a high risk of relapse/recurrence. Cognitive reactivity appears to be a risk factor for relapse. It remains unclear, however, whether dysfunctional cognitions alone or the reactivity of such cognitions to mild states of sadness (ie, cognitive reactivity) is the crucial factor that increases relapse risk. We aimed to assess the long-term predictive value of cognitive reactivity versus dysfunctional cognitions and other risk factors for depressive relapse. METHOD In a prospective cohort of outpatients (N = 116; studied between 2000-2005) who had experienced ≥ 2 previous major depressive episodes (MDEs) and were in remission (DSM-IV) at the start of follow-up, we measured cognitive reactivity, with the Leiden Index of Depression Sensitivity (LEIDS), and dysfunctional cognitions, with the Dysfunctional Attitudes Scale, simultaneously. Course of illness (with the primary outcome of MDE assessed by the Structured Clinical Interview for DSM-IV Axis I Disorders Patient Edition) and time to relapse were monitored prospectively for 3.5 years. RESULTS Cognitive reactivity scores were associated with time to relapse over the 3.5-year follow-up and also when corrected for the number of previous MDEs and concurrent depressive symptoms (hazard ratio for 1 standard deviation [(HR(SD)); 20 points of the LEIDS, measuring cognitive reactivity] = 1.47; 95% CI, 1.04-2.09; P = .031). Rumination appeared to be a particularly strong predictor of relapse (HR(SD) = 1.60; 95% CI, 1.13-2.26; P = .007). Dysfunctional cognitions did not predict relapse over 3.5 years (HR(SD) = 1.00; 95% CI, 0.74-1.37; P = .93). Every 20-point increase on the cognitive reactivity scale resulted in a 10% to 15% increase in risk of relapse (corrected for previous MDEs and concurrent depressive symptoms). CONCLUSIONS Cognitive reactivity--and particularly rumination--is a long-term predictor of relapse. Future research should address whether psychological interventions can improve cognitive reactivity scores and thereby prevent depressive relapses. TRIAL REGISTRATION ISRCTN Identifier: 68246470.
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Affiliation(s)
- Caroline A Figueroa
- Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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7
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Mocking RJT, Pellikaan CM, Lok A, Assies J, Ruhé HG, Koeter MW, Visser I, Bockting CL, Olff M, Schene AH. DHEAS and cortisol/DHEAS-ratio in recurrent depression: State, or trait predicting 10-year recurrence? Psychoneuroendocrinology 2015; 59:91-101. [PMID: 26036454 DOI: 10.1016/j.psyneuen.2015.05.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) has been associated with low dehydroepiandrosterone-sulphate (DHEAS), - particularly relative to high cortisol - although conflicting findings exist. Moreover, it is unclear whether low DHEAS is only present during the depressive state, or manifests as a trait that may reflect vulnerability for recurrence. Therefore, we longitudinally tested whether low DHEAS and high cortisol/DHEAS-ratio in recurrent MDD (I) reflects a trait, and/or (II) varies with depressive state. In addition, we tested associations with (III) previous MDD-episodes, (IV) prospective recurrence, and (V) effects of cognitive therapy. METHODS At study-entry, we cross-sectionally compared morning and evening salivary DHEAS and molar cortisol/DHEAS-ratio of 187 remitted recurrent MDD-patients with 72 matched controls. Subsequently, patients participated in an 8-week randomized controlled cognitive therapy trial. We repeated salivary measures after 3 months and 2 years. We measured clinical symptoms during a 10-year follow-up. RESULTS Remitted patients showed steeper diurnal DHEAS-decline (p<.005) and a flatter diurnal profile of cortisol/DHEAS-ratio (p<.001) than controls. We found no state-effect in DHEAS or cortisol/DHEAS-ratio throughout follow-up and no association with number of previous episodes. Higher morning cortisol/DHEAS-ratio predicted shorter time till recurrence over the 10-year follow-up in interaction with the effects of cognitive therapy (p<.05). Finally, cognitive therapy did not influence DHEAS or cortisol/DHEAS-ratio. CONCLUSIONS Diurnal profiles of DHEAS and cortisol/DHEAS-ratio remain equally altered in between depressive episodes, and may predict future recurrence. This suggests they represent an endophenotypic vulnerability trait rather than a state-effect, which provides a new road to understand recurrent depression and its prevention. TRIAL REGISTRATION www.isrctn.com/ISRCTN68246470.
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Affiliation(s)
- R J T Mocking
- Program for Mood disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands.
