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de Neve-Enthoven NGM, Ringoot AP, Jongerling J, Boersma N, Berges LM, Meijnckens D, Hoogendijk WJG, Grootendorst-van Mil NH. Adolescent Nonsuicidal Self-Injury and Suicidality: A Latent Class Analysis and Associations with Clinical Characteristics in an At-Risk Cohort. J Youth Adolesc 2024; 53:1197-1213. [PMID: 38112847 PMCID: PMC10980641 DOI: 10.1007/s10964-023-01922-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
Nonsuicidal self-injury (NSSI) is frequently encountered in adolescents, but its predictive value for suicidality or other clinical characteristics is challenging due to its heterogeneous nature. This study used latent class analysis to identify subgroups of NSSI and compared these on sociodemographic characteristics, adverse outcomes and protective factors. The study included 966 high-risk adolescents, Mage 14.9 y, SD 0.9 y, 51.8% female. Four classes emerged: (1) "Low NSSI-Low suicidality", (2) "Moderate NSSI-Low suicidality", (3) "Moderate NSSI-High suicidality", and (4) "High NSSI-High suicidality". Girls predominated in the high suicidality classes. Generally, Class 4 had the poorest outcomes: more internalizing and externalizing problems, less social support from friends and families and worst self-esteem. These findings emphasize the need for interventions tailored to specific phenotypes of adolescents engaging in NSSI.
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Affiliation(s)
- N G M de Neve-Enthoven
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - A P Ringoot
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, the Netherlands
- Department of Psychology, Educational and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - J Jongerling
- Tilburg School of Social and Behavioral Sciences, Department of Methodology, Tilburg University, Tilburg, the Netherlands
| | - N Boersma
- Clinical Psychologist at Yulius, Dordrecht, the Netherlands
| | - L M Berges
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - D Meijnckens
- MIND Platform, Utrecht, the Netherlands
- Stichting Zelfbeschadiging (Self-harm Foundation), Utrecht, the Netherlands
| | - W J G Hoogendijk
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - N H Grootendorst-van Mil
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
- Epidemiological and Social Psychiatric Research Institute (ESPRi), Erasmus MC University Medical Center, Rotterdam, the Netherlands.
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Bouter DC, Ravensbergen SJ, Lakerveld J, Hoogendijk WJG, Grootendorst-van Mil NH. Associations between the urban environment and psychotic experiences in adolescents. Schizophr Res 2023; 260:123-131. [PMID: 37639836 DOI: 10.1016/j.schres.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/28/2023] [Accepted: 08/13/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE In 2050 two-thirds of the world's population is predicted to live in cities, which asks for a better understanding of how the urban environment affects mental health. Urbanicity has repeatedly been found to be a risk factor, in particular for psychosis. Here, we explored what factors of the urban exposome underlie the association between urban characteristics and psychotic experiences (PE) in adolescents. METHODS Participants were 815 adolescents (mean age 14.84 years, SD 0.78) from an at-risk cohort (greater Rotterdam area, the Netherlands) oversampled on their self-reported emotional and behavioral problems. We used linear regression analysis to examine the association with detailed geodata on urbanicity (surrounding address density), green space density (high and low vegetation), and mixed noise levels (road, rail, air, industry, and wind power) with PE in adolescents. Analyses were adjusted for multiple socio-economic and parental confounders. Furthermore, we explored sex-interaction effects. RESULTS Higher surrounding address density and low greenspace density were each independently associated with more PE (B = 0.18, 95 % CI 0.02; 0.34 and B = 0.17, 95 % CI 0.01; 0.32, respectively). High mixed noise levels were only associated with more PE in boys (B = 0.23, 95 % CI 0.01; 0.46). A sex-interaction effect was found for high urbanicity (B = -0.46, 95 % CI -0.77; -0.14) and low greenspace density (B = -0.49, 95 % CI -0.73; -0.11), illustrating that these associations with PE were specific for boys. CONCLUSION Multiple characteristics of living in an urban area are associated with more PE in adolescent boys. Our observations provide leads for prevention of mental health problems via urban designing.
