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Thibaut F, Cosyns P, Fedoroff JP, Briken P, Goethals K, Bradford JMW. The World Federation of Societies of Biological Psychiatry (WFSBP) 2020 guidelines for the pharmacological treatment of paraphilic disorders. World J Biol Psychiatry 2020; 21:412-490. [PMID: 32452729 DOI: 10.1080/15622975.2020.1744723] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objectives: The primary aim of these guidelines is to evaluate the role of pharmacological agents in the treatment and management of patients with paraphilic disorders, with a focus on the treatment of adult males. Because such treatments are not delivered in isolation, the role of specific psychotherapeutic interventions is also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients, including sexual offenders, with paraphilic disorders. The aim of these guidelines is to bring together different views on the appropriate treatment of paraphilic disorders from experts representing different countries in order to aid physicians in clinical decisions and to improve the quality of care.Methods: An extensive literature search was conducted using the English-language-literature indexed on MEDLINE/PubMed (1990-2018 for SSRIs) (1969-2018 for hormonal treatments), supplemented by other sources, including published reviews.Results: Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. The type of medication used depends on the severity of the paraphilic disorder and the respective risk of behaviour endangering others. GnRH analogue treatment constitutes the most relevant treatment for patients with severe paraphilic disorders.Conclusions: An algorithm is proposed with different levels of treatment for different categories of paraphilic disorders accompanied by different risk levels.
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Affiliation(s)
- Florence Thibaut
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin, University of Paris, INSERM U1266, Institute of Psychiatry and Neurosciences, Paris, France
| | - Paul Cosyns
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - John Paul Fedoroff
- Division of Forensic Psychiatry, The Royal Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kris Goethals
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp and University Forensic Centre, Antwerp University Hospital, Antwerp, Belgium
| | - John M W Bradford
- The Royal Institute of Mental Health Research, University of Ottawa, McMaster University, Ottawa & Hamilton, ON, Canada
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Van Den Eede F, Van Hecke J, Van Dalfsen A, Van den Bossche B, Cosyns P, Sabbe BGC. The use of atypical antipsychotics in the treatment of catatonia. Eur Psychiatry 2020; 20:422-9. [PMID: 15964746 DOI: 10.1016/j.eurpsy.2005.03.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [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] [Received: 07/05/2004] [Accepted: 03/15/2005] [Indexed: 12/14/2022] Open
Abstract
AbstractPurposeEvidence indicates that classical antipsychotics may aggravate non-malignant and malignant catatonia (MC). Atypical antipsychotics are less likely to cause movement disorders than classical antipsychotics and they are being frequently prescribed in disorders that can be associated with catatonia. Therefore, the important question that arises is whether atypical antipsychotics have a role to play in the treatment of catatonia.Materials and methodsA Medline search was performed to locate papers on the use of atypical antipsychotics in catatonia published between 1970 and 31st December 2004.ResultsThe literature on the use of atypical antipsychotics in catatonia consists of case reports and retrospective studies. In most cases of non-MC a reduction of the catatonic symptoms is reported upon treatment with atypical antipsychotics. Cases of MC relate mainly to the neuroleptic malignant syndrome (NMS), which is considered as an iatrogenic stuporous variant of MC caused by antipsychotics.ConclusionThere are indications that atypical antipsychotics may be useful in non-MC. As a consequence, one should not only focus on the possible extrapyramidal and autonomic side effects of these drugs, but also on the possible beneficial effects on certain brain functions and on the catatonic symptomatology. However, randomized controlled trials are needed to evaluate the effect of these drugs, and caution is advisable, since cases of NMS have been linked to treatment with atypical antipsychotics. There is no evidence to prescribe atypical antipsychotics in MC.
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Affiliation(s)
- Filip Van Den Eede
- Collaborative Antwerp Psychiatric Research Institute, CAPRI, University of Antwerp (UA), Campus Drie Eiken/Building T, Universiteitsplein 1, 2610 Antwerp, Belgium
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Briken P, Turner D, Thibaut F, Bradford J, Cosyns P, Tozdan S. Validation of the Change or Stop Testosterone-Lowering Medication (COSTLow) Scale Using the Delphi Method Among Clinical Experts. J Sex Marital Ther 2018; 45:148-158. [PMID: 30040595 DOI: 10.1080/0092623x.2018.1491910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/15/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
Guidelines for pharmacological treatment of patients with paraphilic disorders have been developed by a working group of the World Federation of Societies of Biological Psychiatry (Thibaut et al., 2010 ). With an increasing duration of experience and number of treated patients as well as aging patients, change of or withdrawal from testosterone-lowering medications (TLM) has become an important issue. The current study aimed to assess the quality of a structured professional judgment procedure that helps switching or discontinuing TLM in patients with paraphilic disorders. We used the Delphi method to estimate the quality of 10 factors originally proposed by the authors. A total of 30 experts participated in the first stage; 18 experts participated in the second stage. The experts' assessment resulted in an instrument of 15 factors that can be used to structure the process of changing or discontinuing TLM. These factors can be grouped into five broader categories: age and duration of treatment; therapeutic alliance; psychopathology and risk factors; motivation; and compliance and level of control. The developed COSTLow-R Scale provides an instrument that can be used to structure the process of changing or discontinuing TLM in patients with severe paraphilic disorders.
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Affiliation(s)
- Peer Briken
- a Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Daniel Turner
- a Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
- b Department of Psychiatry , University Medical Center Mainz , Mainz , Germany
| | - Florence Thibaut
- c Centre of Psychiatry and Neurosciences, Faculty of Medicine Paris Descartes, University Hospital Cochin (site Tarnier) , Paris , France
| | - John Bradford
- d Institute of Mental Health Research , Ottawa , Canada
| | - Paul Cosyns
- e Collaborative Antwerp Psychiatric Research Institute, University Forensic Centre , Antwerp , Belgium
| | - Safiye Tozdan
- a Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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Thibaut F, Bradford JMW, Briken P, De La Barra F, Häßler F, Cosyns P. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the treatment of adolescent sexual offenders with paraphilic disorders. World J Biol Psychiatry 2015; 17:2-38. [PMID: 26595752 PMCID: PMC4743592 DOI: 10.3109/15622975.2015.1085598] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/18/2015] [Indexed: 01/12/2023]
Abstract
The primary aim of these guidelines was to evaluate the role of pharmacological agents in the treatment of adolescents with paraphilic disorders who are also sexual offenders or at-risk of sexual offending. Psychotherapeutic and psychosocial treatments were also reviewed. Adolescents with paraphilic disorders specifically present a different therapeutic challenge as compared to adults. In part, the challenge relates to adolescents being in various stages of puberty and development, which may limit the use of certain pharmacological agents due to their potential side effects. In addition, most of the published treatment programmes have used cognitive behavioural interventions, family therapies and psychoeducational interventions. Psychological treatment is predicated in adolescents on the notion that sexually deviant behaviour can be controlled by the offender, and that more adaptive behaviours can be learned. The main purposes of these guidelines are to improve the quality of care and to aid physicians in their clinical decisions. These guidelines brought together different expert views and involved an extensive literature research. Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for efficacy, safety, tolerability and feasibility. An algorithm is proposed for the treatment of paraphilic disorders in adolescent sexual offenders or those who are at risk.
