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Brouwer JMJL, Wardenaar KJ, Liemburg EJ, Doornbos B, Mulder H, Cath DC. High persistence and low treatment rates of metabolic syndrome in patients with mood and anxiety disorders: A naturalistic follow-up study. J Affect Disord 2024; 354:451-462. [PMID: 38494132 DOI: 10.1016/j.jad.2024.03.042] [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: 10/08/2023] [Revised: 02/21/2024] [Accepted: 03/09/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Patients with affective and anxiety disorders are at risk of metabolic syndrome (MetS) and, consequently, cardiovascular disease and premature death. In this study, the course and treatment of MetS was investigated using longitudinal data from a naturalistic sample of affective- and anxiety-disordered outpatients (Monitoring Outcome of psychiatric PHARmacotherapy [MOPHAR]). METHODS Demographics, clinical characteristics, medication use, and MetS components were obtained for n = 2098 patients at baseline and, in a FU-subsample of n = 507 patients, after a median follow-up (FU) of 11 months. Furthermore, pharmacological treatment rates of MetS were investigated at baseline and FU. Finally, demographic and clinical determinants of change in MetS (component) scores were investigated. RESULTS At baseline, 34.6 % of n = 2098 patients had MetS, 41.4 % of whom received treatment. Of patients with persisting MetS, 46.1 % received treatment for one (or more) MetS component(s) at baseline, and 56.6 % received treatment at FU. Treatment rates of solely elevated blood pressure and reduced HDL-cholesterol did significantly, but modestly, improve. Higher age, male sex, smoking behavior, low education, diabetes, and depressive versus anxiety disorder were predictors of worse outcome at FU on at least one MetS component. LIMITATIONS We did not have data on lifestyle interventions as a form of treatment, which might partly have explained the observed low pharmacotherapeutic treatment rates. CONCLUSION MetS (components) show high persistence rates in affective- and anxiety-disordered patients, and are, despite adequate monitoring, undertreated over time. This indicates that adherence and implementation of monitoring protocols should be crucially improved in psychiatric outpatients in secondary care.
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Affiliation(s)
- Jurriaan M J L Brouwer
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands; GGZ Drenthe Mental Health Services, Assen, the Netherlands; Research School of Behavioral and Cognitive Neurosciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
| | - Klaas J Wardenaar
- GGZ Drenthe Mental Health Services, Assen, the Netherlands; Department of Psychiatry, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, Groningen, the Netherlands; Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - Edith J Liemburg
- GGZ Drenthe Mental Health Services, Assen, the Netherlands; Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bennard Doornbos
- Lentis Psychiatric Institute, Lentis Research, Groningen, the Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands
| | - Danielle C Cath
- GGZ Drenthe Mental Health Services, Assen, the Netherlands; Research School of Behavioral and Cognitive Neurosciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Kraiss JT, Ten Klooster PM, Chrispijn M, Stevens A, Doornbos B, Kupka RW, Bohlmeijer ET. A multicomponent positive psychology intervention for euthymic patients with bipolar disorder to improve mental well-being and personal recovery: A pragmatic randomized controlled trial. Bipolar Disord 2023; 25:683-695. [PMID: 36856065 DOI: 10.1111/bdi.13313] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Mental well-being and personal recovery are important treatment targets for patients with bipolar disorder (BD). The goal of this study was to evaluate the effectiveness of an 8-week group multicomponent positive psychology intervention (PPI) for euthymic patients with BD as an adjunct to treatment as usual (TAU) compared to TAU alone. METHODS Patients with BD were randomized to receive TAU (n = 43) or the PPI in addition to TAU (n = 54). The primary outcome was well being measured with the Mental Health Continuum-Short Form. Personal recovery was measured with the Questionnaire about the Process of Recovery. Data were collected at baseline, mid-treatment, post-treatment and 6- and 12-month follow-up. Life chart interviews were conducted at 12 months to retrospectively assess recurrence of depression and mania. RESULTS Significant group-by-time interaction effects for well-being and personal recovery were found favouring the PPI. At post-treatment, between-group differences were significant for well-being (d = 0.77) and personal recovery (d = 0.76). Between-group effects for well-being were still significant at 6-month follow-up (d = 0.72). Effects on well-being and personal recovery within the intervention group were sustained until 12-month follow-up. Survival analyses showed no significant differences in time to recurrence. CONCLUSIONS The multicomponent PPI evaluated in this study is effective in improving mental well-being and personal recovery in euthymic patients with BD and would therefore be a valuable addition to the current treatment of euthymic BD patients. The fact that the study was carried out in a pragmatic RCT demonstrates that this intervention can be applied in a real-world clinical setting.
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Affiliation(s)
- Jannis T Kraiss
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Peter M Ten Klooster
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | | | - Anja Stevens
- Centre for Bipolar Disorders, Dimence Mental Health, Deventer, The Netherlands
| | - Bennard Doornbos
- Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Outpatient Clinics, Assen, The Netherlands
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Ralph W Kupka
- VU University Medical Center, Department of Psychiatry, Amsterdam Public Health research center, Amsterdam, The Netherlands
| | - Ernst T Bohlmeijer
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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Quadackers D, Liemburg E, Bos F, Doornbos B, Risselada A, Berger M, Visser E, Cath D. Cardiovascular risk assessment methods yield unequal risk predictions: a large cross-sectional study in psychiatric secondary care outpatients. BMC Psychiatry 2023; 23:536. [PMID: 37488548 PMCID: PMC10367364 DOI: 10.1186/s12888-023-05022-1] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Patients with a mental illness are more likely to develop, and die from, cardiovascular diseases (CVD), necessitating optimal CVD-risk (CVR)-assessment to enable early detection and treatment. Whereas psychiatrists use the metabolic syndrome (MetS)-concept to estimate CVR, GPs use absolute risk-models. Additionally, two PRIMROSE-models have been specifically designed for patients with severe mental illness. We aimed to assess the agreement in risk-outcomes between these CVR-methods. METHODS To compare risk-outcomes across the various CVR-methods, we used somatic information of psychiatric outpatients from the PHAMOUS-, and MOPHAR-database, aged 40-70 years, free of past or current CVD and diabetes. We investigated: (1) the degree-of-agreement between categorical assessments (i.e. MetS-status vs. binary risk-categories); (2) non-parametric correlations between the number of MetS-criteria and absolute risks; and (3) strength-of-agreement between absolute risks. RESULTS Seven thousand twenty-nine measurements of 3509 PHAMOUS-patients, and 748 measurements of 748 MOPHAR-patients, were included. There was systematic disagreement between the categorical CVR-assessments (all p < 0.036). Only MetS-status versus binary Framingham-assessment had a fair strength-of-agreement (κ = 0.23-0.28). The number of MetS-criteria and Framingham-scores, as well as MetS-criteria and PRIMROSE lipid-scores, showed a moderate-strong correlation (τ = 0.25-0.34). Finally, only the continuous PRIMROSE desk and lipid-outcomes showed moderate strength-of-agreement (ρ = 0.91). CONCLUSIONS The varying methods for CVR-assessment yield unequal risk predictions, and, consequently, carry the risk of significant disparities regarding treatment initiation in psychiatric patients. Considering the significantly increased health-risks in psychiatric patients, CVR-models should be recalibrated to the psychiatric population from adolescence onwards, and uniformly implemented by health care providers. TRIAL REGISTRATION The MOPHAR research has been prospectively registered with the Netherlands Trial Register on 19th of November 2014 (NL4779).
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Affiliation(s)
- Davy Quadackers
- Mental Health Services Drenthe, P.O. box 30007, 9400 RA, Assen, The Netherlands.