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Affiliation(s)
- D C Bouter
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - S J Ravensbergen
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - J Lakerveld
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands
| | - W J G Hoogendijk
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - N H Grootendorst-van Mil
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Epidemiological and Social Psychiatric Research Institute (ESPRi), Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
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Dijk SW, Steijlen OFM, Kranenburg LW, Rouwet EV, Luik AI, Bierbooms AE, Kouwenhoven-Pasmooij TA, Rizopoulos D, Swanson SA, Hoogendijk WJG, Hunink MGM. DEcrease STress through RESilience training for Students (DESTRESS) Study: Protocol for a randomized controlled trial nested in a longitudinal observational cohort study. Contemp Clin Trials 2022; 122:106928. [PMID: 36116756 DOI: 10.1016/j.cct.2022.106928] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/30/2022] [Accepted: 09/12/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Chronic stress and burnout are highly prevalent among academically trained healthcare professionals, negatively affecting their well-being and capacity to engage in their work. Resilience to stress develops early in one's career path, hence offering resilience training to university students in these professions is one approach to fostering well-being and mental health. The aim of this study is to assess whether offering mindfulness-based resilience training to university students in healthcare professions reduces their perceived chronic stress. METHODS AND ANALYSIS The study has a hybrid design combining a longitudinal observational cohort with a nested randomized controlled trial (RCT) with sequential multiple assignment and multistage adaptive interventions while taking participants' preferences into account. All students in healthcare related programmes at the Erasmus University Rotterdam are invited to participate. Within the observational cohort, students with a score of 14 or higher on the Perceived Stress Scale (PSS) are invited to take part in the RCT (n = 706). Eligible participants are randomized to control or active intervention in a ratio of 1:6. Those randomized to the control group and non-randomized participants in the cohort receive passive web-based psychoeducation about chronic stress and burnout through referral to specific websites. Participants randomized to the intervention group receive one of 8 active mindfulness-based interventions. They select a rank order of 4 preferred interventions and are randomized across these with equal probability. Non-response to the intervention is followed by sequential randomized assignment to another intervention, for a total maximum of 3 sequential interventions. All participants receive questionnaires at baseline, before and after each 8-week intervention period, and at 1- and 2-year follow-up. The primary outcome is perceived chronic stress measured with the PSS. Secondary outcomes include mental well-being, burnout, quality of life, healthcare utilization, drug use, bodyweight, mental and physical stress-related symptoms, resilience, and study progress. ETHICS AND REGISTRATION Approval from the Medical Ethics Review Committee was obtained under protocol number MEC-2018-1645. The trial is registered in the Netherlands National Trial Register by registration number NL7623, 22/03/2019, https://www.trialregister.nl/.
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Affiliation(s)
- S W Dijk
- Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Netherlands Institute for Health Sciences (NIHES), Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, the Netherlands
| | - O F M Steijlen
- Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Netherlands Institute for Health Sciences (NIHES), Rotterdam, the Netherlands
| | - L W Kranenburg
- Department of Psychiatry, Erasmus MC University Medical Center, the Netherlands
| | - E V Rouwet
- Department of Public Health, Erasmus MC University Medical Center, the Netherlands
| | - A I Luik
- Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, the Netherlands
| | - A E Bierbooms
- Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - D Rizopoulos
- Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - S A Swanson
- Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, University of Pittsburgh, Pittsburgh, United States of America
| | - W J G Hoogendijk
- Department of Psychiatry, Erasmus MC University Medical Center, the Netherlands
| | - M G M Hunink
- Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Netherlands Institute for Health Sciences (NIHES), Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, the Netherlands; Centre for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, United States of America.
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Pinto C, Fabbricotti IN, van Wijngaarden J, Hoogendijk WJG, Alsma J, van Busschbach JJ, van Schijndel MA. Moving Beyond the Status Quo of Integrated Inpatient Medical and Psychiatric Care Units: The Path to Real-World Evaluation. Psychiatr Serv 2022; 73:555-560. [PMID: 34704774 DOI: 10.1176/appi.ps.202000811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Integrated inpatient medical and psychiatric care units (IMPUs) are hospital wards that care for inpatients with both acute general medical and psychiatric disorders. IMPU development has stalled, and wide variation in IMPU designs may reflect the fact that IMPUs are still in an early evolutionary stage. High-quality evidence concerning the costs and effectiveness of IMPUs is sparse, because IMPUs do not lend themselves well to traditional evidence-based medicine methods. As a result, most studies of IMPUs have been only observational. Therefore, it is time for a different approach, in which goals for IMPUs are explicitly formulated and IMPU research is incorporated into evidence-based practice (EBP) instead of evidence-based medicine. EBP can be viewed as integrating best available evidence into organizational practices by using four pillars of evidence: organizational, experiential, stakeholder, and scientific. Such types of evidence require an investment in describing the field more precisely. When pragmatic reasoning, where clinical expertise and organizational needs determine IMPU designs, is replaced with EBP, researchers can more effectively perform studies that may convince health care policy makers that IMPUs represent a cost-effective way to improve patients' health and that they increase the well-being of both patients and hospital staff.
