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Veeneman RR, Vermeulen JM, Bialas M, Bhamidipati AK, Abdellaoui A, Munafò MR, Denys D, Bezzina CR, Verweij KJH, Tadros R, Treur JL. Mental illness and cardiovascular health: observational and polygenic score analyses in a population-based cohort study. Psychol Med 2024; 54:931-939. [PMID: 37706306 DOI: 10.1017/s0033291723002635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Individuals with serious mental illness have a markedly shorter life expectancy. A major contributor to premature death is cardiovascular disease (CVD). We investigated associations of (genetic liability for) depressive disorder, bipolar disorder and schizophrenia with a range of CVD traits and examined to what degree these were driven by important confounders. METHODS We included participants of the Dutch Lifelines cohort (N = 147 337) with information on self-reported lifetime diagnosis of depressive disorder, bipolar disorder, or schizophrenia and CVD traits. Employing linear mixed-effects models, we examined associations between mental illness diagnoses and CVD, correcting for psychotropic medication, demographic and lifestyle factors. In a subsample (N = 73 965), we repeated these analyses using polygenic scores (PGSs) for the three mental illnesses. RESULTS There was strong evidence that depressive disorder diagnosis is associated with increased arrhythmia and atherosclerosis risk and lower heart rate variability, even after confounder adjustment. Positive associations were also found for the depression PGSs with arrhythmia and atherosclerosis. Bipolar disorder was associated with a higher risk of nearly all CVD traits, though most diminished after adjustment. The bipolar disorder PGSs did not show any associations. While the schizophrenia PGSs was associated with increased arrhythmia risk and lower heart rate variability, schizophrenia diagnosis was not. All mental illness diagnoses were associated with lower blood pressure and a lower risk of hypertension. CONCLUSIONS Our study shows widespread associations of (genetic liability to) mental illness (primarily depressive disorder) with CVD, even after confounder adjustment. Future research should focus on clarifying potential causal pathways between mental illness and CVD.
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Affiliation(s)
- R R Veeneman
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - J M Vermeulen
- Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - M Bialas
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - A K Bhamidipati
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - A Abdellaoui
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - M R Munafò
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - D Denys
- Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - C R Bezzina
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - K J H Verweij
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - R Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - J L Treur
- Genetic Epidemiology, Department of Psychiatry, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
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2
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Oudijn MS, Linders JTW, Lok A, Schuurman PR, van den Munckhof P, van Elburg AA, van Wingen GA, Mocking RJT, Denys D. Neural effects of deep brain stimulation on reward and loss anticipation and food viewing in anorexia nervosa: a pilot study. J Eat Disord 2023; 11:140. [PMID: 37605212 PMCID: PMC10440869 DOI: 10.1186/s40337-023-00863-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a severe and life-threatening psychiatric disorder. Initial studies on deep brain stimulation (DBS) in severe, treatment-refractory AN have shown clinical effects. However, the working mechanisms of DBS in AN remain largely unknown. Here, we used a task-based functional MRI approach to understand the pathophysiology of AN. METHODS We performed functional MRI on four AN patients that participated in a pilot study on the efficacy, safety, and functional effects of DBS targeted at the ventral limb of the capsula interna (vALIC). The patients and six gender-matched healthy controls (HC) were investigated at three different time points. We used an adapted version of the monetary incentive delay task to probe generic reward processing in patients and controls, and a food-specific task in patients only. RESULTS At baseline, no significant differences for reward anticipation were found between AN and HC. Significant group (AN and HC) by time (pre- and post-DBS) interactions were found in the right precuneus, right putamen, right ventral and medial orbitofrontal cortex (mOFC). No significant interactions were found in the food viewing task, neither between the conditions high-calorie and low-calorie food images nor between the different time points. This could possibly be due to the small sample size and the lack of a control group. CONCLUSION The results showed a difference in the response of reward-related brain areas post-DBS. This supports the hypotheses that the reward circuitry is involved in the pathogenesis of AN and that DBS affects responsivity of reward-related brain areas. Trial registration Registered in the Netherlands Trial Register ( https://www.trialregister.nl/trial/3322 ): NL3322 (NTR3469).
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Affiliation(s)
- M S Oudijn
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - J T W Linders
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A Lok
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P R Schuurman
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P van den Munckhof
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A A van Elburg
- Faculty of Social Sciences, University of Utrecht, Utrecht, The Netherlands
| | - G A van Wingen
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R J T Mocking
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - D Denys
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
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3
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van Leeuwen W, van der Straten A, Bögemann SA, Denys D, van Marle H, van Wingen G. Psychological distress modulates dorsal anterior cingulate cortex responses to salient stimuli in obsessive-compulsive disorder. J Affect Disord 2023; 325:185-193. [PMID: 36587910 DOI: 10.1016/j.jad.2022.12.145] [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: 02/11/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with obsessive-compulsive disorder (OCD) experience an exacerbation of symptoms under psychological distress. The neurobiological underpinnings of this effect of stress remain elusive. Here, we induced psychological distress to explore its effect on neural reactivity of the salience network during a symptom provocation task. METHODS Twenty-three patients with OCD and twenty-three healthy volunteers underwent functional magnetic resonance imaging scanning after stress induction and a control condition in a cross-over design. Psychological distress was induced using the socially evaluated cold pressor test (SECPT) and neural responses were measured during a symptom provocation task. RESULTS OCD participants showed a blunted cortisol response to the stressor. We found a group by stress interaction effect in the dorsal anterior cingulate cortex (dACC), such that psychological distress reduced dACC reactivity to emotionally salient pictures in OCD participants, whereas it increased dACC reactivity in healthy controls. LIMITATIONS A considerable proportion of OCD participants was on medication, and the neuroimaging session was conducted more than 1 h after the initial stressor. CONCLUSIONS Considering this timeline, we speculate that the blunted dACC reactivity towards emotionally salient pictures in OCD participants may reflect impaired emotion regulation in the aftermath of stress.