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Rob Giel Research Center, P.O. box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Edith Liemburg
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Rob Giel Research Center, P.O. box 30.001, 9700 RB, Groningen, The Netherlands
| | - Fionneke Bos
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Rob Giel Research Center, P.O. box 30.001, 9700 RB, Groningen, The Netherlands
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Faculty of Behavioural and Social Sciences, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Bennard Doornbos
- Research Department, Lentis Psychiatric Institute, Hereweg 80, 9725 AG, Groningen, The Netherlands
| | - Arne Risselada
- Department of Clinical Pharmacy, Wilhelmina Hospital, Assen, The Netherlands
| | - Marjolein Berger
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ellen Visser
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Rob Giel Research Center, P.O. box 30.001, 9700 RB, Groningen, The Netherlands
| | - Danielle Cath
- Mental Health Services Drenthe, P.O. box 30007, 9400 RA, Assen, The Netherlands
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Rob Giel Research Center, P.O. box 30.001, 9700 RB, Groningen, The Netherlands
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Bos FM, von Klipstein L, Emerencia AC, Veermans E, Verhage T, Snippe E, Doornbos B, Hadders-Prins G, Wichers M, Riese H. A Web-Based Application for Personalized Ecological Momentary Assessment in Psychiatric Care: User-Centered Development of the PETRA Application. JMIR Ment Health 2022; 9:e36430. [PMID: 35943762 PMCID: PMC9399881 DOI: 10.2196/36430] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Smartphone self-monitoring of mood, symptoms, and contextual factors through ecological momentary assessment (EMA) provides insights into the daily lives of people undergoing psychiatric treatment. Therefore, EMA has the potential to improve their care. To integrate EMA into treatment, a clinical tool that helps clients and clinicians create personalized EMA diaries and interpret the gathered data is needed. OBJECTIVE This study aimed to develop a web-based application for personalized EMA in specialized psychiatric care in close collaboration with all stakeholders (ie, clients, clinicians, researchers, and software developers). METHODS The participants were 52 clients with mood, anxiety, and psychotic disorders and 45 clinicians (psychiatrists, psychologists, and psychiatric nurses). We engaged them in interviews, focus groups, and usability sessions to determine the requirements for an EMA web application and repeatedly obtained feedback on iteratively improved high-fidelity EMA web application prototypes. We used human-centered design principles to determine important requirements for the web application and designed high-fidelity prototypes that were continuously re-evaluated and adapted. RESULTS The iterative development process resulted in Personalized Treatment by Real-time Assessment (PETRA), which is a scientifically grounded web application for the integration of personalized EMA in Dutch clinical care. PETRA includes a decision aid to support clients and clinicians with constructing personalized EMA diaries, an EMA diary item repository, an SMS text message-based diary delivery system, and a feedback module for visualizing the gathered EMA data. PETRA is integrated into electronic health record systems to ensure ease of use and sustainable integration in clinical care and adheres to privacy regulations. CONCLUSIONS PETRA was built to fulfill the needs of clients and clinicians for a user-friendly and personalized EMA tool embedded in routine psychiatric care. PETRA is unique in this codevelopment process, its extensive but user-friendly personalization options, its integration into electronic health record systems, its transdiagnostic focus, and its strong scientific foundation in the design of EMA diaries and feedback. The clinical effectiveness of integrating personalized diaries via PETRA into care requires further research. As such, PETRA paves the way for a systematic investigation of the utility of personalized EMA for routine mental health care.
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Affiliation(s)
- Fionneke M Bos
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lino von Klipstein
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ando C Emerencia
- Research Support, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Erwin Veermans
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Tom Verhage
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Grietje Hadders-Prins
- Rob Giel Research Center, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marieke Wichers
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Harriëtte Riese
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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5
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Bos FM, Schreuder MJ, George SV, Doornbos B, Bruggeman R, van der Krieke L, Haarman BCM, Wichers M, Snippe E. Anticipating manic and depressive transitions in patients with bipolar disorder using early warning signals. Int J Bipolar Disord 2022; 10:12. [PMID: 35397076 PMCID: PMC8994809 DOI: 10.1186/s40345-022-00258-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/01/2022] [Indexed: 11/30/2022] Open
Abstract
Background In bipolar disorder treatment, accurate episode prediction is paramount but remains difficult. A novel idiographic approach to prediction is to monitor generic early warning signals (EWS), which may manifest in symptom dynamics. EWS could thus form personalized alerts in clinical care. The present study investigated whether EWS can anticipate manic and depressive transitions in individual patients with bipolar disorder. Methods Twenty bipolar type I/II patients (with ≥ 2 episodes in the previous year) participated in ecological momentary assessment (EMA), completing five questionnaires a day for four months (Mean = 491 observations per person). Transitions were determined by weekly completed questionnaires on depressive (Quick Inventory for Depressive Symptomatology Self-Report) and manic (Altman Self-Rating Mania Scale) symptoms. EWS (rises in autocorrelation at lag-1 and standard deviation) were calculated in moving windows over 17 affective and symptomatic EMA states. Positive and negative predictive values were calculated to determine clinical utility. Results Eleven patients reported 1–2 transitions. The presence of EWS increased the probability of impending depressive and manic transitions from 32-36% to 46–48% (autocorrelation) and 29–41% (standard deviation). However, the absence of EWS could not be taken as a sign that no transition would occur in the near future. The momentary states that indicated nearby transitions most accurately (predictive values: 65–100%) were full of ideas, worry, and agitation. Large individual differences in the utility of EWS were found. Conclusions EWS show theoretical promise in anticipating manic and depressive transitions in bipolar disorder, but the level of false positives and negatives, as well as the heterogeneity within and between individuals and preprocessing methods currently limit clinical utility. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00258-4.
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Affiliation(s)
- Fionneke M Bos
- Department of Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. .,Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Marieke J Schreuder
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sandip V George
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Computer Science , University College London , London, United Kingdom
| | - Bennard Doornbos
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Richard Bruggeman
- Department of Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Lian van der Krieke
- Department of Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.,Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bartholomeus C M Haarman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke Wichers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Evelien Snippe
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Brouwer JMJL, Risselada AJ, de Wit M, Lubberts J, Westerhuis H, Doornbos B, Mulder H. Lithium surveillance by community pharmacists and physicians in ambulatory patients: a retrospective cohort study. Int J Clin Pharm 2022; 44:975-984. [PMID: 35831730 PMCID: PMC9393139 DOI: 10.1007/s11096-022-01420-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Shared care agreements between clinical pharmacists and physicians can improve suboptimal lithium monitoring in in- and outpatient settings. However, it is unknown whether incorporating community pharmacists in such agreements can also improve lithium monitoring in an outpatient setting. AIM To assess the necessity for a shared care agreement for lithium monitoring in our region by investigating: intervention rates by community pharmacists and whether those are sufficient; lithium monitoring by physicians in ambulatory patients; the extent of laboratory parameter exchange to community pharmacists. METHOD Patient files of lithium users were surveyed in a retrospective cohort study among 21 community pharmacies in the Northern Netherlands. Outcome was the intervention rate by community pharmacists and whether those were deemed sufficient by an expert panel. Additionally, we investigated both the percentages of patients monitored according to current guidelines and of laboratory parameters exchanged to community pharmacists. RESULTS 129 patients were included. Interventions were performed in 64.4% (n = 29), 20.8% (n = 5), and 25.0% (n = 1) of initiations, discontinuations, and dosage alterations of drugs interacting with lithium, respectively. The expert panel deemed 40.0% (n = 14) of these interventions as "insufficient". Physicians monitored 40.3% (n = 52) of the patients according to current guidelines for lithium serum levels and kidney functions combined. Approximately half of the requested laboratory parameters were available to the community pharmacist. CONCLUSION Intervention rates by community pharmacists and lithium monitoring by physicians can be improved. Therefore, a shared care agreement between community pharmacists, clinical pharmacists, and physicians is needed to improve lithium monitoring in ambulatory patients.