| | - C M Pellikaan
- Program for Mood disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - A Lok
- Program for Mood disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands; Arq Psychotrauma Expert Group, Diemen, The Netherlands
| | - J Assies
- Program for Mood disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - H G Ruhé
- Program for Mood disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands; University Medical Center Groningen, Program for Mood and Anxiety Disorders, Department of Psychiatry, The Netherlands
| | - M W Koeter
- Program for Mood disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - I Visser
- Program for Mood disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - C L Bockting
- Department of Clinical Psychology, University of Groningen, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, The Netherlands
| | - M Olff
- Arq Psychotrauma Expert Group, Diemen, The Netherlands; Center for Psychological Trauma, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - A H Schene
- Program for Mood disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands; Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
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8
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Linsen F, Koning RPJ, van Laar M, Niesink RJM, Koeter MW, Brunt TM. 4-Fluoroamphetamine in the Netherlands: more than a one-night stand. Addiction 2015; 110:1138-43. [PMID: 25808511 DOI: 10.1111/add.12932] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/05/2014] [Accepted: 03/17/2015] [Indexed: 11/29/2022]
Abstract
AIMS To investigate the temporal pattern of appearance of a new psychoactive substance (4-fluoroamphetamine) on the Dutch drug market, as well as its patterns of use and effects. DESIGN Data from the Drug Information and Monitoring System (DIMS) was used to investigate the emergence of 4-fluoroamphetamine on the Dutch drug market. An on-line questionnaire was used to study its patterns of use and effects. SETTING Dutch drug-related websites and social media. PARTICIPANTS A convenience sample of 249 life-time 4-fluoroamphetamine users was recruited through the internet. MEASUREMENTS Samples containing 4-fluoroamphetamine were extracted from the DIMS database for further investigation. Patterns of use, settings of use and the subjective effects of 4-fluoroamphetamine, amphetamine and 3,4-methylenedioxymethamphetamine (MDMA) were investigated with the on-line questionnaire. FINDINGS 4-Fluoroamphetamine was first encountered on the Dutch drug market, sold mainly as amphetamine or ecstasy (MDMA), between 2007 and 2009. These misrepresented drug samples declined when the MDMA and amphetamine markets recovered after a period of shortage, whereas purposefully bought 4-fluoroamphetamine samples showed an increase. Survey results showed that 4-fluoroamphetamine is used predominantly [77.1%, 95% confidence interval (CI) = 72.0-82.3] for its specific effects, rather than its legal status (17.7%, 95% CI = 10.7-22.1). The subjective effects of 4-fluoroamphetamine were compared with those of amphetamine and MDMA. Subjective effect scores of 4-fluoroamphetamine ranged between those of amphetamine and MDMA. CONCLUSIONS The stimulant 4-fluoroamphetamine is increasingly popular in the Netherlands, which might be due to its subjective effects profile, which lies intermediate between amphetamine and MDMA.
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Affiliation(s)
- Felix Linsen
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Drug Information and Monitoring System, Department of Drug Monitoring, Utrecht, the Netherlands
| | - Raoul P J Koning
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Drug Information and Monitoring System, Department of Drug Monitoring, Utrecht, the Netherlands
| | - Margriet van Laar
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Drug Information and Monitoring System, Department of Drug Monitoring, Utrecht, the Netherlands
| | - Raymond J M Niesink
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Drug Information and Monitoring System, Department of Drug Monitoring, Utrecht, the Netherlands
| | - Maarten W Koeter
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Tibor M Brunt
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Drug Information and Monitoring System, Department of Drug Monitoring, Utrecht, the Netherlands.,Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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9
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Ruhé HG, Khoenkhoen SJ, Ottenhof KW, Koeter MW, Mocking RJT, Schene AH. Longitudinal effects of the SSRI paroxetine on salivary cortisol in Major Depressive Disorder. Psychoneuroendocrinology 2015; 52:261-71. [PMID: 25544738 DOI: 10.1016/j.psyneuen.2014.10.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 07/08/2014] [Revised: 10/10/2014] [Accepted: 10/30/2014] [Indexed: 11/24/2022]
Abstract
Hypothalamic-pituitary-adrenal (HPA)-axis dysregulation is a prominent finding in more severe Major Depressive Disorder (MDD), and is characterized by increased baseline cortisol levels at awakening (BCL), blunted cortisol awakening response (CAR) and increased area under the cortisol curve (AUC). Selective serotonin reuptake inhibitors (SSRIs) appear to normalize HPA-axis dysfunction, but this is hardly investigated longitudinally. We studied salivary BCL, CAR and AUC at awakening and 30min thereafter. We compared measurements in initially drug-free MDD-patients with healthy controls (HCs) at study-entry. In patients, we repeated measures after 6 and 12 weeks' treatment with the SSRI paroxetine. Non-responding patients received a randomized dose-escalation after six weeks' treatment. We found no significant study-entry differences in BLC, CAR or AUC between MDD-patients (n=70) and controls (n=51). In MDD-patients, we found general decreases of BCL and AUC during paroxetine treatment (p≤0.007), especially in late and non-responders. Importantly, while overall CAR did not change significantly over time, it robustly increased over 12 weeks especially when patients achieved remission (p≤0.041). The dose-escalation intervention did not significantly influence CAR or other cortisol parameters. In conclusion, paroxetine seems to interfere with HPA-axis dysregulation, reflected in significant overall decreases in BCL and AUC during treatment. Paroxetine appears to decrease HPA-axis set-point in MDD, which might result in increased HPA-axis activity over time, which is further improved when patients achieve remission (ISRCTN register nr. ISRCTN44111488).
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Affiliation(s)
- Henricus G Ruhé
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Mood and Anxiety Disorders, Groningen, The Netherlands.
| | - Sharina J Khoenkhoen
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Koen W Ottenhof
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten W Koeter
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Roel J T Mocking
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Aart H Schene
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
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10
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Brunt TM, Koeter MW, Hertoghs N, van Noorden MS, van den Brink W. Sociodemographic and substance use characteristics of γ hydroxybutyrate (GHB) dependent inpatients and associations with dependence severity. Drug Alcohol Depend 2013; 131:316-9. [PMID: 23332440 DOI: 10.1016/j.drugalcdep.2012.12.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 12/19/2012] [Accepted: 12/22/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The number of admissions to addiction treatment centers in the Netherlands for gamma hydroxybutyrate (GHB) dependence is rapidly growing. Until now, treatment seeking GHB users have hardly been studied. This study characterizes inpatients in treatment for GHB dependence in terms of sociodemographics, motives for substance use and reasons for seeking treatment. In addition, variables associated with dependence severity are identified. METHODS Patients were recruited by their therapists at 4 different addiction treatment centers dispersed throughout the Netherlands. They were asked to fill out the questionnaire, including sociodemographic and clinical characteristics, GHB and other drug use, and a modified version of the Drug Use Disorders Identification Test (DUDIT) to screen for GHB dependence. The associations of relevant variables with dependence severity were determined using multiple regression analysis. RESULTS A total of 75 inpatients (response rate 90.4%) participated in the study. Most patients were young (mean 26.8 ± 9.1) males (73%) with low education (78%) and not employed (48%). Most of them (75%) had started using GHB the year before treatment admission, 42 (56%) frequently combined GHB with sedatives and 26 (35%) frequently combined GHB with stimulants. Dependence severity was strongly associated with sleep problems and the combined use of GHB and stimulants. CONCLUSION This study shows that sociodemographic characteristics of GHB inpatients are similar to those of problematic users of other club drugs. Sleep problems and combined use of GHB and stimulants were strongly associated with GHB dependence. Together, these factors might help to better identify people at risk for GHB dependence.
