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Janssen EPCJ, Köhler S, Geraets AFJ, Stehouwer CDA, Schaper NC, Sep SJS, Henry RMA, van der Kallen CJH, Schalkwijk CG, Koster A, Verhey FR, Schram MT. Low-grade inflammation and endothelial dysfunction predict four-year risk and course of depressive symptoms: The Maastricht study. Brain Behav Immun 2021; 97:61-67. [PMID: 34186200 DOI: 10.1016/j.bbi.2021.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/04/2020] [Revised: 05/19/2021] [Accepted: 06/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Low-grade inflammation (LGI) and endothelial dysfunction (ED) might play a key role in the development of depression. We investigated the associations and mediation of LGI and ED with four-year incidence and course of depressive symptoms (remitted, recurrent or persistent). DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS In this prospective cohort study (mean age 59.6 ± 8.2 years, 48.9% women, 26.6% diabetes by design), Cox and multinomial regression analyses, adjusted for age, sex, educational level and diabetes status were used to investigate the associations of LGI and ED with onset and course of depressive symptoms as assessed by the PHQ-9 questionnaire. RESULTS During 10,847 person-years of follow-up, 264 participants developed incident depression. Higher levels of LGI (OR [95%CI] per SD 1.32[1.16-1.49], p < 0.001) and ED (1.26[1.11-1.43], p < 0.001) were associated with incident depressive symptoms. In mediation analysis, 60% of the total effect of ED with incident depressive symptoms could be attributed to LGI. 76 out of 2637 participants had a persistent course of depressive symptoms. Higher levels of LGI (1.75[1.40-2.19], p < 0.001) and ED (1.33[1.04-1.71], p = 0.021) were associated with a persistent course of depressive symptoms. Higher ED was more strongly associated with persistent depressive symptoms (1.33[1.04-1.71], p = 0.021), while LGI was associated with remission of depression symptoms. CONCLUSIONS LGI and ED were both associated with incident depressive symptoms, where the latter association was substantially mediated by LGI. ED was further associated with a persistent course of depressive symptoms, while LGI was not. These results suggest a temporal, vascular contribution of both LGI and ED to the etiology and chronicity of depressive symptoms.
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Affiliation(s)
- Eveline P C J Janssen
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center+, Maastricht, the Netherlands; Mondriaan Department of Old Age Psychiatry, Heerlen, the Netherlands.
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center+, Maastricht, the Netherlands; MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Anouk F J Geraets
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center+, Maastricht, the Netherlands; MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Simone J S Sep
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Carla J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Casper G Schalkwijk
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Frans R Verhey
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center+, Maastricht, the Netherlands; MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Miranda T Schram
- MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands; Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands.
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Banning LCP, Janssen EPCJ, Hamel REG, de Vugt M, Köhler S, Wolfs CAG, Oosterveld SM, Melis RJF, Olde Rikkert MGM, Kessels RPC, Pijnenburg YAL, Koene T, van der Flier WM, Scheltens P, Visser PJ, Verhey FRJ, Aalten P, Ramakers IHGB. Determinants of Cross-Sectional and Longitudinal Health-Related Quality of Life in Memory Clinic Patients Without Dementia. J Geriatr Psychiatry Neurol 2020; 33:256-264. [PMID: 31645191 PMCID: PMC7361660 DOI: 10.1177/0891988719882104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 01/18/2023]
Abstract
OBJECTIVE To identify determinants within 3 different domains (ie, somatic comorbidities, cognitive functioning, and neuropsychiatric symptoms [NPS]) of health-related quality of life (HRQoL) over time in memory clinic patients without dementia. METHODS This longitudinal multicenter cohort study with a 3-year observation period recruited 315 individuals (age: 69.8 ± 8.6, 64.4% males, Mini-Mental State Examination score 26.9 ± 2.6). A multivariable explanatory model was built using linear mixed effects models (forward selection per domain) to select determinants for self-perceived HRQoL over time, as measured by the EuroQoL-5D visual analogue scale (EQ VAS). RESULTS Mean HRQoL at study entry was 69.4 ± 15.6. The presence of agitation, appetite and eating abnormalities, and eyes/ears/nose (ie, sensory impairment) comorbidities were associated with a change in HRQoL over time. Agitation was most strongly associated with HRQoL over time. CONCLUSIONS The association of somatic comorbidities and NPS in memory clinic patients with course of HRQoL shows that these should receive more awareness, detection, and monitoring by clinicians.