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Affiliation(s)
- Jurriaan M. J. L. Brouwer
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Mailbox: 30.001, 9400 RA Assen, The Netherlands ,grid.468637.80000 0004 0465 6592GGZ Drenthe Mental Health Services Drenthe, Assen, The Netherlands ,grid.4830.f0000 0004 0407 1981Department of Psychiatry, Research School of Behavioral and Cognitive Neurosciences, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Arne J. Risselada
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Mailbox: 30.001, 9400 RA Assen, The Netherlands
| | - Marinka de Wit
- grid.4830.f0000 0004 0407 1981Department of Pharmacotherapy, -Epidemiology and -Economics, Department of Pharmacy and Pharmaceutical Sciences, University of Groningen, Groningen, The Netherlands
| | - Janniek Lubberts
- grid.4830.f0000 0004 0407 1981Department of Pharmacotherapy, -Epidemiology and -Economics, Department of Pharmacy and Pharmaceutical Sciences, University of Groningen, Groningen, The Netherlands
| | - Henrieke Westerhuis
- grid.4830.f0000 0004 0407 1981Department of Pharmacotherapy, -Epidemiology and -Economics, Department of Pharmacy and Pharmaceutical Sciences, University of Groningen, Groningen, The Netherlands
| | - Bennard Doornbos
- grid.4830.f0000 0004 0407 1981Lentis Psychiatric Institute, Lentis Research, Groningen, The Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Mailbox: 30.001, 9400 RA, Assen, The Netherlands. .,Dutch Academic Network of Northern Pharmacies (ANNA), Groningen, The Netherlands.
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Schuster MP, Borkent J, Chrispijn M, Ioannou M, Doornbos B, Burger H, Haarman BCM. Increased prevalence of metabolic syndrome in patients with bipolar disorder compared to a selected control group-a Northern Netherlands LifeLines population cohort study. J Affect Disord 2021; 295:1161-1168. [PMID: 34706429 DOI: 10.1016/j.jad.2021.08.139] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/31/2021] [Accepted: 08/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Metabolic syndrome (MetS) is highly prevalent among patients with bipolar disorder (BD). The aims of this cross-sectional study were to determine the prevalence of MetS in Dutch BD subjects and compare it with a control group, to examine the association of demographic and clinical characteristics with MetS in BD, and to determine the extent to which metabolic dysregulation is treated in those patients. METHODS 493 Dutch adult patients (≥ 18 years) with BD receiving psychotropic drugs and 493 matched control subjects were compared using data from the biobank Lifelines. We determined MetS according to the National Cholesterol Education Program Adult Treatment Panel III-Adapted (NCEP ATP III-A) criteria. The difference in the prevalence of MetS and the associations with characteristics were analyzed with logistic regression. RESULTS BD subjects (30.6%) showed a significantly higher prevalence of MetS compared to the control group (14.2%) (p < .001, OR:2.67, 95% CI:1.94-3.66). Univariate analysis showed that smoking, body mass index (BMI) and antidepressant drug use were associated with MetS. Multivariate analysis showed that smoking (OR:2.01) was independently associated with MetS in BD. For hypertension, hyperglycemia and lipid disorder pharmacological treatment was provided to respectively 69.5%, 24% and 18.4% of the BD subjects in our sample. LIMITATIONS Duration of illness of BD subjects was unknown. CONCLUSIONS This study demonstrated a higher prevalence of MetS in Dutch BD subjects compared to persons without BD. In addition, a remarkable undertreatment of some of the components of MetS was found.
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Affiliation(s)
- M P Schuster
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Rob Giel Onderzoekscentrum, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J Borkent
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Rob Giel Onderzoekscentrum, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Biomedical Sciences of Cells and Systems, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - M Chrispijn
- Dimence Mental Health, Zwolle, the Netherlands
| | - M Ioannou
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Rob Giel Onderzoekscentrum, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Biomedical Sciences of Cells and Systems, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - B Doornbos
- Rob Giel Onderzoekscentrum, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; GGZ Drenthe, Assen, the Netherlands
| | - H Burger
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - B C M Haarman
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Rob Giel Onderzoekscentrum, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Snippe E, Doornbos B, Schoevers RA, Wardenaar KJ, Wichers M. Individual and common patterns in the order of symptom improvement during outpatient treatment for major depression. J Affect Disord 2021; 290:81-88. [PMID: 33993084 DOI: 10.1016/j.jad.2021.04.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/19/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Research so far provided few clues on the order in which depressive symptoms typically remit during treatment. This study examined which depressive symptoms improve first, and whether symptoms changed before, simultaneous with, or after the core symptoms of depression (i.e., sad mood, loss of pleasure, and loss of interest). METHODS Participants were 176 patients with Major Depressive Disorder (MDD) receiving outpatient treatment (a combination of pharmacotherapy and psychological interventions) for depression. Participants filled out the Inventory of Depressive Symptomatology - Self Report (IDS-SR) for 16 to 20 consecutive weeks. For each symptom, the timing of onset of a persistent improvement was determined for each single-subject separately. RESULTS Which symptoms improved first differed markedly across patients. The core depression symptoms improved 1.5 to 2 times more often before (48% - 60%) than after (19% -28%) depressive cognitions ('view of myself' and 'view of the future'), anxiety symptoms ('feeling irritable' and 'feeling anxious / tense') and vegetative symptoms ('loss of energy', 'slowed down', and 'physical energy'). Only improvements in suicidal thoughts were more likely to occur before (46% - 48%) than after (29%) improvements in the depression core symptoms. LIMITATIONS Not all 'core depression-non-core symptom' combinations could be tested because some symptoms did not improve in a sufficient number of patients. CONCLUSIONS Which improvements mark the start of symptom remission differed between patients. Improvements in the core depression symptoms 'sad mood', 'loss of interest', and 'loss of pleasure' were more likely to occur before than after improvements in non-core symptoms.
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Affiliation(s)
- Evelien Snippe
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands.
| | - Bennard Doornbos
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands; GGZ Drenthe Mental Health Institute, Department Affective disorders, Assen, The Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands; GGZ Drenthe Mental Health Institute, Department Affective disorders, Assen, The Netherlands
| | - Klaas J Wardenaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, The Netherlands
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Bos F, Schreuder M, Doornbos B, Snippe E, Bruggeman R, Van Der Krieke L, Haarman B, Wichers M, George S. Prospective early warning signals to detect transitions to manic and depressive episodes in bipolar disorder. Eur Psychiatry 2021. [PMCID: PMC9471093 DOI: 10.1192/j.eurpsy.2021.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction For patients with bipolar disorder, early recognition of impending mood episodes is crucial to enable timely intervention. Longitudinal digital mood monitoring using ecological momentary assessment (EMA) enable prospective study of early warning signals (EWS) in momentary affective estates prior to symptom transitions. Objectives The present study examined in a unique longitudinal EMA data set whether EWS prospectively signal transitions to manic or depressive episodes. Methods Twenty bipolar type I/II patients completed EMA questionnaires five times a day for four months (average 491 observations per person), as well as weekly symptom questionnaires concerning depressive (Quick Inventory for Depressive Symptomatology) and manic (Altman Self-Rating Mania Scale) symptoms. Weekly data was used to determine transitions (i.e., abrupt increase in symptoms). Prior to these transitions, EWS (autocorrelation at lag-1 and standard deviation) were calculated in moving windows over 17 affective EMA states. Kendall’s tau was calculated to detect significant rises in the EWS indicator prior to the transition. Results Eleven patients reported one or two transitions to a mood episode. All transitions were preceded by at least one EWS. Average sensitivity for detecting EWS was slightly higher for manic episodes (36%) than for depressive episodes (25%). For manic episodes, EWS in thoughts racing, being full of ideas, and feeling agitated showed the highest sensitivity and specificity, whereas for depression, only feeling tired showed high sensitivity and specify. Conclusions EWS show promise in anticipating transitions to mood episodes in bipolar disorder. Further investigation is warranted. Disclosure No significant relationships.