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Affiliation(s)
- Florence Thibaut
- University Hospital Cochin, Faculty of Medicine Paris Descartes, INSERM U 894 CPN,
Paris,
France
| | - John M. W. Bradford
- University of Ottawa, Institute of Mental Health Research, Division of Forensic Psychiatry, Queen’s University, Clinical Director, Forensic Treatment Unit, Brockville Mental Health Centre, Royal Ottawa Health Care Group,
Brockville,
Ontario,
Canada
| | - Peer Briken
- Institute for Sex Research and Forensic Psychiatry, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf,
Hamburg,
Germany
| | - Flora De La Barra
- East Psychiatry and Mental Health Department, University of Chile,
Clinica Las Condes,
Chile
| | - Frank Häßler
- Clinic for Child and Adolescent Psychiatry, University of Medicine of Rostock,
Rostock,
Germany
| | - Paul Cosyns
- University Forensic Centre (University Hospital of Antwerp),
Belgium
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Peuskens J, De Hert M, Cosyns P, Pieters G, Theys P, Vermote R. Suicide in Young Schizophrenic Patients During and After Inpatient Treatment. International Journal of Mental Health 2015. [DOI: 10.1080/00207411.1996.11449377] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Huygh J, Verhaegen A, Goethals K, Cosyns P, De Block C, Van Gaal L. Prolonged flare-up of testosterone after administration of a gonadotrophin agonist to a sex offender: an under-recognised risk? Crim Behav Ment Health 2015; 25:226-230. [PMID: 25851640 DOI: 10.1002/cbm.1945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/07/2014] [Indexed: 06/04/2023]
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Nuttin B, Wu H, Mayberg H, Hariz M, Gabriëls L, Galert T, Merkel R, Kubu C, Vilela-Filho O, Matthews K, Taira T, Lozano AM, Schechtmann G, Doshi P, Broggi G, Régis J, Alkhani A, Sun B, Eljamel S, Schulder M, Kaplitt M, Eskandar E, Rezai A, Krauss JK, Hilven P, Schuurman R, Ruiz P, Chang JW, Cosyns P, Lipsman N, Voges J, Cosgrove R, Li Y, Schlaepfer T. Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders. J Neurol Neurosurg Psychiatry 2014; 85:1003-8. [PMID: 24444853 PMCID: PMC4145431 DOI: 10.1136/jnnp-2013-306580] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/30/2013] [Accepted: 12/18/2013] [Indexed: 12/02/2022]
Abstract
BACKGROUND For patients with psychiatric illnesses remaining refractory to 'standard' therapies, neurosurgical procedures may be considered. Guidelines for safe and ethical conduct of such procedures have previously and independently been proposed by various local and regional expert groups. METHODS To expand on these earlier documents, representative members of continental and international psychiatric and neurosurgical societies, joined efforts to further elaborate and adopt a pragmatic worldwide set of guidelines. These are intended to address a broad range of neuropsychiatric disorders, brain targets and neurosurgical techniques, taking into account cultural and social heterogeneities of healthcare environments. FINDINGS The proposed consensus document highlights that, while stereotactic ablative procedures such as cingulotomy and capsulotomy for depression and obsessive-compulsive disorder are considered 'established' in some countries, they still lack level I evidence. Further, it is noted that deep brain stimulation in any brain target hitherto tried, and for any psychiatric or behavioural disorder, still remains at an investigational stage. Researchers are encouraged to design randomised controlled trials, based on scientific and data-driven rationales for disease and brain target selection. Experienced multidisciplinary teams are a mandatory requirement for the safe and ethical conduct of any psychiatric neurosurgery, ensuring documented refractoriness of patients, proper consent procedures that respect patient's capacity and autonomy, multifaceted preoperative as well as postoperative long-term follow-up evaluation, and reporting of effects and side effects for all patients. INTERPRETATION This consensus document on ethical and scientific conduct of psychiatric surgery worldwide is designed to enhance patient safety.
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Affiliation(s)
- Bart Nuttin
- Research Group of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Chair of Committee of Neurosurgery for Psychiatric Disorders of the WSSFN and Department of Neurosurgery, UZ Leuven, Leuven, Belgium
- Working Group ‘Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application’. This Working Group is organised by the Europäische Akademie GmbH (Bad Neuenahr-Ahrweiler, Germany, http://www.ea-aw.de). It consists of an interdisciplinary and international team of neurosurgeons, neurologists, psychiatrists, neuropsychologists, bioethicists, philosophers and legal scholars, analysing ethical issues arising from the application of Deep Brain Stimulation for Psychiatric Disorders. Questions such as critical issues around regulatory processes and ethical guidance for the management of conflicts of interest for researchers, engineers and clinicians engaged in the development of therapeutic deep brain stimulation have been comprehensively studied and the results have been published under common authorship
- WSSFN Committee on Neurosurgery for Psychiatric Disorders
| | - Hemmings Wu
- Research Group of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Helen Mayberg
- Working Group ‘Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application’. This Working Group is organised by the Europäische Akademie GmbH (Bad Neuenahr-Ahrweiler, Germany, http://www.ea-aw.de). It consists of an interdisciplinary and international team of neurosurgeons, neurologists, psychiatrists, neuropsychologists, bioethicists, philosophers and legal scholars, analysing ethical issues arising from the application of Deep Brain Stimulation for Psychiatric Disorders. Questions such as critical issues around regulatory processes and ethical guidance for the management of conflicts of interest for researchers, engineers and clinicians engaged in the development of therapeutic deep brain stimulation have been comprehensively studied and the results have been published under common authorship
- Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA
| | - Marwan Hariz
- WSSFN Committee on Neurosurgery for Psychiatric Disorders
- Department of Clinical Neuroscience, UCL Institute of Neurology, Queen Square, London, Umea University, Umea, Sweden
| | - Loes Gabriëls
- WSSFN Committee on Neurosurgery for Psychiatric Disorders
- Chair of the Committee of Neurosurgery for Psychiatric Disorders, Belgium and Belgium and Department of Psychiatry, UZ Leuven, Leuven, Belgium
| | - Thorsten Galert
- Working Group ‘Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application’. This Working Group is organised by the Europäische Akademie GmbH (Bad Neuenahr-Ahrweiler, Germany, http://www.ea-aw.de). It consists of an interdisciplinary and international team of neurosurgeons, neurologists, psychiatrists, neuropsychologists, bioethicists, philosophers and legal scholars, analysing ethical issues arising from the application of Deep Brain Stimulation for Psychiatric Disorders. Questions such as critical issues around regulatory processes and ethical guidance for the management of conflicts of interest for researchers, engineers and clinicians engaged in the development of therapeutic deep brain stimulation have been comprehensively studied and the results have been published under common authorship
- Deutsches Referenzzentrum für Ethik in den Biowissenschaften, Bonn, Germany
| | - Reinhard Merkel
- Working Group ‘Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application’. This Working Group is organised by the Europäische Akademie GmbH (Bad Neuenahr-Ahrweiler, Germany, http://www.ea-aw.de). It consists of an interdisciplinary and international team of neurosurgeons, neurologists, psychiatrists, neuropsychologists, bioethicists, philosophers and legal scholars, analysing ethical issues arising from the application of Deep Brain Stimulation for Psychiatric Disorders. Questions such as critical issues around regulatory processes and ethical guidance for the management of conflicts of interest for researchers, engineers and clinicians engaged in the development of therapeutic deep brain stimulation have been comprehensively studied and the results have been published under common authorship
- Universität Hamburg/Juristische Fakultät Lehrstuhl für Strafrecht und Rechtsphilosophie, Hamburg, Germany
| | - Cynthia Kubu
- Working Group ‘Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application’. This Working Group is organised by the Europäische Akademie GmbH (Bad Neuenahr-Ahrweiler, Germany, http://www.ea-aw.de). It consists of an interdisciplinary and international team of neurosurgeons, neurologists, psychiatrists, neuropsychologists, bioethicists, philosophers and legal scholars, analysing ethical issues arising from the application of Deep Brain Stimulation for Psychiatric Disorders. Questions such as critical issues around regulatory processes and ethical guidance for the management of conflicts of interest for researchers, engineers and clinicians engaged in the development of therapeutic deep brain stimulation have been comprehensively studied and the results have been published under common authorship
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | - Osvaldo Vilela-Filho
- WSSFN Committee on Neurosurgery for Psychiatric Disorders
- Department of Neurosciences, Institute of Neurology of Goiânia, Stereotactic and Functional Neurosurgery Service, Medical School, Federal University of Goiás, Medical School, Pontifical Catholic University of Goiás, Goiânia, Brazil
| | - Keith Matthews
- WSSFN Committee on Neurosurgery for Psychiatric Disorders
- Advanced Interventions Service and Division of Neuroscience, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Takaomi Taira
