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Leijdesdorff SMJ, Huijs CEM, Klaassen RMC, Popma A, van Amelsvoort TAMJ, Evers SMAA. Burden of mental health problems: quality of life and cost-of-illness in youth consulting Dutch walk-in youth health centres. J Ment Health 2023; 32:150-157. [PMID: 33086874 DOI: 10.1080/09638237.2020.1836555] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known about the burden of (sub-threshold) mental health problems in youth. AIM To examine the burden of mental health problems in terms of health-related quality of life (HRQoL) and cost-of-illness, for first visitors of the Dutch youth walk-in centres (@ease). METHOD A bottom-up, prevalence-based burden of disease study from a societal perspective. HRQoL was assessed through the EuroQoL (EQ-5D-5L), and cost-of-illness via items about truancy and health care utilization. RESULTS Participants (N = 80) showed a decreased HRQoL compared to the general population of Dutch youth. In the three months prior to their 1st attendance, participants skipped on average 4.11 days of school and had 1.03 health care visits, leading to total costs of €512.64 per person. Females had significantly higher health care costs and lower HRQoL. Health care use was lower in those not speaking the Dutch language. Living alone was a significant predictor of truancy (costs), and therefore total costs. CONCLUSIONS Mental health problems in youth consulting @ease have a considerable impact on the individual's HRQoL, and an economic impact on society, yet almost 75% is not receiving care. A lack of interventions in this critical period in life may have major lifelong consequences.
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Affiliation(s)
- S M J Leijdesdorff
- Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience (MNeNS) Maastricht University, Maastricht, The Netherlands
| | - C E M Huijs
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - R M C Klaassen
- Department of Child and Adolescent Psychiatry, Duivendrecht, The Netherlands
| | - A Popma
- Department of Child and Adolescent Psychiatry, Duivendrecht, The Netherlands.,Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - T A M J van Amelsvoort
- Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience (MNeNS) Maastricht University, Maastricht, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Trimbos Institute Centre for Economic Evaluation and Machine Learning, Utrecht, the Netherlands
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Gerritsen SE, van Bodegom LS, Dieleman GC, Overbeek MM, Verhulst FC, Wolke D, Rizopoulos D, Appleton R, van Amelsvoort TAMJ, Bodier Rethore C, Bonnet-Brilhault F, Charvin I, Da Fonseca D, Davidović N, Dodig-Ćurković K, Ferrari A, Fiori F, Franić T, Gatherer C, de Girolamo G, Heaney N, Hendrickx G, Jardri R, Kolozsvari A, Lida-Pulik H, Lievesley K, Madan J, Mastroianni M, Maurice V, McNicholas F, Nacinovich R, Parenti A, Paul M, Purper-Ouakil D, Rivolta L, de Roeck V, Russet F, Saam MC, Sagar-Ouriaghli I, Santosh PJ, Sartor A, Schulze UME, Scocco P, Signorini G, Singh SP, Singh J, Speranza M, Stagi P, Stagni P, Street C, Tah P, Tanase E, Tremmery S, Tuffrey A, Tuomainen H, Walker L, Wilson A, Maras A. Demographic, clinical, and service-use characteristics related to the clinician's recommendation to transition from child to adult mental health services. Soc Psychiatry Psychiatr Epidemiol 2022; 57:973-991. [PMID: 35146551 PMCID: PMC9042957 DOI: 10.1007/s00127-022-02238-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/22/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians' advice to continue treatment at AMHS. METHODS Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians' transition recommendations. RESULTS Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. CONCLUSION Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services.
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Affiliation(s)
- S E Gerritsen
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - L S van Bodegom
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
| | - G C Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.