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Bos FM, Snippe E, Bruggeman R, Doornbos B, Wichers M, van der Krieke L. Recommendations for the use of long-term experience sampling in bipolar disorder care: a qualitative study of patient and clinician experiences. Int J Bipolar Disord 2020; 8:38. [PMID: 33258015 PMCID: PMC7704990 DOI: 10.1186/s40345-020-00201-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/22/2020] [Accepted: 09/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background Self-monitoring has been shown to improve the self-management and treatment of patients with bipolar disorder. However, current self-monitoring methods are limited to once-daily retrospectively assessed mood, which may not suit the rapid mood fluctuations in bipolar disorder. The experience sampling method (ESM), which assesses mood in real-time several times a day, may overcome these limitations. This study set out to assess the experiences of patients and clinicians with the addition of ESM monitoring, real-time alerts, and personalized feedback to clinical care. Participants were twenty patients with bipolar disorder type I/II and their clinicians. For four months, patients completed five ESM assessments per day on mood, symptoms, and activities. Weekly symptom questionnaires alerted patients and clinicians to potential episodes. After the monitoring, a personalized feedback report based on the patient’s data was discussed between patient and clinician. Three months later, patient and clinician were both interviewed. Results Thematic analysis of the transcripts resulted in four themes: perceived effects of the monitoring, alerts, and feedback, and recommendations for implementation of ESM. ESM was perceived as helping patients to cope better with their disorder by increasing awareness, offering new insights, and encouraging life style adjustments. ESM was further believed to facilitate communication between patient and clinician and to lead to new treatment directions. However, high assessment burden and pre-occupation with negative mood and having a disorder were also described. Patients and clinicians advocated for increased personalization and embedding of ESM in care. Conclusions This study demonstrates that long-term ESM monitoring, alerts, and personalized feedback are perceived as beneficial to the treatment and self-management of patients with bipolar disorder. Future research should further test the clinical utility of ESM. Clinically relevant feedback and technology need to be developed to enable personalized integration of ESM in clinical care.
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Affiliation(s)
- Fionneke M Bos
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. .,Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Evelien Snippe
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Bennard Doornbos
- Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Outpatient Clinics, Assen, The Netherlands
| | - Marieke Wichers
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lian van der Krieke
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.,Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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11
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Quadackers DMC, Doornbos B, Cath DC. [Visual hallucinations, misidentification and reduplication of time: a sense of distorted reality due to a cerebral metastasis]. Tijdschr Psychiatr 2020; 62:1073-1079. [PMID: 33443761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We describe a 66-year-old female patient with no prior psychiatric history who presented with an unusual psychotic state, largely in accordance with Fregoli syndrome (misidentification of people). Further, the patient suffered from reduplication of time, scenic hallucinations and psychotic perceptions. Symptoms were the result of a brain metastasis originating from a lung carcinoma. We describe the performed (additional) diagnostics and discuss how to differentiate between organic and functional psychosis, as well as the given psychiatric treatment. Finally, potential pathophysiological explanations are discussed that might explain the (reduction of) symptoms in the patient.
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Simoons M, Ruhé HG, van Roon EN, Schoevers RA, Bruggeman R, Cath DC, Muis D, Arends J, Doornbos B, Mulder H. Design and methods of the 'monitoring outcomes of psychiatric pharmacotherapy' (MOPHAR) monitoring program - a study protocol. BMC Health Serv Res 2019; 19:125. [PMID: 30764821 PMCID: PMC6376699 DOI: 10.1186/s12913-019-3951-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/20/2018] [Accepted: 02/07/2019] [Indexed: 11/20/2022] Open
Abstract
Background At many outpatient departments for psychiatry worldwide, standardized monitoring of the safety of prescribed psychotropic drugs is not routinely performed in daily clinical practice. Therefore it is unclear to which extent the drugs used by psychiatric outpatients are prescribed effectively and safely. These issues warrant structured monitoring of medication use, (pre-existing) co-morbidities, effectiveness and side effects during psychiatric outpatient treatment. Improvement of monitoring practices provides an opportunity to ensure that somatic complications and adverse drug effects are detected and dealt with in a timely manner. Structural support for data collection and follow-up tests seems essential for improvement of monitoring practices in psychiatric outpatients. The implementation of a structured somatic monitoring program as part of routine clinical practice, as we describe in this study protocol, may be a solution. Methods In order to address these issues, we developed the innovative program ‘Monitoring Outcomes of Psychiatric Pharmacotherapy (MOPHAR)’. MOPHAR is an infrastructure for implementation of standardized routine outcome monitoring (ROM; including standardized monitoring of treatment effect), monitoring of adverse psychotropic medication effects in psychiatric outpatients, encompassing both somatic adverse effects (e.g. metabolic disturbances) and subjective adverse effects (e.g. sedation or sexual side effects) and medication reconciliation. Discussion In the MOPHAR monitoring program, a nurse performs general and psychotropic drug-specific somatic screenings and provides the treating mental health care providers with more and better information on somatic monitoring for treatment decisions. Given our experience regarding implementation of the MOPHAR program, we expect that the MOPHAR program is feasible and beneficial for patients in any MHS organisation. This paper describes the objectives, target population, setting and the composition and roles of the treatment team. It also indicates what measurements are performed at which time points during outpatient treatment in the MOPHAR monitoring program, as well as the research aspects of this project. Trial registration MOPHAR research has been prospectively registered with the Netherlands Trial Register on 19th of November 2014. (NL4779). Electronic supplementary material The online version of this article (10.1186/s12913-019-3951-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mirjam Simoons
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands.,Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Pharmacy, Unit of Pharmacotherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Henricus G Ruhé
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
| | - Eric N van Roon
- Department of Pharmacy, Unit of Pharmacotherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands. .,Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, PO Box 888, 8901, BR, Leeuwarden, The Netherlands.
| | - Robert A Schoevers
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Centre, University of Groningen, University Medical Centre Groningen, University Centre for Psychiatry, Groningen, The Netherlands
| | - Daniëlle C Cath
- Department of Specialized Training, Psychiatric Hospital MHS Drenthe, Outpatient Clinics, Assen, The Netherlands
| | - Diny Muis
- Department of Specialized Training, Psychiatric Hospital MHS Drenthe, Outpatient Clinics, Assen, The Netherlands
| | - Johan Arends
- Department of Specialized Training, Psychiatric Hospital MHS Drenthe, Outpatient Clinics, Assen, The Netherlands
| | - Bennard Doornbos
- Department of Specialized Training, Psychiatric Hospital MHS Drenthe, Outpatient Clinics, Assen, The Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands.,Department of Specialized Training, Psychiatric Hospital MHS Drenthe, Outpatient Clinics, Assen, The Netherlands
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13
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Simoons M, Mulder H, Doornbos B, Raats PCC, Bruggeman R, Cath DC, Schoevers RA, Ruhé HG, van Roon EN. Metabolic Syndrome at an Outpatient Clinic for Bipolar Disorders: A Case for Systematic Somatic Monitoring. Psychiatr Serv 2019; 70:143-146. [PMID: 30526344 DOI: 10.1176/appi.ps.201800121] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The primary objective of the study was to determine whether the Monitoring Outcomes of Psychiatric Pharmacotherapy (MOPHAR) program improved somatic monitoring practices at an outpatient clinic for bipolar disorders in the Netherlands. The secondary objective was to determine in MOPHAR the frequency of metabolic syndrome (compared with its measurability before MOPHAR) and treatment thereof. METHODS Frequencies of physical examinations and laboratory tests before (retrospectively) and after (prospectively) the active introduction of MOPHAR were compared among adult patients (N=155). RESULTS A median of three measurements (range 0-19) per patient were performed before MOPHAR, compared with 24 measurements (range 3-24) after MOPHAR (p<0.001). MOPHAR revealed somatic abnormalities previously unknown to treating physicians. Metabolic syndrome was present in 53% of patients; of these, 98% were not known to have metabolic syndrome before MOPHAR. CONCLUSIONS Introducing a monitoring program largely improved knowledge regarding metabolic abnormalities, which are frequently present among patients with bipolar disorder.