- Past-president of WSSFN and Chair of Committee of Stereotactic and Functional Neurosurgery, World Federation of Neurosurgical Societies (WFNS), and Department of Neurosurgery, World Federation of Neurosurgical Societies (WFNS), Tokyo Women's Medical University, Tokyo, Japan
| | - Andres M Lozano
- Past-president of WSSFN and Department of Neurosurgery, Toronto Western Hospital, Toronto, Canada
| | - Gastón Schechtmann
- WSSFN Committee on Neurosurgery for Psychiatric Disorders
- Department of Neurosurgery and Clinical Neuroscience, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Paresh Doshi
- WSSFN Committee on Neurosurgery for Psychiatric Disorders
- Stereotactic and Functional Neurosurgery Program, Jaslok Hospital and Research Centre, Mumbai, India
| | - Giovanni Broggi
- WSSFN Committee on Neurosurgery for Psychiatric Disorders
- Department of Neurosurgery, Instituto Neurologico C. Besta, Milano, Italy
| | - Jean Régis
- WSSFN Committee on Neurosurgery for Psychiatric Disorders
- Department of Functional Neurosurgery, Hôpital La Timone, Aix-Marseille Université, Marseille, France
| | - Ahmed Alkhani
- WSSFN Committee on Neurosurgery for Psychiatric Disorders
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, AlFaisal University, Riyadh, Saudi Arabia
| | - Bomin Sun
- WSSFN Committee on Neurosurgery for Psychiatric Disorders
- Center for Functional Neurosurgery, Shanghai Jiao Tong University Rui Jin Hospital, Shanghai, China
| | - Sam Eljamel
- WSSFN Committee on Neurosurgery for Psychiatric Disorders
- Centre of Neurosciences Department of Neurosurgery, Ninewells Hospital and Medical School Dundee, Dundee, Scotland, UK
| | - Michael Schulder
- Department of Neurosurgery, Hofstra North Shore LIJ School of Medicine, North Shore University Hospital, Manhasset, NY, USA
| | - Michael Kaplitt
- Member of the Psychiatric Surgery Committee of the ASSFN and Department of Neurological Surgery, Weill Cornell Medical College, NY, USA
| | - Emad Eskandar
- Member of the Psychiatric Surgery Committee of the ASSFN and Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ali Rezai
- Past President, American Society of Stereotactic and Functional Neurosurgery (ASSFN), Department of Neurosurgery, American Society of Stereotactic and Functional Neurosurgery (ASSFN), Ohio State University, Ohio, USA
| | - Joachim K Krauss
- President of ESSFN and WSSFN, Department of Neurosurgery, Medical University of Hannover, Hannover, Germany
| | | | - Rick Schuurman
- Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Pedro Ruiz
- President of WPA, Department of Psychiatry and Behavioral Sciences, Miami Miller School of Medicine, Miami, USA
| | - Jin Woo Chang
- WSSFN Committee on Neurosurgery for Psychiatric Disorders
- President of Asian Australasian Society for Stereotactic & Functional Neurosurgery Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Paul Cosyns
- Committee of Neurosurgery for Psychiatric Disorders, Belgium, Kortenberg, Belgium
| | - Nir Lipsman
- WSSFN Committee on Neurosurgery for Psychiatric Disorders
- Department of Neurosurgery, Toronto Western Hospital, Toronto, Canada
| | - Juergen Voges
- WSSFN Committee on Neurosurgery for Psychiatric Disorders
- Department of Stereotactic Neurosurgery, Otto-von-Guericke University Magdeburg and Leibniz-Institute for Neurobiology, Magdeburg, Germany
| | - Rees Cosgrove
- WSSFN Committee on Neurosurgery for Psychiatric Disorders
- Department of Neurosurgery, Brown University, Providence, RI, USA
| | - Yongjie Li
- Department of Neurosurgery, Xuanwu Hospital, Beijing, China
| | - Thomas Schlaepfer
- Working Group ‘Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application’. This Working Group is organised by the Europäische Akademie GmbH (Bad Neuenahr-Ahrweiler, Germany, http://www.ea-aw.de). It consists of an interdisciplinary and international team of neurosurgeons, neurologists, psychiatrists, neuropsychologists, bioethicists, philosophers and legal scholars, analysing ethical issues arising from the application of Deep Brain Stimulation for Psychiatric Disorders. Questions such as critical issues around regulatory processes and ethical guidance for the management of conflicts of interest for researchers, engineers and clinicians engaged in the development of therapeutic deep brain stimulation have been comprehensively studied and the results have been published under common authorship
- Chair of the Focus Group ‘Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application’, Chair of the Task Force on Brain Stimulation of the World Federations of Societies of Biological Psychiatry, Chair of the Section of Experimental Brain Stimulation Methods of the German Association of Psychiatry, Psychotherapy and Psychosomatics and member of the Operational Committee on Sections of the World Psychiatric Association. He is professor of Psychiatry and Psychotherapy at the University of Bonn, Germany, and Associate Professor of Psychiatry and Mental Health at The Johns Hopkins University, Baltimore, MD, USA
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Goethals K, Cosyns P. [Sexual disorders in the DSM-5]. Tijdschr Psychiatr 2014; 56:196-200. [PMID: 24643831] [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: 06/03/2023]
Abstract
BACKGROUND In DSM-IV-TR, the subject of 'sexual and gender identity disorders' was dealt with in one chapter; in DSM-5, however, the subject is divided into three chapters, namely sexual dysfunctions , gender dysphoria, and paraphilic disorders. AIM To discuss the above-mentioned changes. METHOD The one-chapter version in DSM-IV is compared with the three-chapter contribution in DSM-5 and the differing criteria are tested for their clinical utility. RESULTS There are minor changes in the chapter 'sexual dysfunctions'. The content of the chapters on 'gender dysphoria' and 'paraphilic disorders' differs substantially from the content of the sections on these subjects in DSM-IV. In the section on gender dysphoria the term 'sex' has been replaced by 'gender' and the term 'identity disorder' has been dropped. With regard to paraphilias, a distinction is now made between a paraphilia and a paraphilic disorder. The DSM-5 makes a new distinction between pathology (paraphilic disorder) on the one hand and other unusual or unconventional non-pathological sexual behavior on the other hand. In the DSM-5 the highly relevant clinical concept 'hypersexuality' has still not been incorporated as a separate category. CONCLUSION In the DSM-5 many parts of the chapters on sexual disorders have been substantially revised.
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Van Den Eede F, Moorkens G, Hulstijn W, Maas Y, Schrijvers D, Stevens SR, Cosyns P, Claes SJ, Sabbe BGC. Psychomotor function and response inhibition in chronic fatigue syndrome. Psychiatry Res 2011; 186:367-72. [PMID: 20797797 DOI: 10.1016/j.psychres.2010.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 06/30/2009] [Revised: 07/20/2010] [Accepted: 07/23/2010] [Indexed: 10/19/2022]
Abstract
Most research points to cognitive slowing in chronic fatigue syndrome (CFS), although there have been negative reports. The present study is one of few that examines fine motor processing and the inhibition of automatic responses in a well-characterised CFS population. A total of 35 female CFS patients without current major depression and 25 female controls performed two computerised figure-copying tasks. The cognitive and fine motor processing of visual-spatial information was measured by recording reaction time (RT) and movement time (MT), respectively. The inhibition of automatic responses was assessed by introducing 'conflicting patterns' (i.e., patterns that were difficult to draw from the preferred left to right). A multivariate general linear model was adopted for the statistical analysis of the movement recordings. As a result, CFS was significantly associated with longer RT and MT in the pooled and in the task-specific analyses. However, there was no interaction between disease status and conflicting character of the patterns. In conclusion, these performance data on the figure-copying tasks provide confirmatory evidence for psychomotor slowing in CFS, but not for a disturbed inhibition of automatic responses. Computerised figure-copying tasks may be promising tools for use in neurobiological research and clinical trials in CFS.
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Affiliation(s)
- Filip Van Den Eede
- Department of Psychiatry, Antwerp University Hospital, Antwerp, Belgium.
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Thibaut F, De La Barra F, Gordon H, Cosyns P, Bradford JMW. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of paraphilias. World J Biol Psychiatry 2010; 11:604-55. [PMID: 20459370 DOI: 10.3109/15622971003671628] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [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] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The primary aim of these guidelines was to evaluate the role of pharmacological agents in the treatment and management of paraphilia, with a focus on the treatment of adults males. Because such treatments are not delivered in isolation, the role of specific psychosocial and psychotherapeutic interventions was also briefly covered. These guidelines are intended for use in clinical practice by clinicians who diagnose and treat patients with paraphilia. The aim of these guidelines is to improve the quality of care and to aid physicians in clinical decisions. METHODS The aim of these guidelines was to bring together different views on the appropriate treatment of paraphilias from experts representing different continents. To achieve this aim, an extensive literature search was conducted using the English language literature indexed on MEDLINE/PubMed (1990-2009 for SSRIs) (1969-2009 for antiandrogen treatments), supplemented by other sources, including published reviews. RESULTS Each treatment recommendation was evaluated and discussed with respect to the strength of evidence for its efficacy, safety, tolerability and feasibility. CONCLUSIONS An algorithm was proposed with six levels of treatment for different categories of paraphilias.