| | - M M Overbeek
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
- Clinical Child and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F C Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - D Wolke
- Department of Psychology, University of Warwick, Coventry, UK
| | - D Rizopoulos
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - T A M J van Amelsvoort
- Department of Psychiatry and Neuropsychology, University of Maastricht, Maastricht, The Netherlands
- Mondriaan Mental Health Care, Heerlen, The Netherlands
| | | | | | - I Charvin
- Centre Hospitalier Universitaire de Marseille, Marseille, France
| | - D Da Fonseca
- Centre Hospitalier Universitaire de Marseille, Marseille, France
| | - N Davidović
- University Hospital Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - K Dodig-Ćurković
- Faculty for Dental Care and Health, Osijek, Croatia
- University Health Center Osijek, Osijek, Croatia
- Unit for Child and Adolescent Psychiatry, Osijek, Croatia
| | - A Ferrari
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- DISM, ULSS 16, SOPROXI Onlus, Padua, Italy
| | - F Fiori
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
- HealthTracker Ltd, Kent, UK
| | - T Franić
- University Hospital Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - C Gatherer
- Warwick Medical School, University of Warwick, Coventry, UK
| | - G de Girolamo
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - N Heaney
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - G Hendrickx
- Department of Neurosciences, Centre for Clinical Psychiatry, KU Leuven, Leuven, Belgium
| | - R Jardri
- Lille Neurosciences and Cognitions, Plasticity and Subjectivity Team, CURE Platform, Université de Lille, INSERM (U-1172), Fontan Hospital, CHU Lille, Lille, France
| | | | | | - K Lievesley
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - J Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - M Mastroianni
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - V Maurice
- Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Montpellier, France
| | - F McNicholas
- School of Medicine & Medical Science, University College Dublin, Dublin, Republic of Ireland
- Lucena CAMHS, SJOG, Dublin, Republic of Ireland
| | - R Nacinovich
- Child and Adolescent Neuropsychiatry Unit, ASST Monza, Monza, Italy
- Università Degli Studi Milano Bicocca, Milan, Italy
| | - A Parenti
- Centre Hospitalier Universitaire de Lille, Lille, France
| | - M Paul
- Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - D Purper-Ouakil
- Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Montpellier, France
- INSERM, CESP U1018, PsyDev, University Paris Saclay, UVSQ, Versailles, France
| | - L Rivolta
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
- Department of Mental Health, Psychiatry Unit, San Gerardo Hospital, Monza, Monza Brianza, Italy
| | - V de Roeck
- Department of Neurosciences, KU Leuven, Leuven, Belgium
- Child and Youth Studies, Campus Social School, University Colleges Leuven Limburg, Heverlee, Belgium
| | - F Russet
- Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Montpellier, France
| | - M C Saam
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - I Sagar-Ouriaghli
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - P J Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
- HealthTracker Ltd, Kent, UK
| | - A Sartor
- Josefinum Augsburg, Klinik für Kinder- und Jugenspsychiatrie und Psychotherapie, Augsburg, Germany
| | - U M E Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - P Scocco
- Department of Mental Health, ULSS 6 Euganea, Padua, Italy
- SOPROXI Onlus, Padua, Italy
| | - G Signorini
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - S P Singh
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - M Speranza
- INSERM, CESP U1018, PsyDev, University Paris Saclay, UVSQ, Versailles, France
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier de Versailles, Versailles, France
| | - P Stagi
- Child and Adolescent Neuropsychiatry Unit, AUSL Modena, Modena, Italy
| | - P Stagni
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- Child and Adolescent Neuropsychiatry, Department of Mental Health, Modena, Italy
| | - C Street
- Warwick Medical School, University of Warwick, Coventry, UK
| | - P Tah
- Warwick Medical School, University of Warwick, Coventry, UK
| | - E Tanase
- Abteilung für Psychiatrie und Psychotherapie des Kindes-und Jugendalters Weissenau, ZfP Südwürttemberg, Ravensburg, Germany
| | - S Tremmery
- Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - A Tuffrey
- Warwick Medical School, University of Warwick, Coventry, UK
| | - H Tuomainen
- Warwick Medical School, University of Warwick, Coventry, UK
| | - L Walker
- Warwick Medical School, University of Warwick, Coventry, UK
| | - A Wilson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - A Maras
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
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van Amelsvoort TAMJ, Swillen A. [Monogenetic causes of psychiatric disorders: a review]. Tijdschr Psychiatr 2022; 64:291-294. [PMID: 35735039] [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: 06/15/2023]
Abstract
BACKGROUND Because of rapid developments in genetic technology, more underlying genetic causes of psychiatric disorders can be detected which may contribute to better monitoring and treatment of co-morbidities than previously. AIM Review of monogenetic causes of psychiatric disorders. METHODE Review of the literature. RESULTATS Research in people with monogenetic disorders will generate new knowledge and insights on psychopathology and cognitive function in general and pave the way to new treatment targets. In this article we discuss four monogenetic disorders that are relevant for clinical psychiatry and (educational) psychology: fragile X syndrome, tuberous sclerosis, Rett Syndrome, and Huntington’s disease. CONCLUSION Given the multisystem nature of these genetic disorders, a well-coordinated, multidisciplinary approach by specialized expert centers is highly recommended.
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van Amelsvoort TAMJ, Zinkstok JR. [A person comes to the psychiatrist: towards sex-gender sensitive mental health care]. Tijdschr Psychiatr 2022; 64:497-499. [PMID: 36117479] [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: 06/15/2023]
Abstract
Background In psychiatric research there has been an increasing interest for sex- and genderspecific aspects in clinical presentation, outcome, and treatment of psychiatric disorders. Scientific studies on psychopathology pay more and more attention to the biological differences and differences in exposure to environmental risk factors between women and men. Aim To give a review on sex- and genderspecific aspects on psychiatric diagnostics and treatment. Method Review of most recent literature. Results The translation of this newly generated knowledge into clinical practice is still lagging behind. An important next step is to integrate this knowledge into clinical guidelines, and in teaching and training programs. Conclusion The development of sex-gender sensitive diagnostic instruments and outcome measures may contribute to personalized healthcare. These are essential steps on the way to sex-gender sensitive mental health care which will ultimately benefit the individual patient.
