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Christ C, van Schaik DJF, Kikkert MJ, de Waal MM, Dozeman E, Hulstijn HL, Koomen LM, Krah IM, Schut DM, Beekman ATF, Dekker JJM. Internet-based emotion regulation training aimed at reducing violent revictimization and depressive symptoms in victimized depressed patients: Results of a randomized controlled trial. J Affect Disord 2024; 355:95-103. [PMID: 38521137 DOI: 10.1016/j.jad.2024.03.028] [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: 08/29/2023] [Revised: 02/26/2024] [Accepted: 03/09/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Depressed patients who have become victim of violence are prone to revictimization. However, no evidence-based interventions aimed at reducing revictimization in this group exist. METHODS This multicenter randomized controlled trial evaluated the effectiveness of an internet-based emotion regulation training (iERT) added to TAU in reducing revictimization, emotion dysregulation, and depressive symptoms in recently victimized, depressed patients compared to TAU alone. Adult outpatients (N = 153) with a depressive disorder who had experienced threat, physical assault, or sexual assault within the previous three years were randomly allocated to TAU+iERT (n = 74) or TAU (n = 79). TAU involved psychotherapy (mainly cognitive behavioral therapy [77.8 %]). iERT comprised six guided online sessions focused on the acquisition of adaptive emotion regulation skills. The primary outcome measure was the number of revictimization incidents at 12 months after baseline, measured with the Safety Monitor. Analyses were performed according to the intention-to-treat principle. RESULTS Both groups showed a large decrease in victimization incidents. Mixed-model negative binomial regression analyses showed that TAU+iERT was not effective in reducing revictimization compared to TAU (IRR = 0.97; 95%CI = 0.64,1.46; p = .886). Linear mixed-model analyses demonstrated that TAU+iERT yielded a larger reduction of emotion dysregulation (B = -7.217; p = .046; Cohens d = 0.33), but not depressive symptoms (B = -1.041; p = .607) than TAU. LIMITATIONS The study was underpowered to detect small treatment effects. Additionally, uptake of iERT was quite low. CONCLUSIONS Although TAU+iERT resulted in a larger decrease of emotion dysregulation than TAU alone, it was not effective in reducing revictimization and depressive symptoms. Patients' revictimization risk substantially decreased during psychotherapy.
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Affiliation(s)
- C Christ
- Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Center, Department of Psychiatry, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Department of Research and Innovation, Amsterdam, the Netherlands; Arkin Mental Health Care, Department of Research, Amsterdam, the Netherlands.
| | - D J F van Schaik
- Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Center, Department of Psychiatry, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Department of Research and Innovation, Amsterdam, the Netherlands
| | - M J Kikkert
- Arkin Mental Health Care, Department of Research, Amsterdam, the Netherlands
| | - M M de Waal
- Arkin Mental Health Care, Department of Research, Amsterdam, the Netherlands
| | - E Dozeman
- Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Center, Department of Psychiatry, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Department of Research and Innovation, Amsterdam, the Netherlands
| | - H L Hulstijn
- PuntP, Department of Affective Disorders, Arkin Mental Health Care, Amsterdam, the Netherlands
| | - L M Koomen
- Arkin BasisGGZ, Department of Primary Mental Health Care, Arkin Mental Health Care, Amsterdam, the Netherlands
| | - I M Krah
- GGZ Breburg, Department of Anxiety and Depressive Disorders, Breda, the Netherlands
| | - D M Schut
- Altrecht Mental Health Institute, Department of Anxiety and Depressive Disorders, Zeist, the Netherlands
| | - A T F Beekman
- Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Center, Department of Psychiatry, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Department of Research and Innovation, Amsterdam, the Netherlands
| | - J J M Dekker
- Arkin Mental Health Care, Department of Research, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department of Clinical Psychology, Faculty of Behavioral and Movement Sciences, Amsterdam Public Health research institute, Amsterdam, Netherlands
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2
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Basten M, Pan KY, van Tuijl LA, de Graeff A, Dekker J, Hoogendoorn AW, Lamers F, Ranchor AV, Vermeulen R, Portengen L, Voogd AC, Abell J, Awadalla P, Beekman ATF, Bjerkeset O, Boyd A, Cui Y, Frank P, Galenkamp H, Garssen B, Hellingman S, Huisman M, Huss A, Keats MR, Kok AAL, Krokstad S, van Leeuwen FE, Luik AI, Noisel N, Payette Y, Penninx BWJH, Rissanen I, Roest AM, Rosmalen JGM, Ruiter R, Schoevers RA, Soave D, Spaan M, Steptoe A, Stronks K, Sund ER, Sweeney E, Twait EL, Teyhan A, Verschuren WMM, van der Willik KD, Geerlings MI. Psychosocial factors, health behaviors and risk of cancer incidence: Testing interaction and effect modification in an individual participant data meta-analysis. Int J Cancer 2024; 154:1745-1759. [PMID: 38289012 DOI: 10.1002/ijc.34852] [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] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 03/14/2024]
Abstract
Depression, anxiety and other psychosocial factors are hypothesized to be involved in cancer development. We examined whether psychosocial factors interact with or modify the effects of health behaviors, such as smoking and alcohol use, in relation to cancer incidence. Two-stage individual participant data meta-analyses were performed based on 22 cohorts of the PSYchosocial factors and CAncer (PSY-CA) study. We examined nine psychosocial factors (depression diagnosis, depression symptoms, anxiety diagnosis, anxiety symptoms, perceived social support, loss events, general distress, neuroticism, relationship status), seven health behaviors/behavior-related factors (smoking, alcohol use, physical activity, body mass index, sedentary behavior, sleep quality, sleep duration) and seven cancer outcomes (overall cancer, smoking-related, alcohol-related, breast, lung, prostate, colorectal). Effects of the psychosocial factor, health behavior and their product term on cancer incidence were estimated using Cox regression. We pooled cohort-specific estimates using multivariate random-effects meta-analyses. Additive and multiplicative interaction/effect modification was examined. This study involved 437,827 participants, 36,961 incident cancer diagnoses, and 4,749,481 person years of follow-up. Out of 744 combinations of psychosocial factors, health behaviors, and cancer outcomes, we found no evidence of interaction. Effect modification was found for some combinations, but there were no clear patterns for any particular factors or outcomes involved. In this first large study to systematically examine potential interaction and effect modification, we found no evidence for psychosocial factors to interact with or modify health behaviors in relation to cancer incidence. The behavioral risk profile for cancer incidence is similar in people with and without psychosocial stress.
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Affiliation(s)
- Maartje Basten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Amsterdam Public Health, Health Behaviors and Chronic Diseases program, Amsterdam, The Netherlands
| | - Kuan-Yu Pan
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lonneke A van Tuijl
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, The Netherlands
| | - Joost Dekker
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adriaan W Hoogendoorn
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Femke Lamers
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adelita V Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Jessica Abell
- Department of Behavioural Science and Health, University College London, London, UK
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aartjan T F Beekman
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Faculty of Medicine and Health Sciences, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andy Boyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yunsong Cui
- Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Philipp Frank
- Department of Behavioural Science and Health, University College London, London, UK
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert Garssen
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sean Hellingman
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Canada
| | - Martijn Huisman
- Department of Epidemiology & Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Melanie R Keats
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Almar A L Kok
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology & Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Norway
- Levanger hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | | | | | - Brenda W J H Penninx
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ina Rissanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Annelieke M Roest
- Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
| | - Judith G M Rosmalen
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Maasstad, Rotterdam, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - David Soave
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Canada
| | - Mandy Spaan
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
- Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik R Sund
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Norway
- Levanger hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ellen Sweeney
- Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emma L Twait
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Alison Teyhan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kimberly D van der Willik
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
- Department of General Practice, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Personalized Medicine, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam, The Netherlands
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Vreijling SR, Neuhaus L, Brouwer A, Penninx BWJH, Beekman ATF, Lamers F, Jansen R, Bremmer M. The role of immuno-metabolic depression features in the effects of light therapy in patients with depression and type 2 diabetes mellitus: A randomized controlled trial. J Psychosom Res 2024; 181:111671. [PMID: 38657564 DOI: 10.1016/j.jpsychores.2024.111671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/22/2024] [Accepted: 04/13/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Immuno-metabolic depression (IMD) is proposed to be a form of depression encompassing atypical, energy-related symptoms (AES), low-grade inflammation and metabolic dysregulations. Light therapy may alleviate AES by modulating inflammatory and metabolic pathways. We investigated whether light therapy improves clinical and biological IMD features and whether effects of light therapy on AES or depressive symptom severity are moderated by baseline IMD features. Associations between changes in symptoms and biomarkers were explored. METHODS In secondary analyses, clinical trial data was used from 77 individuals with depression and type 2 diabetes mellitus (T2DM) randomized to four weeks of light therapy or placebo. AES severity and depressive symptom severity were based on the Inventory of Depressive Symptomatology. Biomarkers included 73 metabolites (Nightingale) summarized in three principal components and CRP, IL-6, TNF-α, INF-γ. Linear regression analyses were performed. RESULTS Light therapy had no effect on AES severity, inflammatory markers and metabolite principle components versus placebo. None of these baseline features moderated the effects of light therapy on AES severity. Only a principle component reflecting metabolites implicated in glucose homeostasis moderated the effects of light therapy on depressive symptom severity (βinteraction = 0.65, P = 0.001, FDR = 0.003). Changes in AES were not associated with changes in biomarkers. CONCLUSION Findings do not support the efficacy of light therapy in reducing IMD features in patients with depression and T2DM. We find limited evidence that light therapy is a more beneficial depression treatment among those with more IMD features. Changes in clinical and biological IMD features did not align over four-weeks' time. TRIAL REGISTRATION The Netherlands Trial Register (NTR) NTR4942.
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Affiliation(s)
- Sarah R Vreijling
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Layla Neuhaus
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands
| | - Annelies Brouwer
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Brenda W J H Penninx
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands
| | - Femke Lamers
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Rick Jansen
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands
| | - Marijke Bremmer
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life Program, Amsterdam, the Netherlands
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Barakat A, Cornelis JE, Dekker JJM, Lommerse NM, Beekman ATF, Blankers M. Economic evaluation of intensive home treatment in comparison to care as usual alongside a randomised controlled trial. Eur J Health Econ 2024:10.1007/s10198-024-01675-1. [PMID: 38598073 DOI: 10.1007/s10198-024-01675-1] [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] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/18/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND There is a dearth of research on the cost-effectiveness of intensive home treatment (IHT), an alternative to psychiatric hospitalisation for patients experiencing psychiatric crises. We therefore present a health economic evaluation alongside a pre-randomised controlled trial of IHT compared to care as usual (CAU). METHOD Patients were pre-randomised to IHT or CAU using a double-consent open-label Zelen design. For the cost-utility analysis, the EuroQol 5-dimensional instrument was used. The cost-effectiveness was assessed using the Brief Psychiatric Rating Scale (BPRS). RESULTS Data of 198 patients showed that each additional QALY gained from offering IHT instead of CAU was on average associated with an extra cost of €48,003. There is a 38% likelihood that IHT will lead to more QALYs at lower costs compared to CAU. An improvement of one additional point on the BPRS by offering IHT instead of CAU was associated with an extra cost of €19,203. There is a 38% likelihood that IHT will lead to higher BPRS score improvements at lower costs. Based on the NICE willingness-to-pay threshold of £30,000 (€35,000) per QALY, IHT could potentially be considered cost-effective with a likelihood of 55-60% when viewed from a societal perspective, and > 75% from a health care perspective. CONCLUSIONS IHT appears slightly more attractive in terms of cost-utility and cost-effectiveness than CAU, although differences in both costs and effects are small especially when viewed from the societal costs perspective. From the health care sector costs perspective, IHT has a higher probability of being cost-effective compared to CAU. TRIALS REGISTRATION Netherlands Trial Register: NTR6151.
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Affiliation(s)
- Ansam Barakat
- Department of Psychiatry Amsterdam UMC/VUmc, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, The Netherlands.
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands.
| | - Jurgen E Cornelis
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Department of Emergency Psychiatry, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
| | - Jack J M Dekker
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nick M Lommerse
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry Amsterdam UMC/VUmc, Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ InGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin Institute for Mental Health Care, Amsterdam, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
- Department of Psychiatry Amsterdam UMC/AMC , Amsterdam Public Health research institute Amsterdam UMC, Amsterdam, The Netherlands
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de Jong M, Wynchank DSMR, Michielsen M, Beekman ATF, Kooij JJS. A Female-Specific Treatment Group for ADHD-Description of the Programme and Qualitative Analysis of First Experiences. J Clin Med 2024; 13:2106. [PMID: 38610871 PMCID: PMC11012758 DOI: 10.3390/jcm13072106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The diagnostics and treatment of attention-deficit/hyperactivity disorder (ADHD) in women remain insufficient. Fluctuations of reproductive hormones during the premenstrual period, postpartum period, and (peri)menopause are neglected, even though they impact ADHD symptoms and associated mood disorders. Therefore, we created a female-specific treatment group for women with ADHD and premenstrual worsening of ADHD and/or mood symptoms. Methods: We describe the group programme and underlying rationale, offering a qualitative analysis of the participants' evaluation. Results: The seven bi-weekly sessions foreground the menstrual cycle and address several ADHD-specific topics in relation to this cyclical pattern. Concurrently, women track their menstrual cycle and (fluctuating) ADHD and mood symptoms with an adjusted premenstrual calendar. In total, 18 women (25-47 years) participated in three consecutive groups. We analysed the evaluation of the last group. Participants experienced the group as a safe and welcoming space. Recognition was valued by all. The topics discussed were deemed valuable, and the structure suited them well. Completing the premenstrual calendar augmented the awareness and recognition of individual cyclical symptoms. A lifespan approach increased self-understanding. Participants took their menstrual cycle more seriously, prioritising self-acceptance and self-care. Conclusions: Exploring a cyclical approach in a group setting seems to be a positive addition to treatment for female ADHD.