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Affiliation(s)
- W van Leeuwen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, PO Box 22660, 1100 DD Amsterdam, the Netherlands.
| | - A van der Straten
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - S A Bögemann
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Kapittelweg 29, 6525 EN Nijmegen, the Netherlands
| | - D Denys
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - H van Marle
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, PO Box 22660, 1100 DD Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Research and Innovation, Oldenaller 1, 1081 HJ Amsterdam, the Netherlands
| | - G van Wingen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, PO Box 22660, 1100 DD Amsterdam, the Netherlands
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4
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Cohen SE, Zantvoord JB, Wezenberg BN, Daams JG, Bockting CLH, Denys D, van Wingen GA. Electroencephalography for predicting antidepressant treatment success: A systematic review and meta-analysis. J Affect Disord 2023; 321:201-207. [PMID: 36341804 DOI: 10.1016/j.jad.2022.10.042] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients suffering from major depressive disorder (MDD) regularly experience non-response to treatment for their depressive episode. Personalized clinical decision making could shorten depressive episodes and reduce patient suffering. Although no clinical tools are currently available, machine learning analysis of electroencephalography (EEG) shows promise in treatment response prediction. METHODS With a systematic review and meta-analysis, we evaluated the accuracy of EEG for individual patient response prediction. Importantly, we included only prediction studies that used cross-validation. We used a bivariate model to calculate prediction success, as expressed by area-under the curve, sensitivity and specificity. Furthermore, we analyzed prediction success for separate antidepressant interventions. RESULTS 15 studies with 12 individual patient samples and a total of 479 patients were included. Research methods varied considerably between studies. Meta-analysis of results from this heterogeneous set of studies resulted in an area under the curve of 0.91, a sensitivity of 83 % (95 % CI 74-89 %), and a specificity of 86 % (95 % CI 81-90 %). Classification performance did not significantly differ between treatments. Although studies were all internally validated, no externally validated studies have been reported. We found substantial risk of bias caused by methodological shortcomings such as non-independent feature selection, though performance of non-biased studies was comparable. LIMITATIONS Sample sizes were relatively small and no study used external validation, increasing the risk of overestimation of accuracy. CONCLUSIONS Electroencephalography can predict the response to antidepressant treatment with high accuracy. However, future studies with more rigorous validation are needed to produce a clinical tool to guide interventions in MDD. PROSPERO REGISTRATION NUMBER CRD42021268169.
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Affiliation(s)
- S E Cohen
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - J B Zantvoord
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - B N Wezenberg
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - J G Daams
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - C L H Bockting
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - D Denys
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - G A van Wingen
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands.
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5
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Oudijn M, Linders J, Mocking R, Lok A, van Elburg A, Denys D. Psychopathological and Neurobiological Overlap Between Anorexia Nervosa and Self-Injurious Behavior: A Narrative Review and Conceptual Hypotheses. Front Psychiatry 2022; 13:756238. [PMID: 35633779 PMCID: PMC9130491 DOI: 10.3389/fpsyt.2022.756238] [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: 08/10/2021] [Accepted: 04/25/2022] [Indexed: 11/29/2022] Open
Abstract
Empirical evidence and clinical observations suggest a strong -yet under acknowledged-link between anorexia nervosa (AN) and non-suicidal self-injurious behavior (NSSI). By reviewing the literature on the psychopathology and neurobiology of AN and NSSI, we shed light on their relationship. Both AN and NSSI are characterized by disturbances in affect regulation, dysregulation of the reward circuitry and the opioid system. By formulating a reward-centered hypothesis, we explain the overlap between AN and NSSI. We propose three approaches understanding the relationship between AN and NSSI, which integrate psychopathology and neurobiology from the perspective of self-destructiveness: (1) a nosographical approach, (2) a research domain (RDoC) approach and (3) a network analysis approach. These approaches will enhance our knowledge of the underlying neurobiological substrates and may provide groundwork for the development of new treatment options for disorders of self-destructiveness, like AN and NSSI. In conclusion, we hypothesize that self-destructiveness is a new, DSM-5-transcending concept or psychopathological entity that is reward-driven, and that both AN and NSSI could be conceptualized as disorders of self-destructiveness.
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Affiliation(s)
- Marloes Oudijn
- Department of Psychiatry, Amsterdam University Medical Centers (Amsterdam UMC), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands
| | - Jara Linders
- Department of Psychiatry, Amsterdam University Medical Centers (Amsterdam UMC), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands
| | - Roel Mocking
- Department of Psychiatry, Amsterdam University Medical Centers (Amsterdam UMC), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands
| | - Anja Lok
- Department of Psychiatry, Amsterdam University Medical Centers (Amsterdam UMC), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands
| | | | - D Denys
- Department of Psychiatry, Amsterdam University Medical Centers (Amsterdam UMC), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands
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6
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Denys D, Fridgeirsson E, Eijsker N, Bais M, Thomas R, Bergfeld I, Schuurman P, van den Munckhof P, de Koning P, Figee M. Concurrent Intracranial and Extracranial Electrophysiological Recordings in Humans: relevance for deep brain stimulation in psychiatric disorders. Brain Stimul 2021. [DOI: 10.1016/j.brs.2021.10.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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7
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Oudijn MS, Mocking RJT, Wijnker RR, Lok A, Schuurman PR, van den Munckhof P, van Elburg AA, Denys D. Deep brain stimulation of the ventral anterior limb of the capsula interna in patients with treatment-refractory anorexia nervosa. Brain Stimul 2021; 14:1528-1530. [PMID: 34678486 DOI: 10.1016/j.brs.2021.10.387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- M S Oudijn
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands.
| | - R J T Mocking
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
| | - R R Wijnker
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
| | - A Lok
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
| | - P R Schuurman
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
| | - P van den Munckhof
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
| | - A A van Elburg
- Faculty of Social Sciences, University of Utrecht, Utrecht, the Netherlands
| | - D Denys
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
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8
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Montagne B, de Geus F, Kessels R, Denys D, de Haan E, Westenberg H. Perception of facial expressions in obsessive-compulsive disorder: A dimensional approach. Eur Psychiatry 2020; 23:26-8. [DOI: 10.1016/j.eurpsy.2007.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Revised: 07/17/2007] [Accepted: 07/24/2007] [Indexed: 10/22/2022] Open
Abstract
AbstractThe study examined the perception of facial expressions of different emotional intensities in obsessive-compulsive disorder (OCD) subtypes. Results showed that the High Risk Assessment and Checking subtype was more sensitive in perceiving the emotions fear and happiness. This suggests that altered affective processing may underlie the clinical manifestation of OCD.
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9
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van Leeuwen WA, van Wingen GA, Luyten P, Denys D, van Marle HJF. Attachment in OCD: A meta-analysis. J Anxiety Disord 2020; 70:102187. [PMID: 31951931 DOI: 10.1016/j.janxdis.2020.102187] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 04/18/2019] [Revised: 11/11/2019] [Accepted: 01/04/2020] [Indexed: 01/15/2023]
Abstract
INTRODUCTION It has been proposed to extend the cognitive-behavioural model of obsessive-compulsive disorder (OCD) with attachment theory to shed light on the affective and developmental factors underlying the disease. With a growing number of empirical studies on the subject, this meta-analysis aims to quantify a possible relationship between attachment insecurity and OCD. METHODS A systematic search was conducted for studies in adult populations of patients with OCD as well as general populations displaying symptoms of OCD. Effect sizes of attachment anxiety and attachment avoidance were calculated separately. Covariates of demographic variables were used in meta-regressions. RESULTS Sixteen studies were included. Meta-analyses showed an association of medium to large effect size (Hedges' g = 0.69; 95 % CI 0.58 - 0.80; p < 0.001) between OCD and attachment anxiety, and an association of medium effect size (Hedges' g = 0.47; 95 % CI 0.39 - 0.54; p < 0.001) between OCD and attachment avoidance. Effect sizes in OCD population and general population studies did not differ significantly. DISCUSSION Robust effect sizes of both attachment anxiety and avoidance in relation to OCD symptomatology corroborate an attachment-centred view of OCD. These findings furthermore suggest that integrating cognitive and attachment-based therapeutic approaches to OCD may benefit patients in which developmental or emotional factors hinder successful treatment.