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Affiliation(s)
- Tibor M Brunt
- Drug Monitoring, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
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11
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van Emmerik–van Oortmerssen K, Vedel E, Koeter MW, de Bruijn K, Dekker JJM, van den Brink W, Schoevers RA. Investigating the efficacy of integrated cognitive behavioral therapy for adult treatment seeking substance use disorder patients with comorbid ADHD: study protocol of a randomized controlled trial. BMC Psychiatry 2013; 13:132. [PMID: 23663651 PMCID: PMC3659028 DOI: 10.1186/1471-244x-13-132] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 04/24/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) frequently co-occurs with substance use disorders (SUD). The combination of ADHD and SUD is associated with a negative prognosis of both SUD and ADHD. Pharmacological treatments of comorbid ADHD in adult patients with SUD have not been very successful. Recent studies show positive effects of cognitive behavioral therapy (CBT) in ADHD patients without SUD, but CBT has not been studied in ADHD patients with comorbid SUD. METHODS/DESIGN This paper presents the protocol of a randomized controlled trial to test the efficacy of an integrated CBT protocol aimed at reducing SUD as well as ADHD symptoms in SUD patients with a comorbid diagnosis of ADHD. The experimental group receives 15 CBT sessions directed at symptom reduction of SUD as well as ADHD. The control group receives treatment as usual, i.e. 10 CBT sessions directed at symptom reduction of SUD only. The primary outcome is the level of self-reported ADHD symptoms. Secondary outcomes include measures of substance use, depression and anxiety, quality of life, health care consumption and neuropsychological functions. DISCUSSION This is the first randomized controlled trial to test the efficacy of an integrated CBT protocol for adult SUD patients with a comorbid diagnosis of ADHD. The rationale for the trial, the design, and the strengths and limitations of the study are discussed.
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Affiliation(s)
- Katelijne van Emmerik–van Oortmerssen
- Arkin Mental Health Care and Addiction Treatment Center, Amsterdam, The Netherlands,Jellinek Substance Abuse Treatment Center, Amsterdam, The Netherlands,Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands,Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ellen Vedel
- Arkin Mental Health Care and Addiction Treatment Center, Amsterdam, The Netherlands,Jellinek Substance Abuse Treatment Center, Amsterdam, The Netherlands
| | - Maarten W Koeter
- Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Kim de Bruijn
- Arkin Mental Health Care and Addiction Treatment Center, Amsterdam, The Netherlands,Jellinek Substance Abuse Treatment Center, Amsterdam, The Netherlands
| | - Jack J M Dekker
- Arkin Mental Health Care and Addiction Treatment Center, Amsterdam, The Netherlands
| | - Wim van den Brink
- Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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12
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Meijer JH, Dekker N, Koeter MW, Quee PJ, van Beveren NJM, Meijer CJ. Cannabis and cognitive performance in psychosis: a cross-sectional study in patients with non-affective psychotic illness and their unaffected siblings. Psychol Med 2012; 42:705-716. [PMID: 21899795 DOI: 10.1017/s0033291711001656] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The relationship between cannabis use and cognitive functioning in patients with psychosis has yielded contradictory findings. In individuals at genetic high risk for psychosis, information is sparse. The aim of this study was to assess the association between recency and frequency of cannabis use and cognitive functioning in patients with psychosis and their unaffected siblings. METHOD We conducted a cross-sectional study in 956 patients with non-affective psychosis, 953 unaffected siblings, and 554 control subjects. Participants completed a cognitive test battery including assessments of verbal learning, set shifting, sustained attention, processing speed, working memory, acquired knowledge, reasoning and problem solving and social cognition. Cannabis use was assessed by urinalysis and by the Composite International Diagnostic Interview. Using random-effect regression models the main effects of cannabis (recency and frequency) and the interaction with status (patient, sibling, control) on cognitive functioning were assessed. RESULTS Current cannabis use was associated with poorer performance on immediate verbal learning, processing speed and working memory (Cohen's d -0.20 to -0.33, p<0.005). Lifetime cannabis use was associated with better performance on acquired knowledge, facial affect recognition and face identity recognition (Cohen's d+0.17 to +0.33, p<0.005). There was no significant interaction between cannabis and status on cognitive functioning. CONCLUSIONS Lifetime cannabis-using individuals might constitute a subgroup with a higher cognitive potential. The residual effects of cannabis may impair short-term memory and processing speed.