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Affiliation(s)
- Leonie C. P. Banning
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Eveline P. C. J. Janssen
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands,Mondriaan Department of Old Age Psychiatry, Heerlen, the Netherlands
| | | | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Claire A. G. Wolfs
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Saskia M. Oosterveld
- Department of Geriatrics & Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rene J. F. Melis
- Department of Geriatrics & Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marcel G. M. Olde Rikkert
- Department of Geriatrics & Radboudumc Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roy P. C. Kessels
- Department of Medical Psychology & Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands,Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, the Netherlands
| | - Yolande A. L. Pijnenburg
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VUmc Medical Center, Amsterdam, the Netherlands
| | - Ted Koene
- Department of Medical Psychology and Neuroscience Campus Amsterdam, VUmc Alzheimer Center, VUmc Medical Center, Amsterdam, the Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VUmc Medical Center, Amsterdam, the Netherlands,Department of Epidemiology & Biostatistics, VUmc Medical Center, Amsterdam, the Netherlands
| | - Philip Scheltens
- Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VUmc Medical Center, Amsterdam, the Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Alzheimer Center & Department of Neurology, Neuroscience Campus Amsterdam, VUmc Medical Center, Amsterdam, the Netherlands
| | - Frans R. J. Verhey
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Inez H. G. B. Ramakers
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands,Inez H. G. B. Ramakers, Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands.
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Houben N, Janssen EPCJ, Hendriks MRC, van der Kellen D, van Alphen BPJ, van Meijel B. Physical health status of older adults with severe mental illness: The PHiSMI-E cohort study. Int J Ment Health Nurs 2019; 28:457-467. [PMID: 30294958 DOI: 10.1111/inm.12547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2018] [Indexed: 12/26/2022]
Abstract
The objective was to use various somatic parameters as basis for investigating the physical health of older adults with severe mental illnesses (SMI). A cross-sectional study design is performed by using baseline data from the Physical Health in SMI-elderly (PHiSMI-E) study. Data were collected using the Nursing Monitoring of Somatic Status and Lifestyle - Mental Health instrument in adults aged over 60 with SMI in a large Dutch mental health institute. Ninety-nine elderly SMI patients were included. Somatic comorbidity (84.8%), use of somatic medication (77.7%) and polypharmacy (67.7%) were prevalent. Extrapyramidal symptoms were experienced by 51% of patients, mainly in the subgroup with psychotic disorders (75.6%). Unhealthy diet was reported in 16.2%, obesity in 27.3%, and physical inactivity in 57.6%. Fatigue (67.7%) and dry mouth (66.6%) were the commonest reported physical symptoms. Mean VAS score (scale 0-10) indicating participants' self-perceived physical health was 6.7 (SD ± 1.6). After division of the total patient group into tertiles based on the VAS scores, the lowest tertile was characterized by less physical activity, unhealthier diet, more use of medication, more fatigue, somnolence, and inner agitation. In conclusion, impaired physical health status was common in these older patients with SMI. Although they had more psychiatric and somatic comorbidity than adult SMI patients described in the literature, they had a healthier lifestyle. To reduce morbidity and premature mortality in these frail patients, it is essential that healthcare providers are aware of the high prevalence of somatic comorbidity and symptoms, and of their interactions with the psychiatric disorders. This study improves our understanding of differences in vulnerability factors of older patients with SMI. The (early) detection of somatic comorbidities may improve long-term health outcomes of these patients.