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Affiliation(s)
- Florence Thibaut
- Faculty of Medicine, Rouen University Hospital Ch. Nicolle, University of Rouen, Rouen, France.
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Schrijvers D, Van Den Eede F, Maas Y, Cosyns P, Hulstijn W, Sabbe BGC. Psychomotor functioning in chronic fatigue syndrome and major depressive disorder: a comparative study. J Affect Disord 2009; 115:46-53. [PMID: 18817977 DOI: 10.1016/j.jad.2008.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [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: 06/06/2008] [Revised: 08/16/2008] [Accepted: 08/17/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Studies comparing chronic fatigue syndrome (CFS) and major depressive disorder (MDD) reported similarities as well as differences between the two disorders. However, whereas psychomotor symptoms have been studied extensively in MDD, such research in CFS is more limited. Moreover, the few studies that compared cognitive and motor performance in MDD and CFS yielded inconsistent results. This study hence directly compares fine psychomotor functioning in both syndromes. METHODS Thirty-eight patients diagnosed with CFS without a current major depressive episode (MDE), 32 MDD patients with a current MDE and 38 healthy controls performed two computerized copying tasks differing in complexity: a line-copying task that mainly requires motor effort and a figure-copying task requiring additional cognitive efforts. All participants were female. A multivariate general linear model was used to compute group differences. RESULT Overall, both patient groups performed more slowly than the controls. Compared to CFS patients, patients with MDD needed significantly more time to copy the single lines but no such between-group performance difference was observed for the figure reproductions. In this latter copying task, the increasing complexity of the figures resulted in prolonged reaction times for all three participant groups with the effect being larger and the magnitude similar for the two patient groups. LIMITATIONS All patients were female and most were on psychotropic medication. CONCLUSIONS Both the MDD and CFS patients tested demonstrated an overall fine motor slowing, with the motor component being more affected in the MDD patients than in the CFS patients while both patient groups showed similar cognitive impairments.
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Affiliation(s)
- D Schrijvers
- Collaborative Antwerp Psychiatric Research Institute, Faculty of Medicine, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium.
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Van campen E, Den Eede FV, Moorkens G, Schotte C, Schacht R, Sabbe BG, Cosyns P, Claes SJ. Use of the Temperament and Character Inventory (TCI) for Assessment of Personality in Chronic Fatigue Syndrome. Psychosomatics 2009; 50:147-54. [DOI: 10.1176/appi.psy.50.2.147] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Maes L, Cosyns P, Buntinx F. [Fitting proof]. Verh K Acad Geneeskd Belg 2009; 71:373-380. [PMID: 20232789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Randomised controled trials (RCT's) and meta analyses of RCT's are known as the best research designs to evaluate if interventions are doing more good than bad. Some interventions can not be evaluated by RCT's because of the heterogeneity of the problems, the cost of the evaluation study or ethical arguments against the study. This is often the case with population based interventions. A typical example is suicide prevention. The shortcomings of the "classic" research designs for the evaluation of suicide prevention are discussed and feasible solutions are suggested for future research.
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Affiliation(s)
- L Maes
- Vakgroep Maatschappelijke Gezondheidkunde, Universiteit Gent
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14
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Cosyns P, Koeck S. Empathy as a Complex Construct: Consequences for the Treatment of Sexual Abusers. Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)70513-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Nearly all treatment programs for sexual abusers contain a module for empathy enhancement, presuming it will help to prevent future offensive or delinquent behaviour. This appears to be a fair presumption, yet research results reveal a more complex reality. Some sexual abusers do not show a generalized lack of empathy (‘trait’), but have a rather selective and contextual deficit, often limited to their own victims (‘state’). Moreover, the construct of empathy consists of cognitive, emotional and behavioral components, which renders it more difficult to deduct precise assertions on its protective role as a whole. This presentation offers current views on the assessment of empathy and it's effect in the dynamics of sexual offences. Referring to clinical illustrations, guidelines will be presented on the timing (staged interventions) and desirability (contraindications) to address the issue during psychotherapy.
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Courjaret J, Schotte CKW, Wijnants H, Moorkens G, Cosyns P. Chronic fatigue syndrome and DSM-IV personality disorders. J Psychosom Res 2009; 66:13-20. [PMID: 19073288 DOI: 10.1016/j.jpsychores.2008.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 05/20/2008] [Accepted: 07/07/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Personality is an important factor in the research of the chronic fatigue syndrome (CFS). Although some studies report a high rate of personality disorders--around the 40% level--in samples of patients with CFS, the generalizability of these findings can be questioned. The present study evaluates the prevalence of Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) personality disorders in a sample of female CFS patients and in two control groups. METHOD The ADP-IV questionnaire (Assessment of DSM Personality Disorders IV) was used to assess the DSM-IV-TR personality disorders at a dimensional and categorical level in a sample of 50 female CFS patients and in two matched control samples of Flemish civilians (n=50) and psychiatric patients (n=50). RESULTS The results indicate a striking lack of statistical significant differences between the CFS sample and the Flemish control group at the level of dimensional Trait scores, number of criteria, and prevalence rates of personality disorder diagnoses. Unsurprisingly, higher scores at these levels were obtained within the psychiatric sample. The prevalence of an Axis II disorder was 12% in the Flemish and CFS samples, whereas the psychiatric sample obtained a prevalence of 54%. CONCLUSION The prominent absence of any significant difference in personality disorder characteristics between the female Flemish general population and the CFS samples seems to suggest only a minor etiological role for personality pathology, as defined by the DSM-IV Axis II, within CFS.
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16
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Van Den Eede F, Moorkens G, Hulstijn W, Van Houdenhove B, Cosyns P, Sabbe BGC, Claes SJ. Combined dexamethasone/corticotropin-releasing factor test in chronic fatigue syndrome. Psychol Med 2008; 38:963-973. [PMID: 17803834 DOI: 10.1017/s0033291707001444] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Studies of hypothalamic-pituitary-adrenal (HPA) axis function in chronic fatigue syndrome (CFS) point to hypofunction, although there are negative reports. Suggested mechanisms include a reduced hypothalamic or supra-hypothalamic stimulus to the HPA axis and enhanced sensitivity to the negative feedback of glucocorticoids. The aim of the current study was to investigate HPA axis function in CFS with the dexamethasone/corticotropin-releasing factor (Dex/CRF) test, in analogy with research in affective disorders. METHOD Thirty-four well-characterized female CFS patients and 25 healthy control subjects participated in the low-dose Dex/CRF test. Current major depressive episode was an exclusion criterion. History of early-life stress (ELS) was assessed with the Structured Trauma Interview. RESULTS Salivary cortisol responses after 0.5 mg Dex were lower in CFS patients than in controls (before 100 microg CRF, p=0.038; after 100 microg CRF, p=0.015). A secondary analysis revealed an influence of early-life stress and of oestrogen intake. After removal of the 10 participants who were taking an oral oestrogen, patients without a history of ELS showed lower cortisol responses than patients with ELS and controls (before CRF, p=0.005; after CRF, p=0.008). CONCLUSIONS CFS is globally associated with reduced cortisol responses in the combined low-dose Dex/CRF test, but this effect is only clearly present in CFS patients without a history of ELS. This study provides further support for an enhanced glucocorticoid negative feedback and/or a reduced central HPA axis drive in CFS. Furthermore, it demonstrates that ELS is an important variable to consider in CFS research.