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Affiliation(s)
- M de Jong
- Expertise Centre Adult ADHD, PsyQ, 2593 HR The Hague, The Netherlands
- Department of Psychiatry, AmsterdamUMC/VUmc, 1081 HJ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU Medical Centre, 1081 HV Amsterdam, The Netherlands
| | - D S M R Wynchank
- Expertise Centre Adult ADHD, PsyQ, 2593 HR The Hague, The Netherlands
| | - M Michielsen
- Expertise Centre Adult ADHD, PsyQ, 2593 HR The Hague, The Netherlands
- Antes Older Adults Outpatient Treatment, 3079 DZ Rotterdam, The Netherlands
| | - A T F Beekman
- Department of Psychiatry, AmsterdamUMC/VUmc, 1081 HJ Amsterdam, The Netherlands
- GGZ inGeest, 1062 NP Amsterdam, The Netherlands
| | - J J S Kooij
- Expertise Centre Adult ADHD, PsyQ, 2593 HR The Hague, The Netherlands
- Department of Psychiatry, AmsterdamUMC/VUmc, 1081 HJ Amsterdam, The Netherlands
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6
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Michielsen M, Böhmer MN, Vermeulen RCH, Vlaanderen JJ, Beekman ATF, Kooij JJS. ADHD, sleep, chronotype and health in a large cohort of Dutch nurses. J Psychiatr Res 2024; 174:159-164. [PMID: 38636152 DOI: 10.1016/j.jpsychires.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/05/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Affiliation(s)
- M Michielsen
- PsyQ, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR, The Hague, the Netherlands.
| | - M N Böhmer
- PsyQ, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR, The Hague, the Netherlands
| | - R C H Vermeulen
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Jenalaan 18d, 3584 CK, Utrecht, Utrecht, the Netherlands
| | - J J Vlaanderen
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Jenalaan 18d, 3584 CK, Utrecht, Utrecht, the Netherlands
| | - A T F Beekman
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center/VUmc, Oldenaller 1, 1081 HL, Amsterdam, the Netherlands
| | - J J S Kooij
- PsyQ, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR, The Hague, the Netherlands; Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center/VUmc, Oldenaller 1, 1081 HL, Amsterdam, the Netherlands
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7
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Dekker J, Doppenberg-Smit E, Braamse A, Lamers F, van Linde M, Verheul HMW, Sprangers M, Beekman ATF. Toward an improved conceptualization of emotions in patients with cancer. Front Psychiatry 2024; 15:1352026. [PMID: 38600981 PMCID: PMC11004313 DOI: 10.3389/fpsyt.2024.1352026] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Cancer and its associated treatment is a major stressor, leading to emotions such as anxiety or depressive mood. Human emotions have developed through the course of evolution because they facilitate adaptation to important events, such as cancer and its associated treatment. On the other hand, emotions can be maladaptive and interfere with adaptation to cancer. Emotions are maladaptive if they are disproportionally severe or persistent, and if they interfere with functioning. We aim to expand the conceptualization of adaptive and maladaptive emotions in patients with cancer. We draw on major theories in the field of mental disorder and mental health, and apply these theories to conceptualize adaptive and maladaptive emotions in patients with cancer. (i) Maladaptive emotions have two essential features: mental dysfunction and patient harm. Maladaptive emotions are characterized by a network of strongly associated emotional symptoms, which may include cancer-related somatic symptoms. The dysfunctional symptom network is hypothesized to be the result of disturbance of life goal pursuit caused by cancer. (ii) Adaptive emotions have two essential features: ability to deal with cancer and functioning well. The ability to use emotions in an adaptive way depends on skills to recognize, express, and regulate emotions in a flexible manner. A secure attachment style facilitates adaptive emotional responses to cancer. The present conceptualization of adaptive and maladaptive emotions is expected to contribute to better understanding and management of emotions in patients with cancer.
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Affiliation(s)
- Joost Dekker
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, Netherlands
| | - Elise Doppenberg-Smit
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, Netherlands
| | - Annemarie Braamse
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, Netherlands
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Femke Lamers
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, Netherlands
| | - Myra van Linde
- Department of Medical Oncology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Henk M. W. Verheul
- Department of Medical Oncology, Erasmus University Rotterdam, Erasmus Medical Center Cancer Institute, Rotterdam, Netherlands
| | - Mirjam Sprangers
- Amsterdam Public Health, Mental Health Program, Amsterdam, Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, Netherlands
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Aartjan T. F. Beekman
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, Netherlands
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8
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Doppenberg-Smit GE, Lamers F, van Linde ME, Braamse AMJ, Sprangers MAG, Beekman ATF, Verheul HMW, Dekker J. Network analysis used to investigate the interplay among somatic and psychological symptoms in patients with cancer and cancer survivors: a scoping review. J Cancer Surviv 2024:10.1007/s11764-024-01543-0. [PMID: 38530627 DOI: 10.1007/s11764-024-01543-0] [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] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/22/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE Patients with cancer often experience multiple somatic and psychological symptoms. Somatic and psychological symptoms are thought to be connected and may reinforce each other. Network analysis allows examination of the interconnectedness of individual symptoms. The aim of this scoping review was to examine the current state of knowledge about the associations between somatic and psychological symptoms in patients with cancer and cancer survivors, based on network analysis. METHODS This scoping review followed the five-stage framework of Arksey and O'Malley. The literature search was conducted in May, 2023 in PubMed, APA PsycINFO, Embase Cochrane central, and CINAHL databases. RESULTS Thirty-two studies were included, with eleven using longitudinal data. Seventeen studies reported on the strength of the associations: somatic and psychological symptoms were associated, although associations among somatic as well as among psychological symptoms were stronger. Other findings were the association between somatic and psychological symptoms was stronger in patients experiencing more severe symptoms; associations between symptoms over time remained rather stable; and different symptoms were central in the networks, with fatigue being among the most central in half of the studies. IMPLICATIONS FOR CANCER SURVIVORS Although the associations among somatic symptoms and among psychological symptoms were stronger, somatic and psychological symptoms were associated, especially in patients experiencing more severe symptoms. Fatigue was among the most central symptoms, bridging the somatic and psychological domain. These findings as well as future research based on network analysis may help to untangle the complex interplay of somatic and psychological symptoms in patients with cancer.
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Affiliation(s)
- G Elise Doppenberg-Smit
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands.
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands.
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
| | - Femke Lamers
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Myra E van Linde
- Department of Medical Oncology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Annemarie M J Braamse
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Medical Psychology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Mirjam A G Sprangers
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Medical Psychology, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, Erasmus MC, Dr. Molewaterplein 40, Rotterdam, the Netherlands
| | - Joost Dekker
- Department of Psychiatry, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
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9
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Vreijling SR, Chin Fatt CR, Williams LM, Schatzberg AF, Usherwood T, Nemeroff CB, Rush AJ, Uher R, Aitchison KJ, Köhler-Forsberg O, Rietschel M, Trivedi MH, Jha MK, Penninx BWJH, Beekman ATF, Jansen R, Lamers F. Features of immunometabolic depression as predictors of antidepressant treatment outcomes: pooled analysis of four clinical trials. Br J Psychiatry 2024; 224:89-97. [PMID: 38130122 PMCID: PMC10884825 DOI: 10.1192/bjp.2023.148] [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] [Received: 04/26/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Profiling patients on a proposed 'immunometabolic depression' (IMD) dimension, described as a cluster of atypical depressive symptoms related to energy regulation and immunometabolic dysregulations, may optimise personalised treatment. AIMS To test the hypothesis that baseline IMD features predict poorer treatment outcomes with antidepressants. METHOD Data on 2551 individuals with depression across the iSPOT-D (n = 967), CO-MED (n = 665), GENDEP (n = 773) and EMBARC (n = 146) clinical trials were used. Predictors included baseline severity of atypical energy-related symptoms (AES), body mass index (BMI) and C-reactive protein levels (CRP, three trials only) separately and aggregated into an IMD index. Mixed models on the primary outcome (change in depressive symptom severity) and logistic regressions on secondary outcomes (response and remission) were conducted for the individual trial data-sets and pooled using random-effects meta-analyses. RESULTS Although AES severity and BMI did not predict changes in depressive symptom severity, higher baseline CRP predicted smaller reductions in depressive symptoms (n = 376, βpooled = 0.06, P = 0.049, 95% CI 0.0001-0.12, I2 = 3.61%); this was also found for an IMD index combining these features (n = 372, βpooled = 0.12, s.e. = 0.12, P = 0.031, 95% CI 0.01-0.22, I2= 23.91%), with a higher - but still small - effect size compared with CRP. Confining analyses to selective serotonin reuptake inhibitor users indicated larger effects of CRP (βpooled = 0.16) and the IMD index (βpooled = 0.20). Baseline IMD features, both separately and combined, did not predict response or remission. CONCLUSIONS Depressive symptoms of people with more IMD features improved less when treated with antidepressants. However, clinical relevance is limited owing to small effect sizes in inconsistent associations. Whether these patients would benefit more from treatments targeting immunometabolic pathways remains to be investigated.
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Affiliation(s)
- Sarah R. Vreijling
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; and Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Cherise R. Chin Fatt
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Leanne M. Williams
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Alan F. Schatzberg
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford University, Stanford, California, USA
| | - Tim Usherwood
- Department of General Practice, Westmead Clinical School, University of Sydney, Sydney, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; and George Institute for Global Health, Sydney, Australia
| | - Charles B. Nemeroff
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, Texas, USA
| | - A. John Rush
- Department of Psychiatry and Behavioral Health, Duke School of Medicine, Durham, North Carolina, USA; and Duke-National University of Singapore, Singapore, Singapore
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Katherine J. Aitchison
- Departments of Psychiatry & Medical Genetics, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada; and Women and Children's Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark; and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Madhukar H. Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Manish K. Jha
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brenda W. J. H. Penninx
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands; and Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Aartjan T. F. Beekman
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands; and Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Rick Jansen
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; and Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Femke Lamers
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; and Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands
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Abstract
OBJECTIVE The course over time of religious delusions (RDs) in late-life schizophrenia and psychotic depression may be relevant to know how long certain aspects of RDs may affect treatment. The present study examines (1) the 1-year follow-up of RDs and other prevalent delusions, (2) the association between RDs and the clinical course of psychotic depression and schizophrenia compared to those without RDs, and (3) associations of RDs and other prevalent delusions with "indicators of complexity" (e.g., suicidality, refusing medication). DESIGN Prospective study (half year and 1-year follow-up combined). SETTING Outpatients and inpatients in Geriatric Psychiatry Institution of Yulius, South-Holland, the Netherlands. PARTICIPANTS One hundred and thirty seven older adult patients, mean age 76.3 (s.d. 8.1). INTERVENTION Natural follow-up study. MEASUREMENTS Diagnostic interview measures included Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1), positive psychosis items of the Community Assessment of Psychic Experiences-42 (CAPE), and the 20-item measures from the Centre for Epidemiologic Studies Depression Scale (CES-D). RESULTS Although RDs in older adults decline in the clinical course of psychotic depression, the course is unfavorable compared to psychotic depression without RDs with regard to depressive symptom severity as measured by CES-D. No significant differences were noted in relation to clinical course of positive psychotic symptoms for both psychotic depression and schizophrenia. In schizophrenia, RDs persist more frequently compared to the most prevalent delusions. No significant difference was observed between patients with RDs compared to patients without RDs regarding indicators of clinical complexity. CONCLUSIONS RDs predicting a less favorable course over time in psychotic depression. In schizophrenia, RDs appears to be relatively pervasive.
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Affiliation(s)
- Annemarie Noort
- Independent Practice for Psychiatry, Centre for Geriatric Psychiatry, Utrecht, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arjan W Braam
- Department of Emergency Psychiatry and Department of Residency Training, Altrecht Mental Health Care, Utrecht, The Netherlands
- Department of Humanist Chaplaincy Studies for a Plural Society, University of Humanistic Studies, Utrecht, The Netherlands
| | - Jan C J M Koolen
- Department of Forensic Addiction Care, Novadic-Kentron, Den Bosch, The Netherlands
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11
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van Andel E, Bijlenga D, Vogel SWN, Beekman ATF, Kooij JJS. Cardiovascular risk in adults with Delayed Sleep Phase Syndrome (DSPS) and Attention-Deficit/Hyperactivity Disorder (ADHD). Chronobiol Int 2023; 40:1566-1573. [PMID: 38017699 DOI: 10.1080/07420528.2023.2287058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 11/19/2023] [Indexed: 11/30/2023]
Abstract
TRIAL REGISTRATION FASE, https://www.trialregister.nl/, #NTR3831.
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Affiliation(s)
- Emma van Andel
- PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands
| | - Denise Bijlenga
- PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands
- Sleep-Wake Center SEIN, Heemstede, The Netherlands
- Neurology, Leiden UMC, Leiden, The Netherlands
| | - Suzan W N Vogel
- PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands
| | - Aartjan T F Beekman
- Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - J J Sandra Kooij
- PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands
- Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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12
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Beekman ATF. How Do Older People Fare in Times of Violence and Social Unrest? Am J Geriatr Psychiatry 2023; 31:1100-1101. [PMID: 37481401 DOI: 10.1016/j.jagp.2023.06.010] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/24/2023]
Affiliation(s)
- Aartjan T F Beekman
- Department of Psychiatry, Vrije Universiteit and Amsterdam University Medical Center, Amsterdam, Netherlands.
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Knapen S, Swildens WE, Mensink W, Hoogendoorn A, Hutsebaut J, Beekman ATF. The development and psychometric evaluation of the Questionnaire Epistemic Trust (QET): A self-report assessment of epistemic trust. Clin Psychol Psychother 2023. [PMID: 37947067 DOI: 10.1002/cpp.2930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
Epistemic trust (ET) refers to the predisposition to trust information as authentic, trustworthy and relevant to the self. Epistemic distrust - resulting from early adversity - may interfere with openness to social learning within the therapeutic encounter, reducing the ability to benefit from treatment. The self-report Questionnaire Epistemic Trust (QET) is a newly developed instrument that aims to assess ET. This study presents the first results on the psychometric properties of the QET in both a community and a clinical sample. Our findings indicate that the QET is composed of four meaningful subscales with good to excellent internal consistency. The QET shows relevant associations with related constructs like personality functioning, symptom distress and quality of life. QET scores clearly distinguish between a clinical and community sample and are associated with the quality of the therapeutic alliance. The QET provides a promising, brief and user-friendly instrument that could be used for a range of clinical and research purposes. Future studies with larger samples are needed to strengthen construct validity and to investigate the value of the QET to predict differential treatment responses or to study mechanisms of change.