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Affiliation(s)
- J H Meijer
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
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13
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Sizoo BB, van den Brink W, Gorissen-van Eenige M, Koeter MW, van Wijngaarden-Cremers PJM, van der Gaag RJ. Using the Autism-spectrum quotient to discriminate Autism Spectrum Disorder from ADHD in adult patients with and without comorbid Substance Use Disorder. J Autism Dev Disord 2009; 39:1291-7. [PMID: 19396535 PMCID: PMC2727364 DOI: 10.1007/s10803-009-0743-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 04/03/2009] [Indexed: 12/28/2022]
Abstract
It is unknown whether the Autism-spectrum quotient (AQ) can discriminate between Autism Spectrum Disorder (ASD) and Attention Deficit and Hyperactivity Disorder (ADHD) with or without comorbid Substance Use Disorder (SUD). ANOVA’s were used to analyse the mean AQ (sub)scores of 129 adults with ASD or ADHD. We applied receiver operating characteristic (ROC) computations to assess discriminant power. All but one of the mean AQ (sub)scores were significantly higher for adults with ASD compared to those with ADHD. The SUD status in general was not significantly associated with AQ (sub)scores. On the Social Skills subscale patients with ASD and comorbid SUD showed less impairment than those without SUD. The cut-off score 26 yielded 73% correct classifications. The clinical use of the AQ in differentiating between ASD and ADHD is limited.
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Affiliation(s)
- Bram B Sizoo
- Department of Developmental Disorders, Dimence Institute of Mental Health, Deventer, The Netherlands.
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14
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Schilt T, Goudriaan AE, Koeter MW, van den Brink W, Schmand B. Decision making as a predictor of first ecstasy use: a prospective study. Psychopharmacology (Berl) 2009; 203:519-27. [PMID: 19020868 PMCID: PMC2761546 DOI: 10.1007/s00213-008-1398-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 10/23/2008] [Indexed: 11/26/2022]
Abstract
RATIONALE Ecstasy (+/-3,4-methylenedioxymethamphetamine) is a widely used recreational drug that may damage the serotonin system and may entail neuropsychological dysfunctions. Few studies investigated predictors for ecstasy use. Self-reported impulsivity does not predict the initiation of ecstasy use; the question is if neuropsychological indicators of impulsivity can predict first ecstasy use. OBJECTIVE This study tested the hypothesis that a neuropsychological indicator of impulsivity predicts initiation of ecstasy use. MATERIALS AND METHODS Decision-making strategy and decision-making reaction times were examined with the Iowa Gambling Task in 149 ecstasy-naive subjects. The performance of 59 subjects who initiated ecstasy use during a mean follow-up period of 18 months (range, 11-26) was compared with the performance of 90 subjects that remained ecstasy-naive. RESULTS Significant differences in decision-making strategy between female future ecstasy users and female persistent ecstasy-naive subjects were found. In addition, the gap between decision-making reaction time after advantageous choices and reaction time after disadvantageous choices was smaller in future ecstasy users than in persistent ecstasy-naives. CONCLUSION Decision-making strategy on a gambling task was predictive for future use of ecstasy in female subjects. Differences in decision-making time between future ecstasy users and persistent ecstasy-naives may point to lower punishment sensitivity or higher impulsivity in future ecstasy users. Because differences were small, the clinical relevance is questionable.
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Affiliation(s)
- Thelma Schilt
- Department of Psychiatry-PB 0.429, Amsterdam Institute for Addiction Research Academic Medical Center, University of Amsterdam, PO Box 75867, 1070 AW Amsterdam, The Netherlands.
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15
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Schilt T, de Win MML, Jager G, Koeter MW, Ramsey NF, Schmand B, van den Brink W. Specific effects of ecstasy and other illicit drugs on cognition in poly-substance users. Psychol Med 2008; 38:1309-1317. [PMID: 17988417 DOI: 10.1017/s0033291707002140] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A large number of studies, reviews and meta-analyses have reported cognitive deficits in ecstasy users. However most ecstasy users are polydrug users, and therefore it cannot be excluded that these deficits are (partly) the result of drugs other than ecstasy. The current study, part of the Netherlands XTC Toxicity (NeXT) study, investigates the specific sustained effects of ecstasy relative to amphetamine, cocaine and cannabis on the brain using neuropsychological examination. METHOD A stratified sample of 67 subjects with such a variation in type and amount of drug use was included that correlations between the consumption of the various drugs were relatively low allowing stepwise linear multiple regression analyses to differentiate between the effects of ecstasy and those of other substances. Subjects were assessed with neuropsychological tests measuring attention, working memory, verbal and visuospatial memory, and visuospatial ability. RESULTS Ecstasy use [mean 327 (S.D.=364) tablets in lifetime] had a specific significant dose-related negative effect on verbal delayed recall after adjusting for the use of other drugs. CONCLUSIONS These findings strongly suggest a specific sustained negative effect of ecstasy use on verbal memory. The clinical relevance is not immediately clear, because test performance generally remained within the normal range. However the magnitude of the effect is substantial (d>0.5) and long-term consequences cannot be excluded.
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Affiliation(s)
- T Schilt
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands.
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Rietdijk EA, van den Bosch LM, Verheul R, Koeter MW, van den Brink W. Predicting self-damaging and suicidal behaviors in female borderline patients: reasons for living, coping, and depressive personality disorder. J Pers Disord 2001; 15:512-20. [PMID: 11778393 DOI: 10.1521/pedi.15.6.512.19188] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aims of this study are to examine (1) whether reasons for living predict self-damaging and suicidal behaviors, (2) the associations of reasons for living with coping strategies and depressive personality disorder (PD), and (3) the unique predictive validity of reasons for living in a multivariate predictor model. Reasons for living (RFL), coping strategies, and depressive personality disorder were measured at baseline in 38 patients who met DSM-IV criteria for borderline personality disorder (BPD). Frequency of self-damaging and suicidal behaviors in the 6-month period following baseline was measured prospectively at 3- and 6-month follow-ups. The RFL has only one subscale that predicts parasuicidal behaviors (i.e. Survival and Coping Beliefs [SCB]). Participants who scored low on this subscale were 6.8 times more likely to exhibit self-damaging and suicidal behaviors in the follow-up period than their high-scoring counter-parts. However, SCB was substantially correlated with the coping strategies "reassuring thoughts," "active coping," and "palliative reaction pattern," as well as with depressive personality traits. In a multivariate model, the predictive power of SCB appeared to be accounted for by reassuring thoughts and depressive PD. Coping scales might be preferable over the RFL as a predictor of self-damaging and suicidal behaviors in borderline patients.