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Affiliation(s)
- F Van Den Eede
- Department of Psychiatry, Antwerp University Hospital, Edegem, Belgium
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17
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Abstract
OBJECTIVE Research on stereotactic neurosurgery for psychiatric disorders (SNPD) is rapidly evolving. Knowledge on patients undergoing SNPD is of crucial importance. We describe applicants for SNPD and examine the necessity for a multidisciplinary advisory board. METHOD Summary of the current practice of the Flemish advisory board (SNPD committee) and analysis of a questionnaire investigating the attitude of clinicians on SNPD. RESULTS In 7 years, 91 applications were submitted, nine patients did not fulfill diagnostic criteria for OCD, 65 patients received a positive recommendation, 50 SNPD procedures were performed. The prevalence of SNPD in the current year in Belgium is 0.6/million inhabitants. Ninety-seven per cent of clinicians consider the expertise and advice of the SNPD committee essential for indication setting. Forty-four percent of clinicians consider referral of a patient for capsulotomy, 82% for electrical brain stimulation. CONCLUSION Neurosurgery is exclusively considered for severe, treatment-refractory psychiatric disorders. Clinicians consider the SNPD committee essential in the decision-making process prior to intervention.
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Affiliation(s)
- L Gabriëls
- Department of Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium
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18
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Cosyns P. Community treatment of sexual offenders. Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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19
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Cosyns P, Koeck S, Verellen R. [Mentally disturbed offenders in Flanders]. Tijdschr Psychiatr 2008; 50 Spec no.:63-68. [PMID: 19067302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In the course of the past 25 years in Flanders there has been a real breakthrough as far as forensic psychiatry is concerned. New types of treatment have become available for mentally disturbed offenders, whether they are in prison or in the community. A new Belgian law on mentally disturbed offenders with diminished responsibility confirms that 'internment' is still regarded as a protective measure and an alternative to punishment. The current university course in psychiatry should now be widened to include the subject of forensic mental health.
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Affiliation(s)
- P Cosyns
- Psychiatrie, Universitair Forensisch Centrum, Universiteit Antwerpen, Edegem, Belgium.
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20
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Van Den Eede F, Moorkens G, Van Houdenhove B, Cosyns P, Claes SJ. Hypothalamic-pituitary-adrenal axis function in chronic fatigue syndrome. Neuropsychobiology 2007; 55:112-20. [PMID: 17596739 DOI: 10.1159/000104468] [Citation(s) in RCA: 78] [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] [Received: 08/29/2006] [Accepted: 03/17/2007] [Indexed: 11/19/2022]
Abstract
There is evidence for a hypofunction of the hypothalamic-pituitary-adrenal (HPA) axis in a proportion of the patients with chronic fatigue syndrome (CFS), despite the negative studies and methodological difficulties. In this review, we focus on challenge studies and on the role of the HPA axis in the pathogenesis of CFS. Mild hypocortisolism, blunted adrenocorticotropin response to stressors and enhanced negative feedback sensitivity to glucocorticoids are the main findings. Several underlying mechanisms have been proposed. Currently, it is a matter of debate whether these disturbances have a primary role in the pathogenesis of CFS. However, even if the HPA axis dysfunctions are secondary to other factors, they are probably a relevant factor in symptom propagation in CFS.
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21
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Van Den Eede F, Venken T, Del-Favero J, Norrback KF, Souery D, Nilsson LG, Van den Bossche B, Hulstijn W, Sabbe BGC, Cosyns P, Mendlewicz J, Adolfsson R, Van Broeckhoven C, Claes SJ. Single nucleotide polymorphism analysis of corticotropin-releasing factor-binding protein gene in recurrent major depressive disorder. Psychiatry Res 2007; 153:17-25. [PMID: 17599466 DOI: 10.1016/j.psychres.2006.12.018] [Citation(s) in RCA: 13] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 09/01/2006] [Accepted: 12/17/2006] [Indexed: 12/01/2022]
Abstract
Corticotropin-releasing factor-binding protein (CRF-BP) regulates the availability of free CRF and is a functional candidate gene for affective disorders. Previous research showed an association between polymorphisms in the CRF-BP gene and recurrent major depression (MDD) in a Swedish sample. The purpose of the current study was to re-evaluate the previous findings in an extended Swedish sample and in an independent Belgian sample of patients with recurrent MDD and in control samples. In total, 317 patients and 696 control individuals were included. Five single nucleotide polymorphisms (SNPs) and a deletion polymorphism in the CRF-BP gene were genotyped and the haplotype block structure of the gene was assessed. In the extended Swedish population, there was a trend towards an association between two SNPs and MDD. The subsequent gender analysis showed significant associations of three SNPs (CRF-BPs2 T; CRF-BPs11 T and CRF-BPs12 C) and haplotype G_T_C_T_C with MDD in Swedish males. However, these findings did not withstand correction for multiple testing and there were no significant SNP or haplotype associations in the Belgian MDD sample. In conclusion, this study does not provide confirmatory evidence for a role of the CRF-BP gene in the vulnerability for MDD in general. The association between genetic CRF-BP variants and MDD may be sexually dimorphic, but this issue requires further investigation in a larger sample.
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Affiliation(s)
- Filip Van Den Eede
- Department of Molecular Genetics VIB8, Flanders Interuniversity Institute for Biotechnology, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium
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22
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van Kuyck K, Gabriëls L, Cosyns P, Arckens L, Sturm V, Rasmussen S, Nuttin B. Behavioural and physiological effects of electrical stimulation in the nucleus accumbens: a review. Acta Neurochir Suppl 2007; 97:375-91. [PMID: 17691326 DOI: 10.1007/978-3-211-33081-4_43] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Electrical stimulation (ES) in the brain is becoming a new treatment option in patients with treatment-resistant obsessive-compulsive disorder (OCD). A possible brain target might be the nucleus accumbens (NACC). This review aims to summarise the behavioural and physiological effects of ES in the NACC in humans and in animals and to discuss these findings with regard to neuroanatomical, electrophysiological and behavioural insights. The results clearly demonstrate that ES in the NACC has an effect on reward, activity, fight-or-flight, exploratory behaviour and food intake, with evidence for only moderate physiological effects. Seizures were rarely observed. Finally, the results of ES studies in patients with treatment-resistant OCD and in animal models for OCD are promising.
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Affiliation(s)
- K van Kuyck
- Laboratory of Experimental Neurosurgery and Neuroanatomy, Department of Neuroscience and Psychiatry, Leuven Provisorium, Belgium
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Abstract
Effective treatment of severe or chronic unipolar depression requires the combination of pharmacological and psychotherapeutic interventions, and demands a theoretical paradigm integrating biological and psychosocial aspects of depression. Supported by recent research, we propose in our article a biopsychosocial diathesis-stress model of depression. Its basic aim is psychoeducational: to provide therapists, patients, and their environment a constructive conceptual framework to understand depressive complaints, vulnerability, and stress. The core of the model consists of the concept of psychobiological vulnerability, which is determined by risk factors-of a biogenetic, psychological, somatic, and societal nature-and by protective factors. Life events with an idiosyncratic, stress-inducing value interact with this vulnerability, triggering severe or chronic distress that affects the individual's resilience and leads to symptoms of depression. The pathogenesis of depression is symbolized by a negative downward loop, in which interactions among symptoms, vulnerability, and stressors drive the patient toward a depressive condition. Moreover, experiencing recurrent depression influences psychobiological vulnerability, the occurrence of stressors, and tremendously increases the risk of further relapse. The model stresses the self-evident integration of biological and psychological therapeutic interventions that need to focus on symptom reduction and on relapse prevention. Moreover, it offers the patient and therapist a psychoeducational context in which the individual's vulnerability and depressive symptoms can be treated. Finally, applications of the depression model as a therapeutic approach to severe depression in the phases of remoralization, symptom reduction, and relapse prevention are presented.
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Affiliation(s)
- Chris K W Schotte
- UZA, University Hospital Antwerp, Department of Psychiatry, Edegem, Belgium.