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Affiliation(s)
- Saskia Knapen
- Altrecht Mental Health Care, Utrecht, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wilma E Swildens
- Altrecht Mental Health Care, Utrecht, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Wendy Mensink
- Altrecht Mental Health Care, Utrecht, The Netherlands
| | - Adriaan Hoogendoorn
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Joost Hutsebaut
- Tilburg University and Viersprong Institute for the Study on Personality Disorders, Halsteren, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
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14
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van den End A, Beekman ATF, Dekker J, Thomaes K. Self-rated personality disorder symptoms do not predict treatment outcome for posttraumatic stress disorder in routine clinical care. Clin Psychol Psychother 2023; 30:1338-1348. [PMID: 37985013 DOI: 10.1002/cpp.2933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To test the hypothesis that self-rated personality disorder (PD) symptoms are a significant and clinically relevant predictor of treatment outcomes in a naturalistic treatment setting specialized in trauma-focused treatment using a single-group pretest-posttest design. METHOD Treatment-seeking patients reporting clinical levels of posttraumatic stress disorder (PTSD) symptoms filled out questionnaires at intake and after treatment. The primary outcome was change in PTSD severity after treatment, measured by the PTSD Checklist for DSM-5 (PCL-5). PD symptoms were measured with the Structured Clinical Interview for DSM-5 Screening Personality Questionnaire (SCID-5-SPQ). Secondary outcomes were general mental health problems, treatment response, number of sessions and dropout. RESULTS N = 1174 patients (59% female, baseline PCL-5 score M [SD] = 53.0 [10.8]) were included for the primary analysis. Regression analysis revealed that PD symptoms explained 0.4% of variance in PTSD symptom change (p = .066). After controlling for baseline PTSD symptoms, PD symptoms explained 0.0% of variance (p = .311). The fully adjusted model including baseline PTSD symptom severity, age, gender, cumulative exposure to potentially traumatic experiences, PD symptoms, and number of sessions together explained 5% of the observed variance in PTSD symptom change. Baseline PTSD severity was the only significant predictor and negatively predicted outcome. Sensitivity analyses with imputed data from N = 2694 cases yielded comparable results. Finally, secondary analyses showed that PD symptoms did not predict significant or clinically relevant changes in treatment response status, general mental health problems, dropout rates or number of sessions. CONCLUSION The findings provide no evidence that self-rated PD symptoms predict treatment outcomes for patients suffering from clinical levels of PTSD symptoms in a naturalistic treatment setting specializing in trauma-focused treatment. Self-report screening for these symptoms to inform clinicians about expected effects of PTSD treatment is not supported by the evidence.
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Affiliation(s)
- Arne van den End
- Department of Psychiatry, Amsterdam University Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Sinai Center, Amstelveen, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Jack Dekker
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
- Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Kathleen Thomaes
- Department of Psychiatry, Amsterdam University Medical Center, Location Vrije Universiteit Medical Center, Amsterdam, The Netherlands
- Sinai Center, Amstelveen, The Netherlands
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
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15
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Feenstra TC, la Cruz EKJ, Obbels J, Laroy M, Bouckaert F, Sienaert P, Oudega M, Dols A, van Exel E, Beekman ATF, Rhebergen D. The Cortisol Awakening Response as a Biomarker for Cognitive Side-Effects of Electroconvulsive Therapy. Am J Geriatr Psychiatry 2023; 31:991-995. [PMID: 37479670 DOI: 10.1016/j.jagp.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE To test whether the cortisol awakening response (CAR) could be a biomarker for cognitive decline during electroconvulsive therapy (ECT). METHODS We studied 50 older patients with depression who were treated with ECT from the MODECT cohort. We used linear regression analyses to examine the association between CAR and cognitive change, assessed by the change in Mini Mental State Examination scores between baseline and 1 week after ECT course. CAR was assessed by the area under the curve of cortisol levels, according to Pruessner's-formula. Associations were adjusted for putative confounders, based on previous literature and availability. RESULTS We found no significant associations between the CAR and cognitive change during the ECT course in (un)adjusted models. CONCLUSION Our results indicate that the CAR is not usable as a biomarker for ECT-induced cognitive decline during ECT course. Further research in cohorts with larger samples is needed.
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Affiliation(s)
- Thomas C Feenstra
- GGZ Centraal Mental Health Care (TCF, EKJLC, DR), Amersfoort, The Netherlands; Amsterdam Public Health Research Institute, Mental Health Program (TCF, ATFB, DR), Amsterdam, The Netherlands.
| | - Eldon K J la Cruz
- GGZ Centraal Mental Health Care (TCF, EKJLC, DR), Amersfoort, The Netherlands
| | - Jasmien Obbels
- Department of Neurosciences (JO, ML, FB, PS), Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Maarten Laroy
- Department of Neurosciences (JO, ML, FB, PS), Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Filip Bouckaert
- Department of Neurosciences (JO, ML, FB, PS), Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium; Department of Geriatric Psychiatry (FB), KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Pascal Sienaert
- Department of Neurosciences (JO, ML, FB, PS), Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Mardien Oudega
- Department of Psychiatry (MO, AD, ATFB, DR), Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; GGZ inGeest Mental Health Care (MO, EVE, ATFB), Amsterdam, The Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program (MO, AD, EVE), Amsterdam, The Netherlands
| | - Annemieke Dols
- Department of Psychiatry (AD), University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Psychiatry (MO, AD, ATFB, DR), Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program (MO, AD, EVE), Amsterdam, The Netherlands
| | - Eric van Exel
- GGZ inGeest Mental Health Care (MO, EVE, ATFB), Amsterdam, The Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program (MO, AD, EVE), Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Amsterdam Public Health Research Institute, Mental Health Program (TCF, ATFB, DR), Amsterdam, The Netherlands; Department of Psychiatry (MO, AD, ATFB, DR), Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; GGZ inGeest Mental Health Care (MO, EVE, ATFB), Amsterdam, The Netherlands
| | - Didi Rhebergen
- GGZ Centraal Mental Health Care (TCF, EKJLC, DR), Amersfoort, The Netherlands; Amsterdam Public Health Research Institute, Mental Health Program (TCF, ATFB, DR), Amsterdam, The Netherlands; Department of Psychiatry (MO, AD, ATFB, DR), Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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16
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van Tuijl LA, Basten M, Pan KY, Vermeulen R, Portengen L, de Graeff A, Dekker J, Geerlings MI, Hoogendoorn A, Lamers F, Voogd AC, Abell J, Awadalla P, Beekman ATF, Bjerkeset O, Boyd A, Cui Y, Frank P, Galenkamp H, Garssen B, Hellingman S, Huisman M, Huss A, de Jong TR, Keats MR, Kok AAL, Krokstad S, van Leeuwen FE, Luik AI, Noisel N, Onland-Moret NC, Payette Y, Penninx BWJH, Rissanen I, Roest AM, Ruiter R, Schoevers RA, Soave D, Spaan M, Steptoe A, Stronks K, Sund ER, Sweeney E, Twait EL, Teyhan A, Verschuren WMM, van der Willik KD, Rosmalen JGM, Ranchor AV. Depression, anxiety, and the risk of cancer: An individual participant data meta-analysis. Cancer 2023; 129:3287-3299. [PMID: 37545248 DOI: 10.1002/cncr.34853] [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] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/16/2023] [Accepted: 04/07/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Depression and anxiety have long been hypothesized to be related to an increased cancer risk. Despite the great amount of research that has been conducted, findings are inconclusive. To provide a stronger basis for addressing the associations between depression, anxiety, and the incidence of various cancer types (overall, breast, lung, prostate, colorectal, alcohol-related, and smoking-related cancers), individual participant data (IPD) meta-analyses were performed within the Psychosocial Factors and Cancer Incidence (PSY-CA) consortium. METHODS The PSY-CA consortium includes data from 18 cohorts with measures of depression or anxiety (up to N = 319,613; cancer incidences, 25,803; person-years of follow-up, 3,254,714). Both symptoms and a diagnosis of depression and anxiety were examined as predictors of future cancer risk. Two-stage IPD meta-analyses were run, first by using Cox regression models in each cohort (stage 1), and then by aggregating the results in random-effects meta-analyses (stage 2). RESULTS No associations were found between depression or anxiety and overall, breast, prostate, colorectal, and alcohol-related cancers. Depression and anxiety (symptoms and diagnoses) were associated with the incidence of lung cancer and smoking-related cancers (hazard ratios [HRs], 1.06-1.60). However, these associations were substantially attenuated when additionally adjusting for known risk factors including smoking, alcohol use, and body mass index (HRs, 1.04-1.23). CONCLUSIONS Depression and anxiety are not related to increased risk for most cancer outcomes, except for lung and smoking-related cancers. This study shows that key covariates are likely to explain the relationship between depression, anxiety, and lung and smoking-related cancers. PREREGISTRATION NUMBER: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=157677.
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Affiliation(s)
- Lonneke A van Tuijl
- Health Psychology Section, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Maartje Basten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Kuan-Yu Pan
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, the Netherlands
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost Dekker
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Aging & Later Life and Personalized Medicine, Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Neurodegeneration and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Adriaan Hoogendoorn
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Femke Lamers
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Jessica Abell
- Department of Behavioural Science and Health, University College London, London, UK
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andy Boyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yunsong Cui
- Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Philipp Frank
- Department of Behavioural Science and Health, University College London, London, UK
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Bert Garssen
- Health Psychology Section, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sean Hellingman
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Martijn Huisman
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | | | - Melanie R Keats
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Almar A L Kok
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Steinar Krokstad
- Department of Public Health and Nursing, Trøndelag Health Study Research Centre, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | | | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Yves Payette
- CARTaGENE, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ina Rissanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Annelieke M Roest
- Department of Developmental Psychology, University of Groningen, Groningen, the Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Maasstad, Rotterdam, the Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - David Soave
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Mandy Spaan
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Erik R Sund
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Department of Public Health and Nursing, Trøndelag Health Study Research Centre, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ellen Sweeney
- Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emma L Twait
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Aging & Later Life and Personalized Medicine, Amsterdam Public Health, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alison Teyhan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Utrecht Bilthoven, the Netherlands
| | - Kimberly D van der Willik
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands
| | - Judith G M Rosmalen
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Adelita V Ranchor
- Health Psychology Section, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Vreijling SR, Penninx BWJH, Beekman ATF, Jansen R, Lamers F. The MooDFOOD randomized controlled trial: the data and its implications for the theory - Authors' reply. Psychol Med 2023; 53:5884-5885. [PMID: 37264832 DOI: 10.1017/s0033291723001484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Sarah R Vreijling
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress program, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress program, Amsterdam, The Netherlands
| | - Rick Jansen
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress program, Amsterdam, The Netherlands
| | - Femke Lamers
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
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18
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van der Burgt MCA, Mérelle S, Beekman ATF, Gilissen R. The Impact of COVID-19 on the Suicide Prevention Helpline in The Netherlands. Crisis 2023; 44:285-291. [PMID: 35723060 PMCID: PMC10448893 DOI: 10.1027/0227-5910/a000863] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 11/23/2022]
Abstract
Background: Although the number of suicides did not increase in 2020, there are concerns about the mental health consequences of the COVID-19 pandemic. Aims: To present the demand for the Dutch suicide prevention helpline during times of lockdown and to describe the coronavirus-related problems discussed. Methods: An observational and exploratory study analyzing the frequency of helpline requests and registration data (n = 893 conversations). Results: Demand for the helpline did increase, but with no distinctive relation with the lockdown measures. During the first lockdown, approximately a quarter of the analyzed helpline conversations were registered as coronavirus-related by the counselors. Most frequently mentioned conversation topics were the interruption to or changes in professional help, social isolation and loss of structure, and ways to find a distraction from suicidal thoughts/rumination. Limitations: Observational study design prevents causal inferences, and demand for the helpline is impacted by multiple factors. Conclusion: These coronavirus-related problems made help-seekers vulnerable to suicidal thoughts and a reduced desire to live. That many suffered from loneliness is concerning as this contributes to the risk of suicidal ideation. The distress among help-seekers due to the sudden loss of mental health care underscores the importance of maintaining contact with those in care and lowering the threshold for help.
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Affiliation(s)
- Margot C. A. van der Burgt
- Department of Research, 113 Suicide Prevention, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers/VUmc, The Netherlands
| | - Saskia Mérelle
- Department of Research, 113 Suicide Prevention, The Netherlands
| | - Aartjan T. F. Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers/VUmc, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Renske Gilissen
- Department of Research, 113 Suicide Prevention, The Netherlands
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19
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van Zutphen EM, Kok AAL, Muller M, Oude Voshaar RC, Rhebergen D, Huisman M, Beekman ATF. Cardiovascular risk indicators among depressed persons: A special case? J Affect Disord 2023; 329:335-342. [PMID: 36842656 DOI: 10.1016/j.jad.2023.02.092] [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: 09/17/2022] [Revised: 02/08/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Traditional cardiovascular risk indicators only partially explain cardiovascular risks in depressed persons. Depressed persons may exhibit a profile of cardiovascular risk indicators that goes beyond traditional cardiovascular risk indicators, such as symptom severity, insomnia, loneliness and neuroticism, yet research on the added value of these depression-related characteristics in predicting cardiovascular risks of depressed persons is scarce. METHODS Data from N = 1028 depressed Dutch adults without prevalent CVD were derived from two longitudinal depression cohort studies. The outcome was medication-confirmed self-reported CVD. Fifteen depression-related clinical and psychological characteristics were included and tested against traditional cardiovascular risk indicators. Data were analysed using Cox regression models. Incremental values of these characteristics were calculated using c-statistics. RESULTS After a median follow-up of 65.3 months, 12.7% of the participants developed CVD. Only anxiety and depressive symptom severity were associated with incident CVD beyond traditional cardiovascular risk indicators. The c-statistic of the model with traditional cardiovascular risk indicators was 85.47%. This increased with 0.56 or 0.33 percentage points after inclusion of anxiety or depression severity, respectively. LIMITATIONS Other relevant depression-related characteristics were not available in the datasets used. CONCLUSION Anxiety and depressive symptom severity were indicative of an increased cardiovascular risk. Including these as additional risk indicators barely improved the ability to assess cardiovascular risks in depressed persons. Although traditional cardiovascular risk indicators performed well in depressed persons, existing risk prediction algorithms need to be validated in depressed persons.