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van Amelsvoort TAMJ. [Loneliness is unhealthy]. Tijdschr Psychiatr 2020; 62:824-825. [PMID: 33184810] [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: 06/11/2023]
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Zinkstok JR, Velders F, Rieken R, Houben M, Fiksinski A, van Amelsvoort TAMJ, Boot E. [Psychosis and movement disorders in an adolescent with 22q11.2 deletion syndrome]. Tijdschr Psychiatr 2020; 62:229-233. [PMID: 32207133] [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: 06/10/2023]
Abstract
The 22q11.2 deletion syndrome (22q11.2ds) is a genetic syndrome affecting multiple organ systems and is associated with increased risk of developing neuropsychiatric disorders. We describe a 15-year old female adolescent with 22q11.2ds, psychotic disorder, and catatonia. Individuals with 22q11.2ds are at increased risk of developing catatonia. Vulnerability for developing extrapyramidal symptoms and epileptic seizures may complicate pharmacological treatment for psychotic episodes. There may be a diagnostic delay of diagnosing Parkinson's disease in patients taking antipsychotics as parkinsonism may be viewed as a side effect. Health professionals working with people with 22q11.2ds should be aware of the increased prevalence of movement disorders and the threshold for referral to 22q11.2ds specialist services should be low.
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Wieland J, Denayer A, van Amelsvoort TAMJ. [Mental health care for people with borderline intellectual functioning or intellectual disabilities]. Tijdschr Psychiatr 2019; 61:819-824. [PMID: 31907895] [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: 06/10/2023]
Abstract
Despite the increasing attention for people with a (borderline) intellectual disability within the field of mental health care in The Netherlands and Flanders, access to mental health care for this vulnerable group is still limited.<br/> AIM: To explore the access to mental health care in the Netherlands and Flanders for people with borderline intellectual functioning or an intellectual disability.<br/> METHOD: A survey of scientific literature, recent reports and available practical knowledge about mental disorders in people with borderline intellectual functioning or an intellectual disability and their access to mental health care.<br/> RESULTS: Insufficient knowledge about mental disorders in long term intellectual disability care and insufficient knowledge of, and experience with borderline intellectual functioning and intellectual disability among mental health care providers play a role in the limited access to good mental health care. More exchange of knowledge and sharing of experiences is necessary to ultimately properly address the needs of this group.<br/> CONCLUSION: Structural collaboration between mental health care and care for people with an intellectual disability is needed.
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van Amelsvoort TAMJ, Zinkstok JR, Vogels A, Wieland J. [Psychiatry and low intelligence]. Tijdschr Psychiatr 2019; 61:746-747. [PMID: 31907882] [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: 06/10/2023]
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9
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van Amelsvoort TAMJ. [Why don't we take good care of our less gifted patients?]. Tijdschr Psychiatr 2018; 60:734-736. [PMID: 30484564] [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: 06/09/2023]
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Boot E, Hollak CEM, Huijbregts SCJ, Jahja R, van Vliet D, Nederveen AJ, Nieman DH, Bosch AM, Bour LJ, Bakermans AJ, Abeling NGGM, Bassett AS, van Amelsvoort TAMJ, van Spronsen FJ, Booij J. Cerebral dopamine deficiency, plasma monoamine alterations and neurocognitive deficits in adults with phenylketonuria. Psychol Med 2017; 47:2854-2865. [PMID: 28552082 DOI: 10.1017/s0033291717001398] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Phenylketonuria (PKU), a genetic metabolic disorder that is characterized by the inability to convert phenylalanine to tyrosine, leads to severe intellectual disability and other cerebral complications if left untreated. Dietary treatment, initiated soon after birth, prevents most brain-related complications. A leading hypothesis postulates that a shortage of brain monoamines may be associated with neurocognitive deficits that are observable even in early-treated PKU. However, there is a paucity of evidence as yet for this hypothesis. METHODS We therefore assessed in vivo striatal dopamine D2/3 receptor (D2/3R) availability and plasma monoamine metabolite levels together with measures of impulsivity and executive functioning in 18 adults with PKU and average intellect (31.2 ± 7.4 years, nine females), most of whom were early and continuously treated. Comparison data from 12 healthy controls that did not differ in gender and age were available. RESULTS Mean D2/3R availability was significantly higher (13%; p = 0.032) in the PKU group (n = 15) than in the controls, which may reflect reduced synaptic brain dopamine levels in PKU. The PKU group had lower plasma levels of homovanillic acid (p < 0.001) and 3-methoxy-4-hydroxy-phenylglycol (p < 0.0001), the predominant metabolites of dopamine and norepinephrine, respectively. Self-reported impulsivity levels were significantly higher in the PKU group compared with healthy controls (p = 0.033). Within the PKU group, D2/3R availability showed a positive correlation with both impulsivity (r = 0.72, p = 0.003) and the error rate during a cognitive flexibility task (r = 0.59, p = 0.020). CONCLUSIONS These findings provide further support for the hypothesis that executive functioning deficits in treated adult PKU may be associated with cerebral dopamine deficiency.