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24
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Cosyns P. Quality standards of expertise cocerning sexual offenders in Belgium. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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25
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Mincke E, Cosyns P, Christophe AB, De Vriese S, Maes M. Lower omega-3 polyunsaturated fatty acids and lower docosahexaenoic acid in men with pedophilia. Neuro Endocrinol Lett 2006; 27:719-23. [PMID: 17187003] [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] [Received: 08/14/2006] [Accepted: 10/15/2006] [Indexed: 05/13/2023]
Abstract
BACKGROUND Previous studies have suggested that abnormalities in plasma phospholipid fatty acids may play a role in aggressive behavior. Recently, it was suggested that a dysfunctional serotonergic turnover in the brain may be involved in the etiopathology of pedophilia. Depletion of n-3 polyunsaturated fatty acids (PUFA) may cause alterations in the serotonergic system that may be related to pedophilia and aggression. METHODS This study examines the serum phospholipid n-3 and n-6 PUFA fractions in pedophilia. Twenty-seven pedophilic men and eighteen healthy volunteers participated in this study. RESULTS In pedophilia there was a significant depletion of the C22:6n-3 (docosahexaenoic acid, DHA), total n-3 fractions and an increase in the total n-6/n-3 and C20:4n-6/C20:5n-3 (arachidonic acid/eicosapentaenoic acid) ratios. Using the NEO Personality Inventory, lower DHA in pedophiles is related to more impulsiveness and lower agreeableness (trust, altruism, straightforwardness, compliance) and conscientiousness (self-discipline). CONCLUSIONS The results of this study suggest that a depletion of the serum phospholipid n-3 higher unsaturated fatty acids (HUFAs) and, in particular, of DHA may take part in the pathophysiology of pedophilia. One hypothesis is that a depletion of n-3 HUFAs and DHA may cause alterations in the serotonergic turnover, which are related to impulse discontrol and aggression-hostility, behaviors which are associated with pedophilia.
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Affiliation(s)
- Elda Mincke
- Department of Psychiatry, Antwerp Forensic Center, University of Antwerp, Edegem, and Department of Internal Medicine, Ghent University Hospital, Belgium
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Van Den Eede F, Van den Bossche B, Hulstijn W, Sabbe BGC, Cosyns P, Claes SJ. Combined dexamethasone/CRF test in remitted outpatients with recurrent major depressive disorder. J Affect Disord 2006; 93:259-63. [PMID: 16677715 DOI: 10.1016/j.jad.2006.03.020] [Citation(s) in RCA: 21] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Revised: 03/27/2006] [Accepted: 03/28/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis is a prominent neurobiological finding during a major depressive episode, reflecting a state dependent factor. An issue under investigation is whether the dysfunction of the HPA axis has also a role to play as a state-independent or trait factor for major depressive disorder (MDD). In relation to this, it is important to examine HPA axis function in patients who are clinically remitted from depression. METHODS Twenty-three remitted outpatients with recurrent MDD and 23 age- and gender-matched control individuals without a history of MDD participated in the sensitive combined dexamethasone/corticotropin-releasing factor (DEX/CRF) test. RESULTS Free salivary cortisol responses were not significantly different between the two groups, although three patients (13%) displayed extremely elevated cortisol responses after CRF. LIMITATIONS Limited sample size. All but one patient were under treatment with an antidepressant. CONCLUSIONS This study shows no evidence for a disturbed DEX/CRF test as a state-independent factor in recurrent MDD on a group level. However, MDD is a complex and heterogenic disorder. Probably, there is a subgroup of patients who show a disturbed DEX/CRF test due to an inherited and/or acquired predisposition or as a biological scar after previous depressive episodes.
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Affiliation(s)
- Filip Van Den Eede
- Collaborative Antwerp Psychiatric Research Institute, Universiteitsplein 1 B-2610 Antwerpen, University of Antwerp, Belgium
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27
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Van Laere K, Nuttin B, Gabriels L, Dupont P, Rasmussen S, Greenberg BD, Cosyns P. Metabolic imaging of anterior capsular stimulation in refractory obsessive-compulsive disorder: a key role for the subgenual anterior cingulate and ventral striatum. J Nucl Med 2006; 47:740-7. [PMID: 16644742] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
UNLABELLED High-frequency anterior capsular stimulation is a new, promising, and reversible neuromodulatory treatment in the research stage for patients with refractory obsessive-compulsive disorder (OCD). The mechanism of action is unknown but hypothesized to be secondary to interruption of the corticothalamostriatocortical circuit. METHODS (18)F-FDG PET was performed on 6 consecutive OCD patients preoperatively and after stimulation. The results were compared with those of 20 age- and sex-matched healthy volunteers by using both a standardized volume-of-interest-based approach for subcortical areas and statistical parametric mapping. Correlations were investigated with Yale-Brown Obsessive Compulsive Scale scores (Y-BOCS) and Hamilton Depression Rating Scale scores (HAM-D). RESULTS Chronic anterior capsular electrostimulation resulted in a further decrease of prefrontal metabolic activity, especially in the subgenual anterior cingulate (P < 0.001). Correlation analysis demonstrated that decreases in Y-BOCS and HAM-D with anterior capsular electrostimulation were inversely related to the metabolic activity changes in the left ventral striatum, left amygdala, and left hippocampus (P < 0.01). Preoperative resting metabolic activity in the subgenual anterior cingulate was predictive of therapeutic response (P = 0.001). CONCLUSION These observations provide evidence that the subgenual anterior cingulate and ventral striatum have a key role in the neuronal circuitry involved in the pathophysiology of OCD with associated major depression and in the neuromodulatory mechanism of anterior capsular stimulation.
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Affiliation(s)
- Koenraad Van Laere
- Division of Nuclear Medicine, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Cosyns P, Van Peteghem P, Raes BCM, Sabbe BGC. [Forensic psychiatry in Flanders at a crossroad?]. Tijdschr Psychiatr 2006; 48:511-3. [PMID: 16956174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Naudts KH, Cosyns P, McInerny T, Audenaert K, van den Eynde F, van Heeringen C. Belgium and its internees: a problem for human rights and a stimulus for service change. Crim Behav Ment Health 2005; 15:148-53. [PMID: 16575820 DOI: 10.1002/cbm.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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30
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Schotte CKW, De Doncker DAM, Dmitruk D, Van Mulders I, D'Haenen H, Cosyns P. The ADP-IV questionnaire: differential validity and concordance with the semi-structured interview. J Pers Disord 2004; 18:405-19. [PMID: 15342327 DOI: 10.1521/pedi.18.4.405.40348] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Assessment of DSM-IV Personality Disorders questionnaire (ADP-IV) is a self-report measure of the DSM-IV Axis II personality disorders (PDs). The ADP-IV assesses for each DSM-IV criterion its typicality as well as the accompanying distress and impairment. This study investigates two important aspects of the construct validity of the ADP-IV: (a) the differential validity (i.e., the ability to differentiate between a sample of the general Flemish population ( n = 659) and a sample of psychiatric inpatients ( n = 487) with a high prevalence of clinical PD diagnoses, and patients with and without a PD in the psychiatric sample; (b) the convergent validity with the SCID-II semi-structured interview in a population of psychiatric inpatients ( n = 59). The results indicate a good differential validity: the dimensional scales and the categorical measures discriminated well between both groups and between patients with and without a PD diagnosis in the psychiatric sample. Concerning the concordance with the SCID-II, a decent level of agreement is exemplified by a correlation of.67 between the dimensional total scores of both instruments and by kappa coefficients for an "any" Axis II diagnosis at the.50 level. In conclusion, the results indicate that the ADP-IV is an efficient method for assessing PD in dimensional and categorical ways.
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Affiliation(s)
- Chris K W Schotte
- UZA, University Hospital Antwerp, Department of Psychiatry, and CAPRI, Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Belgium.
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31
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Gabriëls L, Cosyns P, Nuttin B, Demeulemeester H, Gybels J. Deep brain stimulation for treatment-refractory obsessive-compulsive disorder: psychopathological and neuropsychological outcome in three cases. Acta Psychiatr Scand 2003; 107:275-82. [PMID: 12662250] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Investigation of deep brain stimulation (DBS) as a last-resort treatment alternative to capsulotomy in treatment-refractory obsessive-compulsive disorder (OCD). METHOD Prospective single-case based design with evaluation of DBS impact on emotions, behaviour, personality traits and executive function in three patients with OCD. RESULTS Two patients experienced sustained improvement of OCD symptoms with DBS. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) dropped 12 points and 23 points to baseline and Y-BOCS self-rating scale (Y-BOCS-SRS) and Profile of Mood States (POMS) for depression and tension decreased with increasing stimulation amplitude. Total Maladjustment Score on the Brief Psychiatric Rating Scale reduced with 44 and 59% to baseline. Reduction in psychopathology was sustained under continuous stimulation. No deleterious impact of DBS on neuropsychological testing or personality traits measured on a self-rated personality inventory was detected. CONCLUSION These preliminary findings demonstrate that DBS may have important therapeutic benefits on psychopathology in OCD. No harmful side-effects were detected during follow-up (33/33/39 months, respectively).