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Affiliation(s)
- Elisabeth M van Zutphen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands.
| | - Almar A L Kok
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands
| | - Majon Muller
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Internal Medicine - Geriatrics, De Boelelaan 1117, Amsterdam, Netherlands; Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Richard C Oude Voshaar
- University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Didi Rhebergen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Mental Health Care Institute GGZ Centraal, Amersfoort, the Netherlands
| | - Martijn Huisman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands; Department of Sociology, VU University, Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands
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20
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van der Burgt MCA, Mérelle S, Brinkman WP, Beekman ATF, Gilissen R. Breaking Down Barriers to a Suicide Prevention Helpline: Protocol for a Web-Based Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e41078. [PMID: 37093641 PMCID: PMC10167578 DOI: 10.2196/41078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Globally, suicide is among the leading causes of death, with men being more at risk to die from suicide than women. Research suggests that people with suicidal ideation often struggle to find adequate help. Every month, around 4000 people fill in the anonymous self-test for suicidal thoughts on the website of the Dutch suicide prevention helpline. This self-test includes the Suicidal Ideation Attributes Scale (SIDAS), which educates users about the severity of their suicidal thoughts. The vast majority (70%) of people who complete the self-test score higher than the cutoff point (≥21) for severe suicidal thoughts. Unfortunately, despite this, less than 10% of test-takers navigate to the web page about contacting the helpline. OBJECTIVE This protocol presents the design of a web-based randomized controlled trial that aims to reduce barriers to contacting the suicide prevention helpline. The aim of this study is 2-fold: (1) to measure the effectiveness of a brief barrier reduction intervention (BRI) provided in the self-test motivating people with severe suicidal thoughts to contact the Dutch suicide prevention helpline and (2) to specifically evaluate the effectiveness of the BRI in increasing service use by high-risk groups for suicide such as men and middle-aged people. METHODS People visiting the self-test for suicidal thoughts on the website of the suicide prevention helpline will be asked to participate in a study to improve the self-test. Individuals with severe suicidal thoughts and little motivation to contact the helpline will be randomly allocated either to a brief BRI, in which they will receive a short tailored message based on their self-reported barrier to the helpline (n=388) or care as usual (general advisory text, n=388). The primary outcome measure is the use of a direct link to contact the helpline after receiving the intervention or control condition. Secondary outcomes are the self-reported likelihood of contacting the helpline (on a 5-point scale) and satisfaction with the self-test. In the BRI, participants receive tailored information to address underlying concerns and misconceptions of barriers to the helpline. A pilot study was conducted among current test-takers to identify these specific barriers. RESULTS The pilot study (N=1083) revealed multiple barriers to contacting the helpline. The most prominent were the belief that a conversation with a counselor would not be effective, fear of the conversation itself, and emotional concerns about talking about suicidal thoughts. CONCLUSIONS Our study will provide insight into the effectiveness of a brief BRI designed to increase the use of a suicide prevention helpline provided in a self-test on suicidal thoughts. If successful, this intervention has the potential to be a low-cost, easily scalable, and feasible method to increase service use for helplines across the world. TRIAL REGISTRATION ClinicalTrials.gov NCT05458830; https://clinicaltrials.gov/ct2/show/NCT05458830. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/41078.
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Affiliation(s)
- Margot C A van der Burgt
- Department of Research, 113 Suicide Prevention, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Saskia Mérelle
- Department of Research, 113 Suicide Prevention, Amsterdam, Netherlands
| | - Willem-Paul Brinkman
- Department of Intelligent Systems, Delft University of Technology, Delft, Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Renske Gilissen
- Department of Research, 113 Suicide Prevention, Amsterdam, Netherlands
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21
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Elzinga E, de Beurs DP, Beekman ATF, Maarsingh OR, Gilissen R. Nudging General Practitioners to explore suicidal thoughts among depressed patients. BMC Prim Care 2023; 24:88. [PMID: 37005569 PMCID: PMC10067310 DOI: 10.1186/s12875-023-02043-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/22/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND While frank discussion of suicidal thoughts in patients with depression is important for the prevention of suicide, suicide exploration of General Practitioners (GPs) is suboptimal. This study aimed to assess whether an intervention that prompts pop-up screens nudges GPs to more frequently explore suicidal thoughts over the course of two years. METHODS From January 2017 to December 2018, the intervention was incorporated in the information system of the Dutch general practice sentinel network. New registration of an episode of depression triggered a pop-up screen referring to a questionnaire about GPs' behaviour with regard to exploring suicidal thoughts. In two years, 625 questionnaires were completed by GPs and analysed using multilevel logistic regression analyses. RESULTS Compared to the first year, GPs were 50% more likely to explore suicidal thoughts among patients in the second year (OR 1.48; 95%CI 1.01-2.16). When adjusting for patients' gender and age we found that the effect of the pop-up screens disappeared (OR 1.33; 95% CI 0.90-1.97). Suicide exploration occurred less frequently in women than in men (OR 0.64; 95% CI 0.43-0.98) and in older compared to younger patients (OR 0.97; 95% CI 0.96-0.98 per year older). In addition, 26% of variation in suicide exploration was because of differences in general practice. There was no evidence that general practices developed differently over time. CONCLUSIONS Although low cost and easy to administer, the pop-up system was not effective in nudging GPs to explore suicidality more frequently. We encourage studies to test whether implementing these nudges as part of a multifaceted approach will lead to a stronger effect. Moreover, we recommend researchers to include more variables, such as work experience or previous mental health training, to better understand the effects of the intervention on GPs' behaviour.
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Affiliation(s)
- Elke Elzinga
- 113 Suicide prevention, research department, Paasheuvelweg 25, Amsterdam, 1105 BP, the Netherlands.
- Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Derek P de Beurs
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Research & Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Otto R Maarsingh
- Department of General Practice, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Renske Gilissen
- 113 Suicide prevention, research department, Paasheuvelweg 25, Amsterdam, 1105 BP, the Netherlands
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22
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Holwerda TJ, Jaarsma E, van Zutphen EM, Beekman ATF, Pan KY, van Vliet M, Stringa N, van den Besselaar JH, MacNeil-Vroomen JL, Hoogendijk EO, Kok AAL. The impact of COVID-19 related adversity on the course of mental health during the pandemic and the role of protective factors: a longitudinal study among older adults in The Netherlands. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02457-5. [PMID: 36964770 PMCID: PMC10039342 DOI: 10.1007/s00127-023-02457-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 02/27/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE Many studies report about risk factors associated with adverse changes in mental health during the COVID-19 pandemic while few studies report about protective and buffering factors, especially in older adults. We present an observational study to assess protective and buffering factors against COVID-19 related adverse mental health changes in older adults. METHODS 899 older adults (55 +) in the Netherlands were followed from 2018/19 to two pandemic time points (June-October 2020 and March-August 2021). Questionnaires included exposure to pandemic-related adversities ("COVID-19 exposure"), depressive and anxiety symptoms, loneliness, and pre-pandemic functioning. Linear regression analyses estimated main effects of COVID-19 exposure and protective factors on mental health changes; interaction effects were tested to identify buffering factors. RESULTS Compared to pre-pandemic, anxiety symptoms, depression symptoms and loneliness increased. A higher score on the COVID-19 adversity index was associated with stronger negative mental health changes. Main effects: internet use and high mastery decreased depressive symptoms; a larger network decreased anxiety symptoms; female gender, larger network size and praying decreased loneliness. COVID-19 vaccination buffered against COVID-19 exposure-induced anxiety and loneliness, a partner buffered against COVID-19 exposure induced loneliness. CONCLUSION Exposure to COVID-19 adversity had a cumulative negative impact on mental health. Improving coping, finding meaning, stimulating existing religious and spiritual resources, network interventions and stimulating internet use may enable older adults to maintain mental health during events with large societal impact, yet these factors appear protective regardless of exposure to specific adversities. COVID-19 vaccination had a positive effect on mental health.
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Affiliation(s)
- Tjalling J Holwerda
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands.
- Department of Psychiatry, ARKIN Mental Health Care Amsterdam, Amsterdam, The Netherlands.
- Amsterdam UMC Location Vrije Universiteit, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Eva Jaarsma
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Elisabeth M van Zutphen
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Kuan-Yu Pan
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Majogé van Vliet
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Najada Stringa
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Judith H van den Besselaar
- Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Janet L MacNeil-Vroomen
- Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Almar A L Kok
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
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23
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Wouts L, Marijnissen RM, Oude Voshaar RC, Beekman ATF. Strengths and Weaknesses of the Vascular Apathy Hypothesis: A Narrative Review. Am J Geriatr Psychiatry 2023; 31:183-194. [PMID: 36283953 DOI: 10.1016/j.jagp.2022.09.016] [Citation(s) in RCA: 1] [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: 07/06/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 10/07/2022]
Abstract
The vascular apathy hypothesis states that cerebral small vessel disease (CSVD) can cause apathy, even when no other symptoms of CSVD are present. In order to examine this hypothesis, the objectives of this narrative review are to evaluate the evidence for a pathophysiological mechanism linking CSVD to apathy and to examine whether CSVD can be a sole cause of apathy. The nature of the CSVD-apathy relationship was evaluated using the Bradford Hill criteria as a method for research on the distinction between association and causation. Pathological, neuroimaging, and behavioral studies show that CSVD can cause lesions in the reward network, which causes an apathy syndrome. Studies in healthy older individuals, stroke patients and cognitively impaired persons consistently show an association between CSVD markers and apathy, although studies in older persons suffering from depression are inconclusive. A biological gradient is confirmed, as well as a temporal relationship, although the evidence for the latter is still weak. The specificity of this causal relationship is low given there often are other contributing factors in CSVD patients with apathy, particularly depression and cognitive deterioration. Differentiating between vascular apathy and other apathy syndromes on the basis of clinical features is not yet possible, while in-depth knowledge about differences in the prognosis and efficacy of treatment options for apathy caused by CSVD and other apathy syndromes is lacking. Since we cannot differentiate between etiologically different apathy syndromes as yet, it is premature to use the term vascular apathy which would suggest a distinct clinical apathy syndrome.
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Affiliation(s)
- Lonneke Wouts
- Department of Old Age Psychiatry (L.W.), Pro Persona Mental Health Institute, Nijmegen, the Netherlands; Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands.
| | - Radboud M Marijnissen
- Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Richard C Oude Voshaar
- Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry (A.T.F.B.), Amsterdam UMC, Vrije Universiteit, and GGZinGeest, Amsterdam, the Netherlands
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Wagenmakers MJ, Oudega ML, Klaus F, Wing D, Orav G, Han LKM, Binnewies J, Beekman ATF, Veltman DJ, Rhebergen D, van Exel E, Eyler LT, Dols A. BrainAge of patients with severe late-life depression referred for electroconvulsive therapy. J Affect Disord 2023; 330:1-6. [PMID: 36858270 DOI: 10.1016/j.jad.2023.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 01/28/2023] [Accepted: 02/12/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Severe depression is associated with accelerated brain aging. BrainAge gap, the difference between predicted and observed BrainAge, was investigated in patients with late-life depression (LLD). We aimed to examine BrainAge gap in LLD and its associations with clinical characteristics indexing LLD chronicity, current severity, prior to electroconvulsive therapy (ECT) and ECT outcome. METHODS Data was analyzed from the Mood Disorders in Elderly treated with Electroconvulsive Therapy (MODECT) study. A previously established BrainAge algorithm (BrainAge R by James Cole, (https://github.com/james-cole/brainageR)) was applied to pre-ECT T1-weighted structural MRI-scans of 42 patients who underwent ECT. RESULTS A BrainAge gap of 1.8 years (SD = 5.5) was observed, Cohen's d = 0.3. No significant associations between BrainAge gap, number of previous episodes, current episode duration, age of onset, depression severity, psychotic symptoms or ECT outcome were observed. LIMITATIONS Limited sample size. CONCLUSIONS Our initial findings suggest an older BrainAge than chronological age in patients with severe LLD referred for ECT, however with high degree of variability and direction of the gap. No associations were found with clinical measures. Larger samples are needed to better understand brain aging and to evaluate the usability of BrainAge gap as potential biomarker of prognosis an treatment-response in LLD. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02667353.
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Affiliation(s)
- Margot J Wagenmakers
- GGZ inGeest Specialized Mental Health Care, Psychiatry, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep and Stress, Amsterdam, the Netherlands.
| | - Mardien L Oudega
- GGZ inGeest Specialized Mental Health Care, Psychiatry, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep and Stress, Amsterdam, the Netherlands
| | - Federica Klaus
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032 Zurich, Switzerland; Department of Psychiatry, University of California San Diego, San Diego, USA
| | - David Wing
- Exercise and Physical Activity Resource Center (EPARC), Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego (UCSD), La Jolla, CA, USA
| | - Gwendolyn Orav
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Laura K M Han
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Julia Binnewies
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep and Stress, Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- GGZ inGeest Specialized Mental Health Care, Psychiatry, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands
| | - Dick J Veltman
- GGZ inGeest Specialized Mental Health Care, Psychiatry, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood Anxiety Psychosis Sleep and Stress, Amsterdam, the Netherlands
| | - Didi Rhebergen
- Amsterdam Public Health Research Institute, Mental Health, Amsterdam, the Netherlands; GGZ Centraal Specialized Menthal Health Care, Amersfoort, the Netherlands
| | - Eric van Exel
- GGZ inGeest Specialized Mental Health Care, Psychiatry, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, San Diego, USA; Desert-Pacific MIRECC, VA San Diego Healthcare, San Diego, CA, USA
| | - Annemieke Dols
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands and Amsterdam UMC
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25
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Metz MJ, van Bueren MM, van Dijk M, van Son GE, Bramsen I, Boenink AD, Beekman ATF. [Shared decision-making using outcome information: qualitative research among patients]. Tijdschr Psychiatr 2023; 65:301-307. [PMID: 37434567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
BACKGROUND In the period 2019-2022, eight mental health care organizations have been working on the development and implementation of shared decision-making (SDM) using routine outcome monitoring (ROM) as a source of information. AIM To obtain insight in needs and experiences of patients among SDM using ROM, and to investigate which implementation approach this requires. METHOD Explorative, qualitative research consisting of semi-structured interviews and focusgroups with patients (n = 101) treated by mental health care organizations across the Netherlands. RESULTS Patients reported SDM as important. Generic aspects (listening, trust, complete information and equal input) and customization (connecting to the need for help, and for every decision meta-communication about the roles of patients, relatives and clinicians and the way of giving information) were equally important. Patients valued ROM as source of information during SDM, providing that questionnaires are not too long, are related to the problems and results are discussed. CONCLUSION SDM using ROM is as yet not widely implemented in mental health care. This requires continuous stimulation and evaluation. Implementation requires (re)training clinicians and supporting patients by relatives, peer experts and psycho-education. Patients appreciate ROM as an aid in SDM; access to their own ROM is helpful here.