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Affiliation(s)
- E Boot
- Department of Nuclear Medicine,Academic Medical Center,Amsterdam,The Netherlands
| | - C E M Hollak
- Division of Endocrinology and Metabolism, Department of Internal Medicine,Academic Medical Center,Amsterdam,The Netherlands
| | - S C J Huijbregts
- Department of Clinical Child and Adolescent Studies & Leiden,Institute for Brain and Cognition, Leiden University,Leiden,The Netherlands
| | - R Jahja
- Division of Metabolic Diseases,University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital,Groningen,The Netherlands
| | - D van Vliet
- Division of Metabolic Diseases,University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital,Groningen,The Netherlands
| | - A J Nederveen
- Department of Radiology,Academic Medical Center,Amsterdam,The Netherlands
| | - D H Nieman
- Department of Psychiatry,Academic Medical Center,Amsterdam,The Netherlands
| | - A M Bosch
- Department of Pediatrics,Emma Children's Hospital, Academic Medical Center,Amsterdam,The Netherlands
| | - L J Bour
- Department of Neurology and Clinical Neurophysiology,Academic Medical Center,Amsterdam,The Netherlands
| | - A J Bakermans
- Department of Radiology,Academic Medical Center,Amsterdam,The Netherlands
| | - N G G M Abeling
- Laboratory for Genetic Metabolic Diseases,Academic Medical Center,Amsterdam,The Netherlands
| | - A S Bassett
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, andCenter for Mental Health, University Health Network,Toronto, Ontario,Canada
| | - T A M J van Amelsvoort
- Department of Psychiatry and Psychology,Maastricht University,Maastricht,The Netherlands
| | - F J van Spronsen
- Division of Metabolic Diseases,University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital,Groningen,The Netherlands
| | - J Booij
- Department of Nuclear Medicine,Academic Medical Center,Amsterdam,The Netherlands
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Hutsebaut J, Videler AC, Schoutrop MJA, van Amelsvoort TAMJ, van Alphen SPJ. [Personality disorders: life span perspective makes sense]. Tijdschr Psychiatr 2017; 59:52-55. [PMID: 28098925] [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: 06/06/2023]
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Gerritsen SE, Dieleman GC, Beltman MAC, Tangenbergh AAM, Maras A, van Amelsvoort TAMJ, van Staa AL. [Transitional psychiatry in the Netherlands: experiences and views of mental health professionals]. Tijdschr Psychiatr 2017; 59:341-349. [PMID: 28613366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Psychopathology manifests itself primarily in late adolescence and continues into adulthood. Continuity of care is essential during this phase of life. The current care service distinguishes between child/adolescent (CAMHS) and adult mental health services (AMHS). The separation of services can interfere with the continuity of care.<br/> AIM: To map professionals' experiences of and views on the transition and associated problems that young people can experience as they are transferred from CAMHS to AMHS.<br/> METHOD: We distributed an online questionnaire among professionals providing mental health care to young people (aged 15-25) with psychiatric problems.<br/> RESULTS: The questionnaire was completed by 518 professionals. Decisions relating to transition were generally based on the professional's own deliberations. The preparation consisted mainly of discussing changes with the adolescent and his or her parents. The majority of transition-related problems were experienced in CAMHS, particularly with regard to collaboration with AMHS. Respondents were of the opinion that the developmental age ought to be the determining factor in the decision-making process with regard to transition and they considered it important that developmentally appropriate services should be available in order to bridge the gap.<br/> CONCLUSION: Professionals in CAMHS and AMHS are encountering problems in preparing the transitional phase and in organising the required structural collaboration between the two separate services. The problems relate mainly to coordination, communication and rules and regulations. Professionals are keen to improve the situation and want to see greater flexibility. In their view, there should be a wider range of specialised facilities for young people, enabling them to benefit from transitional psychiatry.