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Affiliation(s)
- C Pinto
- Department of Psychiatry (Pinto, Hoogendijk), Department of Internal Medicine (Alsma), and Department of Medical Psychology (van Busschbach), Erasmus University Medical Centre, Rotterdam, the Netherlands; Erasmus School of Health Policy and Management,Erasmus University Rotterdam, Rotterdam, the Netherlands (Fabbricotti, Wijngaarden, van Schijndel)
| | - I N Fabbricotti
- Department of Psychiatry (Pinto, Hoogendijk), Department of Internal Medicine (Alsma), and Department of Medical Psychology (van Busschbach), Erasmus University Medical Centre, Rotterdam, the Netherlands; Erasmus School of Health Policy and Management,Erasmus University Rotterdam, Rotterdam, the Netherlands (Fabbricotti, Wijngaarden, van Schijndel)
| | - J van Wijngaarden
- Department of Psychiatry (Pinto, Hoogendijk), Department of Internal Medicine (Alsma), and Department of Medical Psychology (van Busschbach), Erasmus University Medical Centre, Rotterdam, the Netherlands; Erasmus School of Health Policy and Management,Erasmus University Rotterdam, Rotterdam, the Netherlands (Fabbricotti, Wijngaarden, van Schijndel)
| | - W J G Hoogendijk
- Department of Psychiatry (Pinto, Hoogendijk), Department of Internal Medicine (Alsma), and Department of Medical Psychology (van Busschbach), Erasmus University Medical Centre, Rotterdam, the Netherlands; Erasmus School of Health Policy and Management,Erasmus University Rotterdam, Rotterdam, the Netherlands (Fabbricotti, Wijngaarden, van Schijndel)
| | - J Alsma
- Department of Psychiatry (Pinto, Hoogendijk), Department of Internal Medicine (Alsma), and Department of Medical Psychology (van Busschbach), Erasmus University Medical Centre, Rotterdam, the Netherlands; Erasmus School of Health Policy and Management,Erasmus University Rotterdam, Rotterdam, the Netherlands (Fabbricotti, Wijngaarden, van Schijndel)
| | - J J van Busschbach
- Department of Psychiatry (Pinto, Hoogendijk), Department of Internal Medicine (Alsma), and Department of Medical Psychology (van Busschbach), Erasmus University Medical Centre, Rotterdam, the Netherlands; Erasmus School of Health Policy and Management,Erasmus University Rotterdam, Rotterdam, the Netherlands (Fabbricotti, Wijngaarden, van Schijndel)
| | - M A van Schijndel
- Department of Psychiatry (Pinto, Hoogendijk), Department of Internal Medicine (Alsma), and Department of Medical Psychology (van Busschbach), Erasmus University Medical Centre, Rotterdam, the Netherlands; Erasmus School of Health Policy and Management,Erasmus University Rotterdam, Rotterdam, the Netherlands (Fabbricotti, Wijngaarden, van Schijndel)
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van Westrhenen R, van Schaik RHN, van Gelder T, Birkenhager TK, Bakker PR, Houwink EJF, Bet PM, Hoogendijk WJG, van Weelden-Hulshof MJM. Policy and Practice Review: A First Guideline on the Use of Pharmacogenetics in Clinical Psychiatric Practice. Front Pharmacol 2021; 12:640032. [PMID: 33995044 PMCID: PMC8117336 DOI: 10.3389/fphar.2021.640032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/21/2021] [Indexed: 11/13/2022] Open
Abstract
Effective pharmacologic treatments for psychiatric disorders are available, but their effect is limited due to patients' genetic heterogeneity and low compliance-related to frequent adverse events. Only one third of patients respond to treatment and experience remission. Pharmacogenetics is a relatively young field which focusses on genetic analyses in the context of the metabolism and outcome of drug treatment. These genetic factors can, among other things, lead to differences in the activity of enzymes that metabolize drugs. Recently, a clinical guideline was authorized by the Dutch Clinical Psychiatric Association (NVvP) on the clinical use of pharmacogenetics in psychiatry. The main goal was to provide guidance, based on current evidence, on how to best use genotyping in clinical psychiatric practice. A systematic literature search was performed, and available publications were assessed using the GRADE methodology. General recommendations for psychiatric clinical practice were provided, and specific recommendations per medication were made available. This clinical guideline for caregivers prescribing psychotropic drugs is the product of a broad collaboration of professionals from different disciplines, making use of the information available at the Dutch Pharmacogenetics Working Group (DPWG) and the Clinical Pharmacogenetics Implementation Consortium (CPIC) so far. We summarize the relevant literature and all recommendations in this article. General recommendations are provided and also detailed recommendations per medication. In summary we advise to consider genotyping, when there are side effects or inefficacy for CYP2C19 and CYP2D6. When genotype information is available use this to select the right drug in the right dose for the right patient.
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Affiliation(s)
- R van Westrhenen
- Outpatient Clinic Pharmacogenetics in Psychiatry, Parnassia Group Amsterdam, Amsterdam, Netherlands.,Maastricht Department of Psychiatry andNeuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - R H N van Schaik
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, Netherlands
| | - T van Gelder
- Dept of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - T K Birkenhager
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
| | - P R Bakker
- Institute for Mental Health, Arkin, Amsterdam, Netherlands.,Maastricht Department of Psychiatry andNeuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - E J F Houwink
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, Netherlands
| | - P M Bet
- Department of Clinical Chemistry and Hospital Pharmacy, Amsterdam UMC Location VUMC, Amsterdam, Netherlands
| | - W J G Hoogendijk
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
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Caarls PJ, van Schijndel MA, Kromkamp M, Wierdsma AI, Osse RJ, van der Hoeven G, Hoogendijk WJG, van Busschbach JJ. Need analysis for a new high acuity medical psychiatry unit: which patients are considered for admission? BMC Health Serv Res 2019; 19:139. [PMID: 30819164 PMCID: PMC6394074 DOI: 10.1186/s12913-019-3967-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 02/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study aims were: to estimate the proportion of patients with an indication for admission to a new high acuity Medical Psychiatric Unit (MPU), to explore the reasons for MPU-admission according to different health disciplines, and to check for differences in patient characteristics. The results of this study are to be utilized in the proposed establishment of a high-acuity MPU in a University Medical Center. Such a unit currently does not exist at Erasmus MC. METHODS Hospital in-patients were included if they received psychiatric consultation from the Psychiatric Consultative Service (PCS). As part of the study protocol, psychiatrists, other medical specialists, and nurses determined the need for admission to the proposed MPU. Patient groups were compared with respect to diagnoses, socio-demographic characteristics and patient routing. RESULTS One hundred and fifty-one patients were included, 43% had an indication for MPU-admission, for the other patients PCS involvement was sufficient. There was agreement on suicide attempts as a reason for MPU-admission. For psychiatrists, the need for further diagnostic evaluation was a common reason for MPU admission, while other medical specialists more often emphasized the need for safety measures. Patients with an unplanned hospital admission had a higher chance of MPU eligibility (OR = 2.72, 95% CI 1.10-6.70). The main psychiatric diagnoses of MPU-eligible patients were organic disorders (including delirium), mood disorders, and disorders related to substance abuse. The most common diagnoses found were similar to those in previous research on MPU populations. CONCLUSION Different medical disciplines have different views on the advantages of MPUs, while all see the need for such facilities. The proposed MPU should be able to accommodate patients directly from the Emergency Unit, and the MPU should provide specialized diagnostic care in an extra safe environment.