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Feenstra TC, Blake Y, Hoogendoorn AW, Koekenbier K, Beekman ATF, Rhebergen D. Pharmacological prevention of postictal agitation after electroconvulsive therapy-A systematic review and meta-analysis. Front Psychiatry 2023; 14:1170931. [PMID: 37151968 PMCID: PMC10157235 DOI: 10.3389/fpsyt.2023.1170931] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/22/2023] [Indexed: 05/09/2023] Open
Abstract
Background Postictal agitation (PIA) after electroconvulsive therapy (ECT) is a serious clinical problem estimated to occur in 7-36% of patients and recur in 19-54% of patients. PIA has the potential to cause dangerous situations for the patient and staff members aside from the financial impact. To date, it is unclear which pharmacological interventions should be used in the management of PIA. This study aimed to systematically review the (preventative) pharmacological treatment options for PIA after ECT. Method A systematic search was done in PubMed, EMBASE, PsycINFO, and Web of Science from inception until 10 November 2022. We included randomized trials with any pharmacological intervention or comparison and a predefined outcome measure on PIA. Studies that solely included patients with neurodegenerative disorders or stroke were excluded. Data quality was assessed with the RoB2 and GRADE. Meta-analysis was performed if possible. This study was registered on PROSPERO under CRD42021262323. Results We screened 2,204 articles and included 14 studies. Dexmedetomidine was investigated in 10 studies. Alfentanil, lignocaine, esmolol, midazolam, propofol, ketamine, haloperidol, and diazepam were each studied in only one study. Meta-analysis revealed an OR of 0.45 (0.32-0.63), a moderate effect size, in favor of dexmedetomidine than placebo to prevent PIA with very low heterogeneity (I2 = 0%). The certainty of the evidence was moderate. The other interventions studied were all found to have low certainty of evidence. Conclusion For clinical practice, we believe that our results indicate that dexmedetomidine should be considered for the prevention of PIA in patients that have previously experienced PIA.
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Affiliation(s)
- Thomas C. Feenstra
- GGZ Centraal Mental Health Care, Amersfoort, Netherlands
- Mental Health Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- *Correspondence: Thomas C. Feenstra
| | - Yvonne Blake
- GGZ Centraal Mental Health Care, Amersfoort, Netherlands
| | - Adriaan W. Hoogendoorn
- Mental Health Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Krista Koekenbier
- GGZ InGeest Mental Health Care, Amsterdam, Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Aartjan T. F. Beekman
- Mental Health Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- GGZ InGeest Mental Health Care, Amsterdam, Netherlands
| | - Didi Rhebergen
- GGZ Centraal Mental Health Care, Amersfoort, Netherlands
- Mental Health Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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27
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Lambrichts S, Wagenmakers MJ, Vansteelandt K, Obbels J, Schouws SNTM, Verwijk E, van Exel E, Bouckaert F, Vandenbulcke M, Schrijvers D, Veltman DJ, Beekman ATF, Oudega ML, Sienaert P, Dols A. Long-term Outcome Following Electroconvulsive Therapy for Late-Life Depression: Five-Year Follow-up Data From the MODECT Study. Am J Geriatr Psychiatry 2022; 30:1283-1294. [PMID: 35667960 DOI: 10.1016/j.jagp.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Electroconvulsive therapy (ECT) is the most effective treatment for late-life depression (LLD). Research addressing long-term outcome following an acute course of ECT for LLD is limited. We aimed to describe relapse, cognitive impairment and survival 5 years after a treatment with ECT for severe LLD, and assess the association of clinical characteristics with all three outcome measures. METHODS This cohort study was part of the Mood Disorders in Elderly treated with ECT (MODECT) study, which included patients aged 55 years and older with major depressive disorder. Data regarding clinical course, cognitive impairment and mortality were collected 5 years after the index ECT course. We used multivariable Cox proportional hazards models and logistic regression models to assess the association of clinical characteristics with relapse and survival, and cognitive impairment, respectively. RESULTS We studied 110 patients with a mean age of 72.9 years. 67.1% of patients who showed response at the end of the index ECT course relapsed, and the included clinical characteristics were not significantly associated with the risk of relapse. 38.8% of patients with available data showed cognitive impairment at five-year follow-up. 27.5% were deceased; higher age and a higher number of previous psychiatric admissions were significantly associated with increased risk of mortality. CONCLUSIONS Five-year outcome after a course of ECT for severe LLD seems to be in line with long-term outcome following other acute treatments for severe LLD in terms of relapse, cognitive impairment and survival. Additional studies aimed at improving long-term outcome in severe LLD are warranted.
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Affiliation(s)
- Simon Lambrichts
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium.
| | - Margot J Wagenmakers
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Kristof Vansteelandt
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Jasmien Obbels
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Sigfried N T M Schouws
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands
| | - Esmée Verwijk
- Amsterdam UMC location University of Amsterdam, Medical Psychology, Amsterdam, The Netherlands; Department of Psychology, Brain & Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric van Exel
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Filip Bouckaert
- Geriatric Psychiatry, University Psychiatric Center KU Leuven (UPC KU Leuven), and Leuven Brain Institute, KU Leuven
| | - Mathieu Vandenbulcke
- Geriatric Psychiatry, University Psychiatric Center KU Leuven (UPC KU Leuven), and Leuven Brain Institute, KU Leuven
| | - Didier Schrijvers
- UAntwerp, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University Psychiatric Hospital Duffel, Duffel, Belgium
| | - Dick J Veltman
- Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands
| | - Mardien L Oudega
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands
| | - Pascal Sienaert
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Neuropsychiatry, Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (UPC KU Leuven), Kortenberg, Belgium
| | - Annemiek Dols
- GGZ inGeest Specialized Mental Health Care, Old Age Psychiatry, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Psychiatry, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Mental Health, Amsterdam, The Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress program, Amsterdam, The Netherlands
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28
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van Andel E, Bijlenga D, Vogel SWN, Beekman ATF, Kooij JJS. Attention-Deficit/Hyperactivity Disorder and Delayed Sleep Phase Syndrome in Adults: A Randomized Clinical Trial on the Effects of Chronotherapy on Sleep. J Biol Rhythms 2022; 37:673-689. [PMID: 36181304 DOI: 10.1177/07487304221124659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Delayed sleep phase syndrome (DSPS) is the most common sleep disturbance in adults with attention-deficit/hyperactivity disorder (ADHD). We previously showed that chronotherapy with melatonin effectively advanced the dim-light melatonin onset (DLMO), a biomarker for the internal circadian rhythm, by 1.5 h and reduced ADHD symptoms by 14%. Melatonin combined with bright light therapy (BLT) advanced the DLMO by 2 h, but did not affect ADHD symptoms. This article explores whether sleep times advanced along with DLMO, leading to longer sleep duration and better sleep in general, which might explain the working mechanism behind the reduction in ADHD symptoms after treatment with melatonin. This article presents exploratory secondary analysis on objective and self-reported sleep characteristics from a three-armed double-blind randomized placebo-controlled clinical trial (RCT), which included 49 adults (18-55 years) with ADHD and DSPS. Participants were randomized to receive sleep education and 3 weeks of (1) 0.5 mg/day placebo, (2) 0.5 mg/day melatonin, or (3) 0.5 mg/day melatonin plus 30 min of bright light therapy (BLT) between 0700 and 0800 h. Sleep was assessed at baseline, directly after treatment, and 2 weeks after the end of treatment. Objective measures were obtained by actigraphy, self-reported measures by various sleep questionnaires and a sleep diary. Melatonin with or without BLT did not advance sleep times, improve sleep in general, or strengthen wake-activity rhythms. So even though the DLMO had advanced, sleep timing did not follow. Adding extensive behavioral coaching to chronotherapy is necessary for advancing sleep times along with DLMO and to further alleviate ADHD symptoms.
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Affiliation(s)
- Emma van Andel
- PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands
| | - Denise Bijlenga
- PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands
- Sleep-Wake Center SEIN, Heemstede, The Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Suzan W N Vogel
- PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - J J Sandra Kooij
- PsyQ, Expertise Center Adult ADHD, The Hague, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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29
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van Veen SMP, Evans N, Ruissen AM, Vandenberghe J, Beekman ATF, Widdershoven GAM. Irremediable Psychiatric Suffering in The Context of Medical Assistance in Dying: A Delphi-Study. Can J Psychiatry 2022; 67:758-767. [PMID: 35311599 PMCID: PMC9510999 DOI: 10.1177/07067437221087052] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Patients with a psychiatric disorder are eligible to request medical assistance in dying (MAID) in a small but growing number of jurisdictions, including the Netherlands and Belgium. In Canada, MAID for mental illness will become possible in 2023. For this request to be granted, most of these jurisdictions demand that the patient is competent in her request, and that the suffering experienced is unbearable and irremediable. Especially the criterion of irremediability is challenging to establish in patients with psychiatric disorders. The aim of this research is to establish what criteria Dutch and Belgian experts agree to be necessary in characterising irremediable psychiatric suffering (IPS) in the context of MAID. METHODS A two-round Delphi procedure among psychiatrists with relevant experience. RESULTS Thirteen consensus criteria were established: five diagnostic and eight treatment-related criteria. Diagnostically, the participants deem a narrative description and attention to contextual and systemic factors necessary. Also, a mandatory second opinion is required. The criteria concerning treatment show that extensive biopsychosocial treatment is needed, and the suffering must be present for several years. Finally, in the case of refusal, the participants agree that there are limits to the number of diagnostic procedures or treatments a patient must undergo. CONCLUSIONS Consensus was found among a Dutch and Belgian expert group on potential criteria for establishing IPS in the context of MAID. These criteria can be used in clinical decision-making and can inform future procedural demands and research.
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Affiliation(s)
- Sisco M P van Veen
- Department of Psychiatry, Amsterdam University Medical Center, the Netherlands.,Department of Ethics, Law and Humanities, Amsterdam University Medical Center, the Netherlands.,113 Suicide prevention, Amsterdam, the Netherlands
| | - Natalie Evans
- Department of Ethics, Law and Humanities, Amsterdam University Medical Center, the Netherlands
| | - Andrea M Ruissen
- Department of Ethics, Law and Humanities, Amsterdam University Medical Center, the Netherlands
| | | | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Center, the Netherlands
| | - Guy A M Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam University Medical Center, the Netherlands
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30
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Wagenmakers MJ, Oudega ML, Bouckaert F, Rhebergen D, Beekman ATF, Veltman DJ, Sienaert P, van Exel E, Dols A. Remission Rates Following Electroconvulsive Therapy and Relation to Index Episode Duration in Patients With Psychotic Versus Nonpsychotic Late-Life Depression. J Clin Psychiatry 2022; 83. [PMID: 35950901 DOI: 10.4088/jcp.21m14287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objective: Electroconvulsive therapy (ECT) is a safe and effective treatment, especially in psychotic late-life depression (LLD). However, it is not yet clear whether the greater efficacy seen in psychotic LLD is because of a shorter index episode duration. The first aim of this study was to substantiate the superior ECT remission rates in patients with psychotic LLD, as compared to patients with nonpsychotic LLD, and a second aim was to investigate whether this association is independent of the index duration. Methods: 186 patients with LLD treated with ECT were included in the study: 76 from the Valerius cohort (data collection from 2001 to 2006) and 110 from the Mood Disorders Treated with Electroconvulsive Therapy (MODECT) cohort (data collection from 2011 to 2013). The Montgomery-Asberg Depression Rating Scale (MADRS) was used to evaluate depression severity, with remission defined as 2 consecutive MADRS scores < 10. Diagnosis of depression was based on DSM-IV (Valerius) and DSM-IV-TR (MODECT) criteria. A stepwise logistic regression model was built to assess the association between psychotic symptoms, index duration, and remission. Results: Patients with psychotic LLD showed significantly higher remission rates compared to patients with nonpsychotic LLD (68.9% vs 51.0%), independent of index duration, additionally corrected for age, sex, and baseline depression severity (OR = 2.10 [95% CI, 1.07-4.10], P = .03). Conclusions: Patients with psychotic LLD treated with ECT show higher remission rates compared to patients with nonpsychotic LLD. The high remission rates in patients with psychotic LLD are not explained by a shorter index duration. Future studies focusing on neurobiological differences in psychotic versus nonpsychotic depression may indicate why this subtype of depression is very responsive to ECT. Trial Registration: ClinicalTrials.gov identifier: NCT02667353.
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Affiliation(s)
- Margot J Wagenmakers
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands.,*Corresponding author: Margot J. Wagenmakers, GGZ inGeest, Department of Research and Innovation, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands .,‡Share first authorship
| | - Mardien L Oudega
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands.,‡Share first authorship
| | - Filip Bouckaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium
| | - Didi Rhebergen
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands
| | - Dick J Veltman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium.,University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium
| | - Eric van Exel
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands.,§Share last authorship
| | - Annemieke Dols
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health, Mental Health Program, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands.,§Share last authorship
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31
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Cornelis J, Barakat A, Blankers M, Peen J, Lommerse N, Eikelenboom M, Zoeteman J, Van H, Beekman ATF, Dekker J. The effectiveness of intensive home treatment as a substitute for hospital admission in acute psychiatric crisis resolution in the Netherlands: a two-centre Zelen double-consent randomised controlled trial. Lancet Psychiatry 2022; 9:625-635. [PMID: 35779532 DOI: 10.1016/s2215-0366(22)00187-0] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/24/2022] [Accepted: 04/29/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although de-institutionalisation has been underway for decades, admission to hospital followed by low-intensity outpatient care remains the usual treatment for patients with an acute psychiatric crisis. Intensive home treatment has been developed for patients in a severe psychiatric crisis as an alternative to inpatient care. This study aimed to evaluate the potential of intensive home treatment to reduce bed-days and its clinical effectiveness compared with treatment as usual. METHODS We did a two-armed, two-centre, open-label, Zelen, double-consent, pragmatic randomised controlled trial. Patients aged 18-65 years were recruited at the psychiatric emergency service and psychiatric emergency wards of the two major mental health institutions (Arkin and GGZ inGeest) in Amsterdam, the Netherlands. Patients diagnosed with at least one DSM-IV-TR or DSM-5 disorder and in a psychiatric crisis and for whom psychiatrists had indicated or completed a clinical admission could be included. Trained psychiatric emergency service and hospital professionals did the automated web-based pre-randomisation procedure upon first contact with the patient. A seeded pseudo-random number generator allocated patients (2:1) to intensive home treatment or treatment as usual. Informed consent was obtained after randomisation as soon as the patient was mentally capable within 14 days. Due to the nature of this study, patients and professionals were not masked to treatment. Intensive home treatment was tailored to the nature of the crisis and goals of patients and relatives, and developed in collaboration with them and a multidisciplinary professional team. All main analyses were intention-to-treat, and the primary outcome was the total number of admission days 12 months after randomisation. To investigate the effect of treatment conditions on the outcome measures, linear mixed modelling analyses using restricted maximum likelihood estimation were done. This trial was prospectively registered with Trialregister.nl, NL-6020 (NTR-6151). FINDINGS Between Nov 15, 2016, and Oct 15, 2018, 246 patients were included in the study (183 patients with intensive home treatment vs 63 patients with treatment as usual). 135 women (55%) and 111 men (45%) were included, with a mean age of 41·01 years (range 18-65; SD 12·68). 114 participants (46%) were born in the Netherlands and 85 (35%) elsewhere (missing data on 47 [19%] participants). Ethnicity data were not available. After 12 months, the mean number of admission days in the intensive home treatment condition was 42·47 (SD 53·92) versus 67·02 (SD 79·03) for treatment as usual, a reduction of 24·55 days (SD 10·73) or 36·6% (p=0·033). 26 adverse events were registered, 23 (89%) of which were suicide attempts. The number of patients with a reported adverse event did not differ significantly between the groups (15 [8%] in the intensive home treatment group vs five [8%] in the treatment as usual group; p=0·950). Five patients died by suicide (three [2%] in the intensive home treatment group vs two [3%] in the treatment as usual group; p=0·610). No treatment-related deaths occurred. INTERPRETATION Intensive home treatment is a safe and effective partial substitute for conventional psychiatric crisis care that led to a reduction in admission days, causing patients to stay longer in their social environment, with similar clinical effects, patient satisfaction and adverse events. FUNDING De Stichting tot Steun Vereniging voor Christelijke Verzorging van Geestes-en Zenuwzieken.