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Bakker G, Caan MWA, Schluter RS, Bloemen OJN, da Silva-Alves F, de Koning MB, Boot E, Vingerhoets WAM, Nieman DH, de Haan L, Booij J, van Amelsvoort TAMJ. Distinct white-matter aberrations in 22q11.2 deletion syndrome and patients at ultra-high risk for psychosis. Psychol Med 2016; 46:2299-2311. [PMID: 27193339 DOI: 10.1017/s0033291716000970] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Patients with a deletion at chromosome 22q11.2 (22q11DS) have 30% lifetime risk of developing a psychosis. People fulfilling clinical criteria for ultra-high risk (UHR) for psychosis have 30% risk of developing a psychosis within 2 years. Both high-risk groups show white-matter (WM) abnormalities in microstructure and volume compared to healthy controls (HC), which have been related to psychotic symptoms. Comparisons of WM pathology between these two groups may specify WM markers related to genetic and clinical risk factors. METHOD Fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD) were assessed using diffusion tensor magnetic resonance imaging (MRI), and WM volume with structural MRI, in 23 UHR patients, 21 22q11DS patients, and 33 HC. RESULTS Compared to UHR patients 22q11DS patients had (1) lower AD and RD in corpus callosum (CC), cortical fasciculi, and anterior thalamic radiation (ATR), (2) higher FA in CC and ATR, and (3) lower occipital and superior temporal gyrus WM volume. Compared to HC, 22q11DS patients had (1) lower AD and RD throughout cortical fasciculi and (2) higher FA in ATR, CC and inferior fronto-occipital fasciculus. Compared to HC, UHR patients had (1) higher mean MD, RD, and AD in CC, ATR and cortical fasciculi, (2) no differences in FA. CONCLUSIONS UHR and 22q11DS patients share a susceptibility for developing psychosis yet were characterized by distinct patterns of WM alterations relative to HC. While UHR patients were typified by signs suggestive of aberrant myelination, 22q11DS subjects showed signs suggestive of lower axonal integrity.
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Affiliation(s)
- G Bakker
- Department of Psychiatry & Psychology,University of Maastricht,The Netherlands
| | - M W A Caan
- Department of Radiology,Academic Medical Center, University of Amsterdam,Amsterdam,The Netherlands
| | - R S Schluter
- Department of Radiology,Academic Medical Center, University of Amsterdam,Amsterdam,The Netherlands
| | - O J N Bloemen
- Department of Psychiatry & Psychology,University of Maastricht,The Netherlands
| | - F da Silva-Alves
- Department of Psychiatry,Academic Medical Center, University of Amsterdam,Amsterdam,The Netherlands
| | - M B de Koning
- Department of Psychiatry,Academic Medical Center, University of Amsterdam,Amsterdam,The Netherlands
| | - E Boot
- Department of Nuclear Medicine,Academic Medical Center, University of Amsterdam,Amsterdam,The Netherlands
| | - W A M Vingerhoets
- Department of Psychiatry & Psychology,University of Maastricht,The Netherlands
| | - D H Nieman
- Department of Psychiatry,Academic Medical Center, University of Amsterdam,Amsterdam,The Netherlands
| | - L de Haan
- Department of Psychiatry,Academic Medical Center, University of Amsterdam,Amsterdam,The Netherlands
| | - J Booij
- Department of Nuclear Medicine,Academic Medical Center, University of Amsterdam,Amsterdam,The Netherlands
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14
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Evers LJM, Engelen JJM, Houben LMH, Curfs LMG, van Amelsvoort TAMJ. The use of two different MLPA kits in 22q11.2 deletion syndrome. Eur J Med Genet 2016; 59:183-8. [PMID: 26921528 DOI: 10.1016/j.ejmg.2016.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 02/15/2016] [Accepted: 02/21/2016] [Indexed: 11/30/2022]
Abstract
22q11.2 deletion syndrome (22q11DS) is one of the most common recurrent copy-number variant disorder, caused by a microdeletion in chromosome band 22q11.2 and occurring with a population prevalence of 1 in 2000. Until today there has been no evidence that the size of the deletion has an influence on the clinical phenotype. Most studies report that 22q11DS is associated with mild or borderline intellectual disability. There are a limited number of reports on 22q11DS subjects with moderate or severe intellectual disability. In this study we describe 63 adult patients with 22q11DS, including 22q11DS patients functioning at a moderate to severe intellectual disabled level. Deletion size was established with an experimental Multiplex ligation-dependent probe amplification (MLPA) mixture (P324) in addition to the commonly used MLPA kit (P250). We compared deletion size with intellectual functioning and presence of psychotic symptoms during life. The use of the experimental MLPA kit gives extra information on deletion size, only when combined with the common MLPA kit. We were able to detect eleven atypical deletions and in two cases the deletion size was shorter than all other "typical ones". We conclude that the use of the experimental kit P324 gives extra information about the deletion size, but only when used together with the standard P250 kit. We did not found any relation of deletion size with intelligence or presence of psychosis.