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Affiliation(s)
- Mirjam Simoons
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Bennard Doornbos
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Pascal C C Raats
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Richard Bruggeman
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Daniëlle C Cath
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Robert A Schoevers
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Henricus G Ruhé
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
| | - Eric N van Roon
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands (Simoons, Mulder); Interdisciplinary Centre for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands (Simoons, Schoevers, Ruhé); Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom (Ruhé); Outpatient Clinics and Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Assen, the Netherlands (Mulder, Doornbos, Raats, Cath); Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen (Bruggeman); Unit of Pharmacotherapy, Epidemiology, and Economics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands, and Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands (van Roon)
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Grootens KP, Meijer A, Hartong EG, Doornbos B, Roberto Bakker P, Al Hadithy A, Hoogerheide KN, Overmeire F, Marijnissen RM, Ruhe HG. Correction to: Weight changes associated with antiepileptic mood stabilizers in the treatment of bipolar disorder. Eur J Clin Pharmacol 2018; 74:1491. [DOI: 10.1007/s00228-018-2556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Naudé PJW, Roest AM, Stein DJ, de Jonge P, Doornbos B. Anxiety disorders and CRP in a population cohort study with 54,326 participants: The LifeLines study. World J Biol Psychiatry 2018; 19:461-470. [PMID: 29376460 DOI: 10.1080/15622975.2018.1433325] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 10/18/2022]
Abstract
OBJECTIVES Growing evidence indicates that inflammatory processes may play a role in the pathogenesis of anxiety disorders. Nevertheless, much remains to be learned about the involvement of inflammation, including C-reactive protein (CRP), in specific anxiety disorders. This study examines the relation between anxiety disorders and CRP. METHODS Associations of serum CRP with anxiety disorders were determined in a large population study (n = 54,326 participants, mean age = 47 years; 59% female), the LifeLines cohort. Depressive and anxiety disorders (generalized anxiety disorder, social anxiety phobia, panic disorder with or without agoraphobia and agoraphobia without panic disorder) were assessed using the Mini-International Neuropsychiatric Interview. RESULTS Anxiety disorders, with the exception of social anxiety disorder, were significantly associated with increased CRP. After adjusting for demographics, life style factors, health factors, medication use, depression, and psychological stressors, CRP remained significantly associated with panic disorder with agoraphobia (β = 0.01, P = .013). Moreover, CRP levels were significantly higher in people with panic disorder with agoraphobia compared to other anxiety disorders, independent of all covariates (F = 3.00, df = 4, P = .021). CONCLUSIONS Panic disorder with agoraphobia is associated with increased CRP, although the effect size of this association is small. This indicates that neuroinflammatory mechanisms may play a potential role in its pathophysiology.
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Affiliation(s)
- Petrus J W Naudé
- a Department of Psychiatry and Mental Health , Brain Behaviour Unit, University of Cape Town , Cape Town , South Africa
| | - Annelieke M Roest
- b Department of Psychology , Developmental Psychology, University of Groningen , Groningen , The Netherlands
| | - Dan J Stein
- a Department of Psychiatry and Mental Health , Brain Behaviour Unit, University of Cape Town , Cape Town , South Africa.,c SU/UCT MRC Unit on Risk and Resilience in Mental Disorders and Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | - Peter de Jonge
- b Department of Psychology , Developmental Psychology, University of Groningen , Groningen , The Netherlands
| | - Bennard Doornbos
- d Interdisciplinary Centre Psychopathology and Emotion Regulation, Department of Psychiatry , University Medical Centre Groningen, University of Groningen , Groningen , The Netherlands.,e Department of Affective and Bipolar Disorders , GGZ Drenthe , Assen , The Netherlands.,f Department of Psychiatry , University Medical Centre Groningen, University of Groningen , Groningen , The Netherlands
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Simoons M, Mulder H, Doornbos B, Schoevers RA, van Roon EN, Ruhé HG. Monitoring of somatic parameters at outpatient departments for mood and anxiety disorders. PLoS One 2018; 13:e0200520. [PMID: 30130372 PMCID: PMC6103503 DOI: 10.1371/journal.pone.0200520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/28/2018] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Somatic complications account for the majority of the 13-30 years shortened life expectancy in psychiatric patients compared to the general population. The study aim was to assess to which extent patients visiting outpatient departments for mood and anxiety disorders were monitored for relevant somatic comorbidities and (adverse) effects of psychotropic drugs-more specifically a) metabolic parameters, b) lithium safety and c) ECGs-during their treatment. METHODS We performed a retrospective clinical records review and cross-sectional analysis to assess the extent of somatic monitoring at four outpatient departments for mood and anxiety disorders in The Netherlands. We consecutively recruited adult patients visiting a participating outpatient department between March and November 2014. The primary outcome was percentage of patients without monitoring measurements. Secondary outcomes were number of measurements per parameter per patient per year and time from start of treatment to first measurement. RESULTS We included 324 outpatients, of whom 60.2% were female. Most patients were treated for depressive disorders (39.8%), anxiety disorders (16.7%) or bipolar or related disorders (11.7%) and 198 patients (61.1%) used at least one psychotropic drug. For 186 patients (57.4%), no monitoring records were recorded (median treatment period 7.3 months, range 0-55.6). The median number of measurements per parameter per year since the start of outpatient treatment for patients with monitoring measurements was 0.31 (range 0.0-12.9). The median time to first monitoring measurement per parameter for patients with monitoring measurements was 3.8 months (range 0.0-50.7). DISCUSSION Somatic monitoring in outpatients with mood and anxiety disorders is not routine clinical practice. Monitoring practices need to be improved to prevent psychiatric outpatients from undetected somatic complications.
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Affiliation(s)
- Mirjam Simoons
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion regulation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Pharmacotherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands
- Mental Health Services Drenthe, Assen, The Netherlands
| | | | - Robert A. Schoevers
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion regulation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Eric N. van Roon
- Department of Pharmacotherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Henricus G. Ruhé
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion regulation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
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Sorgdrager FJH, Doornbos B, Penninx BWJH, de Jonge P, Kema IP. The association between the hypothalamic pituitary adrenal axis and tryptophan metabolism in persons with recurrent major depressive disorder and healthy controls. J Affect Disord 2017; 222:32-39. [PMID: 28668713 DOI: 10.1016/j.jad.2017.06.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 03/25/2017] [Revised: 06/02/2017] [Accepted: 06/23/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Persistent changes in serotonergic and hypothalamic pituitary adrenal (HPA) axis functioning are implicated in recurrent types of major depressive disorder (MDD). Systemic tryptophan levels, which influence the rate of serotonin synthesis, are regulated by glucocorticoids produced along the HPA axis. We investigated tryptophan metabolism and its association with HPA axis functioning in single episode MDD, recurrent MDD and non-depressed individuals. METHODS We included depressed individuals (n = 1320) and controls (n = 406) from the Netherlands Study of Depression and Anxiety (NESDA). The kynurenine to tryptophan ratio (kyn/trp ratio) was established using serum kynurenine and tryptophan levels. Several HPA axis parameters were calculated using salivary cortisol samples. We adjusted the regression analyses for a wide range of potential confounders and differentiated between single episode MDD, recurrent MDD and control. RESULTS Tryptophan, kynurenine and the kyn/trp ratio did not differ between controls and depressed individuals. Increased evening cortisol levels were associated with a decreased kyn/trp ratio in the total sample (Crude: β = -.102, p < .001; Adjusted: β = -.083, p < .001). This association was found to be restricted to recurrently depressed individuals (Crude: β = -.196, p < .001; Adjusted: β = -.145, p = .001). Antidepressant treatment did not affect this association. CONCLUSIONS Our results suggest that an imbalance between HPA axis function and tryptophan metabolism could be involved in recurrent depression.