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Affiliation(s)
- Jurgen Cornelis
- Department of Research, Arkin, Amsterdam, Netherlands; Psychiatric Emergency Service, Arkin, Amsterdam, Netherlands; Psychiatric Residence Training Program, Arkin, Amsterdam, Netherlands.
| | - Ansam Barakat
- Department of Research, Arkin, Amsterdam, Netherlands
| | - Matthijs Blankers
- Department of Research, Arkin, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam University Medical Center, Location AMC, University of Amsterdam, Amsterdam, Netherlands; Trimbos Institute: The Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Jaap Peen
- Department of Research, Arkin, Amsterdam, Netherlands
| | - Nick Lommerse
- Department of Research, Arkin, Amsterdam, Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Psychiatry Amsterdam University Medical Centre/Vrije Universiteit Medisch Centrum and Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands
| | - Jeroen Zoeteman
- Department of Research, Arkin, Amsterdam, Netherlands; Psychiatric Emergency Service, Arkin, Amsterdam, Netherlands
| | - Henricus Van
- Department of Research, Arkin, Amsterdam, Netherlands; Psychiatric Residence Training Program, Arkin, Amsterdam, Netherlands; NPI, Arkin, Amsterdam, Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Psychiatry Amsterdam University Medical Centre/Vrije Universiteit Medisch Centrum and Amsterdam Public Health Research Institute Amsterdam UMC, Amsterdam, Netherlands
| | - Jack Dekker
- Department of Research, Arkin, Amsterdam, Netherlands; Vrije Universiteit Department Clinical Psychology, Amsterdam, The Netherlands
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Van den Eynde V, Abdelmoemin WR, Abraham MM, Amsterdam JD, Anderson IM, Andrade C, Baker GB, Beekman ATF, Berk M, Birkenhäger TK, Blackwell BB, Blier P, Blom MBJ, Bodkin AJ, Cattaneo CI, Dantz B, Davidson J, Dunlop BW, Estévez RF, Feinberg SS, Finberg JPM, Fochtmann LJ, Gotlib D, Holt A, Insel TR, Larsen JK, Mago R, Menkes DB, Meyer JM, Nutt DJ, Parker G, Rego MD, Richelson E, Ruhé HG, Sáiz-Ruiz J, Stahl SM, Steele T, Thase ME, Ulrich S, van Balkom AJLM, Vieta E, Whyte I, Young AH, Gillman PK. The prescriber's guide to classic MAO inhibitors (phenelzine, tranylcypromine, isocarboxazid) for treatment-resistant depression. CNS Spectr 2022; 28:1-14. [PMID: 35837681 DOI: 10.1017/s1092852922000906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This article is a clinical guide which discusses the "state-of-the-art" usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion-this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy-while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward "bridging" methods that may be used to transition simply and safely from other antidepressants to MAOIs.
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Affiliation(s)
| | | | | | - Jay D Amsterdam
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ian M Anderson
- Department of Psychiatry, University of Manchester, Manchester, UK
| | - Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Glen B Baker
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Tom K Birkenhäger
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Barry B Blackwell
- Department of Psychiatry, University of Wisconsin, Milwaukee, WI, USA
| | - Pierre Blier
- Departments of Psychiatry and Cellular & Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | | | | | - Bezalel Dantz
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, IL, USA
| | - Jonathan Davidson
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Ryan F Estévez
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Shalom S Feinberg
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, USA
| | - John P M Finberg
- Department of Molecular Pharmacology, Technion-Israel Institute of Technology, Haifa, Israel
| | - Laura J Fochtmann
- Department of Psychiatry, Department of Pharmacological Sciences, and Biomedical Informatics, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | | | - Andrew Holt
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Thomas R Insel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jens K Larsen
- Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
| | - Rajnish Mago
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David B Menkes
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jonathan M Meyer
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, CA, USA
| | - David J Nutt
- Department of Brain Sciences, Imperial College, London, UK
| | - Gordon Parker
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW, Australia
| | - Mark D Rego
- Yale Institute for Global Health, Yale School of Medicine, New Haven, CT, USA
| | - Elliott Richelson
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Henricus G Ruhé
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Stephen M Stahl
- Department of Psychiatry and Neuroscience, University of California, Riverside, Riverside, CA, USA
| | - Thomas Steele
- Department of Psychiatry and Behavioral Sciences, University of South Carolina, Columbia, SC, USA
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Anton J L M van Balkom
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Eduard Vieta
- Department of Psychiatry and Psychology, University of Barcelona Hospital Clinic, Barcelona, Spain
| | - Ian Whyte
- Department of Clinical Toxicology and Pharmacology, University of Newcastle, Callaghan, NSW, Australia
| | - Allan H Young
- Department of Psychological Medicine, King's College London, London, UK
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van Veen SMP, Widdershoven GAM, Beekman ATF. Physician-Assisted Death for Patients With Dementia. JAMA Psychiatry 2022; 79:637-638. [PMID: 35507363 DOI: 10.1001/jamapsychiatry.2022.0808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sisco M P van Veen
- GGZ inGeest Mental Healthcare, Amsterdam, the Netherlands.,Department of Ethics, Law and Humanities, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Guy A M Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- GGZ inGeest Mental Healthcare, Amsterdam, the Netherlands.,Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands
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34
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van der Markt A, Klumpers UMH, Dols A, Boks MP, Vreeker A, Beekman ATF, Kupka RW. Clinical profiles of subsequent stages in bipolar disorder: Results from the Dutch Bipolar Cohort. Bipolar Disord 2022; 24:424-433. [PMID: 34821429 PMCID: PMC9542330 DOI: 10.1111/bdi.13159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The manifestation of bipolar disorder (BD) is hypothesized to be determined by clinical characteristics such as familial loading, childhood abuse, age at onset, illness duration, comorbid psychiatric disorders, addiction, treatment resistance, and premorbid cognitive functioning. Which of these are associated with a more severe course and worse outcome is currently unknown. Our objective is to find a combination of clinical characteristics associated with advancement to subsequent stages in two clinical staging models for BD. METHODS Using cross-sectional data from the Dutch Bipolar Cohort, staging was applied to determine the progression of bipolar-I-disorder (BD-I; N = 1396). Model A is primarily defined by recurrence of mood episodes, ranging from prodromal to chronicity. Model B is defined by level of inter-episodic functioning, ranging from prodromal to inability to function autonomously. For both models, ordinal logistic regression was conducted to test which clinical characteristics are associated with subsequent stages. RESULTS For model A, familial loading, childhood abuse, earlier onset, longer illness duration, psychiatric comorbidity, and treatment resistance were all predictors for a higher stage in contrast to addiction and cognitive functioning. For model B, childhood abuse, psychiatric comorbidity, cognitive functioning, and treatment resistance were predictors for a more severe stage, whereas age at onset, illness duration, and addiction were not. DISCUSSION/CONCLUSIONS Differences in clinical characteristics across stages support the construct validity of both staging models. Characteristics associated with a higher stage largely overlapped across both models. This study is a first step toward determining different clinical profiles, with a corresponding course and outcome.
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Affiliation(s)
- Afra van der Markt
- Amsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstitutePsychiatryThe Netherlands,GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| | - Ursula M. H. Klumpers
- GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands,Amsterdam UMCVrije Universiteit AmsterdamAmsterdam NeurosciencePsychiatryThe Netherlands
| | - Annemiek Dols
- Amsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstitutePsychiatryThe Netherlands,GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands,Amsterdam UMCVrije Universiteit AmsterdamAmsterdam NeurosciencePsychiatryThe Netherlands
| | - Marco P. Boks
- Department of PsychiatryUniversity Medical Center UtrechtUtrechtThe Netherlands,Brain Center University Medical Center UtrechtUniversity UtrechtUtrechtThe Netherlands
| | - Annabel Vreeker
- Department of Child and Adolescent Psychiatry and PsychologyErasmus MCRotterdamThe Netherlands
| | - Aartjan T. F. Beekman
- Amsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstitutePsychiatryThe Netherlands,GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| | - Ralph W. Kupka
- Amsterdam UMCVrije Universiteit AmsterdamAmsterdam Public Health Research InstitutePsychiatryThe Netherlands,GGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
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35
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Brouwer A, van de Ven PM, Kok A, Snoek FJ, Beekman ATF, Bremmer MA. Symptoms of depression and insomnia in older age: A within-individual analysis over 20 years. J Am Geriatr Soc 2022; 70:2051-2059. [PMID: 35383906 PMCID: PMC9541249 DOI: 10.1111/jgs.17765] [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: 02/14/2021] [Revised: 02/17/2022] [Accepted: 02/24/2022] [Indexed: 11/29/2022]
Abstract
Background Depression and insomnia often co‐occur, and precede one another. Possibly, insomnia gives rise to depression, and vice versa. We tested whether insomnia symptoms of an older individual are associated with later depressive symptoms in that older individual, and vice versa. Methods We performed a longitudinal analysis of data from a prospective cohort study in a large sample of community‐dwelling older people (N = 3081), with measurements every three years, over a time period of 20 years. The within‐individual longitudinal reciprocal relationship between symptoms of depression (Center for Epidemiological Studies Depression Scale), and symptoms of insomnia (three‐item questionnaire, including difficulty initiating sleep, nightly awakenings, and early morning awakening) was modeled by means of a bivariate linear growth model. We tested whether symptoms of insomnia were associated with symptoms of depression three years later, and vice versa. Results Severity of symptoms of depression and insomnia and their within‐individual average change over time were moderately correlated (correlation of intercepts: rho 0.41, 95% CI: 0.36 to 0.46 p < 0.001; correlation of slopes: rho 0.39, 95% CI: 0.25 to 0.52, p < 0.001). Symptoms of depression were not found to be associated with an additional risk of higher symptoms of insomnia three years later, and vice versa (p = 0.329 and p = 0.919, respectively). Similar results were found when analyses were corrected for covariates. Conclusions In older individuals, depression and insomnia are associated and tend to increase concurrently over time, but constitute no additional risk for one another over repeated three‐year intervals. These findings contradict previous research that suggests that depression and insomnia are risk factors for one another over time. The current study stands out due to the longitudinal within‐individual statistical approach, but is limited by the three‐year interval between measures.
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Affiliation(s)
- Annelies Brouwer
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam, the Netherlands.,Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Amsterdam UMC, Vrije Universiteit, Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Almar Kok
- Amsterdam UMC, Vrije Universiteit, Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam, the Netherlands.,Department of Sociology, VU University, Amsterdam, the Netherlands
| | - Frank J Snoek
- Amsterdam UMC, Vrije Universiteit and University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam, the Netherlands.,Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Marijke A Bremmer
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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36
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van Veen SMP, Ruissen AM, Beekman ATF, Evans N, Widdershoven GAM. Establishing irremediable psychiatric suffering in the context of medical assistance in dying in the Netherlands: a qualitative study. CMAJ 2022; 194:E485-E491. [PMID: 35273025 PMCID: PMC8985907 DOI: 10.1503/cmaj.210929] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 01/04/2023] Open
Abstract
Background: Establishing irremediability of suffering is a central challenge in determining the appropriateness of medical assistance in dying (MAiD) for patients with a psychiatric disorder. We sought to evaluate how experienced psychiatrists define irremediable psychiatric suffering in the context of MAiD and what challenges they face while establishing irremediable psychiatric suffering. Methods: We conducted a qualitative study of psychiatrists in the Netherlands with experience assessing irremediable psychiatric suffering in the context of MAiD. We collected data from in-depth, semistructured interviews focused on the definition of irremediable psychiatric suffering and on the challenges in establishing irremediability. We analyzed themes using a modified grounded theory approach. Results: The study included 11 psychiatrists. Although irremediable psychiatric suffering is a prospective concept, most participants relied on retrospective dimensions to define it, such as a history of failed treatments, and expressed that uncertainty was inevitable in this process. When establishing irremediable psychiatric suffering, participants identified challenges related to diagnosis and treatment. The main diagnostic challenge identified was the frequent co-occurrence of more than 1 psychiatric diagnosis. Important challenges related to treatment included assessing the quality of past treatments, establishing when limits of treatment had been reached and managing “treatment fatigue.” Interpretation: Challenges regarding the definition, diagnosis and treatment of irremediable psychiatric suffering complicate the process of establishing it in the context of MAiD. Development of consensus clinical criteria for irremediable psychiatric suffering in this context and further research to understand “treatment fatigue” among patients with psychiatric disorders may help address these challenges. Registration: This study was preregistered under osf.io/2jrnd.