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Affiliation(s)
- P J Caarls
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - M A van Schijndel
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.,Rijnstate Hospital, Department of Psychiatry, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - M Kromkamp
- University Medical Center Utrecht, Department of Psychiatry, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - A I Wierdsma
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - R J Osse
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - G van der Hoeven
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - W J G Hoogendijk
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - J J van Busschbach
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
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Molenaar NM, Tiemeier H, van Rossum EFC, Hillegers MHJ, Bockting CLH, Hoogendijk WJG, van den Akker EL, Lambregtse-van den Berg MP, El Marroun H. Prenatal maternal psychopathology and stress and offspring HPA axis function at 6 years. Psychoneuroendocrinology 2019; 99:120-127. [PMID: 30223193 DOI: 10.1016/j.psyneuen.2018.09.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/30/2018] [Accepted: 09/03/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Intrauterine exposures such as maternal psychopathology and stress are known to influence the physical and mental health of the offspring. One of the proposed pathways underlying these associations is dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity in the offspring. This study examined the relation of perinatal maternal symptoms of psychopathology and stress with offspring HPA axis activity at 6 years as measured by hair cortisol and cortisone concentrations. METHODS The study was part of the population-based Generation R Study, a prospective population-based cohort from fetal life onwards. 2546 children and their mothers formed the study population. Perinatal maternal psychopathology and stress were assessed by questionnaires in the second and third trimester. Principal components for both psychopathology and stress were created to reduce the number of explanatory variables. Child hair samples for cortisol and cortisone measurements were collected at the age of 6. Linear regression analysis, adjusted for covariates, was used to examine associations between maternal psychopathology and stress and child hair cortisol and cortisone levels. RESULTS The maternal psychopathology principal component was associated with higher child hair cortisone (adjusted B = 0.24, 95%CI 0.08;0.40, p-value < 0.01). Effect estimates of the individual dimensions ranged from 0.97 (95%CI 0.21;1.73, p-value = 0.01) for interpersonal sensitivity to 1.67 (95%CI 0.86;2.47, p-value < 0.01) for paranoid ideation. In addition, children exposed to intrauterine stress, as measured by the principal component, had higher hair cortisone levels (adjusted B = 0.54, 95%CI 0.21;0.88, p-value < 0.01). Exposure to maternal psychopathology and stress was not associated with offspring hair cortisol. Stratification by child sex resulted in associations between maternal symptoms of psychopathology during pregnancy and child hair cortisone levels in boys and associations between maternal symptoms of stress during pregnancy and child hair cortisone levels in girls. CONCLUSION Our results suggest that maternal psychopathology and stress during pregnancy are associated with long-term HPA axis activity of the offspring. The association of maternal psychopathology and stress during pregnancy with offspring hair cortisone levels is a novel finding. Future studies should examine whether these psychophysiological differences between exposed and non-exposed children underlie offspring morbidity associated with maternal psychopathology and stress during pregnancy.
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Affiliation(s)
- N M Molenaar
- The Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - H Tiemeier
- The Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands; The Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, USA
| | - E F C van Rossum
- The Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M H J Hillegers
- The Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - C L H Bockting
- The Department of Psychiatry, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W J G Hoogendijk
- The Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E L van den Akker
- The Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M P Lambregtse-van den Berg
- The Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands; The Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - H El Marroun
- The Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands; The Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands; The Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Rotterdam, The Netherlands.
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8
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Vermeiden M, Kamperman AM, Hoogendijk WJG, van den Broek WW, Birkenhäger TK. A randomized clinical trial comparing two two-phase treatment strategies for in-patients with severe depression. Acta Psychiatr Scand 2017; 136:118-128. [PMID: 28478653 DOI: 10.1111/acps.12743] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the efficacy of two antidepressant treatment strategies in severely depressed in-patients, that is, imipramine vs. venlafaxine, both with subsequent lithium addition in non-responders. METHOD In-patients (n = 88) with major depressive disorder were randomized to 7-week treatment with imipramine or venlafaxine (phase I). All non-responders (n = 44) received 4-week plasma level-targeted dose lithium addition (phase II). Efficacy was evaluated after 11 weeks of treatment. RESULTS Analyzing phases I and II combined, non-inferiority was established and the difference in the proportion of responders (HAM-D score reduction ≥50%) by the end of phase II demonstrated the venlafaxine-lithium treatment strategy to be significantly superior to the imipramine-lithium treatment strategy (77% vs. 52%) (χ2 (1) = 6.03; P = 0.01). Regarding remission (HAM-D score ≤ 7), 15 of 44 (34%) patients in the imipramine-lithium treatment group were remitters compared to 22 of 44 (50%) patients in the venlafaxine-lithium treatment group, a non-significant difference. Patients in the venlafaxine-lithium treatment group had a non-significant larger mean HAM-D score reduction compared with patients in the imipramine-lithium treatment group (16.1 vs. 13.5 points, respectively; Cohen's d = 0.30). CONCLUSION The venlafaxine-lithium treatment strategy can be considered a valuable alternative for the imipramine-lithium treatment strategy in the treatment of severely depressed in-patients.