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Affiliation(s)
- Noortje Houben
- Department of Old Age Psychiatry, Mondriaan, Heerlen, The Netherlands.,Department of Advanced Nursing Practice, School for Nursing, Zuyd University, Heerlen, The Netherlands
| | - Eveline P C J Janssen
- Department of Old Age Psychiatry, Mondriaan, Heerlen, The Netherlands.,Department of Psychiatry and Neuropsychology, MHeNs School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marike R C Hendriks
- Department of Advanced Nursing Practice, School for Nursing, Zuyd University, Heerlen, The Netherlands
| | - Digna van der Kellen
- Department of Mental Health, Indigo Rijnmond, Rotterdam, The Netherlands.,uTOPiGGZ, Training and Coaching, Spijkenisse, The Netherlands
| | - Bas P J van Alphen
- Department of Old Age Psychiatry, Mondriaan, Heerlen, The Netherlands.,Department of Clinical and Lifespan Psychology, Vrije universiteit Brussel (VUB), Brussels, Belgium.,Department of Medical and Clinical Psychology, School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
| | - Berno van Meijel
- Inholland University of Applied Sciences, Research Group Mental Health Nursing, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Parnassia Psychiatric Institute, The Hague, The Netherlands.,GGZ-VS, Academy for Masters in Advanced Nursing Practice, Utrecht, The Netherlands
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Janssen EPCJ, de Vugt M, Köhler S, Wolfs C, Kerpershoek L, Handels RLH, Orrell M, Woods B, Jelley H, Stephan A, Bieber A, Meyer G, Engedal K, Selbaek G, Wimo A, Irving K, Hopper L, Gonçalves-Pereira M, Portolani E, Zanetti O, Verhey FR. Caregiver profiles in dementia related to quality of life, depression and perseverance time in the European Actifcare study: the importance of social health. Aging Ment Health 2017; 21:49-57. [PMID: 27869480 DOI: 10.1080/13607863.2016.1255716] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To identify caregiver profiles of persons with mild to moderate dementia and to investigate differences between identified caregiver profiles, using baseline data of the international prospective cohort study Actifcare. METHODS A latent class analysis was used to discover different caregiver profiles based on disease related characteristics of 453 persons with dementia and their 453 informal caregivers. These profiles were compared with regard to quality of life (CarerQoL score), depressive symptoms (HADS-D score) and perseverance time. RESULTS A 5-class model was identified, with the best Bayesian Information Criterion value, significant likelihood ratio test (p < 0.001), high entropy score (0.88) and substantive interpretability. The classes could be differentiated on two axes: (i) caregivers' age, relationship with persons with dementia, severity of dementia, and (ii) tendency towards stress and difficulty adapting to stress. Classes showed significant differences with all dependent variables, and were labelled 'older low strain', 'older intermediate strain', 'older high strain', 'younger low strain' and 'younger high strain'. CONCLUSION Differences exist between types of caregivers that explain variability in quality of life, depressive symptoms and perseverance time. Our findings may give direction for tailored interventions for caregivers of persons with dementia, which may improve social health and reduce health care costs.
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Affiliation(s)
- Eveline P C J Janssen
- a Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center , Maastricht , The Netherlands.,b Department of Old Age Psychiatry , Mondriaan , Heerlen , The Netherlands
| | - Marjolein de Vugt
- a Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center , Maastricht , The Netherlands
| | - Sebastian Köhler
- a Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center , Maastricht , The Netherlands
| | - Claire Wolfs
- a Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center , Maastricht , The Netherlands
| | - Liselot Kerpershoek
- a Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center , Maastricht , The Netherlands
| | - Ron L H Handels
- a Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center , Maastricht , The Netherlands
| | - Martin Orrell
- c Department of Psychiatry and Applied Psychology, Faculty of Medicine & Health Sciences , Institute of Mental Health, University of Nottingham , Nottingham , United Kingdom
| | - Bob Woods
- d Dementia Services Development Centre Wales , Bangor University , Bango , United Kingdom