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Affiliation(s)
- F J H Sorgdrager
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - B Doornbos
- University Center Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Interdisciplinary Center of Psychiatric Epidemiology, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; GGZ Drenthe Mental Health Center, Department of Affective and Bipolar Disorders, Assen, The Netherlands
| | - B W J H Penninx
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - P de Jonge
- Interdisciplinary Center of Psychiatric Epidemiology, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - I P Kema
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Meurs M, Roest AM, Groenewold NA, Franssen CFM, Westerhuis R, Kloppenburg WD, Doornbos B, Beukema L, Lindmäe H, de Groot JC, van Tol MJ, de Jonge P. Gray matter volume and white matter lesions in chronic kidney disease: exploring the association with depressive symptoms. Gen Hosp Psychiatry 2016; 40:18-24. [PMID: 27040607 DOI: 10.1016/j.genhosppsych.2016.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 02/09/2016] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Chronic kidney disease (CKD) is associated with structural brain damage and with a high prevalence of depression. We therefore investigated structural brain alterations in both gray and white matter in CKD patients, focusing on depression-related (frontal-subcortical) regions. METHOD This cross-sectional MRI study in 24 CKD patients and 24 age- and sex-matched controls first tested whether CKD was associated with regionally lower gray matter (GM) volumes and more severe white matter lesions (WMLs). In exploratory subanalyses, we examined whether differences were more pronounced in CKD patients with depressive symptoms. RESULTS CKD patients showed lower global GM volume (P=.04) and more severe WMLs (P=.04) compared to controls. In addition, we found substantial clusters of lower GM in the bilateral orbitofrontal-cortex for CKD patients, which were however nonsignificant after proper multiple-comparison correction. In exploratory analyses for depressed CKD patients, reduced GM clusters were mainly detected within the frontal lobe. WML severity was unrelated to depression. CONCLUSION CKD was characterized by differences in brain structure. Although subthreshold, lower GM volumes were observed in depression-related brain areas and were more pronounced for depressed patients. There is a need for replication in larger and longitudinal studies to investigate whether WMLs and regional GM reductions may render CKD patients more susceptible for depression.
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Affiliation(s)
- Maaike Meurs
- University of Groningen/University Medical Center Groningen, Department of psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands.
| | - Annelieke M Roest
- University of Groningen/University Medical Center Groningen, Department of psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands.
| | - Nynke A Groenewold
- University of Groningen/University Medical Center Groningen, Department of psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands.
| | - Casper F M Franssen
- University of Groningen/University Medical Center Groningen, Department of Internal Medicine, Division of Nephrology, The Netherlands.
| | | | | | - Bennard Doornbos
- University Medical Center Groningen, department of Psychiatry, the Netherlands, GGZ Drenthe, Assen, the Netherlands.
| | - Lindy Beukema
- University of Groningen/University Medical Center Groningen, Department of psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands.
| | - Hanna Lindmäe
- University of Groningen/University Medical Center Groningen, department of Radiology, The Netherlands.
| | - Jan Cees de Groot
- University of Groningen/University Medical Center Groningen, department of Radiology, The Netherlands.
| | - Marie-José van Tol
- University of Groningen/University Medical Center Groningen, Neuroimaging Center, department of Neuroscience, section Cognitive NeuroPsychiatry, The Netherlands.
| | - Peter de Jonge
- University of Groningen/University Medical Center Groningen, Department of psychiatry - Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), The Netherlands.
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Groenewold NA, Doornbos B, Zuidersma M, Vogelzangs N, Penninx BWJH, Aleman A, de Jonge P. Comparing cognitive and somatic symptoms of depression in myocardial infarction patients and depressed patients in primary and mental health care. PLoS One 2013. [PMID: 23342019 DOI: 10.1371/journal.pone.00589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Depression in myocardial infarction patients is often a first episode with a late age of onset. Two studies that compared depressed myocardial infarction patients to psychiatric patients found similar levels of somatic symptoms, and one study reported lower levels of cognitive/affective symptoms in myocardial infarction patients. We hypothesized that myocardial infarction patients with first depression onset at a late age would experience fewer cognitive/affective symptoms than depressed patients without cardiovascular disease. Combined data from two large multicenter depression studies resulted in a sample of 734 depressed individuals (194 myocardial infarction, 214 primary care, and 326 mental health care patients). A structured clinical interview provided information about depression diagnosis. Summed cognitive/affective and somatic symptom levels were compared between groups using analysis of covariance, with and without adjusting for the effects of recurrence and age of onset. Depressed myocardial infarction and primary care patients reported significantly lower cognitive/affective symptom levels than mental health care patients (F (2,682) = 6.043, p = 0.003). Additional analyses showed that the difference between myocardial infarction and mental health care patients disappeared after adjusting for age of onset but not recurrence of depression. These group differences were also supported by data-driven latent class analyses. There were no significant group differences in somatic symptom levels. Depression after myocardial infarction appears to have a different phenomenology than depression observed in mental health care. Future studies should investigate the etiological factors predictive of symptom dimensions in myocardial infarction and late-onset depression patients.
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Affiliation(s)
- Nynke A Groenewold
- Interdisciplinary Center for Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands.
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Tak LM, van Berlo-van de Laar IRF, Doornbos B. [No quetiapine for sleeping disorders]. Ned Tijdschr Geneeskd 2013; 157:A5740. [PMID: 23343742] [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
The prescribing of low doses of quetiapine for the treatment of sleeping disorders appears to be widespread. Recently, in a systematic literature review on low-dose quetiapine use for the treatment of sleeping disorders, it was concluded that evidence for its efficacy is currently lacking. Furthermore, quetiapine is probably associated with potentially severe adverse effects, also at low doses. In conclusion, sufficient scientific evidence that justifies the current practice of off-label prescribing of low-dose quetiapine for the treatment of sleeping disorders is insufficient; further research into its efficacy and safety is needed.
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Stramrood CAI, van der Velde J, Doornbos B, Marieke Paarlberg K, Weijmar Schultz WCM, van Pampus MG. The patient observer: eye-movement desensitization and reprocessing for the treatment of posttraumatic stress following childbirth. Birth 2012; 39:70-6. [PMID: 22369608 DOI: 10.1111/j.1523-536x.2011.00517.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND No standard intervention with proved effectiveness is available for women with posttraumatic stress following childbirth because of insufficient research. The objective of this paper was to evaluate the possibility of using eye-movement desensitization and reprocessing treatment for women with symptoms of posttraumatic stress disorder following childbirth. The treatment is internationally recognized as one of the interventions of choice for the condition, but little is known about its effects in women who experienced the delivery as traumatic. METHODS Three women suffering from posttraumatic stress symptoms following the birth of their first child were treated with eye-movement desensitization and reprocessing during their next pregnancy. Patient A developed posttraumatic stress symptoms following the lengthy labor of her first child that ended in an emergency cesarean section after unsuccessful vacuum extraction. Patient B suffered a second degree vaginal rupture, resulting in pain and inability to engage in sexual intercourse for years. Patient C developed severe preeclampsia postpartum requiring intravenous treatment. RESULTS Patients received eye-movement desensitization and reprocessing treatment during their second pregnancy, using the standard protocol. The treatment resulted in fewer posttraumatic stress symptoms and more confidence about their pregnancy and upcoming delivery compared with before the treatment. Despite delivery complications in Patient A (secondary cesarean section due to insufficient engaging of the fetal head); Patient B (second degree vaginal rupture, this time without subsequent dyspareunia); and Patient C (postpartum hemorrhage, postpartum hypertension requiring intravenous treatment), all three women looked back positively at the second delivery experience. CONCLUSIONS Treatment with eye-movement desensitization and reprocessing reduced posttraumatic stress symptoms in these three women. They were all sufficiently confident to attempt vaginal birth rather than demanding an elective cesarean section. We advocate a large-scale, randomized controlled trial involving women with postpartum posttraumatic stress disorder to evaluate the effect of eye-movement desensitization and reprocessing in this patient group.