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Affiliation(s)
- W A van Leeuwen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, PO Box 22660, 1100 DD Amsterdam, the Netherlands.
| | - G A van Wingen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - P Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Tiensestraat 102, PO Box 3720, 3000 Leuven, Belgium; Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - D Denys
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - H J F van Marle
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 5, PO Box 22660, 1100 DD Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, de Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; GGZ InGeest Specialized Mental Health Care, Research and Innovation, Oldenaller 1, 1081 HJ, Amsterdam, the Netherlands
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10
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Ehmer I, Feenstra M, Willuhn I, Denys D. Instrumental learning in a mouse model for obsessive-compulsive disorder: Impaired habit formation in Sapap3 mutants. Neurobiol Learn Mem 2020; 168:107162. [PMID: 31927083 DOI: 10.1016/j.nlm.2020.107162] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 12/19/2019] [Accepted: 01/08/2020] [Indexed: 01/23/2023]
Abstract
It has been hypothesized that maladaptive habit formation contributes to compulsivity in psychiatric disorders such as obsessive-compulsive disorder (OCD). Here, we used an established animal model of OCD, Sapap3 knockout mice (SAPAP3-/-), to investigate the balance of goal-directed and habitual behavior in compulsive individuals and if altered habit formation is associated with compulsive-like behavior. We subjected 24 SAPAP3-/- and 24 wildtype littermates (WT) to two different schedules of reinforcement in a within-subjects design: a random-ratio (RR) schedule to promote goal-directedness, and a random-interval (RI) schedule, known to facilitate habitual responding. SAPAP3-/- acquired responding under both schedules, but showed lower response rates and fewer attempts to collect food pellets than WT, indicative of altered reward processing. As expected, WT were sensitive to sensory-specific satiety (outcome devaluation) following RR training, but not RI training, demonstrating schedule-specific acquisition of goal-directed and habitual responding, respectively. In contrast, SAPAP3-/- were sensitive to outcome devaluation after both RR and RI training, suggesting decreased engagement of a habitual response strategy. No linear relation was observed between increased grooming and behavior during the outcome devaluation test in SAPAP3-/-. Together, our findings demonstrate altered reward processing and impaired habit learning in SAPAP3-/-. We report a diminished propensity to form habits in these mice, which albeit inconsistent with the predominant idea of excessive habit formation in OCD, nonetheless points at dysregulation of behavioral automation in the context of compulsivity. Thus, the habit hypothesis of compulsivity should be updated to state that an imbalance of habitual and goal-directed responding in either direction can contribute to the development of compulsive behavior.
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Affiliation(s)
- I Ehmer
- Netherlands Institute for Neuroscience, Royal Academy of Arts and Sciences, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M Feenstra
- Netherlands Institute for Neuroscience, Royal Academy of Arts and Sciences, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - I Willuhn
- Netherlands Institute for Neuroscience, Royal Academy of Arts and Sciences, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - D Denys
- Netherlands Institute for Neuroscience, Royal Academy of Arts and Sciences, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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11
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Abdellaoui A, Treur JL, Nivard MG, Smit DJA, Veul L, Vermeulen JM, Peyrot W, Penninx BWJH, Boomsma DI, van den Brink W, Denys D, Verweij KJH. [Genes and environment both important in psychological suffering]. Tijdschr Psychiatr 2020; 62:835-838. [PMID: 33184812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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12
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Graat I, van Rooijen G, Mocking R, de Koning P, Denys D. Is comorbid autism or bipolar disorder a contra-indication for DBS in patients with OCD? Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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13
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Graat I, Mocking R, Figee M, Vulink N, de Koning P, Ooms P, Mantione M, van den Munckhof P, Schuurman R, Denys D. Long-term effects of deep brain stimulation of the ventral anterior limb of the internal capsule for obsessive compulsive disorder. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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14
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Figee M, Schuurman PR, Denys D. [Deep brain stimulation for psychiatric disorders]. Ned Tijdschr Geneeskd 2018; 162:D2333. [PMID: 29676713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
- Deep brain stimulation (DBS) corrects pathological activity of neuropsychiatric brain networks with high frequency current via implanted brain electrodes.- DBS is an effective and safe treatment for therapy-refractory obsessive-compulsive disorder and potentially also for therapy-refractory major depressive disorder.- Experimental psychiatric indications for DBS are Tourette syndrome, addiction, anorexia nervosa, post-traumatic stress disorder, autism and schizophrenia.- DBS influences brain networks that are relevant for a variety of psychiatric symptoms. Potentially, in the future this interventional technique may therefore be deployed more broadly.
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Affiliation(s)
- M Figee
- Academisch Medisch Centrum, Amsterdam
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Denys D. [Does psychiatry revert to subjectivity?]. Tijdschr Psychiatr 2018; 60:619-626. [PMID: 30215450] [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: 06/08/2023]
Abstract
Psychiatry is currently challenged by two main issues, subjectivity and non-exclusivity.<br /> AIM: The re-appraisal of phenomenological psychiatry.<br /> METHOD: Personal reflection. <br /> RESULTS: Phenomenology may contribute to psychiatry by 1. offering a method, 2. focusing on descriptive observation, and 3. taking a neutral stance.<br /> CONCLUSION: By emphasizing the subjective experience, phenomenology offers psychiatry an opportunity to become proficient and to distinguish itself from other disciplines through the continued development of insight and understanding of mental disorders.
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van der Straten AL, Denys D, van Wingen GA. Impact of treatment on resting cerebral blood flow and metabolism in obsessive compulsive disorder: a meta-analysis. Sci Rep 2017; 7:17464. [PMID: 29234089 PMCID: PMC5727319 DOI: 10.1038/s41598-017-17593-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 11/28/2017] [Indexed: 12/23/2022] Open
Abstract
Neurobiological models of obsessive-compulsive disorder (OCD) posit that its clinical symptoms such as repetitive thoughts and behaviors are related to hyperactivity in the cortico-striato-thalamo-cortical (CSTC) circuit. Small scale neuroimaging studies have shown that treatment of OCD is associated with reduced activity across different brain structures within this circuitry. We performed the first meta-analysis of positron emission tomography (PET) and single photon emission computed tomography (SPECT) studies that investigated cerebral blood flow or glucose metabolism in patients with OCD before and after pharmacological or psychological treatment. We calculated standardized mean differences for the regions-of-interest most often reported. The meta-analysis revealed small reductions in activity in the caudate nucleus and orbitofrontal cortex after treatment with a serotonin reuptake inhibitor or cognitive behavioral therapy. Small reductions were also observed in the thalamus when one SPECT study with a large opposite effect was excluded from the analysis. Meta-regression analyses for the caudate nucleus showed no significant effect of the type of treatment, decrease in symptom severity, mean duration until the follow-up scan, or year of publication. These results show that pharmacological and psychological treatments reduce resting CSTC circuit activity, and provide further support for the CSTC circuit model in OCD.