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Affiliation(s)
- M Vermeiden
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A M Kamperman
- Department of Psychiatry, Erasmus Medical Center, Epidemiological and Social Psychiatric Research Institute, Rotterdam, The Netherlands
| | - W J G Hoogendijk
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - W W van den Broek
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - T K Birkenhäger
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
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Zalli A, Jovanova O, Hoogendijk WJG, Tiemeier H, Carvalho LA. Low-grade inflammation predicts persistence of depressive symptoms. Psychopharmacology (Berl) 2016; 233:1669-78. [PMID: 25877654 PMCID: PMC4828485 DOI: 10.1007/s00213-015-3919-9] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 03/21/2015] [Indexed: 01/02/2023]
Abstract
RATIONALE Evidence suggests that depression is cross-sectionally and longitudinally associated with activation of inflammatory response system. A few studies, however, have investigated the longitudinal relationship between raised inflammatory biomarkers and persistence of depressive symptoms. We examined the temporal relationship between serum levels of inflammatory biomarkers and persistence of depressive symptoms among older participants. METHODS Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depressive symptoms at baseline and at 5-year follow-up in 656 participants (233 men, 423 women) aged >60 years of the Rotterdam Study. Markers of inflammation interleukin (IL)-6, alpha-1-antichymotrypsin (ACT) and C-reactive protein (CRP) were assessed at baseline, and all participants taking antidepressant medications were excluded from the analysis. RESULTS No cross-sectional association was found between IL-6, ACT and CRP with depressive symptoms at baseline. However, higher levels of IL-6 and CRP predicted depressive symptoms at 5-year follow-up. Adjustment for confounding variables had no impact on the observed associations. Similarly, a positive association was found between baseline levels of IL-6 (OR = 2.44, p = 0.030) and CRP (OR = 1.81, p = 0.052) and persistence of depressive symptoms over 5 years. CONCLUSION Our data suggest that dysregulation of the inflammatory response system is associated with a more severe form of depression more likely to re-occur.
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Affiliation(s)
- A. Zalli
- />Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - O. Jovanova
- />Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - W. J. G. Hoogendijk
- />Department of Psychiatry, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - H. Tiemeier
- />Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - L. A. Carvalho
- />Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
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10
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Bet PM, Verbeek EC, Milaneschi Y, Straver DBM, Uithuisje T, Bevova MR, Hugtenburg JG, Heutink P, Penninx BWJH, Hoogendijk WJG. A common polymorphism in the ABCB1 gene is associated with side effects of PGP-dependent antidepressants in a large naturalistic Dutch cohort. Pharmacogenomics J 2015; 16:202-8. [DOI: 10.1038/tpj.2015.38] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 03/23/2015] [Accepted: 04/07/2015] [Indexed: 11/09/2022]
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11
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van Os J, Kahn R, Denys D, Schoevers RA, Beekman ATF, Hoogendijk WJG, van Hemert AM, Hodiamont PPG, Scheepers F, Delespaul PAEG, Leentjens AFG. [Behavioural standard or coercive measure? Some considerations regarding the special issue on ROM]. Tijdschr Psychiatr 2012; 54:245-253. [PMID: 22422417] [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: 05/31/2023]
Abstract
BACKGROUND The cost of mental health care has possibly risen more than costs in other sectors of health care in the Netherlands. In an attempt to control the rising costs, new policies have been implemented that include the introduction of selective financial penalties for those in need of mental health care as well as the start of performance-based mental health care reimbursement. In order to achieve the latter goal, a nation-wide large-scale data collection was introduced based on clinical routine outcome monitoring (ROM) data, with a view to using these data for benchmarking. AIM Closer inspection of the benchmarking efforts in terms of scientific validity. METHOD Qualitative review and analysis. RESULTS Analysis shows that the type of ROM data that is collected in the Netherlands is valid for tracking the outcomes of individual patients, but unsuitable for performance comparisons between institutions for reasons of case-mix, instrument-mix, bias and lack of sensitivity. CONCLUSION Attempts to introduce benchmarking based on rom will probably have a negative impact on the practice of mental health care in the Netherlands. More input from mental health professionals and scientists is required in order to identify more rational and efficient ways of spending scarce resources.
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Affiliation(s)
- J van Os
- Maastricht Universitair Medisch Centrum, Postbus 616, 6200 MD (drt 12), Maastricht.