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Affiliation(s)
- Claire A I Stramrood
- Department of Obstetrics & Gynecology, University Medical Center Groningen, Groningen, The Netherlands
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Bouma EMC, Riese H, Doornbos B, Ormel J, Oldehinkel AJ. Genetically based reduced MAOA and COMT functioning is associated with the cortisol stress response: a replication study. Mol Psychiatry 2012; 17:119-21. [PMID: 21912392 DOI: 10.1038/mp.2011.115] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Stramrood CAI, Wessel I, Doornbos B, Aarnoudse JG, van den Berg PP, Schultz WCMW, van Pampus MG. Posttraumatic Stress Disorder Following Preeclampsia and PPROM. Reprod Sci 2011; 18:645-53. [DOI: 10.1177/1933719110395402] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- C. A. I. Stramrood
- Department of Obstetrics & Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - I. Wessel
- Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands
| | - B. Doornbos
- University Center for Psychiatry, Groningen, The Netherlands
| | - J. G. Aarnoudse
- Department of Obstetrics & Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - P. P. van den Berg
- Department of Obstetrics & Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - W. C. M. Weijmar Schultz
- Department of Obstetrics & Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - M. G. van Pampus
- Department of Obstetrics & Gynecology, University Medical Center Groningen, Groningen, The Netherlands
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de Jonge P, Rosmalen JG, Kema IP, Doornbos B, van Melle JP, Pouwer F, Kupper N. Psychophysiological biomarkers explaining the association between depression and prognosis in coronary artery patients: A critical review of the literature. Neurosci Biobehav Rev 2010; 35:84-90. [DOI: 10.1016/j.neubiorev.2009.11.025] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Revised: 10/30/2009] [Accepted: 11/26/2009] [Indexed: 12/22/2022]
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Doornbos B, Dijck-Brouwer DAJ, Kema IP, Tanke MAC, van Goor SA, Muskiet FAJ, Korf J. The development of peripartum depressive symptoms is associated with gene polymorphisms of MAOA, 5-HTT and COMT. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:1250-4. [PMID: 19625011 DOI: 10.1016/j.pnpbp.2009.07.013] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2009] [Revised: 07/09/2009] [Accepted: 07/10/2009] [Indexed: 12/17/2022]
Abstract
BACKGROUND Polymorphisms of monoamine-related genes have been associated with depression following life events. The peripartum is a physiologically and psychologically challenging period, characterized by fluctuations in depressive symptoms, therefore facilitating prospective investigations in this gene x environment (G x E) interaction. METHODS Eighty nine pregnant women filled in two Edinburgh Postpartum Depression Scale (EPDS) questionnaires during pregnancy and two in the postpartum period. MAOA, COMT and 5-HTT polymorphisms were analyzed. RESULTS We found a significant interaction between the development of depressive symptoms in the course of pregnancy and polymorphisms in 5-HTT (p=0.019); MAOA (p=0.044) and COMT (p=0.026), and MAOA x COMT (p<0.001). Particularly, women carrying the combination of low activity variants of MAOA and COMT showed increased EPDS scores at week 36 of pregnancy and 6 weeks postpartum, but not during early pregnancy or 12 weeks postpartum. CONCLUSION We found that MAOA in combination with COMT appears to regulate not only the stress response in laboratory experiments, but also seems to influence the stress-evoked onset of mood during normal, mild, stressful events, such as experienced in the peripartum period. These findings support the GxE concept for depression, but they underline the complexity of this concept, as the cumulating effects of these polymorphic genes (i.e. MAOA+COMT) might be needed and the effects of these polymorphic genes becomes apparent in special environmental or physiological conditions (i.e. the peripartum period). We therefore suggest that G x E interactions become especially noticeable from longitudinal study designs in specific physiological or social challenging periods.
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Affiliation(s)
- Bennard Doornbos
- Graduate School of Behavioral and Cognitive Neuroscience, University Center for Psychiatry, University Medical Center Groningen, The Netherlands.
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26
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Zuidersma M, Doornbos B, de Jonge P. [Standard screening for depression in heart patients is not yet useful]. Ned Tijdschr Geneeskd 2009; 153:640-641. [PMID: 19425318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Marij Zuidersma
- Universitair Medisch Centrum Groningen, Universitair Centrum Psychiatrie, Groningen.
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27
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Doornbos B, van Goor SA, Dijck-Brouwer DAJ, Schaafsma A, Korf J, Muskiet FAJ. Supplementation of a low dose of DHA or DHA+AA does not prevent peripartum depressive symptoms in a small population based sample. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33:49-52. [PMID: 18955102 DOI: 10.1016/j.pnpbp.2008.10.003] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 10/06/2008] [Accepted: 10/06/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND The decrease of maternal docosahexaenoic (DHA) status during pregnancy has been associated with postpartum depression, especially in women with a low intake of DHA. Since the DHA intake in the Netherlands is low, we investigated whether supplementation of low doses of DHA or DHA plus arachidonic acid (AA) during pregnancy and lactation could prevent depressive symptoms and sleep disturbances in this period. METHODS Women were supplemented daily with placebo, DHA (220 mg) or DHA+AA (220 mg each) from week 16 of pregnancy till three months postpartum. Fatty acid analyses were performed in the available plasma samples at 16 and 36 weeks of pregnancy. Depressive symptoms were measured in weeks 16 and 36 of pregnancy and six weeks postpartum using EPDS and within one week postpartum using a blues questionnaire. RESULTS 119 women completed the study. The average frequency of fish intake was low, 0.94 times per week, and did not differ between the groups. The supplementation groups did not differ in mean EPDS scores or changes in EPDS scores, nor in incidence or severity of postpartum blues. Red blood cell DHA, AA and DHA/AA ratio did not correlate with EPDS or blues scores. Indices of sleep quality did not differ between the groups. CONCLUSION Supplementation of 220 mg/day DHA or DHA+AA (220 mg/day each) does not prevent peri-partum depressive symptoms, in a population based sample with low background DHA intake. TRIAL REGISTRATION ISRCTN Register nr. ISRCTN58176213.
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Affiliation(s)
- B Doornbos
- Graduate School of Behavioral and Cognitive Neuroscience, University Center for Psychiatry, University Medical Center Groningen, The Netherlands.
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Doornbos B, Fokkema DS, Molhoek M, Tanke MA, Postema F, Korf J. Abrupt rather than gradual hormonal changes induce postpartum blues-like behavior in rats. Life Sci 2009; 84:69-74. [DOI: 10.1016/j.lfs.2008.10.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 10/07/2008] [Accepted: 10/29/2008] [Indexed: 11/29/2022]
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van Goor SA, Dijck-Brouwer DAJ, Hadders-Algra M, Doornbos B, Erwich JJHM, Schaafsma A, Muskiet FAJ. Human milk arachidonic acid and docosahexaenoic acid contents increase following supplementation during pregnancy and lactation. Prostaglandins Leukot Essent Fatty Acids 2009; 80:65-9. [PMID: 19118992 DOI: 10.1016/j.plefa.2008.11.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 11/03/2008] [Accepted: 11/07/2008] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Docosahexaenoic acid (DHA) and arachidonic acid (AA) are important for neurodevelopment. Maternal diet influences milk DHA, whereas milk AA seems rather constant. We investigated milk AA, DHA and DHA/AA after supplementation of AA plus DHA, or DHA alone during pregnancy and lactation. SUBJECTS AND METHODS Women were supplemented with AA+DHA (220mg each/day), DHA (220mg/day) or placebo during pregnancy and lactation. Milk samples were collected at 2 (n=86) and 12 weeks (n=69) postpartum. RESULTS Supplementation of AA+DHA elevated milk AA (week 2, 14%; week 12, 23%) and DHA (43% and 52%) as compared to placebo. DHA tended to decrease milk AA and vice versa. Milk AA, DHA and DHA/AA decreased from 2 to 12 weeks postpartum. CONCLUSIONS Milk AA and in particular DHA are sensitive to maternal supplementation. It seems that maternal AA and notably DHA status decline with advancing lactation.