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Affiliation(s)
- A L van der Straten
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
- Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands.
| | - D Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - G A van Wingen
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
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Dell'Osso B, Benatti B, Rodriguez CI, Arici C, Palazzo C, Altamura AC, Hollander E, Fineberg N, Stein DJ, Nicolini H, Lanzagorta N, Marazziti D, Pallanti S, Van Ameringen M, Lochner C, Karamustafalioglu O, Hranov L, Figee M, Drummond L, Grant J, Denys D, Cath D, Menchon JM, Zohar J. Obsessive-compulsive disorder in the elderly: A report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS). Eur Psychiatry 2017; 45:36-40. [PMID: 28728093 DOI: 10.1016/j.eurpsy.2017.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a highly disabling condition, with frequent early onset. Adult/adolescent OCD has been extensively investigated, but little is known about prevalence and clinical characterization of geriatric patients with OCD (G-OCD≥65years). The present study aimed to assess prevalence of G-OCD and associated socio-demographic and clinical correlates in a large international sample. METHODS Data from 416 outpatients, participating in the ICOCS network, were assessed and categorized into 2 groups, age<vs≥65years, and then divided on the basis of the median age of the sample (age<vs≥42years). Socio-demographic and clinical variables were compared between groups (Pearson Chi-squared and t tests). RESULTS G-OCD compared with younger patients represented a significant minority of the sample (6% vs 94%, P<.001), showing a significantly later age at onset (29.4±15.1 vs 18.7±9.2years, P<.001), a more frequent adult onset (75% vs 41.1%, P<.001) and a less frequent use of cognitive-behavioural therapy (CBT) (20.8% vs 41.8%, P<.05). Female gender was more represented in G-OCD patients, though not at a statistically significant level (75% vs 56.4%, P=.07). When the whole sample was divided on the basis of the median age, previous results were confirmed for older patients, including a significantly higher presence of women (52.1% vs 63.1%, P<.05). CONCLUSIONS G-OCD compared with younger patients represented a small minority of the sample and showed later age at onset, more frequent adult onset and lower CBT use. Age at onset may influence course and overall management of OCD, with additional investigation needed.
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Affiliation(s)
- B Dell'Osso
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; Department of Psychiatry and Behavioral Sciences, Stanford University, 94305 Stanford, CA, USA
| | - B Benatti
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy.
| | - C I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, 94305 Stanford, CA, USA
| | - C Arici
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - C Palazzo
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - A C Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - E Hollander
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, 10467 New York, USA
| | - N Fineberg
- Mental Health Unit, Hertfordshire Partnership Foundation Trust, Queen Elizabeth II Hospital, AL7 4HQ Welwyn Garden City, UK
| | - D J Stein
- MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry and Mental Health, University of Cape Town, 7935 Cape Town, South Africa
| | - H Nicolini
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), 03100 Mexico City, Mexico; Carracci Medical Group, 03100 Mexico City, Mexico
| | - N Lanzagorta
- Carracci Medical Group, 03100 Mexico City, Mexico
| | - D Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Sezione di Psichiatria, Università di Pisa, 56126 Pisa, Italy
| | - S Pallanti
- Department of Psychiatry, University of Florence, and Institute of Neurosciences, 50121 Florence, Italy
| | - M Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, ON L8S 4L8 Hamilton, Canada
| | - C Lochner
- MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, 7599 Stellenbosch, South Africa
| | - O Karamustafalioglu
- Department of Psychiatry, Sisli Eftal Teaching and Research Hospital, 34371 Istanbul, Turkey
| | - L Hranov
- University Multiprofile Hospital for Active Treatment in Neurology and Psychiatry Sveti Naum, 1797 Sofia, Bulgaria
| | - M Figee
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, 1105 Amsterdam, Netherlands
| | - L Drummond
- National and Trustwide Services for OCD/BDD, SW London and St George's NHS Trust, SW17 7DJ London, UK
| | - J Grant
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, 60607 Chicago, USA
| | - D Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, 1105 Amsterdam, Netherlands
| | - D Cath
- Department of Clinical and Health Psychology, Utrecht University, 3512 Utrecht, The Netherlands
| | - J M Menchon
- Psychiatry Unit at Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - J Zohar
- Department of Psychiatry, Chaim Sheba Medical Center, 52621 Tel Hashomer, Israel
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18
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Bergfeld IO, Mantione M, Hoogendoorn MLC, Ruhé HG, Horst F, Notten P, van Laarhoven J, van den Munckhof P, Beute G, Schuurman PR, Denys D. Impact of deep brain stimulation of the ventral anterior limb of the internal capsule on cognition in depression. Psychol Med 2017; 47:1647-1658. [PMID: 28179035 DOI: 10.1017/s0033291717000113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 01/19/2023]
Abstract
BACKGROUND Preliminary studies report no negative and a possible positive impact of deep brain stimulation (DBS) on cognition of patients with treatment-resistant depression (TRD). However, these studies neither controlled for practice effects nor compared active with sham stimulation. METHOD To address these limitations, we compared 25 TRD patients, who underwent DBS of the ventral anterior limb of the internal capsule (vALIC), with 21 healthy controls (HCs) matched on gender, age and education level. Both groups did subtests of the Cambridge Neuropsychological Test Automated Battery assessing verbal and visuospatial memory, attention, cognitive flexibility, psychomotor functioning, planning and object naming. TRD patients were tested 3 weeks prior to DBS surgery (baseline), 3 weeks following surgery (T1) and following 52 weeks of DBS optimization (T2). HCs were tested at baseline, 6 weeks following baseline (T1) and 20-24 weeks following baseline (T2). Subsequently, TRD patients entered a randomized, double-blind crossover phase, in which they were tested in an active and a sham stimulation phase. RESULTS TRD patients did not improve on a test of immediate verbal recognition from baseline to T1, whereas HCs did (group x time: p = 0.001). Both TRD patients and HCs improved over sessions on tests measuring delayed verbal recall, visuospatial memory, planning and object naming (all p < 0.01). Active and sham stimulation did not have an impact on any of the tests differentially. CONCLUSIONS vALIC DBS neither has a lasting positive nor negative impact on cognition in TRD patients. DBS surgery might have a temporary negative effect on verbal memory.