| | - Hannah Jelley
- d Dementia Services Development Centre Wales , Bangor University , Bango , United Kingdom
| | - Astrid Stephan
- e Medical Faculty , Institute for Health and Nursing Science , Halle-Wittenberg , Germany
| | - Anja Bieber
- e Medical Faculty , Institute for Health and Nursing Science , Halle-Wittenberg , Germany
| | - Gabriele Meyer
- e Medical Faculty , Institute for Health and Nursing Science , Halle-Wittenberg , Germany
| | - Knut Engedal
- f Norwegian National Advisory Unit on Ageing and Health , Vestfold Hospital Trust , Tønsberg , Norway
| | - Geir Selbaek
- f Norwegian National Advisory Unit on Ageing and Health , Vestfold Hospital Trust , Tønsberg , Norway
| | - Anders Wimo
- g Department of Neurobiology, Care sciences and Society , Karolinska Institut , Stockholm , Sweden
| | - Kate Irving
- h School of Nursing and Human Sciences, Dublin City University , Dublin , Ireland
| | - Louise Hopper
- h School of Nursing and Human Sciences, Dublin City University , Dublin , Ireland
| | - Manuel Gonçalves-Pereira
- i CEDOC - Chronic Diseases Research Center , Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa , Lisbon , Portugal
| | - Elisa Portolani
- j Alzheimer Unit , IRCCS Centro San Giovanni di Dio, Fatebenefratelli , Brescia , Italy
| | - Orazio Zanetti
- j Alzheimer Unit , IRCCS Centro San Giovanni di Dio, Fatebenefratelli , Brescia , Italy
| | - Frans R Verhey
- a Department of Psychiatry and Neuropsychology , School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center , Maastricht , The Netherlands
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Janssen EPCJ, Köhler S, Stehouwer CDA, Schaper NC, Dagnelie PC, Sep SJS, Henry RMA, van der Kallen CJH, Verhey FR, Schram MT. The Patient Health Questionnaire-9 as a Screening Tool for Depression in Individuals with Type 2 Diabetes Mellitus: The Maastricht Study. J Am Geriatr Soc 2016; 64:e201-e206. [DOI: 10.1111/jgs.14388] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Eveline P. C. J. Janssen
- Department of Psychiatry and Neuropsychology; Maastricht University Medical Center; Maastricht the Netherlands
- Mondriaan Department of Old Age Psychiatry; Heerlen the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology; Maastricht University Medical Center; Maastricht the Netherlands
- MHeNs School for Mental Health and Neuroscience; Maastricht University; Maastricht the Netherlands
| | - Coen D. A. Stehouwer
- Department of Internal Medicine; Maastricht University Medical Center; Maastricht the Netherlands
- Cardiovasculair Research Institute Maastricht; Maastricht University; Maastricht the Netherlands
| | - Nicolaas C. Schaper
- Department of Internal Medicine; Maastricht University Medical Center; Maastricht the Netherlands
- Cardiovasculair Research Institute Maastricht; Maastricht University; Maastricht the Netherlands
- CAPHRI School for Public Health and Primary Care; Maastricht University; Maastricht the Netherlands
| | - Pieter C. Dagnelie
- Cardiovasculair Research Institute Maastricht; Maastricht University; Maastricht the Netherlands
- CAPHRI School for Public Health and Primary Care; Maastricht University; Maastricht the Netherlands
- Department of Epidemiology; Maastricht University; Maastricht the Netherlands
| | - Simone J. S. Sep
- Department of Internal Medicine; Maastricht University Medical Center; Maastricht the Netherlands
- Cardiovasculair Research Institute Maastricht; Maastricht University; Maastricht the Netherlands
| | - Ronald M. A. Henry
- Department of Internal Medicine; Maastricht University Medical Center; Maastricht the Netherlands
- Cardiovasculair Research Institute Maastricht; Maastricht University; Maastricht the Netherlands
| | - Carla J. H. van der Kallen
- Department of Internal Medicine; Maastricht University Medical Center; Maastricht the Netherlands
- Cardiovasculair Research Institute Maastricht; Maastricht University; Maastricht the Netherlands
| | - Frans R. Verhey
- Department of Psychiatry and Neuropsychology; Maastricht University Medical Center; Maastricht the Netherlands
- MHeNs School for Mental Health and Neuroscience; Maastricht University; Maastricht the Netherlands
| | - Miranda T. Schram
- Department of Internal Medicine; Maastricht University Medical Center; Maastricht the Netherlands
- Cardiovasculair Research Institute Maastricht; Maastricht University; Maastricht the Netherlands