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Affiliation(s)
- L J M Evers
- Koraalgroup, MFCG, Heel, The Netherlands; Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - J J M Engelen
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L M H Houben
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L M G Curfs
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands; CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - T A M J van Amelsvoort
- Department of Psychiatry and Psychology, Maastricht University, Maastricht, The Netherlands; Mondriaan Mental Healthcare, Heerlen, The Netherlands; Virenze Mental Healthcare, Gronsveld, The Netherlands
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15
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van Amelsvoort TAMJ. [Diversity within psychiatry]. Tijdschr Psychiatr 2016; 58:432-433. [PMID: 27320506] [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: 06/06/2023]
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16
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Boot E, Butcher NJ, Vorstman JAS, van Amelsvoort TAMJ, Fung WLA, Bassett AS. Pharmacological treatment of 22q11.2 deletion syndrome-related psychoses. Pharmacopsychiatry 2015; 48:219-20. [PMID: 26091278 DOI: 10.1055/s-0035-1554645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In their recent article in Pharmacopsychiatry Verhoeven and Egger report a case series of 28 patients and state that "treatment of psychotic symptoms in patients with 22q11.2 deletion syndrome (22q11.2DS) with quetiapine or clozapine in combination with valproic acid appears likely to be more effective than with other psychotropic compounds". In this letter, we discuss the limitations of their case series and the lack of evidence for such a sweeping conclusion. In lieu of strong evidence to the contrary, standard pharmacological treatments of psychotic illness in 22q11.2DS remains recommended, with attention to 22q11.2DS-related issues. The latter would include management strategies to help ameliorate the elevated risk of seizures (e. g. when using clozapine), and vigilance for Parkinson's disease or other potential movement disorders.
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Affiliation(s)
- E Boot
- The Dalglish Family Hearts and Minds Clinic for Adults with 22q11.2 Deletion Syndrome, Toronto, Canada
| | - N J Butcher
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto
| | - J A S Vorstman
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T A M J van Amelsvoort
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - W L A Fung
- The Dalglish Family Hearts and Minds Clinic for Adults with 22q11.2 Deletion Syndrome, Toronto, Canada
| | - A S Bassett
- The Dalglish Family Hearts and Minds Clinic for Adults with 22q11.2 Deletion Syndrome, Toronto, Canada
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17
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Reichart CG, Roza S, van Amelsvoort TAMJ, Van West D. [Child and adolescent psychiatry: inspiring and dynamic]. Tijdschr Psychiatr 2015; 57:864-865. [PMID: 26727559] [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: 06/05/2023]
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18
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Otter M, van Amelsvoort TAMJ. [Lithium therapy in patients with mild mental retardation]. Tijdschr Psychiatr 2015; 57:531-534. [PMID: 26189422] [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: 06/04/2023]
Abstract
In the psychiatric treatment of patients with mild learning disabilities or borderline intellectual functioning, signs and symptoms of psychiatric disorders are sometimes misinterpreted as behaviour that reflects problems that are known to patients with mental retardation. We report on two case studies in which lithium therapy made a substantial contribution to (partial) recovery. One patient had bipolar disorder and the other had a major depressive disorder combined with suicidal behaviour. Each patient also had a mild learning disability or borderline intellectual functioning.
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19
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van Houtem-Solberg DMWR, Chatrou EWCH, Werrij MQ, van Amelsvoort TAMJ. [Youth F-ACT: mapping the problems of a special population]. Tijdschr Psychiatr 2015; 57:892-896. [PMID: 26727565] [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: 06/05/2023]
Abstract
BACKGROUND Youth f-act teams have been set up for the purpose of providing the care needed by young people suspected of having complex psychiatric problems. AIM To obtain insight into the problems of this population at the beginning and at the end of treatment provided by the youth f-act team in South Limburg. METHOD We based our study on a cohort of 68 patients who met the criteria for f-act during the period from January 2013 up to and including October 2014. We evaluated the effect of f-act treatment of 41 patients who had completed their treatment during the above-mentioned period. We examined the records for patients' daily functioning and quality of life and we noted patient characteristics at beginning and end of treatment in order to collect more information about the problems of this population. RESULTS Besides having psychiatric problems, our study population also appeared to have malfunctioned at several other areas. At the end of treatment patients' daily functioning was found to have improved, but there was little or no improvement in patients' quality of life. CONCLUSION Treatment by the youth f-act team seems able to deal successfully with the problems of the young people under study. However, factors that influence patients' quality of life need to be studied more thoroughly so that in the future the quality of treatment will be of a higher standard.