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12
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Lieverse R, Riemersma-van der Lek RF, Voermans JM, Hoogendijk WJG. [Chronotherapy for affective disorders]. Tijdschr Psychiatr 2012; 54:527-537. [PMID: 22753185] [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: 06/01/2023]
Abstract
BACKGROUND In the literature there is increasing interest in the chronobiology of affective disorders and in the most important chronotherapies for treating these disorders. AIM To discuss the background to and the main features of the most important therapies for affective disorders. METHOD Using PubMed, we performed a concise review of the literature on the use of chronotherapeutics in affective disorders and we also studied the standard textbooks on the subject. RESULTS Light therapy is the type of chronotherapy that has been studied most. Chronotherapies show interesting and promising results in open label studies, but so far there have been no randomized double-blind placebo controlled trials. CONCLUSION Chronotherapeutics provides a neurobiological model and a series of promising, possibly effective non-pharmacological therapies, particularly for affective disorders. Light therapy deserves to be included in the multidisciplinary treatment guidelines relating to affective disorders. However, more, better and longer trials are needed in order to evaluate the various types of chronotherapies.
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Affiliation(s)
- R Lieverse
- Psychiatrie en Neuropsychologie, Maastricht University, Maastricht, The Netherlands.
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13
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Van Bokhoven P, Oomen CA, Hoogendijk WJG, Smit AB, Lucassen PJ, Spijker S. Reduction in hippocampal neurogenesis after social defeat is long-lasting and responsive to late antidepressant treatment. Eur J Neurosci 2011; 33:1833-40. [PMID: 21488984 DOI: 10.1111/j.1460-9568.2011.07668.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Major depressive disorder is a chronic disabling disease, often triggered and exacerbated by stressors of a social nature. Hippocampal volume reductions have been reported in depressed patients. In support of the neurogenesis theory of depression, in several stress-based animal models of depression, adult hippocampal neurogenesis was reduced and subsequently rescued by parallel antidepressant treatment. Here, we investigated whether repeated social defeat and subsequent individual housing for 3 months induces long-lasting changes in adult hippocampal neurogenesis in rats, and whether these can be normalized by late antidepressant treatment, as would match human depression. Neurogenesis was analysed by stereological quantification of the number of immature doublecortin (DCX)-immunopositive cells, in particular young (class I) and more mature (class II) DCX(+) cells, to distinguish differential effects of stress or drug treatment on these subpopulations. Using this social defeat paradigm, the total DCX(+) cell number was significantly reduced. This was most profound for older (class II) DCX(+) cells with long apical dendrites, whereas younger, class I cells remained unaffected. Treatment with the broad-acting tricyclic antidepressant imipramine, only during the last 3 weeks of the 3-month period after social defeat, completely restored the reduction in neurogenesis by increasing both class I and II DCX(+) cell populations. We conclude that despite the lack of elevated corticosterone plasma levels, neurogenesis is affected in a lasting manner by a decline in a distinct neuronal population of more mature newborn cells. Thus, the neurogenic deficit induced by this social defeat paradigm is long-lasting, but can still be normalized by late imipramine treatment.
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Affiliation(s)
- P Van Bokhoven
- Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus Amsterdam, VU University and VU Medical Center, Amsterdam, The Netherlands
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14
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Meynen G, Unmehopa UA, Hofman MA, Swaab DF, Hoogendijk WJG. Hypothalamic vasopressin and oxytocin mRNA expression in relation to depressive state in Alzheimer's disease: a difference with major depressive disorder. J Neuroendocrinol 2009; 21:722-9. [PMID: 19500216 DOI: 10.1111/j.1365-2826.2009.01890.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Arginine vasopressin (AVP) and oxytocin (OXT), produced in the hypothalamic paraventricular (PVN) and supraoptic nucleus (SON), are considered to be involved in the pathophysiology of major depressive disorder (MDD). The objective of this study was to determine, for the first time, the relationship between AVP and OXT gene expression and depressive state in Alzheimer's disease (AD). Post-mortem brain tissue was obtained from six control subjects, and from a prospectively studied cohort of 23 AD patients, using the DSM-IIIR and the Cornell Scale for Depression in Dementia to determine depression diagnosis and severity. The amount of AVP and OXT mRNA was determined by in situ hybridisation. AD patients did not differ from controls with respect to the amount of AVP or OXT mRNA in the PVN or SON. Also, no differences were found between depressed and nondepressed AD patients and no relationship was found between the depression severity and AVP or OXT mRNA expression. The results indicate that AVP and OXT gene expression in the PVN and SON is unchanged in depressed AD patients compared to nondepressed AD patients. This is in contrast with the enhanced AVP gene expression in MDD, suggesting a difference in pathophysiology between MDD and depression in AD.