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Affiliation(s)
- I O Bergfeld
- Department of Psychiatry,Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - M Mantione
- Department of Psychiatry,Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - M L C Hoogendoorn
- Department of Psychiatry,Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - H G Ruhé
- Department of Psychiatry,Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - F Horst
- Department of Psychiatry,ETZ, location Elisabeth,Tilburg,The Netherlands
| | - P Notten
- Department of Psychiatry,ETZ, location Elisabeth,Tilburg,The Netherlands
| | - J van Laarhoven
- Department of Psychiatry,ETZ, location Elisabeth,Tilburg,The Netherlands
| | - P van den Munckhof
- Department of Neurosurgery,Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - G Beute
- Department of Neurosurgery,ETZ, location Elisabeth,Tilburg,The Netherlands
| | - P R Schuurman
- Department of Neurosurgery,Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - D Denys
- Department of Psychiatry,Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
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van Rooijen G, Strypet M, Maat A, Scheepens DS, Oudijn MS, Klopper KE, Denys D. Early introduction of clozapine after neuroleptic malignant syndrome may prevent malignant catatonia: A case report. Eur Neuropsychopharmacol 2017; 27:91-92. [PMID: 27939254 DOI: 10.1016/j.euroneuro.2016.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/08/2016] [Revised: 10/31/2016] [Accepted: 11/21/2016] [Indexed: 11/26/2022]
Affiliation(s)
- G van Rooijen
- Department of Psychiatry, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M Strypet
- Department of Intensive Care and Mobile Intensive Care Unit, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - A Maat
- Department of Psychiatry, Waterland Ziekenhuis, Waterlandlaan 250, 1441 RN, Purmerend, The Netherlands
| | - D S Scheepens
- Department of Psychiatry, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M S Oudijn
- Department of Psychiatry, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - K E Klopper
- Department of Intensive Care and Mobile Intensive Care Unit, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - D Denys
- Department of Psychiatry, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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20
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Figee M, Bervoets C, Denys D. [Deep brain stimulation in psychiatry]. Tijdschr Psychiatr 2017; 59:638-642. [PMID: 29077140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is now used regularly to treat therapy-refractory obsessive-compulsive disorders, and is being applied experimentally for refractory depression, Tourette syndrome, addiction, eating disorders, post-traumatic stress disorder, autism and schizophrenia. AIM To review the effects and mechanisms of dbs and to consider the future opportunities for this type of treatment in psychiatry. METHOD We reviewed the literature using PubMed. RESULTS DBS is effective and safe to use in the treatment of therapy-refractory OCD and has produced encouraging results in cases of refractory depression and Tourette syndrome. However, further investigations are needed with regard to the use of DBS for treating other psychiatric disorders. DBS influences brain networks that are relevant for a whole range of psychiatric symptoms. CONCLUSION DBS should always be considered as possible treatment for therapy-refractory OCD. DBS often leads to marked and rapid improvement in mood, anxiety, behaviour and other psychiatric symptoms, making it a promising intervention for a variety of refractory patient groups. The development of DBS for psychiatry will benefit from our increased knowledge about how specific brain networks relate to psychiatric dysfunctioning.
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21
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de Koning PP, Figee M, Endert E, van den Munckhof P, Schuurman PR, Storosum JG, Denys D, Fliers E. Rapid effects of deep brain stimulation reactivation on symptoms and neuroendocrine parameters in obsessive-compulsive disorder. Transl Psychiatry 2016; 6:e722. [PMID: 26812043 PMCID: PMC5068888 DOI: 10.1038/tp.2015.222] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/02/2015] [Accepted: 12/02/2015] [Indexed: 11/09/2022] Open
Abstract
Improvement of obsessions and compulsions by deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) is often preceded by a rapid and transient mood elevation (hypomania). In a previous study we showed that improvement of mood by DBS for OCD is associated with a decreased activity of the hypothalamus-pituitary adrenal axis. The aim of our present study was to evaluate the time course of rapid clinical changes following DBS reactivation in more detail and to assess their association with additional neuroendocrine parameters. We included therapy-refractory OCD patients treated with DBS (>1 year) and performed a baseline assessment of symptoms, as well as plasma concentrations of thyroid-stimulating hormone (TSH), prolactin, growth hormone, copeptin and homovanillic acid. This was repeated after a 1-week DBS OFF condition. Next, we assessed the rapid effects of DBS reactivation by measuring psychiatric symptom changes using visual analog scales as well as repeated neuroendocrine measures after 30 min, 2 h and 6 h. OCD, anxiety and depressive symptoms markedly increased during the 1-week OFF condition and decreased again to a similar extent already 2 h after DBS reactivation. We found lower plasma prolactin (41% decrease, P=0.003) and TSH (39% decrease, P=0.003) levels during DBS OFF, which increased significantly already 30 min after DBS reactivation. The rapid and simultaneous increase in TSH and prolactin is likely to result from stimulation of hypothalamic thyrotropin-releasing hormone (TRH), which may underlie the commonly observed transient mood elevation following DBS.
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Affiliation(s)
- P P de Koning
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, PA.0-152, PO Box 22660, Amsterdam 1100 DD, The Netherlands. E-mail:
| | - M Figee
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - E Endert
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - P van den Munckhof
- Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - P R Schuurman
- Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J G Storosum
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - D Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - E Fliers
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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22
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van Waarde JA, Scholte HS, van Oudheusden LJB, Verwey B, Denys D, van Wingen GA. A functional MRI marker may predict the outcome of electroconvulsive therapy in severe and treatment-resistant depression. Mol Psychiatry 2015; 20:609-14. [PMID: 25092248 DOI: 10.1038/mp.2014.78] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [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: 01/12/2014] [Revised: 06/01/2014] [Accepted: 06/17/2014] [Indexed: 12/12/2022]
Abstract
Electroconvulsive therapy (ECT) is effective even in treatment-resistant patients with major depression. Currently, there are no markers available that can assist in identifying those patients most likely to benefit from ECT. In the present study, we investigated whether resting-state network connectivity can predict treatment outcome for individual patients. We included forty-five patients with severe and treatment-resistant unipolar depression and collected functional magnetic resonance imaging scans before the course of ECT. We extracted resting-state networks and used multivariate pattern analysis to discover networks that predicted recovery from depression. Cross-validation revealed two resting-state networks with significant classification accuracy after correction for multiple comparisons. A network centered in the dorsomedial prefrontal cortex (including the dorsolateral prefrontal cortex, orbitofrontal cortex and posterior cingulate cortex) showed a sensitivity of 84% and specificity of 85%. Another network centered in the anterior cingulate cortex (including the dorsolateral prefrontal cortex, sensorimotor cortex, parahippocampal gyrus and midbrain) showed a sensitivity of 80% and a specificity of 75%. These preliminary results demonstrate that resting-state networks may predict treatment outcome for individual patients and suggest that resting-state networks have the potential to serve as prognostic neuroimaging biomarkers to guide personalized treatment decisions.