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20
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Evers LJM, van Amelsvoort TAMJ, Candel MJJM, Boer H, Engelen JJM, Curfs LMG. Psychopathology in adults with 22q11 deletion syndrome and moderate and severe intellectual disability. J Intellect Disabil Res 2014; 58:915-925. [PMID: 24528781 DOI: 10.1111/jir.12117] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND 22q11 deletion syndrome (22q11DS) is associated with mild or borderline intellectual disability (ID). There are hardly any reports on subjects with 22q11DS with moderate or severe ID, and therefore its behavioural and psychiatric characteristics are unknown. METHOD We describe behavioural and psychiatric characteristics of 33 adults with 22q11DS and a Full-Scale IQ (FSIQ) below 55. Participants were divided into two groups: one group having a FSIQ ≤ 55 caused by intellectual decline (n = 21) and one group with a FSIQ ≤ 55 who had always functioned at this level (n = 12). RESULTS High scores on psychopathology sub-scales were found for both subgroups. 22q11DS patients with intellectual decline showed higher rates of co-morbid psychopathology, particularly psychosis. Furthermore, psychosis and intellectual decline were positive correlated. CONCLUSION This is the first report addressing adult patients with 22q11DS and moderate to severe ID. Overall we found high levels of psychopathology with higher scores of psychopathology in the intellectual decline group. Life time psychosis seems to be related to deterioration.
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Affiliation(s)
- L J M Evers
- MFCG, Koraalgroup, Heel, The Netherlands; Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
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21
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van Amelsvoort TAMJ, Van Den Eede F, Goethals K, van Marle HJC, Beekman AJ. [DSM-5; a positive sound]. Tijdschr Psychiatr 2014; 56:150-151. [PMID: 24643821] [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: 06/03/2023]
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22
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van Amelsvoort TAMJ, Van Den Eede F, Goethals K, van Marle HJC, Beekman AJ. [Structural changes in DSM-5: the beginning of a transformation?]. Tijdschr Psychiatr 2014; 56:152-156. [PMID: 24643822] [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 The dsm-5 received both praise and criticism following its publication in May 2013. Some blamed the dsm classification system for the unsatisfactory diagnostic system within psychiatry. Over the last 30 years or so there have been no major breakthroughs in our field and there has been no reduction in the number of mental health problems in Western society. It is time for a change; the question is whether DSM-5 will succeed in bringing about this change. AIM To update and analyse the structural, diagnosis-independent changes that have been incorporated in DSM-5. METHOD We discuss the changes. RESULTS The most important structural, diagnosis-independent changes include: 1. the separate classification of disorders that begin in childhood from those that begin in adolescence has been abolished; 2. the multi-axial system has disappeared; 3. the approach has become more dimensional, which allows for the assessment of the severity of a disorder. CONCLUSION In the DSM-5 there are clear signs that a transformation of our psychiatric assessment system has begun; this can only be seen as a positive development, but is probably just the tip of the iceberg. Further changes are likely to occur, some in the near future, others in the long term.
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23
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Bloemen OJN, de Koning MB, Schmitz N, Nieman DH, Becker HE, de Haan L, Dingemans P, Linszen DH, van Amelsvoort TAMJ. White-matter markers for psychosis in a prospective ultra-high-risk cohort. Psychol Med 2010; 40:1297-1304. [PMID: 19895720 DOI: 10.1017/s0033291709991711] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [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: 12/20/2022]
Abstract
BACKGROUND Subjects at 'ultra high risk' (UHR) for developing psychosis have differences in white matter (WM) compared with healthy controls. WM integrity has not yet been investigated in UHR subjects in relation to the development of subsequent psychosis. Hence, we investigated a prospective cohort of UHR subjects comparing whole brain fractional anisotropy (FA) of those later developing psychosis (UHR-P) to those who did not (UHR-NP). METHOD We recruited 37 subjects fulfilling UHR criteria and 10 healthy controls. Baseline 3 Tesla magnetic resonance imaging (MRI) scans and Positive and Negative Syndrome Scale (PANSS) ratings were obtained. UHR subjects were assessed at 9, 18 and 24 months for development of frank psychosis. We compared baseline FA of UHR-P to controls and UHR-NP subjects. Furthermore, we related clinical data to MRI outcome in the patient population. RESULTS Of the 37 UHR subjects, 10 had transition to psychosis. UHR-P subjects showed significantly lower FA values than control subjects in medial frontal lobes bilaterally. UHR-P subjects had lower FA values than UHR-NP subjects, lateral to the right putamen and in the left superior temporal lobe. UHR-P subjects showed higher FA values, compared with UHR-NP, in the left medial temporal lobe. In UHR-P, positive PANSS negatively correlated to FA in the left middle temporal lobe. In the total UHR group positive PANSS negatively correlated to FA in the right superior temporal lobe. CONCLUSIONS UHR subjects who later develop psychosis have differences in WM integrity, compared with UHR subjects who do not develop psychosis and to healthy controls, in brain areas associated with schizophrenia.
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Affiliation(s)
- O J N Bloemen
- Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands.