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Affiliation(s)
- G Meynen
- Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
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15
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van Someren EW, Riemersma-van der Lek RF, Twisk J, Hol EM, Hoogendijk WJG, Swaab DF. [Symptomatic treatment of patients with dementia: light, but not melatonin, is probably worthwhile]. Ned Tijdschr Geneeskd 2008; 152:2435. [PMID: 19055145] [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: 05/27/2023]
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16
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Bremmer MA, Beekman ATF, Deeg DJH, Penninx BWJH, Dik MG, Hack CE, Hoogendijk WJG. Inflammatory markers in late-life depression: results from a population-based study. J Affect Disord 2008; 106:249-55. [PMID: 17716746 DOI: 10.1016/j.jad.2007.07.002] [Citation(s) in RCA: 242] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 07/03/2007] [Accepted: 07/04/2007] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous studies have reported conflicting results concerning the association between several inflammatory markers and depression. The association between inflammation and depression may depend on the presence of specific chronic diseases or be relevant in specific sub-groups of depressed patients only. OBJECTIVE To assess associations between inflammatory markers and depression in older people, taking account of confounding and effect-modifying factors. METHOD Population-based study of 1285 participants of the Longitudinal Aging Study Amsterdam, aged 65 and over. Plasma concentrations of Interleukin-6 (IL-6) and C-reactive protein (CRP) were measured. Major depression (first- or recurrent episode) and sub-threshold depression were assessed. Associations were adjusted for confounding variables. Associations with inflammatory markers were further studied with regard to severity and duration of depression, and with regard to specific depressive symptoms. RESULTS High levels of IL-6 (above 5 pg/mL) were associated with major depression (odds ratio 2.49 (1.07-5.80), both in recurrent and first episodes. No significant effect of either one of the markers on specific symptom dimensions of depression was found. Mildly elevated plasma levels of CRP (above 3.2 mg/L) were associated with higher CES-D scores, but not after correction for the confounding effect of age and chronic diseases. LIMITATIONS The cross-sectional design limits conclusions regarding causality. CONCLUSIONS A high plasma level of IL-6, but not CRP, is associated with an increased prevalence of major depression in older people, independent of age, chronic diseases, cognitive functioning and anti-depressants. Present results suggest new directions for clinical research into the prevention of physical consequences of depression.
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Affiliation(s)
- M A Bremmer
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
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17
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Wolfensberger SPA, Veltman DJ, Hoogendijk WJG, De Ruiter MB, Boomsma DI, de Geus EJC. The neural correlates of verbal encoding and retrieval in monozygotic twins at low or high risk for depression and anxiety. Biol Psychol 2008; 79:80-90. [PMID: 18342424 DOI: 10.1016/j.biopsycho.2008.01.002] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 01/03/2008] [Accepted: 01/09/2008] [Indexed: 10/22/2022]
Abstract
Emotional processing and brain activation were examined during an encoding and recognition paradigm using emotionally salient words in a sample of monozygotic twin pairs at low or high risk for anxiety and depression. Discordant twin pairs were used to chart the effects of environmental risk factors and concordant twin pairs were used to chart the effects of genetic risk factors on performance and brain activation. Performance data did not support the existence of a negative response bias in subjects at high risk. At the neural level, however, increased left inferior frontal gyrus (LIFG) activation by negative words was found in high-risk subjects, most prominently during recognition. Increased LIFG activity was found in subjects at high risk through either genetic or environmental risk factors. These results suggest that fMRI activation of the LIFG in a verbal emotional memory task may be a useful vulnerability marker for anxiety and depression.
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18
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Stek ML, van der Wurff FB, Uitdehaag BMJ, Beekman ATF, Hoogendijk WJG. ECT in the treatment of depressed elderly: lessons from a terminated clinical trial. Int J Geriatr Psychiatry 2007; 22:1052-4. [PMID: 17457952 DOI: 10.1002/gps.1800] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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19
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20
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Braam AW, Visser S, Cath DC, Hoogendijk WJG. Investigation of the syndrome of apotemnophilia and course of a cognitive-behavioural therapy. Psychopathology 2006; 39:32-7. [PMID: 16282717 DOI: 10.1159/000089661] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [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: 01/26/2004] [Accepted: 03/01/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND The syndrome of apotemnophilia, body integrity or amputee identity disorder, is defined as the desire for amputation of a healthy limb, and may be accompanied by behaviour of pretending to be an amputee and sometimes, but not necessarily, by sexual arousal. SAMPLING AND METHODS A case history is presented of a 35-year-old man who was referred because of his desire for amputation of his left leg, without sexual connotations. The course of a combined cognitive behavioural psychotherapy with SSRI treatment is described. RESULTS Symptoms showed considerable similarity with obsessive-compulsive disorder, and some similarity with body dysmorphic disorder according to DSM-IV, but the core symptom seemed to be strongly connected with a sense of identity. Treatment with a selective serotonin re-uptake inhibitor decreased levels of distress only. The effects of cognitive restructuring of the psychotherapy were limited, whereas the behavioural elements substantially reduced the behaviour of pretending to be an amputee. CONCLUSIONS The rare syndrome of apotemnophilia raises unresolved questions of classification. Psychotic disorders should be ruled out carefully. The model designed in the current cognitive behavioural approach may serve as a starting point for further development of intervention protocols for this rare disorder.
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Affiliation(s)
- Arjan W Braam
- Institute of Extramural Medicine (EMGO), Amsterdam, The Netherlands.
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21
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van der Wurff FB, Stek ML, Hoogendijk WJG, Beekman ATF. Discrepancy between opinion and attitude on the practice of ECT by psychiatrists specializing in old age in the Netherlands. J ECT 2004; 20:37-41. [PMID: 15087995 DOI: 10.1097/00124509-200403000-00008] [Citation(s) in RCA: 16] [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: 11/26/2022]
Abstract
BACKGROUND Current guidelines consider electroconvulsive therapy (ECT) in the Netherlands a treatment of choice for a depressive disorder with psychotic features, severe suicidal behavior, severe physical exhaustion, or resistance to treatment with antidepressants (consecutively SSRIs, TCAs, lithium, MAO inhibitors). It is advised to use ECT early on in the treatment of depressed elderly patients. In practice, ECT is applied to only a minority of depressed elderly patients in the Netherlands. This situation dates back to the 1970s, in which strong aversive opinions toward ECT grew in the Netherlands, largely as a reaction to the malpractice of ECT in that time and influenced by social-cultural opinions toward psychiatry. Negative attitudes among professionals and lack of knowledge may contribute to the under use in depressed elderly patients. METHODS A postal questionnaire was sent to 152 psychiatrists who specialize in old age to assess their opinions and attitudes toward ECT. RESULTS Only a small minority thought ECT was a treatment of choice in a depressive disorder with psychotic features (4%), severe suicidal risk (2%), or physical exhaustion (5%). The majority of the psychiatrists had strongly reserved opinions in considering ECT as a treatment of first, second or third choice in depressed elderly patients, even in treatment-resistant depressive disorders. CONCLUSIONS Many psychiatrists who specialize in old age in the Netherlands divert from the current guidelines and are reluctant toward using ECT as a treatment of choice in a number of specific, clinical situations. This might be a major contributing factor to the present and past underuse of ECT in depressed elderly patients in the Netherlands.