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Aerts L, Janssen EPCJ, Janssen NJJF, Boogaard LH, Fincken JMC, Voogd LPA, van Well GTJ, Schieveld JNM. [Pathological hoarding by children and adolescents]. Tijdschr Psychiatr 2012; 54:349-357. [PMID: 22508353] [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 There is a dearth of knowledge and understanding concerning hoarding by children and adolescents. Psychiatrists need to know more about the phenomenon of hoarding since it can be a marker of psychopathology and it sometimes is symptomatic of a psychiatric disorder. AIM To review hoarding from an epidemiological and psychopathological perspective and to discuss it in relation to the developmental aspect of the first object acquisition: the transitional object. METHOD We conducted a literature search in PubMed, Medline, PsycINFO and the Cochranedatabase using primarily the search term ‘hoarding', but also in combination with the terms: primates, child, adolescent, psych*, klepto*, transitional object, obsessive-compulsive disorder, collecting and attachment. RESULTS Both animals and humans engage frequently in collecting and hoarding. Up to 60% of normally functioning children and adolescents are involved in collecting. A strong emotional attachment to possessions may be a response to an attachment problem. Hoarding combined with psychopathology is seen in persons of all ages but the prevalence rates for children and adults are unknown. CONCLUSION Hoarding is a worrisome type of behaviour which must be regarded as an indication of serious comorbid psychopathology. It can occur either as a symptom of an existing disorder or as a separate disorder. Finally we recommend that hoarding be included in the diagnostic criteria of the dsm and icd.
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Affiliation(s)
- L Aerts
- Medisch Centrum Sint-Jozefte Munsterbilzen en in de Dagkliniek voor Kinderen Jeugdigen te Hasselt
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Janssen NJJF, Tan EYL, Staal M, Janssen EPCJ, Leroy PLJM, Lousberg R, van Os J, Schieveld JNM. On the utility of diagnostic instruments for pediatric delirium in critical illness: an evaluation of the Pediatric Anesthesia Emergence Delirium Scale, the Delirium Rating Scale 88, and the Delirium Rating Scale-Revised R-98. Intensive Care Med 2011; 37:1331-7. [PMID: 21567109 PMCID: PMC3136686 DOI: 10.1007/s00134-011-2244-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 03/11/2011] [Indexed: 02/07/2023]
Abstract
Purpose Delirium is a poor-prognosis neuropsychiatric disorder. Pediatric delirium (PD) remains understudied, particularly at pediatric intensive care units (PICU). Although the Pediatric Anesthesia Emergence Delirium (PAED) scale, the Delirium Rating Scale (DRS-88), and the Delirium Rating Scale-Revised (DRS-R-98) are available, none have been validated for use in PICU settings. The aim of the present study was to investigate the use of the DRS/PAED instruments as diagnostic tools for PD in the PICU. Methods A prospective panel study was conducted, under circumstances of routine clinical care, investigating the diagnostic properties of the PAED, DRS-88, and DRS-R-98 in PICU patients at a tertiary university medical center. A total of 182 non-electively admitted, critically ill pediatric patients, aged 1–17 years, were included between November 2006 and February 2010. Sensitivity, specificity, and receiver operating characteristic (ROC) curves were calculated. Three psychometric properties were analyzed: (1) internal consistency (2) proportion of items not rateable, and (3) discriminative ability. Results The PAED could be completed in 144 (93.5%) patients, much more frequently than either the DRS-88 (66.9%) or the DRS-R-98 (46.8%). Compared with the clinical gold standard diagnosis of delirium, the PAED had a sensitivity of 91% and a specificity of 98% (AUC 0.99). The optimal PAED cutoff score as a screening instrument in this PICU setting was 8. Cronbach’s alpha was 0.89; discriminative ability was high. Conclusions The PAED is a valid instrument for PD in critically ill children, given its reliance on routinely rateable observational signs and symptoms.
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Affiliation(s)
- Nathalie J J F Janssen
- Division of Child and Adolescent Psychiatry and Psychology, Department of Psychiatry and Psychology, European Graduate School of Neuroscience, Maastricht University Medical Centre, SEARCH, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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