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Affiliation(s)
- L Gabriëls
- University of Antwerpen, University Hospital Antwerpen, Department of psychiatry, Edegem, Belgium.
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Nuttin B, Gybels J, Cosyns P, Gabriels L, Meyerson B, Andreewitch S, Rasmussen SA, Greenberg B, Friehs G, Rezai AR, Montgomery E, Malone D, Fins JJ. Deep brain stimulation for psychiatric disorders. Neurosurg Clin N Am 2003; 14:xv-xvi. [PMID: 12856486 DOI: 10.1016/s1042-3680(03)00007-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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33
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Nuttin BJ, Gabriels L, van Kuyck K, Cosyns P. Electrical stimulation of the anterior limbs of the internal capsules in patients with severe obsessive-compulsive disorder: anecdotal reports. Neurosurg Clin N Am 2003; 14:267-74. [PMID: 12856493 DOI: 10.1016/s1042-3680(02)00117-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [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: 11/17/2022]
Abstract
Anterior capsular stimulation induces some improvement in severe treatment-resistant OCD patients. At this stage, not all stimulation-induced effects can be explained. The effects are a valuable source for further neurophysiologic and neuroanatomic research. It was reassuring that when the group of Drs Rasmussen, Greenberg, and Friehs in Providence and the group of Drs Rezai, Montgomery, and Malone in Cleveland started to operate on OCD patients using exactly the same technique, similar effects were seen in the patients. The authors still want to stress that anterior capsular stimulation remains investigational and needs optimization, especially to try to solve the problem of the short battery life of the stimulators.
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Affiliation(s)
- Bart J Nuttin
- Department of Neurosurgery, Katholieke Universiteit Leuven, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
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Cosyns P, Gabriels L, Nuttin B. Deep brain stimulation in treatment refractory obsessive compulsive disorder. Verh K Acad Geneeskd Belg 2003; 65:385-99; discussion 399-400. [PMID: 14964038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Obsessive-compulsive disorder is a worldwide psychiatric disorder with a lifetime prevalence of 2% and mainly characterized by obsessional ideas and compulsive behaviors and rituals. Many patients show improvement under cognitive behavioral and/or pharmacological treatment. A minority of patients is refractory to all available therapy and may benefit from capsulotomy. This study aims to investigate deep brain stimulation (DBS) as a last resort treatment alternative to capsulotomy in treatment refractory obsessive-compulsive disorder. Eight patients have been implanted bilaterally in the anterior limbs of the internal capsules with a quadripolar electrode. This paper presents the results of the first 4 operated patients. Acute deep brain stimulation displays an immediate improvement of the speech, mood, eye contact and motor function. Chronic deep brain stimulation improves significantly the obsessional and compulsive symptomatology in three out of the four patients. This study definitely needs replication, but the results are promising. Reversible deep brain stimulation may improve the symptomatology of treatment refractory OCD patients, without significant side effects.
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Affiliation(s)
- P Cosyns
- University of Antwerp-Universitair Ziekenhuis Antwerpen, Department of Psychiatry, Wilrijkstraat 10-B 2650 Edegem
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35
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Nuttin B, Gybels J, Cosyns P, Gabriels L, Meyerson B, Andréewitch S, Rasmussen S, Greenberg B, Friehs G, Rezai AR, Montgomery E, Malone D, Fins JJ. Deep Brain Stimulation for Psychiatric Disorders. Neurosurgery 2002. [DOI: 10.1227/00006123-200208000-00044] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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36
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Dierick M, De Nayer A, Ansseau M, D'Haenen H, Cosyns P, Verbruggen W, Seghers A, Pelc I, Fossion P, Stefos G, Peuskens J, Malfroid M, Leyman S, Mignon A. An eight-week, open-label, uncontrolled, multicenter, Phase IV study of remission rates in outpatients and inpatients with major depression treated with venlafaxine. Curr Ther Res Clin Exp 2002. [DOI: 10.1016/s0011-393x(02)80053-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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37
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Cosyns P, Gabriëls L, Nuttin B. Deep brain stimulation in severe treatment refractory OCD. Eur Psychiatry 2002. [DOI: 10.1016/s0924-9338(02)80140-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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38
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39
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De Raedt R, Schacht R, Cosyns P, Ponjaert-Kristoffersen I. Pain-provoking behaviour as a driven reaction to psychological distress: the bio-psycho-social neurotic loop model. New Ideas in Psychology 2002. [DOI: 10.1016/s0732-118x(00)00017-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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40
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Cosyns P. [The treatment of internees: a breakthrough in a new law?]. Verh K Acad Geneeskd Belg 2002; 63:305-18; discussion 318-20. [PMID: 11603057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Mentally disordered offenders can be declared criminal irresponsible according the Belgian Law of Social Defense (1 July 1964) and as a consequence they are "interned". The treatment of this population of "internees" is inadequate and the law must be revised. A commission "internment" has, at the request of the Minister of Justice, put forward conclusions in his report of 1999. Proposals are made to introduce the multidisciplinary psychiatric expert report, to improve the labeling of the question asked to the experts according to current psychiatric knowledge, and to operationalise important concepts as for example "dangerousness". The quality of the psychiatric treatment in the Belgian Prison system is bad for all the categories of inmates, detainees on remand, condemned or interned. The commission proposed that the Minister(s) in charge of Public Health and Social Affairs should be responsible for the treatment for the treatment of psychiatric disordered offenders, be it inside or outside prison. The political authorities plan to review this law of Social Defense, but these efforts will remain vain if no decisions are taken to implement the medical requirements of the law, and if no valuable forensic psychiatric treatment network is developed.
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Affiliation(s)
- P Cosyns
- Universiteit Antwerpen UZA-Dienst Psychiatrie Wilrijkstraat 10-B 2650 Edegem
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41
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Maes M, De Vos N, Van Hunsel F, Van West D, Westenberg H, Cosyns P, Neels H. Pedophilia is accompanied by increased plasma concentrations of catecholamines, in particular epinephrine. Psychiatry Res 2001; 103:43-9. [PMID: 11472789 DOI: 10.1016/s0165-1781(01)00268-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Plasma epinephrine and norepinephrine concentrations were measured in pedophiles and normal men both in placebo conditions and after administration of meta-chlorophenylpiperazine (mCPP), a post-synaptic 5-HT2 receptor agonist. The plasma concentrations of catecholamines, in particular epinephrine, were significantly increased in pedophiles. It is concluded that pedophiles may have an increased activity of the sympathoadrenal system.
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Affiliation(s)
- M Maes
- Department of Psychiatry and Neuropsychology, University Hospital of, Maastricht, Maastricht, The Netherlands.
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Maes M, van West D, De Vos N, Westenberg H, Van Hunsel F, Hendriks D, Cosyns P, Scharpé S. Lower baseline plasma cortisol and prolactin together with increased body temperature and higher mCPP-induced cortisol responses in men with pedophilia. Neuropsychopharmacology 2001; 24:37-46. [PMID: 11106874 DOI: 10.1016/s0893-133x(00)00177-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is some evidence that hormonal and serotonergic alterations may play a role in the pathophysiology of paraphilias. The aims of the present study were to examine: 1) baseline plasma cortisol, plasma prolactin, and body temperature; and 2) cortisol, prolactin, body temperature, as well as behavioral responses to meta-chlorophenylpiperazine (mCPP) and placebo in pedophiles and normal men. Pedophiles showed significantly lower baseline plasma cortisol and prolactin concentrations and a higher body temperature than normal volunteers. The mCPP-induced cortisol responses were significantly greater in pedophiles than in normal volunteers. In normal volunteers, mCPP-induced a hyperthermic response, whereas in pedophiles no such response was observed. mCPP induced different behavioral responses in pedophiles than in normal men. In pedophiles, but not in normal men, mCPP increased the sensations "feeling dizzy, " "restless," and "strange" and decreased the sensation "feeling hungry". The results suggest that there are several serotonergic disturbances in pedophiles. It is hypothesized that the results are compatible with a decreased activity of the serotonergic presynaptic neuron and a 5-HT2 postsynaptic receptor hyperresponsivity.