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Affiliation(s)
- J A van Waarde
- Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands
| | - H S Scholte
- Cognitive Neuroscience Group, University of Amsterdam, Amsterdam, The Netherlands
| | | | - B Verwey
- Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands
| | - D Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - G A van Wingen
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
BACKGROUND Deep brain stimulation (DBS) is a promising new treatment for patients with treatment-refractory obsessive-compulsive disorder (OCD). However, since most DBS patients only show a partial response, the treatment still needs to be improved. In this study we hypothesized that cognitive-behavioural therapy (CBT) could optimize the post-operative management in DBS and we evaluated the efficacy of CBT as augmentation to DBS targeted at the nucleus accumbens. METHOD A total of 16 patients with treatment-refractory OCD were treated with DBS targeted at the nucleus accumbens. After stabilization of decline in OCD symptoms, a standardized 24-week CBT treatment programme was added to DBS in an open-phase trial of 8 months. Changes in obsessive-compulsive, anxiety and depressive symptoms were evaluated using the Yale-Brown Obsessive Compulsive Scale, Hamilton Anxiety Scale and Hamilton Rating Scale for Depression. RESULTS Following the addition of CBT to DBS, a significant decrease in obsessive-compulsive symptoms was observed, but not in anxiety and depressive symptoms. In a subsequent double-blind phase, in which stimulation was discontinued, OCD symptoms returned to baseline (relapse) and anxiety and depressive symptoms worsened (rebound) compared with baseline. CONCLUSIONS The results of this explorative study suggest that a combined treatment of accumbens DBS and CBT may be optimal for improving obsessive-compulsive symptoms in treatment-refractory OCD. However, a subsequent randomized controlled trial is necessary to draw firm conclusions. It seems that DBS results in affective changes that may be required to enable response prevention in CBT. This may indicate that DBS and CBT act as two complementary treatments.
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Affiliation(s)
- M Mantione
- Department of Psychiatry, Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - D H Nieman
- Department of Psychiatry, Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - M Figee
- Department of Psychiatry, Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - D Denys
- Department of Psychiatry, Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
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Smolders R, Figee M, Luigjes J, Mazaheri A, van Wingen G, Denys D. O24: An EEG and fMRI investigation into the therapeutic mechanism of deep brain stimulation in psychiatric disorders. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50130-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Klomp A, van Wingen G, de Ruiter M, Caan M, Denys D, Reneman L. Test–retest reliability of task-related pharmacological MRI with a single-dose oral citalopram challenge. Neuroimage 2013; 75:108-116. [DOI: 10.1016/j.neuroimage.2013.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/28/2013] [Accepted: 03/04/2013] [Indexed: 10/27/2022] Open
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Fineberg NA, Baldwin DS, Menchon JM, Denys D, Grünblatt E, Pallanti S, Stein DJ, Zohar J. Manifesto for a European research network into obsessive-compulsive and related disorders. Eur Neuropsychopharmacol 2013; 23:561-8. [PMID: 22796228 DOI: 10.1016/j.euroneuro.2012.06.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 05/31/2012] [Accepted: 06/07/2012] [Indexed: 10/28/2022]
Abstract
Obsessive-compulsive and related disorders (O-CRDs) are highly disabling psychiatric illnesses of early-onset. They are responsible for considerable morbidity and socioeconomic burden. Existing treatments are usually only partially successful and there is an urgent need to understand the aetiological factors and neurobiological bases of the disorders in order to develop new and more effective strategies for prevention, early detection and effective treatment. Emerging data from the neurosciences supports the reconceptualisation of obsessive-compulsive disorder as a spectrum disorder, related to but different from the anxiety disorders and closely aligned with other less well understood psychiatric disorders characterised by compulsive acts such as body dysmorphic disorder, trichotillomania, skin-picking disorder, hoarding disorder; and possibly extending to tic disorders and other neurodevelopmental disorders such as autism. A new, O-CRDs research network, supported by the Networks Initiative of the European College of Neuropsychopharmacology and comprising leading figures in preclinical and clinical research, has been established. It aims to provide a European perspective on the current debate around internationally-accepted diagnostic criteria and treatment strategies for O-CRDs. Its objectives include; (1) identifying the key outstanding research questions that depend upon cross-centre collaborative investigation, (2) setting a research agenda that is likely to produce an impact on health-outcomes, and (3) strengthening existing projects and collaborative enterprises with these objectives in mind. This paper reviews some of these critical research priorities. By establishing shared multinational databases, collaborative research networks, multicentre studies and joint publications, it is hoped that progress will be achieved.
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Luigjes J, van den Brink W, Feenstra M, van den Munckhof P, Schuurman PR, Schippers R, Mazaheri A, De Vries TJ, Denys D. Deep brain stimulation in addiction: a review of potential brain targets. Mol Psychiatry 2012; 17:572-83. [PMID: 21931318 DOI: 10.1038/mp.2011.114] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [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: 01/28/2023]
Abstract
Deep brain stimulation (DBS) is an adjustable, reversible, non-destructive neurosurgical intervention using implanted electrodes to deliver electrical pulses to areas in the brain. DBS is currently investigated in psychiatry for the treatment of refractory obsessive-compulsive disorder, Tourette syndrome and depressive disorder. Although recent research in both animals and humans has indicated that DBS may be an effective intervention for patients with treatment-refractory addiction, it is not yet entirely clear which brain areas should be targeted. The objective of this review is to provide a systematic overview of the published literature on DBS and addiction and outline the most promising target areas using efficacy and adverse event data from both preclinical and clinical studies. We found 7 animal studies targeting six different brain areas: nucleus accumbens (NAc), subthalamic nucleus (STN), dorsal striatum, lateral habenula, medial prefrontal cortex (mPFC) and hypothalamus, and 11 human studies targeting two different target areas: NAc and STN. Our analysis of the literature suggests that the NAc is currently the most promising DBS target area for patients with treatment-refractory addiction. The mPFC is another promising target, but needs further exploration to establish its suitability for clinical purposes. We conclude the review with a discussion on translational issues in DBS research, medical ethical considerations and recommendations for clinical trials with DBS in patients with addiction.
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Affiliation(s)
- J Luigjes
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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28
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Ooms P, van Loon A, Denys D. [Psychotherapy and neurobiology in obsessive-compulsive disorders]. Tijdschr Psychiatr 2012; 54:449-451. [PMID: 22588959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- P Ooms
- afdeling Psychiatrie, AMC, Amsterdam.
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van Os J, Kahn R, Denys D, Schoevers RA, Beekman ATF, Hoogendijk WJG, van Hemert AM, Hodiamont PPG, Scheepers F, Delespaul PAEG, Leentjens AFG. [Behavioural standard or coercive measure? Some considerations regarding the special issue on ROM]. Tijdschr Psychiatr 2012; 54:245-253. [PMID: 22422417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The cost of mental health care has possibly risen more than costs in other sectors of health care in the Netherlands. In an attempt to control the rising costs, new policies have been implemented that include the introduction of selective financial penalties for those in need of mental health care as well as the start of performance-based mental health care reimbursement. In order to achieve the latter goal, a nation-wide large-scale data collection was introduced based on clinical routine outcome monitoring (ROM) data, with a view to using these data for benchmarking. AIM Closer inspection of the benchmarking efforts in terms of scientific validity. METHOD Qualitative review and analysis. RESULTS Analysis shows that the type of ROM data that is collected in the Netherlands is valid for tracking the outcomes of individual patients, but unsuitable for performance comparisons between institutions for reasons of case-mix, instrument-mix, bias and lack of sensitivity. CONCLUSION Attempts to introduce benchmarking based on rom will probably have a negative impact on the practice of mental health care in the Netherlands. More input from mental health professionals and scientists is required in order to identify more rational and efficient ways of spending scarce resources.