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Affiliation(s)
- E A Rietdijk
- Amsterdam Institute for Addiction Research (AIAR), Department of Psychiatry, Academic Medical Center, University of Amsterdam (AMC-UvA), Amsterdam, The Netherlands
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17
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Korzec A, Bär M, Koeter MW, de Kieviet W. Diagnosing alcoholism in high-risk drinking drivers: comparing different diagnostic procedures with estimated prevalence of hazardous alcohol use. Alcohol Alcohol 2001; 36:594-602. [PMID: 11704628 DOI: 10.1093/alcalc/36.6.594] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In several European countries, drivers under influence (DUI), suspected of an alcohol use disorder (AUD, 'alcoholism') are referred for diagnostic examination. The accuracy of diagnostic procedures used in diagnosing AUD in the DUI population is unknown. The aim of this study was to compare three prevalence estimates of AUD based on a structured clinical interview (SCID), a restrictive diagnostic procedure (RDP) and usual clinical diagnostic procedure (CDP), with a prevalence estimate based on sensitivity and specificity data of biological markers of excessive use of alcohol in non-judicial samples. The latter unbiased estimate provides an external yardstick against which the biased patient-based prevalence estimates in this special sample can be evaluated. The unbiased estimate derived from sensitivity and specificity data resulted in a prevalence estimate of excessive use of alcohol between 74 and 82%, which is much higher than the three diagnostic procedures. SCID identified maximally 5% of alcoholics found with the unbiased estimate. RDP identified > or =31% of the unbiased estimate, while CDP identified > or =60% of the unbiased estimate. The high chance of false positive diagnosis, however, makes CDP unacceptable in the legal context of AUD diagnosis in DUI populations.
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Affiliation(s)
- A Korzec
- Department of Psychiatry, St Lucas Andreas Hospital, Amsterdam, The Netherlands
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18
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Abstract
BACKGROUND Although widely used in Europe, the conceptual and psychometric qualities of the Lancashire Quality of Life Profile (LQoLP) have not been thoroughly examined. Four issues need attention: coverage, scale construction, systematic missing data, and psychometric properties. METHOD Concept mapping was used to examine the coverage, and exploratory factor analysis to examine the empirical scale structure of the LQoLP. Data of 518 long-term patients from ten different mental health care settings were used. Modifications to the LQoLP were proposed on the basis of these findings, and its psychometric properties were tested. Thirty-one respondents participated in a test-retest reliability study (T1-T2: 2 weeks). RESULTS The modified LQoLP covers the quality of life-concept in a more comprehensive manner. Internal consistency, test-retest reliability and validity are good. CONCLUSIONS The modified version of the LQoLP now covers ten domains, paying specific attention to patients' definition of quality of life (autonomy, coping, self-worth). Domains are now based on factor analysis. The problem of systematic missing data is solved. Psychometric properties are good. Because of moderate alphas, two domains need further investigation.
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Affiliation(s)
- C van Nieuwenhuizen
- Department of Psychotherapy and Research, TBS-kliniek De Kijvelanden, Forensic Psychiatric Hospital, PO Box 900, 3160 AC Rhoon, The Netherlands.
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Abstract
OBJECTIVE We examined the prevalence of mental health problems in refugees living in camps that emerged in Tanzania during the Rwanda crisis that started in 1994. METHOD Using the 28-item version of the General Health Questionnaire (GHQ-28), we examined two samples: a random sample (n = 854) and a sample of clients of a psychosocial support programme in these camps (n = 23). Sensitivity, specificity and positive- and negative predictive values were estimated for several cut-off scores of the GHQ-28. RESULTS The prevalence of serious mental health problems was estimated at 50% (SE 12%). When using the GHQ-28 as a screener, a cut-off score of 14 is recommended. CONCLUSION Given the high prevalence of mental health problems, psychosocial programmes for large refugee populations should aim at strengthening community structures and supporting groups instead of focusing at individuals. The screening capacity of the GHQ-28 could be used to identify mentally vulnerable groups.
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Affiliation(s)
- J P de Jong
- Médecins Sans Frontières, Holland, Amsterdam, The Netherlands
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20
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Verheul R, van den Brink W, Koeter MW, Hartgers C. Antisocial alcoholic patients show as much improvement at 14-month follow-up as non-antisocial alcoholic patients. Am J Addict 1999; 8:24-33. [PMID: 10189512 DOI: 10.1080/105504999306054] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
The authors investigated the impact of DSM-III-R adult criteria for antisocial personality disorder (and co-occurrence of childhood conduct or mood disorder) on one-year changes of multi-domain problem severity in 309 alcoholic patients. Adult antisocial traits were associated with more drug, legal, and psychiatric problems at baseline and with more drug problems at follow-up. However, patients with antisocial traits showed at least as much improvement from baseline through follow-up as their non-antisocial counterparts. Furthermore, the co-occurrence of childhood conduct disorder or mood disorder among the antisocial alcoholics did not define prognostically relevant subgroups. These findings suggest that antisocial alcoholics benefit from treatment at least as much as non-antisocial alcoholics.