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Affiliation(s)
- Sisco M P van Veen
- Department of Ethics, Law and Humanities (van Veen, Ruissen, Evans, Widdershoven), Amsterdam University Medical Center; Department of Psychiatry (van Veen, Beekman), Amsterdam University Medical Center; 113 Suicide Prevention (van Veen), Amsterdam, the Netherlands
| | - Andrea M Ruissen
- Department of Ethics, Law and Humanities (van Veen, Ruissen, Evans, Widdershoven), Amsterdam University Medical Center; Department of Psychiatry (van Veen, Beekman), Amsterdam University Medical Center; 113 Suicide Prevention (van Veen), Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Department of Ethics, Law and Humanities (van Veen, Ruissen, Evans, Widdershoven), Amsterdam University Medical Center; Department of Psychiatry (van Veen, Beekman), Amsterdam University Medical Center; 113 Suicide Prevention (van Veen), Amsterdam, the Netherlands
| | - Natalie Evans
- Department of Ethics, Law and Humanities (van Veen, Ruissen, Evans, Widdershoven), Amsterdam University Medical Center; Department of Psychiatry (van Veen, Beekman), Amsterdam University Medical Center; 113 Suicide Prevention (van Veen), Amsterdam, the Netherlands
| | - Guy A M Widdershoven
- Department of Ethics, Law and Humanities (van Veen, Ruissen, Evans, Widdershoven), Amsterdam University Medical Center; Department of Psychiatry (van Veen, Beekman), Amsterdam University Medical Center; 113 Suicide Prevention (van Veen), Amsterdam, the Netherlands
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37
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Schouws SNTM, Orhan M, Korten N, Zyto S, Beekman ATF, Kupka RW, Scherder E, Dols A. Evaluating feasibility and satisfaction of a group intervention for mild cognitive impairment in older age bipolar disorder: "Brain train". Bipolar Disord 2022; 24:217-219. [PMID: 34534395 PMCID: PMC9292643 DOI: 10.1111/bdi.13126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/07/2021] [Accepted: 09/12/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Susan Zyto
- GGZ North Holland NorthHoornthe Netherlands,Department of PsychiatryAmsterdam UMC, location VUmcAmsterdam NeuroscienceAmsterdam Public Health (research institute)Amsterdamthe Netherlands
| | - Aartjan T. F. Beekman
- GGZ inGeestAmsterdamthe Netherlands,Department of PsychiatryAmsterdam UMC, location VUmcAmsterdam NeuroscienceAmsterdam Public Health (research institute)Amsterdamthe Netherlands
| | - Ralph W. Kupka
- GGZ inGeestAmsterdamthe Netherlands,Department of PsychiatryAmsterdam UMC, location VUmcAmsterdam NeuroscienceAmsterdam Public Health (research institute)Amsterdamthe Netherlands
| | - Erik Scherder
- Department of Clinical NeuropsychologyVU UniversityAmsterdamthe Netherlands
| | - Annemiek Dols
- GGZ inGeestAmsterdamthe Netherlands,Department of PsychiatryAmsterdam UMC, location VUmcAmsterdam NeuroscienceAmsterdam Public Health (research institute)Amsterdamthe Netherlands
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38
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van Sprang ED, Maciejewski DF, Milaneschi Y, Elzinga BM, Beekman ATF, Hartman CA, van Hemert AM, Penninx BWJH. Familial risk for depressive and anxiety disorders: associations with genetic, clinical, and psychosocial vulnerabilities. Psychol Med 2022; 52:696-706. [PMID: 32624018 PMCID: PMC8961330 DOI: 10.1017/s0033291720002299] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/21/2020] [Accepted: 06/09/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND In research and clinical practice, familial risk for depression and anxiety is often constructed as a simple Yes/No dichotomous family history (FH) indicator. However, this measure may not fully capture the liability to these conditions. This study investigated whether a continuous familial loading score (FLS), incorporating family- and disorder-specific characteristics (e.g. family size, prevalence of depression/anxiety), (i) is associated with a polygenic risk score (PRS) for major depression and with clinical/psychosocial vulnerabilities and (ii) still captures variation in clinical/psychosocial vulnerabilities after information on FH has been taken into account. METHODS Data came from 1425 participants with lifetime depression and/or anxiety from the Netherlands Study of Depression and Anxiety. The Family Tree Inventory was used to determine FLS/FH indicators for depression and/or anxiety. RESULTS Persons with higher FLS had higher PRS for major depression, more severe depression and anxiety symptoms, higher disease burden, younger age of onset, and more neuroticism, rumination, and childhood trauma. Among these variables, FH was not associated with PRS, severity of symptoms, and neuroticism. After regression out the effect of FH from the FLS, the resulting residualized measure of FLS was still associated with severity of symptoms of depression and anxiety, rumination, and childhood trauma. CONCLUSIONS Familial risk for depression and anxiety deserves clinical attention due to its associated genetic vulnerability and more unfavorable disease profile, and seems to be better captured by a continuous score that incorporates family- and disorder-specific characteristics than by a dichotomous FH measure.
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Affiliation(s)
- Eleonore D. van Sprang
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Dominique F. Maciejewski
- Department of Developmental Psychopathology, Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Yuri Milaneschi
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Bernet M. Elzinga
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Aartjan T. F. Beekman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Catharina A. Hartman
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, Groningen, The Netherlands
| | - Albert M. van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Brenda W. J. H. Penninx
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Juurlink TT, Betts JK, Nicol K, Lamers F, Beekman ATF, Cotton SM, Chanen AM. Characteristics and Predictors of Educational and Occupational Disengagement Among Outpatient Youth With Borderline Personality Disorder. J Pers Disord 2022; 36:116-128. [PMID: 34427492 DOI: 10.1521/pedi_2021_35_534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study aimed to investigate predictors of vocational disengagement (referred to as Not in Employment, Education, or Training [NEET]) in young people with borderline personality disorder (BPD). The sample comprised 112 outpatients with a BPD diagnosis, aged 15-25 years, who participated in a randomized controlled trial (ANZCTR12610000100099). The proportion of participants who were NEET (39.3%) at study entry did not improve after 18 months and NEET status frequently changed. Therefore, multinomial regression analyses were used to study three groups: Non-NEET, NEET, and Unstable NEET status. NEET status was predicted by not achieving expected age-appropriate educational milestones, greater instability in identity, and emptiness. Greater instability in interpersonal relationships and identity predicted Unstable NEET status. The findings suggest that specific vocational interventions, that also incorporate a focus on interpersonal functioning, emptiness, and identity disturbance, are needed to improve functioning in youth with BPD, especially when educational milestones are not achieved.
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Affiliation(s)
- Trees T Juurlink
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, The Netherlands and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Jennifer K Betts
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Katie Nicol
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Femke Lamers
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, The Netherlands and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, The Netherlands and GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Sue M Cotton
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Andrew M Chanen
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Australia
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Beekman ATF, van Veen SMP. Death With Dignity and Suicide Compared. Am J Geriatr Psychiatry 2022; 30:221-222. [PMID: 34419364 DOI: 10.1016/j.jagp.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Center/VUmc Department of Psychiatry (ATFB), the Netherlands
| | - Sisco M P van Veen
- GGzinGeest and Amsterdam UMC/VUmc Department of Psychiatry (SMPvV), the Netherlands; Department of Medical Ethics, Amsterdam University Medical Center, Law and Humanities Amsterdam (SMPvV), the Netherlands
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Van HL, Muller DP, Beekman ATF, De Koning MB. [Migratieachtergrond en de opleiding tot psychiater]. Tijdschr Psychiatr 2022; 64:521-523. [PMID: 36117485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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42
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Beekman ATF, van der Lee A. [Het spook risicoselectie; ggz onverzekerbaar in huidig stelsel]. Tijdschr Psychiatr 2022; 64:411-415. [PMID: 36040080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The Dutch health care system is a hybrid mix of public and market oriented elements. The market orientation harbours strong financial incentives for health insurance companies to select for the most healthy, least costly insurees. This is countered by an elaborate financial compensation for high risk, more costly health care users. Dysfunctioning of the compensatory financial mechanisms would render the mental health sector uninsurable. AIM To test the risk-compensatory mechanisms for mental health care in the Netherlands and to discuss consequences of malfunctioning. METHOD We used governmental data to study: the distribution of mental health costs, the total mental health expenditures that are redirected to compensate insurance companies, and the accuracy of this compensation. The consequences of putative inaccuracies are discussed. RESULTS 0.8% of the insured (all Dutch citizens are insured) are responsible for 66% of the mental health care costs. To compensate insurance companies for unequal distribution of costs, 3.9 billion euros were redirected. This compensation is based on inaccurate predictions of future health care costs of individual patients. The consequence is that insurance companies run a loss on every patient that uses mental health care. This loss is directly proportional to the amount of care used and therefore highest in patients with severe mental illness. CONCLUSION Due to inaccurate redirection of mental health-care costs, a strong financial incentive is in place to avoid investing in mental health care. Under prevailing regulations, mental health is de facto uninsurable in the Netherlands. This affects especially patients with the most severe and complex mental illness.
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Henstra MJ, Feenstra TC, Kok RM, Spaans HP, van Exel E, Dols A, Oudega M, Vergouwen ACM, van der Loo A, Bet PM, Loer SA, Eikelenboom M, Sienaert P, Lambrichts S, Bouckaert F, Bosmans JE, van der Velde N, Beekman ATF, Stek ML, Rhebergen D. Rivastigmine for ECT-induced cognitive adverse effects in late life depression (RECALL study): A multicenter, randomized, double blind, placebo-controlled, cross-over trial in patients with depression aged 55 years or older: Rationale, objectives and methods. Front Psychiatry 2022; 13:953686. [PMID: 35911242 PMCID: PMC9334653 DOI: 10.3389/fpsyt.2022.953686] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognitive side-effects are an important reason for the limited use of electroconvulsive therapy (ECT). Cognitive side-effects are heterogeneous and occur frequently in older persons. To date, insight into these side-effects is hampered due to inconsistencies in study designs and small sample sizes. Among all cognitive side-effects, confusion and delirious states are especially troublesome for patients, relatives and clinicians. In particular inter-ictal delirium-like states are worrisome, since they may lead to premature treatment discontinuation. Besides a need for further insight into determinants of cognitive side-effects of ECT, there is a great need for treatment options. METHODS AND DESIGN The Rivastigmine for ECT-induced Cognitive Adverse effects in Late Life depression (RECALL) study combines a multicenter, prospective cohort study on older patients with depression, treated with ECT, with an embedded randomized, placebo-controlled cross-over trial to examine the effect of rivastigmine on inter-ictal delirium. Patients are recruited in four centers across the Netherlands and Belgium. We aim to include 150 patients into the cohort study, in order to be able to subsequently include 30 patients into the trial. Patients are included in the trial when inter-ictal delirium, assessed by the Confusion Assessment method (CAM), or a drop in Mini Mental State Examination (MMSE) score of ≥4 during ECT, develops. In the cohort study, comprehensive measurements of ECT-related cognitive side-effects-and their putative determinants-are done at baseline and during the ECT-course. The primary outcome of the clinical trial is the effectiveness of rivastigmine on inter-ictal delirium-severity, assessed with a change in the Delirium Rating Scale-Revised-98. Secondary outcomes of the clinical trial are several ECT-characteristics and side-effects of rivastigmine. DISCUSSION This study is the first clinical trial with a focus on ECT-induced, inter-ictal delirium. The cohort provides the basis for recruitment of patients for the cross-over trial and additionally provides an excellent opportunity to unravel cognitive side-effects of ECT and identify putative determinants. This paper describes the rationale and study protocol. CLINICAL TRIAL REGISTRATION EudraCT 2014-003385-24.
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Affiliation(s)
- Marieke J Henstra
- Department of Internal Medicine and Geriatrics, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands.,Aging and Later Life Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Thomas C Feenstra
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ Centraal Mental Health Care, Amersfoort, Netherlands
| | - Rob M Kok
- Department of Old Age Psychiatry and ECT Center Haaglanden, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Harm-Pieter Spaans
- Department of Old Age Psychiatry and ECT Center Haaglanden, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Eric van Exel
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep and Stress Program, Amsterdam, Netherlands
| | - Annemiek Dols
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep and Stress Program, Amsterdam, Netherlands.,Amsterdam Neuroscience, Neurodegeneration Program, Amsterdam, Netherlands
| | - Mardien Oudega
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep and Stress Program, Amsterdam, Netherlands
| | - Anton C M Vergouwen
- Department of Psychiatry and Medical Psychology, OLVG Hospital, Amsterdam, Netherlands
| | - Adriano van der Loo
- Department of Psychiatry and Medical Psychology, OLVG Hospital, Amsterdam, Netherlands
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC location VUmc, Amsterdam, Netherlands
| | - Stephan A Loer
- Department of Anesthesiology, Amsterdam UMC location VUmc, Amsterdam, Netherlands
| | - Merijn Eikelenboom
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pascal Sienaert
- Department of Neurosciences, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, Leuven, Belgium
| | - Simon Lambrichts
- Department of Neurosciences, University Psychiatric Center KU Leuven, Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, Leuven, Belgium
| | - Filip Bouckaert
- Department of Geriatric Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Leuven, Belgium
| | - Judith E Bosmans
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Health Sciences, Faculty of Science, Vrije Universiteit, Amsterdam, Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine and Geriatrics, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, Netherlands.,Aging and Later Life Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Aartjan T F Beekman
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Max L Stek
- Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands
| | - Didi Rhebergen
- Amsterdam Public Health Research Institute, Mental Health Program, Amsterdam, Netherlands.,Department of Research, GGZ Centraal Mental Health Care, Amersfoort, Netherlands.,Department of Research, GGZ inGeest Mental Health Care, Amsterdam, Netherlands
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Beekman ATF. [Psychiatrie en sociaal domein: 'living apart together' of 'living together apart'?]. Tijdschr Psychiatr 2022; 64:346-347. [PMID: 35748144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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van Andel E, Ten Have M, Bijlenga D, Beekman ATF, de Graaf R, Sandra Kooij JJ. Combined impact of ADHD and insomnia symptoms on quality of life, productivity, and health care use in the general population. Psychol Med 2022; 52:36-47. [PMID: 32597743 DOI: 10.1017/s0033291720001592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Both attention-deficit/hyperactivity disorder (ADHD) and insomnia have been independently related to poorer quality of life (QoL), productivity loss, and increased health care use, although most previous studies did not take the many possible comorbidities into account. Moreover, ADHD and insomnia often co-occur. Symptoms of ADHD and insomnia together may have even stronger negative effects than they do separately. We investigated the combined effects of symptoms of ADHD and insomnia, in addition to their independent effects, on QoL, productivity, and health care use, thereby controlling for a wide range of possible comorbidities and confounders. METHODS Data from the third wave of the Netherlands Mental Health Survey and Incidence Study-2 were used, involving N = 4618 from the general population. Both the inattention and the hyperactivity ADHD symptom dimensions were studied, assessed by the ASRS Screener. RESULTS Mental functioning and productivity were negatively associated with the co-occurrence of ADHD and insomnia symptoms, even after adjusting for comorbidity and confounders. The results show no indication of differences between inattention and hyperactivity. Poorer physical functioning and health care use were not directly influenced by the interaction between ADHD and insomnia. CONCLUSIONS People with both ADHD and sleep problems have increased risk for poorer mental functioning and productivity loss. These results underscore the importance of screening for sleep problems when ADHD symptoms are present, and vice versa, and to target both disorders during treatment.