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Affiliation(s)
- J van Os
- Maastricht Universitair Medisch Centrum, Postbus 616, 6200 MD (drt 12), Maastricht.
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de Vries F, Denys D, Cath D, Figee M, Vulink N, Veltman D, van der Doef T, Boellaard R, Westenberg H, van Balkom A, Lammertsma A, van Berckel B. Dopaminergic activity in Tourette's syndrome and obsessive–compulsive disorder. Neuroimage 2010. [DOI: 10.1016/j.neuroimage.2010.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
BACKGROUND In this study we compared subjects with obsessive and/or compulsive symptoms who did not meet all criteria for obsessive-compulsive disorder (OCD) (subthreshold subjects) to subjects with full-blown OCD and also to subjects without obsessions or compulsions. METHOD The data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a large representative sample of the general Dutch population (n=7076). Using the Composite International Diagnostic Interview, Version 1.1 (CIDI 1.1), three groups were distinguished: subjects without lifetime obsessions or compulsions (94.2%), subthreshold subjects (4.9%) and subjects with full-blown OCD according to DSM-III-R (0.9%). These three groups were compared on various items, including psychological vulnerability, health and functional status, psychiatric co-morbidity and seeking treatment. RESULTS Subthreshold and OCD subjects had similar scores on the majority of the items measured. Thus, there was little difference between subthreshold and OCD subjects in health, functional status, psychological vulnerability and psychiatric co-morbidity. However, OCD and subthreshold subjects scored worse on most of these items when compared to the controls without obsessions or compulsions. CONCLUSION Having obsessions and compulsions is associated with substantial suffering and disability. Most subjects with obsessions and/or compulsions are not diagnosed with OCD according to the DSM-III-R criteria although these subjects generally display similar consequences to full-blown OCD subjects. We recommend that these subthreshold cases receive special attention in the development of DSM-V.
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Affiliation(s)
- C de Bruijn
- Sint Franciscus Gasthuis, GGZ Delfland, 3045 PM Rotterdam, The Netherlands.
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Vulink N, Rosenberg A, Plooij J, Koole R, Bergé S, Denys D. Body dysmorphic disorder screening in maxillofacial outpatients presenting for orthognathic surgery. Int J Oral Maxillofac Surg 2008; 37:985-91. [DOI: 10.1016/j.ijom.2008.06.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2007] [Revised: 01/08/2008] [Accepted: 06/06/2008] [Indexed: 10/21/2022]
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Denys D. [Deep brain stimulation in psychiatric disorders]. Ned Tijdschr Geneeskd 2008; 152:2330-2335. [PMID: 19024063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Deep brain stimulation is a technique in which electrodes are stereotactically implanted in specific regions of the brain to administer electric pulses. After implantation, the activity of the electrodes can be adjusted. The field of psychiatry shows great interest in deep brain stimulation because there is little risk of complications and because it is reversible and postoperatively adjustable to optimalize the treatment. Deep brain stimulation is being investigated as a potential treatment for obsessive compulsive disorder, Tourette's syndrome, and major depressive disorder. Deep brain stimulation for psychiatric conditions is still strictly experimental. It is expected that deep brain stimulation will be the treatment of choice for chronic therapy-refractory psychiatric disorders. The speed of responses following deep brain stimulation is urging psychiatrists to reconsider basic pathophysiological mechanisms of psychiatric disorders.
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Affiliation(s)
- D Denys
- Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Psychiatrie, PA.2-179, Postbus 75.867, 1070 AW Amsterdam.
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Denys D, de Haan L. [25 years antipsychotics: back to the future?]. Tijdschr Psychiatr 2008; 50 Spec no.:105-109. [PMID: 19067308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The introduction of antipsychotics 50 years ago caused a revolution in psychiatry and deinstitutionalised psychotic patients on a massive scale. However, the new atypical antipsychotics introduced in the last 25 years have done very little to improve the treatment of psychosis. During this period pharmacological research into new antipsychotics has concentrated on the development of drugs which are just as effective as typical antipsychotics but which cause fewer extra-pyramidal side effects and have a more powerful effect on negative symptoms and cognitive problems. Although some patients have undoubtedly benefited from these new atypical antipsychotics, the drugs have not lived up to our expectations.
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Affiliation(s)
- D Denys
- Afdeling Psychiatrie, Academisch Medisch Centrum/Universiteit van Amsterdam, Amsterdam.
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de Bruijn C, Denys D. Post-traumatic stress disorder after life events. Br J Psychiatry 2006; 188:394-5; author reply 395. [PMID: 16582071 DOI: 10.1192/bjp.188.4.394-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Vulink NCC, Sigurdsson V, Kon M, Bruijnzeel-Koomen CAFM, Westenberg HGM, Denys D. [Body dysmorphic disorder in 3-8% of patients in outpatient dermatology and plastic surgery clinics]. Ned Tijdschr Geneeskd 2006; 150:97-100. [PMID: 16440565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To determine the 6-month prevalence of body dysmorphic disorder (BDD) in outpatient clinics of dermatology and plastic surgery in a university medical centre. DESIGN Questionnaire study. METHOD In the period January 2004-June 2004, the self-reported Body dysmorphic disorder questionnaire was completed by 530 and 475 new patients in the outpatient clinics of dermatology and plastic surgery, respectively. The dermatologist or plastic surgeon assessed the severity of the defect. To meet the DSM-IV criteria for BDD, the patient must have been preoccupied with treatment of all or part of their appearance, experienced obvious suffering or restriction of function with minimal or no defect present (defect score 1 or 2). RESULTS In the outpatient clinics ofdermatology and plastic surgery 8.5% (95% CI: 6.1-10.9) and 3.2% (95% CI: 1.7-4.7) of patients screened positive for BDD, respectively. CONCLUSION A high prevalence of BDD was found in the outpatient clinics ofdermatology and plastic surgery. Because dermatologists and plastic surgeons do not often recognise BDD, a simple screening tool is needed.
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Affiliation(s)
- N C C Vulink
- Universitair Medisch Centrum Utrecht, B.01.206, Postbus 85.500, 3508 GA Utrecht.