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Affiliation(s)
- R Verheul
- Amsterdam Institute for Addiction Research, University of Amsterdam, The Netherlands
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21
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Abstract
We evaluated the temporal stability of diagnostic criteria for antisocial personality disorder in 432 male alcohol dependent patients. Indicators for temporal stability were criterion continuation (i.e., the proportion of current or recent diagnoses among those with a lifetime diagnosis) and criterion duration (i.e., the length of time between the first occurrence and the last occurrence). In addition, the effect of diagnostic status (ASPD- versus ASPD+) on stability was examined. Among the criteria, "no regard for the truth" showed consistently high stability; "recklessness" showed moderate to high stability; "inconsistent work behavior," "failure to meet financial obligations," "failure to plan ahead" and "parental irresponsibility" showed consistently low stability. The continuation and duration parameters diverged with respect to "nonconformism" and "irritability/aggressiveness." Temporal stability for "nonconformism" was consistently greater among those with ASPD than among those without. It was concluded that both continuation and duration rates clearly differentiated among criteria. This new criterion-based approach seems to be useful as a strategy for improving the ASPD criteria set.
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Affiliation(s)
- R Verheul
- Amsterdam Institute for Addiction Research, Department of Psychiatry, University of Amsterdam, The Netherlands
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22
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Abstract
This article focuses on (1) the dimensionality of the caregiving concept; (2) the relation between the identified caregiving dimensions and characteristics of the patient, the caregiver, and their relationship; and (3) the relation between caregiving dimensions and caregiver distress. Findings are based on data from 480 members of the Dutch family organization for patients with schizophrenia/chronic psychosis who completed (1) the Involvement Evaluation Questionnaire (IEQ), which assesses general information (e.g., household characteristics), caregiving, help seeking, coping and distress, and (2) a questionnaire comprising questions on onset and course of the patient's disorder and symptoms characteristic of schizophrenic disorders. Four caregiving domains were found: tension, supervision, worrying, and urging. These domains were strongly related to the patient's symptomatology, contact between the relative and the patient's mental health professional, and the number of hours of mutual contact between the patient and the relative. The connection between patient, caregiver, and relationship variables and the caregivers' distress could be explained substantially by the overall caregiving score. Our findings suggest that caregiving tasks and problems may be diminished and related distress lowered by reducing the patient's symptomatology, increasing relatives' coping capacities, and decreasing the number of contact hours. If distress is reduced, relatives may use less psychotropic medication and may visit their general practitioner less often.
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Affiliation(s)
- A H Schene
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, The Netherlands
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23
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Verheul R, Hartgers C, Van den Brink W, Koeter MW. The effect of sampling, diagnostic criteria and assessment procedures on the observed prevalence of DSM-III-R personality disorders among treated alcoholics. J Stud Alcohol 1998; 59:227-36. [PMID: 9500311 DOI: 10.15288/jsa.1998.59.227] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
UNLABELLED OBJECTIVE. In a recent review of empirical studies on the prevalence of DSM-III-R personality disorders among substance abusers, wide ranges of prevalence rates for overall Axis II, antisocial personality disorder (APD) and borderline personality disorder (BPD) were shown. Utilizing subsamples from within a single study population, the current report explores the effect of sampling, diagnostic criteria and assessment procedures on the observed prevalence of DSM-III-R personality disorders among treated alcoholics. METHOD Personality disorders were assessed with the Personality Diagnostic Questionnaire Revised (PDQR) at two times of measurement (Time 1 n = 459; Time 2 n = 90). In addition, APD was measured with the Composite International Diagnostic Interview (CIDI; n = 587). Finally, an unselected subgroup (n = 136) was interviewed with the International Personality Disorder Examination (IPDE). RESULTS There were few differences between inpatients or outpatients or between males and females. Using the IPDE, the exclusion of substance-related pathology did not affect the prevalence estimate. However, the prevalence rates according to the PDQR varied greatly across age groups. In a representative subsample (n = 109), the prevalence rates also varied greatly across assessment methods (PDQR, 52% vs IPDE, 31%). The prevalence estimate of APD according to the CIDI was related to setting, gender, age group and the applied time-frame. CONCLUSIONS These findings indicate the examined factors to be necessary qualifiers of prevalence estimates and, consequently, support the use of a multiple-criteria/multimethod assessment battery in research as well as in clinical work.
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Affiliation(s)
- R Verheul
- Amsterdam Institute for Addiction Research, University of Amsterdam, The Netherlands
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Havenaar JM, Rumyantzeva GM, van den Brink W, Poelijoe NW, van den Bout J, van Engeland H, Koeter MW. Long-term mental health effects of the Chernobyl disaster: an epidemiologic survey in two former Soviet regions. Am J Psychiatry 1997; 154:1605-7. [PMID: 9356574 DOI: 10.1176/ajp.154.11.1605] [Citation(s) in RCA: 125] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study assessed the long-term mental health effects of the nuclear accident at Chernobyl. METHOD Two population samples (N = 3,044), one from the Gomel region, close to the accident site, and one from Tver, 500 miles away, were studied 6 1/2 years after the event with the use of a variety of self-report questionnaires and a standardized psychiatric interview. RESULTS The prevalence of psychological distress and DSM-III-R psychiatric disorders was exceptionally high in both regions. Scores on the self-report scales were consistently higher in the exposed region; however, a higher risk of DSM-III-R psychiatric disorders could be demonstrated only among women with children under 18 years of age in the exposed region. CONCLUSIONS A substantial long-term mental health effect of the Chernobyl incident was demonstrated, mainly at a subclinical level.