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Affiliation(s)
- M Maes
- Department of Psychiatry & Neuropsychology, University of Maastricht, Maastricht, The Netherlands
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43
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Gabriëls L, Cosyns P, Nuttin B. FC04.02 Deep brain stimulation for severe refractory obsessive-compulsive disorder: A new last-resort therapeutic option? Eur Psychiatry 2000. [DOI: 10.1016/s0924-9338(00)94045-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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44
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Cosyns P. S18.01 Involuntary, compulsory or coerced treatment: New trends in Belgium. Eur Psychiatry 2000. [DOI: 10.1016/s0924-9338(00)94058-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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45
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46
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Nuttin B, Cosyns P, Demeulemeester H, Gybels J, Meyerson B. Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet 1999; 354:1526. [PMID: 10551504 DOI: 10.1016/s0140-6736(99)02376-4] [Citation(s) in RCA: 491] [Impact Index Per Article: 19.6] [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: 01/11/2023]
Abstract
Chronic electrical stimulation instead of bilateral capsulotomy was done in four selected patients with long-standing treatment-resistant obsessive-compulsive disorder. In three of them beneficial effects were observed.
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47
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Schotte CK, de Doncker D, Vankerckhoven C, Vertommen H, Cosyns P. Self-report assessment of the DSM-IV personality disorders. Measurement of trait and distress characteristics: the ADP-IV. Psychol Med 1998; 28:1179-1188. [PMID: 9794025 DOI: 10.1017/s0033291798007041] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Self-report instruments assessing the DSM personality disorders are characterized by overdiagnosis due to their emphasis on the measurement of personality traits rather than the impairment and distress associated with the criteria. METHODS The ADP-IV, a Dutch questionnaire, introduces an alternative assessment method: each test item assesses 'Trait' as well as 'Distress/impairment' characteristics of a DSM-IV criterion. This item format allows dimensional as well as categorical diagnostic evaluations. The present study explores the validity of the ADP-IV in a sample of 659 subjects of the Flemish population. RESULTS The dimensional personality disorder subscales, measuring Trait characteristics, are internally consistent and display a good concurrent validity with the Wisconsin Personality Disorders Inventory. Factor analysis at the item-level resulted in 11 orthogonal factors, describing personality dimensions such as psychopathy, social anxiety and avoidance, negative affect and self-image. Factor analysis at the subscale-level identified two basic dimensions, reflecting hostile (DSM-IV Cluster B) and anxious (DSM-IV Cluster C) interpersonal attitudes. Categorical ADP-IV diagnoses are obtained using scoring algorithms, which emphasize the Trait or the Distress concepts in the diagnostic evaluation. Prevalences of ADP-IV diagnoses of any personality disorder according to these algorithms vary between 2.28 and 20.64%. CONCLUSIONS Although further research in clinical samples is required, the present results support the validity of the ADP-IV and the potential of the measurement of trait and distress characteristics as a method for assessing personality pathology.
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Affiliation(s)
- C K Schotte
- Department of Psychiatry, University Hospital of Antwerp, Belgium
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48
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Parizel PM, Van Goethem JW, van den Hauwe L, Dillen C, Verlooy J, Cosyns P, De Schepper AM. Imaging findings in diffuse axonal injury after closed head trauma. Eur Radiol 1998; 8:960-5. [PMID: 9683701 DOI: 10.1007/s003300050496] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.2] [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: 11/29/2022]
Abstract
Even in patients with closed head trauma, brain parenchyma can be severely injured due to disruption of axonal fibers by shearing forces during acceleration, deceleration, and rotation of the head. In this article we review the spectrum of imaging findings in patients with diffuse axonal injuries (DAI) after closed head trauma. Knowledge of the location and imaging characteristics of DAI is important to radiologists for detection and diagnosis. Common locations of DAI include: cerebral hemispheric gray-white matter interface and subcortical white matter, body and splenium of corpus callosum, basal ganglia, dorsolateral aspect of brainstem, and cerebellum. In the acute phase, CT may show punctate hemorrhages. The true extent of brain involvement is better appreciated with MR imaging, because both hemorrhagic and non-hemorrhagic lesions (gliotic scars) can be detected. The MR appearance of DAI lesions depends on several factors, including age of injury, presence of hemorrhage or blood-breakdown products (e. g., hemosiderin), and type of sequence used. Technical aspects in MR imaging of these patients are discussed. Non-hemorrhagic lesions can be detected with fluid attenuated inversion recovery (FLAIR), proton-density-, or T2-weighted images, whereas gradient echo sequences with long TE increase the visibility of old hemorrhagic lesions.
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Affiliation(s)
- P M Parizel
- Department of Radiology, Universitair Ziekenhuis Antwerpen (University of Antwerp), Wilrijkstraat 10, B-2650 Edegem, Belgium
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49
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Song C, Lin A, Bonaccorso S, Heide C, Verkerk R, Kenis G, Bosmans E, Scharpe S, Whelan A, Cosyns P, de Jongh R, Maes M. The inflammatory response system and the availability of plasma tryptophan in patients with primary sleep disorders and major depression. J Affect Disord 1998; 49:211-9. [PMID: 9629951 DOI: 10.1016/s0165-0327(98)00025-1] [Citation(s) in RCA: 180] [Impact Index Per Article: 6.9] [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: 02/07/2023]
Abstract
BACKGROUND It is now well established that major depression is accompanied by an immune-inflammatory system response and that indicators of the latter are inversely correlated with lower availability of plasma tryptophan in depression. Inflammation and infection can alter sleep architecture, whereas sleep disturbances can impair immune functions. AIMS AND METHODS The aims of the present study were to examine: (i) immune-inflammatory markers, i.e. serum interleukin-6 (IL-6), IL-8, IL-6 receptor (IL-6R), IL-1R antagonist (IL-1RA), gp130, and prostaglandin E2 (PGE2) production by mitogen-stimulated whole blood and the availability of plasma tryptophan in patients with primary sleep disorders, major depression and healthy volunteers; and (ii) the relationships between the availability of tryptophan and indicators of the immune-inflammatory response system. RESULTS Mitogen-stimulated release of PGE2, and serum IL-6 and IL-8, were significantly increased in both depressed and sleep disordered patients compared to normal controls. Serum IL-1RA was significantly higher in depressed patients than in normal controls. Patients with depression and sleep disorders had a significantly lower availability of tryptophan than normal controls. There were significant and inverse relationships between the availability of plasma tryptophan and serum IL-1RA, IL-6 and IL-8. CONCLUSIONS The results suggest that (i) there is an activation of the immune-inflammatory response system in primary sleep disorders and depression; and (ii) the decreased availability of plasma tryptophan may be related to the inflammatory system response.
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Affiliation(s)
- C Song
- Clinical Research Center for Mental Health, University Department of Psychiatry, Antwerp, Belgium
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50
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Cosyns P. [The treatment of pedophilia under juridical compulsion]. Verh K Acad Geneeskd Belg 1998; 59:379-95; discussion 395-9. [PMID: 9490925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Public opinion is more and more concerned about the fate of victims of sexual violence and sexual abuse. Until now the focus of scientific research concerned the most appropriate approach of children and women as the main victims of male sexual offenders. We need more research on the psychopathology of sexuality and aggression in order to develop scientifically founded treatment modalities to prevent relapse of sexual abuse. The University Forensic Centre of the University of Antwerp started in 1993 with an outpatient consultation for the diagnosis and treatment of paraphilia disorders. During the first 3 years, 265 consecutive clients have been examined, including 157 persons referred for pedosexual activities. This paper reflects the experience of the diagnostic and treatment team with this specific population. The specialised outpatient treatment program is mainly based on cognitive and behaviour therapy. The program can be divided in six phases: 1. intake, 2. provision of the necessary safeguards, 3. diagnostic (bio-psycho-social and criminological), 4. enhancement of motivation for treatment, 5. relapse prevention I where the focus is on behavioural control and 6. relapse prevention II where the focus is on life style imbalances. Difficult ethical problems must be taken into account in the treatment of sexual abusers referred by judicial authorities (74% of our cases), 1) the lack of motivation for treatment, 2) the problem of confidentiality.
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Affiliation(s)
- P Cosyns
- Psychiatrie, U.I.A. U.Z. Antwerpen, Edegem
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