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Affiliation(s)
- Saskia A van Goor
- Pathology and Laboratory Medicine, UMCG, University Medical Center Groningen, The Netherlands.
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Tanke MAC, Kema IP, Dijck-Brouwer J, Doornbos B, De Vries EGE, Korf J. Low plasma tryptophan in carcinoid patients is associated with increased urinary cortisol excretion. Psychoneuroendocrinology 2008; 33:1297-301. [PMID: 18722719 DOI: 10.1016/j.psyneuen.2008.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 07/14/2008] [Accepted: 07/17/2008] [Indexed: 01/19/2023]
Abstract
BACKGROUND Previously we observed in patients suffering from a metastatic carcinoid tumor that irritability, aggression and lack of impulse control are associated with low levels of plasma tryptophan and presumably with low brain serotonin function. In rats we showed that a diet of low tryptophan resulted in higher stress responses and higher corticosterone production. Here we tested in carcinoid patients whether tryptophan depletion due to tumor 5-HT overproduction is associated with high cortisol production. METHODS Urinary excretion of cortisol, serotonin, 5-hydroxyindole acetic acid (the main metabolite of serotonin a marker of tumor activity), plasma levels of tryptophan and platelet content of serotonin (index of peripheral serotonin synthesis) were determined in metastatic midgut carcinoid patients. Patients (N = 25) were divided into two groups based on their plasma tryptophan levels (< or = 25 micromol/l, n = 12 and > or = 49 micromol/l, n = 13). RESULTS Carcinoid patients with low plasma tryptophan levels had significantly higher urinary excretion of free cortisol (p < 0.01), independent of tumor activity. The inter-individual differences in the low tryptophan group, however, were substantial. CONCLUSIONS In a subgroup of the patients suffering from metastatic carcinoid disease the cerebral access of plasma tryptophan is impaired, thus rendering cerebral serotonin neurotransmission suboptimal and leading to hypercortisolism. The present study provides further support to the idea that low serotonergic function is a risk for developing stress-associated psychopathology.
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Affiliation(s)
- Marit A C Tanke
- University Center Psychiatry, University Medical Center Groningen, The Netherlands.
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Doornbos B, de Jonge P, Bockting CLH. [Selective publication of research into antidepressants: consequences for the practice guideline 'depression']. Ned Tijdschr Geneeskd 2008; 152:1406-1408. [PMID: 18624001] [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: 05/26/2023]
Abstract
It was recently shown in a publication in The New England Journal of Medicine that the publicly accessible information about the effectiveness of antidepressive medication is incomplete and biased. The authors calculated from published and unpublished data that the effectiveness of antidepressants as published in the literature is overestimated probably by 32%. Based on this publication and other publications questioning the effectiveness of antidepressants, adjustment of the Dutch practice guideline for depression is proposed: only severely depressed patients should be treated with antidepressants. Some measures to prevent publication bias are also proposed. These require the cooperation of all parties participating in registration ofdrugs and publication of drug research.
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Affiliation(s)
- B Doornbos
- Universitair Medisch Centrum Groningen, Universitair Centrum Psychiatrie, Postbus 30.001, 9700 RB Groningen.
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Tanke MAC, Fokkema DS, Doornbos B, Postema F, Korf J. Sustained release of corticosterone in rats affects reactivity, but does not affect habituation to immobilization and acoustic stimuli. Life Sci 2008; 83:135-41. [PMID: 18590746 DOI: 10.1016/j.lfs.2008.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 04/18/2008] [Accepted: 05/31/2008] [Indexed: 10/22/2022]
Abstract
Depression is often preceded by stressful life events and accompanied with elevated cortisol levels and glucocorticoid resistance. It has been suggested that a major depressive disorder may result from impaired coping with and adaptation to stress. The question is whether or not hypothalamus-pituitary-adrenal (HPA)-axis dysfunction influences the process of adaptation. We examined the effect of a dysregulated HPA-axis on the adaptation to acoustic stimuli in rats with or without preceding restraint stress. HPA-axis function was altered via slow release of corticosterone (CORT, 90 mg) from subcutaneously implanted pellets for 7 or 14 days. The rate of body temperature increases during restraint (10 min) and the response to acoustic stimuli (of 80+120 dB) were used to quantify daily stress reactivity. Rats habituated to either stress regardless of CORT treatment. CORT treatment combined with restraint decreased the initial reactivity and the variability in response, but the rate of habituation was not influenced. These results show that suppressing normal HPA-axis function by chronic exposure to CORT does affect the course of habituation, but not habituation per se. This implies that altered HPA-axis function in depressed patients may not be causally related to stress coping, but instead may influence the course of the disorder.
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Affiliation(s)
- Marit A C Tanke
- Graduate School of Behavioral and Cognitive Neuroscience, University of Groningen, University Center of Psychiatry, University Medical Center Groningen, The Netherlands.
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Tanke MAC, Alserda E, Doornbos B, van der Most PJ, Goeman K, Postema F, Korf J. Low tryptophan diet increases stress-sensitivity, but does not affect habituation in rats. Neurochem Int 2008; 52:272-81. [PMID: 17673334 DOI: 10.1016/j.neuint.2007.05.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 04/10/2007] [Accepted: 05/31/2007] [Indexed: 11/22/2022]
Abstract
Cerebral dysfunction of 5-HT (serotonin) has been associated with stress response and with affective disorders. Stress alone is insufficient to induce depression, since only a minor proportion of subjects that have experienced stressful life events develop depressive episodes. We investigated whether long-term brain 5-HT depletion induced in rats by a diet with low content of its precursor tryptophan affects stress-responsiveness in rats. Stress-sensitivity was measured through various physiological parameters and by measuring the rats' response to acoustic stimuli. One group of rats was subjected to daily acoustic stimulus sessions for 5 days. Other groups received both immobilization stress and acoustic stimulus sessions daily for either 9 days (chronic experiment) or 1 day (acute experiment). A low tryptophan diet led to decreases in plasma tryptophan levels, low ratio of tryptophan/large neutral amino acid, whole blood 5-HT, and neuronal 5-HT content in the Dorsal and Median Raphe Nuclei, as well as altered c-fos expression in the brain. Without concomitant immobilization, the diet alone did not affect reactivity and habituation to acoustic stimuli, although plasma corticosterone levels, but not the adrenal weights, were increased on day 5. Low tryptophan and chronic immobilization stress together with the acoustic testing procedure increased adrenal weight, plasma corticosterone levels and reactivity to the acoustic stimuli, but not the rate of habituation to acoustic stimuli. These results show that cerebral dysfunction of serotonin achieved through a low tryptophan diet, increases the sensitivity of rats to external and stressful stimuli, but does not impair the capacity to adapt to these stimuli. Accordingly, brain-serotonin modulates reactivity to stress, but not stress coping.
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Affiliation(s)
- Marit A C Tanke
- Department of Psychiatry, University Medical Center Groningen, Graduate School of Behavioral Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
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Paalvast Y, Doornbos B, Korf J. [Psychiatric disorders in pregnant and puerperal women]. Ned Tijdschr Geneeskd 2006; 150:877; author reply 877-8. [PMID: 16676519] [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: 05/09/2023]
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