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Affiliation(s)
- J M Havenaar
- Department of Psychiatry, University Hospital Utrecht, The Netherlands
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25
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Havenaar JM, Poelijoe NW, Kasyanenko AP, Van den Bout J, Koeter MW, Filipenko VV. Screening for psychiatric disorders in an area affected by the Chernobyl disaster: the reliability and validity of three psychiatric screening questionnaires in Belarus. Psychol Med 1996; 26:837-844. [PMID: 8817719 DOI: 10.1017/s0033291700037867] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The reliability and criterion validity of Russian versions of three psychiatric screening questionnaire (the General Health Questionnaire, 12-item version; the Goldberg scales for anxiety and depression; and, the Bradford Somatic Inventory) were assessed in the Gomel region (Belarus), one of the most severely contaminated areas that resulted from the nuclear power plant explosion at Chernobyl in 1986. All instruments were found to have good internal reliability indices. Retest reliability of the GHQ, not tested for in the other instruments, was modest. Criterion validity, using a semi-structured interview on the basis of the Munich Diagnostic Checklist for DSM-III-R as external criterion, was good for the Goldberg scales, but modest for the two other instruments.
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Affiliation(s)
- J M Havenaar
- Department of Psychiatry, University Hospital of Utrecht, The Netherlands
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26
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Abstract
In this article the development, utility, reliability, and validity of the Inventory for Déjà vu Experiences Assessment (IDEA) are described. The IDEA is a 23-item self-administered questionnaire consisting of a general section of nine questions and qualitative section of 14 questions. The latter questions comprise 48 topics. The questionnaire appeared to be a user-friendly instrument with satisfactory to good reliability and validity. The IDEA permits the study of quantitative and qualitative characteristics of déjà vu experiences.
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Affiliation(s)
- H N Sno
- University Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
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27
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Wohlfarth TD, van den Brink W, Ormel J, Koeter MW, Oldehinkel AJ. The relationship between social dysfunctioning and psychopathology among primary care attenders. Br J Psychiatry 1993; 163:37-44. [PMID: 8353697 DOI: 10.1192/bjp.163.1.37] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The extent of social dysfunctioning and its relationship to psychological disorders among Dutch primary care patients was examined. Social dysfunctioning in these patients was rather limited, but was more pronounced in patients with a psychological disorder than in those without. Disabilities were largely restricted to the occupational and social roles, with family role functioning and self-care relatively intact. Social dysfunctioning was moderately related to psychopathology, with higher levels of dysfunctioning in more severe and depressed cases. The extent of social dysfunctioning among patients with both anxiety and depression was similar to that of patients with a single diagnosis of depression. Depressed patients had a similar level of dysfunctioning to non-psychotic psychiatric out-patients. Analyses regarding the effects of diagnosis and severity on social dysfunctioning revealed considerable overlap between these two aspects of psychopathology. This study supports the need for a simultaneous but separate assessment of psychopathology and social dysfunctioning. However, future research should incorporate additional predictors of social dysfunctioning (e.g. personality, life events, long-term difficulties, physical disorders), and prospective studies should be conducted to clarify the temporal sequences of symptom severity, diagnosis, and comorbidity on the one hand, and social dysfunctioning on the other.
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Affiliation(s)
- T D Wohlfarth
- Department of Social Psychiatry, University of Groningen, The Netherlands
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28
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Abstract
The question of the relationship between anxiety and depression remains to be solved. The fact that clinical pictures show substantial overlap makes it difficult, using conventional instruments, to distinguish between the co-occurrence of anxiety and depression and overlap in definitions and measurement of the two syndromes. This calls for the construction of scales which exclude symptoms common to both syndromes and incorporate symptoms specific only to anxiety or only to depression; i.e. scales with maximum discriminant validity. This article describes the construction of two such scales based on PSE symptoms; a prototypical anxiety scale and a prototypical depression scale. In a sample of 134 non-psychotic psychiatric out-patients these scales show good reliability and validity, both as a measure of severity and as a screening device. Compared to the Hamilton anxiety and depression scales (HARS and HRSD), the correlation between the prototypical anxiety and depression scales is low.
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Affiliation(s)
- M W Koeter
- Academisch Ziekenhuis, Groningen, The Netherlands
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29
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Abstract
This article presents the results of a comparison between the validity of the SCL anxiety, phobic anxiety and depression scales and the GHQ-28 anxiety-/insomnia and severe depression scales in a psychiatric outpatient population. Validity was studied at a categorical level with DSM-III diagnosis, and at a dimensional level with a prototypical anxiety and a prototypical depression scale. The SCL anxiety and depression scales and the GHQ depression scale all showed good convergent and divergent validity, however the GHQ anxiety/insomnia scale showed neither convergent nor divergent validity. It is concluded that as a screening instrument, the relative shortness of the GHQ-28 is a considerable advantage over the SCL-90. However, the GHQ-12 may be an even better alternative. As a multi dimensional measure of psychopathology, the SCL-90 is to be preferred, because it covers more dimensions. If one is interested in anxiety, the SCL-90 also seems the better choice.
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Affiliation(s)
- M W Koeter
- Department of Social Psychiatry, University of Groningen, The Netherlands
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30
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Abstract
This article addresses the issues of recognition of psychiatric disorders by general physicians (GPs) and the effects of recognition on management and course. Among 1994 patients who were screened with the General Health Questionnaire and who were rated by their GP, 1450 (72.7%) had not been identified by the GP as having a psychiatric disorder in the year before the index visit. Among these "new" patients, 557 (38.4%) had positive General Health Questionnaire scores. Only 47% of the new patients who met Bedford College diagnostic criteria for anxiety, depression, or ill-defined disorder had their psychiatric disorder recognized by their GP. Among patients who met Bedford College criteria, mean episode durations were longer for anxiety disorders (20 to 22 months) than for depressive disorders (9 to 10 months). Among the new patients, those with psychiatric disorders recognized by the GP were more likely to receive mental health interventions. Recognition was associated with shorter episode duration among patients with an anxiety disorder, but not among patients with depressive or ill-defined disorders.