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Abstract
Pharmacotherapy and behavioural treatment are the main treatment options for patients with obsessive-compulsive disorder (OCD). Nevertheless, studies on the appropriateness of these treatments are scarce. We aimed to assess the adequacy of treatment in general, and pharmacotherapy in particular, in patients with OCD. Three hundred and thirteen outpatients with OCD were interviewed on admission at the University Medical Center (UMC) Utrecht, The Netherlands. Patients were evaluated for demographic and clinical characteristics. Current treatment was assessed on admission and treatment history was appraised retrospectively. On admission, only one-half of the patients took appropriate medication, of which 7.6% were prescribed maximal effective doses, 11.8% mean effective doses, 15% minimal effective doses and 19.4% ineffective doses. Approximately 35% of patients were prescribed no drugs and 16% inappropriate drugs. Although the majority of the patients had been treated on average three times prior to their current treatment, 24% had never received a serotonin reuptake inhibitor (SRI) or behaviour therapy. For approximately 50% of the total sample, the maximal effective dose of SRIs had never been taken during the course of treatment history. A large proportion of patients with OCD fail to receive adequate treatment. Many patients were prescribed SRIs at doses below those recommended for the guidelines.
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Affiliation(s)
- D Denys
- Department of Psychiatry, University Medical Center, Utrecht, The Netherlands.
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Denys D, van Megen HJ, Westenberg HG. [Inadequate pharmacotherapy in patients with obsessive-compulsive disorder]. Ned Tijdschr Geneeskd 2001; 145:914-8. [PMID: 11387867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
OBJECTIVE To determine the adequacy of drug treatment for patients with obsessive compulsive disorder (OCD). DESIGN Retrospective. METHOD One hundred and fifty outpatients with OCD, admitted at the University Medical Centre in Utrecht, the Netherlands, were evaluated for severity as measured with the 'Yale-Brown obsessive compulsive scale' (Y-BOCS). RESULTS At the intake, 35% of the patients used no medication, 58% used an antidepressant, less than 1% an antipsychotic and 6% a benzodiazepine. The average active dose was taken by 12% of the patients, 5% took the maximum dosage and 41% too low a dosage. Consequently, 6 out of the 10 patients used the correct medication (antidepressant) and less than 20% used a sufficiently high dosage. Of the patients, 38% had never previously taken antidepressants, 31% had previously used one antidepressant, 17% two different antidepressants and 12% at least three different antidepressants; 13% had taken the antidepressant at the highest dosage, 18% at the average active dosage and 31% at too low (thus ineffective) a dosage. This means that from a pharmacotherapeutic viewpoint not more than 1 in 8 patients had had an adequate treatment history. CONCLUSION The results of this study show that only 1 in 8 OCD patients were treated appropriately.
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Affiliation(s)
- D Denys
- Universitair Medisch Centrum, afd. Psychiatrie, Heidelberglaan 100, 3584 CX, Utrecht.
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Abstract
To determine whether radiation delivered to children treated for head and neck cancer causes deformity, we performed a quantitative analysis for craniofacial asymmetry. A total of 42 patients, with either rhabdomyosarcoma or nasopharyngeal carcinoma, treated between 1980 and 1991, were analyzed. Exclusions included 16 subjects, leaving 26 children of mixed race and gender with a median age at diagnosis of 13 years (range: 2-18) and a median age at follow-up of 4 years (range: 3-37). Data from 14 measurements of the cranium and facial skeleton, for which normative data exist, were recorded. Symmetry of the face and head were determined and each measurement was compared to age specific standards. Deviation occurred in the cranial vault, the anterior and mid-interorbital distances and lateral orbital wall length. Asymmetry existed in the medial and lateral orbital wall lengths and the zygomatic arches. We conclude that, children irradiated for head and neck malignancies, have significant alterations in some skeletal measurements indicative of treatment induced asymmetry and potential deformity.
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Affiliation(s)
- D Denys
- University of Tennessee Health Science Center, Memphis, USA
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Ruckenstein MJ, Denys D. Lateral skull-base surgery--a review of recent advances in surgical approaches. J Otolaryngol 1998; 27:46-54. [PMID: 9511121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The expanding field of lateral skull-base surgery is reviewed. The rapid evolution of this subspecialty of otolaryngology--head and neck surgery has occurred subsequent to the primary postgraduate training of many practitioners of our specialty. Furthermore, it can be difficult for many resident physicians to acquire concise, up-to-date references pertaining to this area of subspecialization. This article is designed to provide a succinct, up-to-date review of the field of lateral skull-base surgery. MATERIALS AND METHODS The current literature is reviewed. RESULTS Lateral skull-base surgery is a rapidly evolving discipline involving neurologists and neurosurgeons in the resection of complex lesions of the skull base that had previously been difficult or impossible to adequately access. Otolaryngologists,via the subspecialty of neurotology, have been leaders in developing and applying the different lateral skull-base approaches. CONCLUSIONS This article categorizes the various lateral skull-base approaches, outlines the principles of the surgical exposures, and discusses the indications for their use.
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Affiliation(s)
- M J Ruckenstein
- Department of Otolaryngology, Head and Neck Surgery, University of Tennessee, Memphis 38163, USA
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Denys D, Kumar P, Wong FS, Newman LA, Robbins KT. The predictive value of tumor regression rates during chemoradiation therapy in patients with advanced head and neck squamous cell carcinoma. Am J Surg 1997; 174:561-4. [PMID: 9374238 DOI: 10.1016/s0002-9610(97)00147-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The value of tumor regression rates in predicting survival outcome during chemoradiation therapy was prospectively evaluated. METHODS AND MATERIALS Sixty-two patients diagnosed with locally advanced stage III/IV unresectable head and neck squamous cell carcinoma underwent weekly clinical and endoscopic serial assessment of primary and nodal tumor sizes during chemoradiation therapy between July 1993 and September 1995. Chemoradiation therapy consisted of protocol treatment using supradose intra-arterial targeted cisplatin (SIT-P) at 150 mg/m2 four times at weekly intervals along with intravenous sodium thiosulfate at 9 g/m2 and concurrent conventionally fractionated radiotherapy at 1.8 to 2.0 Gy/fraction (fx) to a total dose of 68 to 74 Gy. Tumor reduction was serially measured as a percentage of the original pretreatment size at weekly intervals by the same team of surgical and radiation oncologists. Correlations were then made between tumor regression rates and survival. RESULTS Complete or near complete regression of disease during chemoradiation therapy as compared with nonresponsive/partially responsive disease was associated with better survival outcome (P = 0.001 and P = 0.013, respectively). Among patients exhibiting complete or near complete regression of disease, rapid tumor reduction (median = 4.2 weeks) was associated with inferior survival outcome when compared with slower disease regression (median = 6.4 weeks, P = 0.007). CONCLUSIONS Our findings fail to support the "traditional" hypothesis that rapid tumor regression during treatment is predictive of an improved survival outcome. Treatment strategies that alter ongoing therapy based upon initial tumor regression rates should be avoided.
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Affiliation(s)
- D Denys
- Department of Otolaryngology and Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, USA
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