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24
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de Koning MB, Bloemen OJN, van Amelsvoort TAMJ, Becker HE, Nieman DH, van der Gaag M, Linszen DH. Early intervention in patients at ultra high risk of psychosis: benefits and risks. Acta Psychiatr Scand 2009; 119:426-42. [PMID: 19392813 DOI: 10.1111/j.1600-0447.2009.01372.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [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: 11/29/2022]
Abstract
OBJECTIVE Prediction of transition to psychosis in the prodromal phase of schizophrenia has raised interest in intervention prior to the onset of frank psychosis. The aim of this review was to examine whether interventions in the prodromal phase have a favourable benefit/risk ratio. METHOD A literature search in PubMed, EMBASE and PsycINFO was performed. RESULTS Three randomized clinical trials with antipsychotic medication and/or cognitive behavioural therapy as clinical intervention suggested a positive effect at the end of treatment, but no significant differences were found at the end of follow-up periods from 1 to 4 years. Naturalistic studies present a hypothesis about a possible preventive effect of antidepressive medication. The results of eight other studies are more difficult to interpret. Side-effects of antipsychotic medication and non-adherence with medication are essential problems. CONCLUSION At the present time, the data concerning the benefits and risks do not justify prodromal intervention as standard clinical practice.
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Affiliation(s)
- M B de Koning
- Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands.
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25
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Beukers RJ, Booij J, Weisscher N, Zijlstra F, van Amelsvoort TAMJ, Tijssen MAJ. Reduced striatal D2 receptor binding in myoclonus-dystonia. Eur J Nucl Med Mol Imaging 2008; 36:269-74. [PMID: 18719906 DOI: 10.1007/s00259-008-0924-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Accepted: 07/28/2008] [Indexed: 11/28/2022]
Abstract
PURPOSE To study striatal dopamine D(2) receptor availability in DYT11 mutation carriers of the autosomal dominantly inherited disorder myoclonus-dystonia (M-D). METHODS Fifteen DYT11 mutation carriers (11 clinically affected) and 15 age- and sex-matched controls were studied using (123)I-IBZM SPECT. Specific striatal binding ratios were calculated using standard templates for striatum and occipital areas. RESULTS Multivariate analysis with corrections for ageing and smoking showed significantly lower specific striatal to occipital IBZM uptake ratios (SORs) both in the left and right striatum in clinically affected patients and also in all DYT11 mutation carriers compared to control subjects. CONCLUSIONS Our findings are consistent with the theory of reduced dopamine D(2) receptor (D2R) availability in dystonia, although the possibility of increased endogenous dopamine, and consequently, competitive D2R occupancy cannot be ruled out.
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Affiliation(s)
- R J Beukers
- Department of Neurology, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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26
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Craig MC, Cutter WJ, Wickham H, van Amelsvoort TAMJ, Rymer J, Whitehead M, Murphy DGM. Effect of long-term estrogen therapy on dopaminergic responsivity in post-menopausal women--a preliminary study. Psychoneuroendocrinology 2004; 29:1309-16. [PMID: 15288710 DOI: 10.1016/j.psyneuen.2004.03.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [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: 11/14/2003] [Revised: 02/05/2004] [Accepted: 03/28/2004] [Indexed: 10/26/2022]
Abstract
Females have a higher prevalence than men of neuropsychiatric disorders in which dopaminergic abnormalities play a prominent role, e.g. very late-onset schizophrenia and Parkinson's disease (PD). The biological basis of these sex differences is unknown but may include modulation of the dopaminergic system by sex hormones, as there is preliminary evidence that estrogen modulates treatment response in these disorders. Furthermore, sex differences in dopamine-mediated cognitive decline suggest estrogen may also play a role in healthy aging. However, the effects of estrogen on the dopaminergic system are poorly understood, and nobody has examined the effect of long-term estrogen therapy (ET) on this system. We compared dopaminergic responsivity (growth hormone (GH) response to apomorphine) in post-menopausal women on ET to women who were ET-naïve. GH response to subcutaneous apomorphine (0.005 mg/kg) was measured in two groups of healthy post-menopausal women aged between 55 and 70 years: those taking ET (n = 13) and those who had never taken ET (n = 13). Neither group was taking any other medication. GH was measured at 15 min intervals from -30 min before administration of apomorphine to 90 min post-administration. GH response was measured in two ways: area under the curve (AUC) and maximum response over baseline (GH). There were no between-group differences in demographic or baseline variables. The ET treated women had a significantly greater (p = 0.03) AUC than ET naïve women (mean +/- S.D.; 5.3 +/- 4.7 vs. 2.6 +/- 2.3). However, (GH) did not differ significantly between groups (6.1 mU/l +/- 6.2 vs. 2.7 mU/l +/- S.D. = 4.1). Also, analysis of GH response over time revealed a significant main effect of time (p < 0.0005), and a group by time interaction (p = 0.004) , but no significant main effect of group. Our results suggest that ET may enhance dopaminergic responsivity in post-menopausal women. Estrogen deficiency following menopause may partly explain age and gender differences in late-onset neuropsychiatric disorders.
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Affiliation(s)
- M C Craig
- Section of Brain Maturation, Department of Psychological Medicine, Institute of Psychiatry, PO 50, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
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