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Affiliation(s)
- Emma van Andel
- PsyQ, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR The Hague, The Netherlands
| | - Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Da Costakade 45, 3521 VSUtrecht, The Netherlands
| | - Denise Bijlenga
- PsyQ, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR The Hague, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, A.J. Ernststraat 1187, 1081 HLAmsterdam, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Da Costakade 45, 3521 VSUtrecht, The Netherlands
| | - J J Sandra Kooij
- PsyQ, Expertise Center Adult ADHD, Carel Reinierszkade 197, 2593 HR The Hague, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, A.J. Ernststraat 1187, 1081 HLAmsterdam, The Netherlands
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Karchoud JF, de Kruif AJTCM, Lamers F, van Linde ME, van Dodewaard-de Jong JM, Braamse AMJ, Sprangers MAG, Beekman ATF, Verheul HMW, Dekker J. Clinical judgment of the need for professional mental health care in patients with cancer: a qualitative study among oncologists and nurses. J Cancer Surviv 2021; 17:884-893. [PMID: 34855132 DOI: 10.1007/s11764-021-01151-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE In daily practice, oncologists and nurses frequently need to decide whether or not to refer a patient for professional mental health care. We explored the indicators oncologists and nurses use to judge the need for professional mental health care in patients with cancer. METHODS In a qualitative study, oncologists (n = 8) and nurses (n = 6) were each asked to select patients who were or were not referred for professional mental health care (total n = 75). During a semi-structured interview, they reflected on their decision concerning the possible referral of the patient. Thematic analysis was used to analyze the data. RESULTS Respondents reported using a strategy when judging whether professional mental health care was needed. They allowed patients time to adjust, while monitoring patients' psychological well-being, especially if patients exhibited specific risk factors. Risk and protective factors for emotional problems included personal, social, and disease- and treatment-related factors. Respondents considered referral for professional mental health care when they noted specific indicators of emotional problems. These indicators included lingering or increasing emotions, a disproportionate intensity of emotions, and emotions with a negative impact on a patient's daily life or treatment. CONCLUSIONS This study identified the strategy, risk and protective factors, and the indicators of emotional problems used by oncologists and nurses when judging the need for professional mental health care in patients with cancer. IMPLICATIONS FOR CANCER SURVIVORS Oncologists and nurses can play an important role in the identification of patients in need of professional mental health care.
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Affiliation(s)
- Jeanet F Karchoud
- Department of Psychiatry, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health Research Institute, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Anja J Th C M de Kruif
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Femke Lamers
- Department of Psychiatry, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health Research Institute, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Myra E van Linde
- Department of Medical Oncology, Amsterdam University Medical Centers, Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Annemarie M J Braamse
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health Research Institute, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost Dekker
- Department of Psychiatry, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam Public Health Research Institute, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.
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Solis EC, van Hemert AM, Carlier IVE, Wardenaar KJ, Schoevers RA, Beekman ATF, Penninx BWJH, Giltay EJ. The 9-year clinical course of depressive and anxiety disorders: New NESDA findings. J Affect Disord 2021; 295:1269-1279. [PMID: 34706441 DOI: 10.1016/j.jad.2021.08.108] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 08/06/2021] [Accepted: 08/30/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND In longitudinal research, switching between diagnoses should be considered when examining patients with depression and anxiety. We investigated course trajectories of affective disorders over a nine-year period, comparing a categorical approach using diagnoses to a dimensional approach using symptom severity. METHOD Patients with a current depressive and/or anxiety disorder at baseline (N = 1701) were selected from the Netherlands Study of Depression and Anxiety (NESDA). Using psychiatric diagnoses, we described 'consistently recovered,' 'intermittently recovered,' 'intermittently recurrent', and 'consistently chronic' at two-, four-, six-, and nine-year follow-up. Additionally, latent class growth analysis (LCGA) using depressive, anxiety, fear, and worry symptom severity scores was used to identify distinct classes. RESULTS Considering the categorical approach, 8.5% were chronic, 32.9% were intermittently recurrent, 37.6% were intermittently recovered, and 21.0% remained consistently recovered from any affective disorder at nine-year follow-up. In the dimensional approach, 66.6% were chronic, 25.9% showed partial recovery, and 7.6% had recovered. LIMITATIONS 30.6% of patients were lost to follow-up. Diagnoses were rated by the interviewer and questionnaires were completed by the participant. CONCLUSIONS Using diagnoses alone as discrete categories to describe clinical course fails to fully capture the persistence of affective symptoms that were observed when using a dimensional approach. The enduring, fluctuating presence of subthreshold affective symptoms likely predisposes patients to frequent relapse. The commonness of subthreshold symptoms and their adverse impact on long-term prognoses deserve continuous clinical attention in mental health care as well further research.
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Affiliation(s)
- Ericka C Solis
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands.
| | - Albert M van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Ingrid V E Carlier
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Klaas J Wardenaar
- Department of Psychiatry, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, Groningen, the Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, Groningen, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands; Department of Psychiatry, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, Groningen, the Netherlands; Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
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Jongkind A, Hendriks M, Grootens K, Beekman ATF, van Meijel B. Evaluation of a collaborative care program for patients with treatment-resistant schizophrenia: Protocol for a multiple case-study. (Preprint). JMIR Res Protoc 2021; 11:e35336. [PMID: 35700002 PMCID: PMC9237776 DOI: 10.2196/35336] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/11/2022] [Accepted: 04/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background Approximately one-third of all patients with schizophrenia are treatment resistant. Worldwide, undertreatment with clozapine and other effective treatment options exist for people with treatment-resistant schizophrenia (TRS). In this respect, it appears that regular health care models do not optimally fit this patient group. The Collaborative Care (CC) model has proven to be effective for patients with severe mental illness, both in primary care and in specialized mental health care facilities. The key principles of the CC model are that both patients and informal caregivers are part of the treatment team, that a structured treatment plan is put in place with planned evaluations by the team, and that the treatment approach is multidisciplinary in nature and uses evidence-based interventions. We developed a tailored CC program for patients with TRS. Objective In this paper, we provide an overview of the research design for a potential study that seeks to gain insight into both the process of implementation and the preliminary effects of the CC program for patients with TRS. Moreover, we aim to gain insight into the experiences of professionals, patients, and informal caregivers with the program. Methods This study will be underpinned by a multiple case study design (N=20) that uses a mixed methods approach. These case studies will focus on an Early Psychosis Intervention Team and 2 Flexible Assertive Community treatment teams in the Netherlands. Data will be collected from patient records as well as through questionnaires, individual interviews, and focus groups. Patient recruitment commenced from October 2020. Results Recruitment of participants commenced from October 2020, with the aim of enrolling 20 patients over 2 years. Data collection will be completed by the end of 2023, and the results will be published once all data are available for reporting. Conclusions The research design, framed within the process of developing and testing innovative interventions, is discussed in line with the aims of the study. The limitations in clinical practice and specific consequences of this study are explained. International Registered Report Identifier (IRRID) DERR1-10.2196/35336
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Affiliation(s)
- Amy Jongkind
- Reinier van Arkel, 's-Hertogenbosch, Netherlands
- Amsterdam University Medical Center (VUmc), Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | - Koen Grootens
- Reinier van Arkel, 's-Hertogenbosch, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Aartjan T F Beekman
- Amsterdam University Medical Center (VUmc), Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Berno van Meijel
- Amsterdam University Medical Center (VUmc), Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Inholland University of Applied Sciences, Department of Health, Sports & Welfare, Cluster Nursing, Amsterdam, Netherlands
- Parnassia Psychiatric Institute, Parnassia Academy, The Hague, Netherlands
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Brouwer A, van Raalte DH, Lamers F, Rutters F, Elders PJM, Van Someren EJW, Snoek FJ, Beekman ATF, Bremmer MA. Insulin resistance as a marker for the immune-metabolic subtype of depression. J Affect Disord 2021; 295:1371-1376. [PMID: 34565592 DOI: 10.1016/j.jad.2021.08.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/14/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Insulin resistance (IR), a marker of metabolic dysregulation and pro-inflammatory state, moderates the antidepressant treatment effect in patients with type 2 diabetes (T2D) and is therefore a potential marker for personalized treatment. Based on data from a light therapy trial (NTR4942), we aimed to evaluate whether 1) depression symptoms differ according to the level of IR, and 2) improvement of specific depression symptoms drive the positive effects of light therapy in those with higher IR. METHODS This secondary analysis in 59 individuals with depression and T2D explored differences in depressive symptom profile (30-item Inventory of Depressive Symptomatology (IDS)) at baseline and in response to light therapy (versus placebo), between lower and higher IR individuals, using Likelihood Ratio tests and Linear-by-linear association. IR was measured using the gold standard, a hyperinsulinemic-euglycaemic clamp. RESULTS At baseline, higher IR individuals reported more symptoms of irritability (p=0.024) anhedonia (no interest in people and activities: p=0.011; absence of pleasure and enjoyment: p=0.021), fatigue (fatigue: p=0.036; physical fatigue: p=0.035) and hypersomnia (p=0.029) relative to persons with lower IR, who reported more insomnia (nightly awakening: p=0.041; early morning awakening: p=0.012). Light therapy led to an improvement across IDS symptoms in higher IR individuals, while in lower IR individuals, light therapy improved early morning awakening (p=0.005) and interest in people and activities (p=0.015), but worsened mood (feeling sad: p=0.001; feeling irritable: p=0.002; interpersonal sensitivity: p=0.014). CONCLUSIONS Results add to the hypothesis of an immune-metabolic subtype of depression, and suggest that IR might be a promising focus for precision medicine.
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Affiliation(s)
- Annelies Brouwer
- Amsterdam UMC and GGZ inGeest, Dept. of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Postbus, 7075, 1007 MB, Amsterdam, the Netherlands.
| | - Daniël H van Raalte
- Amsterdam UMC, Dept. of Internal Medicine, Diabetes Center, Vrije Universiteit, Amsterdam, the Netherlands
| | - Femke Lamers
- Amsterdam UMC and GGZ inGeest, Dept. of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Postbus, 7075, 1007 MB, Amsterdam, the Netherlands
| | - Femke Rutters
- Amsterdam UMC, Dept. of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, the Netherlands
| | - Petra J M Elders
- Amsterdam UMC, Dept. of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, the Netherlands
| | - Eus J W Van Someren
- Amsterdam UMC and GGZ inGeest, Dept. of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Postbus, 7075, 1007 MB, Amsterdam, the Netherlands; Dept. of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, the Netherlands; Amsterdam UMC, Dept. of Integrative Neurophysiology, Centre for Neurogenomics and Cognitive Research, Neuroscience Campus Amsterdam, Vrije Universiteit, Amsterdam, the Netherlands
| | - Frank J Snoek
- Amsterdam UMC, Dept. of Medical Psychology, Amsterdam Public Health research institute, Vrije Universiteit and University of Amsterdam, Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Amsterdam UMC and GGZ inGeest, Dept. of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Postbus, 7075, 1007 MB, Amsterdam, the Netherlands
| | - Marijke A Bremmer
- Amsterdam UMC and GGZ inGeest, Dept. of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Postbus, 7075, 1007 MB, Amsterdam, the Netherlands
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Wagenmakers MJ, Vansteelandt K, van Exel E, Postma R, Schouws SNTM, Obbels J, Rhebergen D, Bouckaert F, Stek ML, Barkhof F, Beekman ATF, Veltman DJ, Sienaert P, Dols A, Oudega ML. Transient Cognitive Impairment and White Matter Hyperintensities in Severely Depressed Older Patients Treated With Electroconvulsive Therapy. Am J Geriatr Psychiatry 2021; 29:1117-1128. [PMID: 33454176 DOI: 10.1016/j.jagp.2020.12.028] [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: 11/12/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although electroconvulsive therapy (ECT) is a safe and effective treatment for patients with severe late life depression (LLD), transient cognitive impairment can be a reason to discontinue the treatment. The aim of the current study was to evaluate the association between structural brain characteristics and general cognitive function during and after ECT. METHODS A total of 80 patients with LLD from the prospective naturalistic follow-up Mood Disorders in Elderly treated with Electroconvulsive Therapy study were examined. Magnetic resonance imaging scans were acquired before ECT. Overall brain morphology (white and grey matter) was evaluated using visual rating scales. Cognitive functioning before, during, and after ECT was measured using the Mini Mental State Examination (MMSE). A linear mixed-model analysis was performed to analyze the association between structural brain alterations and cognitive functioning over time. RESULTS Patients with moderate to severe white matter hyperintensities (WMH) showed significantly lower MMSE scores than patients without severe WMH (F(1,75.54) = 5.42, p = 0.02) before, during, and post-ECT, however their trajectory of cognitive functioning was similar as no time × WMH interaction effect was observed (F(4,65.85) = 1.9, p = 0.25). Transient cognitive impairment was not associated with medial temporal or global cortical atrophy (MTA, GCA). CONCLUSION All patients showed a significant drop in cognitive functioning during ECT, which however recovered above baseline levels post-ECT and remained stable until at least 6 months post-ECT, independently of severity of WMH, GCA, or MTA. Therefore, clinicians should not be reluctant to start or continue ECT in patients with severe structural brain alterations.
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Affiliation(s)
- Margot J Wagenmakers
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Kristof Vansteelandt
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium
| | - Eric van Exel
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands
| | - Rein Postma
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Sigfried N T M Schouws
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands
| | - Jasmien Obbels
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium; University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium
| | - Didi Rhebergen
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands
| | - Filip Bouckaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium
| | - Max L Stek
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands
| | - Frederik Barkhof
- Institute of Healthcare Engineering, University College London, London, UK; Institute of Neurology, University College London, London, UK; Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands
| | - Dick J Veltman
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands
| | - Pascal Sienaert
- Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center KU Leuven (Catholic University of Leuven), Leuven, Belgium
| | - Annemieke Dols
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands
| | - Mardien L Oudega
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health (Research Institute), Amsterdam, The Netherlands
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