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Affiliation(s)
- J Ormel
- Department of Psychiatry, University of Groningen, The Netherlands
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31
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Ormel J, Van Den Brink W, Koeter MW, Giel R, Van Der Meer K, Van De Willige G, Wilmink FW. Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study. Psychol Med 1990; 20:909-923. [PMID: 2284397 DOI: 10.1017/s0033291700036606] [Citation(s) in RCA: 181] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This article addresses the issues of recognition and labelling of psychological disorders (PDs) by general practitioners (GPs), and the association of recognition with management and outcome. Nearly 2000 attenders of 25 GPs were screened with the GHQ and a stratified sample of 296 patients was examined twice, using the Present State Examination (PSE) and Groningen Social Disability Schedule (GSDS). Prevalence rates of PDs according to the GHQ, GP and PSE were 46%, 26% and 15% respectively. For the 1450 'new' patients, i.e. patients who had no PD diagnosed by their GP in the 12 months prior to the enrollment visit, these rates were 38%, 14%, and 10%. GPs missed half of the PSE cases and typically assigned non-specific diagnoses to recognized cases. Depressions were more readily recognized than anxiety disorders, and the detection rates for severe disorders were higher than those for less severe disorders. Recognition was strongly associated with management and outcome. Recognized as compared to non-recognized cases were more likely to receive mental health interventions from their GP and had better outcomes in terms of both psychopathology and social functioning. Initial severity, psychological reasons for encounter, recency of onset, diagnostic category, and psychiatric comorbidity were related to both better recognition and outcome. However, these variables could not account for the association of recognition with management and outcome, but some did modify the association. A causal model of the relationships is presented and possible reasons for non-recognition and for the beneficial effects of recognition are discussed.
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Affiliation(s)
- J Ormel
- Department of Social Psychiatry, Family Medicine, University of Groningen, The Netherlands
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32
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Abstract
Substantial cross-sectional correlations have been reported between the GHQ and PSE (and CIS) total scores. Although necessary, this is not a sufficient condition for assuming good validity of the GHQ as a severity measure in longitudinal and health care evaluation studies. For this purpose the GHQ should also accurately reflect changes in severity over time. To examine their concurrent validity, GHQ and PSE scores were compared, in a three-wave longitudinal study, among 175 new psychiatric out-patients. Using a longitudinal structural equation model that takes measurement error into account, the strength of both the cross-sectional and longitudinal relationship between GHQ and PSE were estimated. The GHQ performed remarkably well; changes in severity as defined by PSE-ID and PSE total score were clearly reflected by changes in GHQ scores. The revised scoring method of the GHQ proposed by Goodchild and Duncan-Jones did not yield superior results.
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Affiliation(s)
- J Ormel
- Department of Social Psychiatry, University of Groningen, The Netherlands
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33
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Ormel J, Koeter MW, van den Brink W. Measuring change with the General Health Questionnaire (GHQ). The problem of retest effects. Soc Psychiatry Psychiatr Epidemiol 1989; 24:227-32. [PMID: 2510314 DOI: 10.1007/bf01788963] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [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: 01/01/2023]
Abstract
The available evidence suggests that the GHQ is a valid case-finding and screening instrument and a reasonable measure of severity of functional non-psychotic psychopathology. However, recently Henderson et al. (1981) have demonstrated a substantial retest effect for the GHQ, which may affect its usefulness in longitudinal population and outcome studies. In a three-wave longitudinal study among 175 new psychiatric outpatients, we examined whether retest effects can also be found in treatment settings and what its likely causes might be. A substantial retest effect was found, and the social desirability and legitimation hypotheses appeared to offer the most likely explanations. The implications of the findings for longitudinal and treatment evaluation studies are discussed.
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34
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Abstract
The sensitivity of the GHQ and a revised scoring procedure (CGHQ) for chronic psychiatric complaints was investigated on 175 out-patients. The mean level of severity of symptoms of the groups with and without chronic complaints was not significantly different. However, patients with chronic complaints showed a significantly lower mean GHQ score than patients without chronic complaints. The mean CGHQ scores of the two groups did not differ, suggesting that the CGHQ is a better indicator of the severity of the chronic psychiatric state than the GHQ. The revised scoring procedure resulted in a decrease in the number of false negatives. The strongest reduction in false negatives, however, was induced by a combination of the original and the revised scoring procedures. This reduction was achieved at the expense of only a small increase in the number of false positives. Altogether, the revised scoring procedure proved to be only marginally better.
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Affiliation(s)
- M W Koeter
- Department of Social Psychiatry, State University of Groningen, The Netherlands
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35
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van den Brink W, Koeter MW, Ormel J, Dijkstra W, Giel R, Slooff CJ, Wohlfarth TD. Psychiatric diagnosis in an outpatient population. A comparative study of PSE-Catego and DSM-III. Arch Gen Psychiatry 1989; 46:369-72. [PMID: 2930333 DOI: 10.1001/archpsyc.1989.01810040075011] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Two diagnostic systems are compared in a psychiatric outpatient population of 175 patients. The Present State Examination (PSE)-Catego system identified 121 patients (69%) as "cases," whereas DSM-III identified 152 patients (87%) as cases. The two systems converged in 115 patients, yielding a kappa coefficient of only .32. Approximately one third of the DSM-III cases that were not detected by the PSE-Catego system was due to the restricted coverage of the latter system; the remaining two thirds could be attributed to differences in threshold and time framing. Compared with DSM-III, the PSE-Catego system showed a strong bias toward depression, and the system was extremely insensitive to the detection of social phobias and obsessive-compulsive disorders. Only 58% of cases of depression and 46% of cases of anxiety were diagnosed by both systems. The results are compared with other studies, and some consequences are discussed.
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Affiliation(s)
- W van den Brink
- Department of Psychiatry, Rijksuniversiteit Groningen, The Netherlands
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