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Affiliation(s)
- F B van der Wurff
- Department of Psychiatry, Vrije Universiteit-VUmc and GGZ-Buitenamstel, Valeriusplein 9, 1075 BG Amsterdam, The Netherlands.
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22
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Alkemade A, Unmehopa UA, Brouwer JP, Hoogendijk WJG, Wiersinga WM, Swaab DF, Fliers E. Decreased thyrotropin-releasing hormone gene expression in the hypothalamic paraventricular nucleus of patients with major depression. Mol Psychiatry 2003; 8:838-9. [PMID: 14515134 DOI: 10.1038/sj.mp.4001364] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
BACKGROUND Although little doubt exists among practising clinicians in old age psychiatry about the efficacy and safety of ECT in depression, opinions about acceptability differ widely. The objectives of this review were to determine the efficacy and safety of ECT based on both randomised and non-randomised evidence in elderly with a major depressive disorder. METHODS Randomised and non-randomised studies on efficacy and safety of ECT in elderly with and without concomitant disorders such as cerebrovascular disorders, Alzheimer's dementia, vascular dementia and Parkinson's disease were selected. Literature was systematically searched in a number of electronic databases. RESULTS Although 121 studies were included in the review process, only four provided randomised evidence. No negative studies with respect to efficacy were found. ECT is effective in the acute treatment of late life depression. ECT is generally safe, although a number of serious complications possibly related to ECT have been described. Most of the objectives of this review could not be answered or refuted with certainty, because firm randomised evidence on the efficacy and safety of ECT in the depressed elderly is missing. CONCLUSIONS ECT is effective in the acute treatment of late life depression and is generally safe. Important questions such as the relative efficacy of ECT over antidepressants, the long-term efficacy of ECT, morbidity and mortality related to ECT, cost-effectiveness and the efficacy of ECT in subgroups of patients cannot be answered and need to be studied further.
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Affiliation(s)
- F B van der Wurff
- Department of Psychiatry, Vrije Universiteit-Vumc/GGz-Buitenamstel, Amsterdam, The Netherlands.
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24
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de Neeling JND, Gersons-Wolfensberger DCM, Hoogendijk WJG. [Centenary of the Health Council of the Netherlands. VII. Influencing the human brain in the future]. Ned Tijdschr Geneeskd 2002; 146:2047-50. [PMID: 12428467] [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: 02/27/2023]
Abstract
On the occasion of its centenary, the Health Council of the Netherlands issued an advisory report on future possibilities for influencing the human brain. The Council foresees that, in the future, it will probably become possible to prevent or extensively delay diseases such as dementia and Parkinson's disease. The burden of many mental disorders will be markedly relieved by early detection and treatment. Developments are to be expected in the fields of function enhancement, pharmacotherapy, psychotherapy and electrostimulation. The promising developments aimed at the prevention of brain disorders have important ethical and societal implications which require uninterrupted attention.
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Abstract
Pathological, genetic and epidemiological studies support the opinion that inflammatory mechanisms are involved in the pathogenesis of Alzheimer's disease (AD). Recent pathological and neuroradiological (PET) data show that activation of microglia is an early pathogenic event that precedes the process of severe neuropil destruction in AD brains. In this paper we review the evidence that inflammatory mediators can play a pathogenic role in some behavioural disorders frequently encountered during the clinical course in AD patients. Motivational disturbances are the most striking of the depressive symptoms in AD and can be present in a preclinical stage of the disease. Experimental animal studies and clinical trials in humans have shown that cytokines can induce similar symptoms which were described as 'sickness behaviour' or 'depressive-like' state. Delirious states are frequently observed in more advanced stages of dementia. Delirium is generally considered the result of an imbalance in neurotransmitter systems with severe deficits of the cholinergic systems. Animal studies show that pro-inflammatory cytokines, such as interleukin-1, induce a reduced activity of the cholinergic system. In AD, the release of cytokines would exacerbate any already existing disturbances in the cholinergic neurotransmission. This could explain the susceptibility of demented patients to delirium provoked by a wide variety of trivial incidents that are accompanied by an acute phase response. The data reviewed in this paper suggest that it could be worthwhile employing a neuroimmunological approach to study at molecular level the pathogenesis of a broad spectrum of behavioural disturbances common in the clinical course of AD patients.
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Affiliation(s)
- P Eikelenboom
- Graduate School Neuroscience, Amsterdam, The Netherlands.
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