1
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Ferreira BR, Vulink N, Mostaghimi L, Jafferany M, Balieva F, Gieler U, Poot F, Reich A, Romanov D, Szepietowski JC, Tomas-Aragones L, Campos R, Tausk F, Zipser M, Bewley A, Misery L. Classification of psychodermatological disorders: Proposal of a new international classification. J Eur Acad Dermatol Venereol 2024; 38:645-656. [PMID: 38084889 DOI: 10.1111/jdv.19731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/17/2023] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Several classifications of psychodermatology disorders have been proposed, with most of them based on two to four main disorder category groups. However, there is, to date, no classification that has resulted from a consensus established by psychodermatology experts. The DSM-5-TR (Diagnostic and statistical manual of mental disorders (5th ed.), Text Revision) and the ICD-11 (International classification of diseases (11th revision)) also do not provide a systematized approach of psychodermatology disorders. Taking into consideration that classifications are a key pillar for a comprehensive approach to the pathologies of each branch of medicine, the proposal of a classification in psychodermatology appeared as a central need for the recognition of psychodermatological disorders, in an attempt to improve their recognition and, in that sense, to find a common language for the development of this subspecialty that crosses dermatology and psychiatry. METHODS Previously published classifications in psychodermatology were critically reviewed and discussed by expert opinion from an international multidisciplinary panel of 16 experts in psychodermatology and a new classification system is proposed, considering classical concepts in general dermatology and psychopathology. RESULTS Two main categories of disorders are presented (a main group related to primary mental health disorders and another main group related to primary skin disorders), which are subsequently subdivided into subgroups considering pathophysiological and phenomenological similarities, including key aspects of dermatological examination, namely the presence of visible skin lesions (primary and secondary skin lesions) and psychopathological correlates. CONCLUSION This new classification aims to unify previous classifications, systematize the disorders that belong to psychodermatology and highlight their tenuous boundaries, to improve their management. It has been built and approved by the Psychodermatology Task Force of the European Academy of Dermatology and Venereology (EADV), the European Society for Dermatology and Psychiatry (ESDaP) and the Association for Psychoneurocutaneous Medicine of North America (APMNA).
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Affiliation(s)
- Bárbara Roque Ferreira
- Department of Dermatology, Centre Hospitalier de Mouscron, Mouscron, Belgium
- Univ Brest, LIEN, Brest, Portugal
- CFCUL, Lisboa, Portugal
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Nienke Vulink
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ladan Mostaghimi
- Wisconsin Psychocutaneous Clinic, Middleton, Wisconsin, USA
- Dermatology Department, University of Wisconsin, Madison, Wisconsin, USA
| | - Mohammad Jafferany
- Department of Psychiatry and Behavioral Sciences, Central Michigan University/CMU Medical Education Partners, Saginaw, Michigan, USA
| | - Flora Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, Department of Public Health, University of Stavanger, Stavanger, Norway
| | - Uwe Gieler
- Department of Dermatology, Justus Liebig University of Giessen, Giessen, Germany
- Vitos-Clinic for Psychosomatic Medicine, Giessen, Germany
| | - Françoise Poot
- ULB-Erasme Hospital Department Dermatology, Brussels, Belgium
- IFTS, Charleroi, Belgium
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | - Dmitry Romanov
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Ricardo Campos
- Department of Psychiatry, Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain
| | - Francisco Tausk
- Department of Dermatology, Allergy, Immunology and Rheumatology, University of Rochester, Rochester, New York, USA
| | - Marie Zipser
- Sanatorium Kilchberg - Centre for Psychosomatics, Zurich, Switzerland
| | - Anthony Bewley
- Barts Health NHS Trust & Queen Mary University, London, UK
| | - Laurent Misery
- Univ Brest, LIEN, Brest, Portugal
- Department of Dermatology, University Hospital of Brest, Brest, France
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2
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Zeidler C, Kupfer J, Dalgard FJ, Bewley A, Evers AWM, Gieler U, Lien L, Sampogna F, Tomas Aragones L, Vulink N, Finlay AY, Legat FJ, Titeca G, Jemec GB, Misery L, Szabó C, Grivcheva Panovska V, Spillekom van Koulil S, Balieva F, Szepietowski JC, Reich A, Ferreira BR, Lvov A, Romanov D, Marron SE, Gracia Cazaña T, Elyas A, Altunay IK, Thompson AR, van Beugen S, Ständer S, Schut C. Dermatological patients with itch report more stress, stigmatization experience, anxiety and depression compared to patients without itch: Results from a European multi-centre study. J Eur Acad Dermatol Venereol 2024. [PMID: 38468596 DOI: 10.1111/jdv.19913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/23/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Itch as the most common symptom in dermatology has been shown to be related to psychological factors such as stress, anxiety and depression. Moreover, associations were found between perceived stigmatization and itch. However, studies investigating the differences between patients with dermatoses with and without itch regarding perceived stress, stigmatization, anxiety and depression are missing. Therefore, one of the aims of the second study of the European Society for Dermatology and Psychiatry (ESDaP study II) was to investigate these relationships in a large cohort of patients with different itchy dermatoses. RESULTS 3399 patients with 14 different itchy dermatoses were recruited at 22 centres in 17 European countries. They filled in questionnaires to assess perceived stigmatization, stress, signs of clinically relevant anxiety or depression, itch-related quality of life, the overall health status, itch duration, frequency and intensity. The most significant association between the severity of itching and the perception of stress was observed among individuals with rosacea (correlation coefficient r = 0.314). Similarly, the strongest links between itch intensity and experiences of stigmatization, anxiety, and depression were found in patients with seborrheic dermatitis (correlation coefficients r = 0.317, r = 0.356, and r = 0.400, respectively). Utilizing a stepwise linear regression analysis, it was determined that within the entire patient cohort, 9.3% of the variation in itch intensity could be accounted for by factors including gender, levels of anxiety, depression, and perceived stigmatization. Females and individuals with elevated anxiety, depression, and perceived stigmatization scores reported more pronounced itch intensities compared to those with contrary attributes. CONCLUSION This study underscores the connection between experiencing itch and its intensity and the psychological strain it places on individuals. Consequently, psychological interventions should encompass both addressing the itch itself and the interconnected psychological factors. In specific cases, it becomes imperative for dermatologists to direct individuals towards suitable healthcare resources to undergo further psychological assessment.
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Affiliation(s)
- C Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - J Kupfer
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
| | - F J Dalgard
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Dermatology and Venereology, Skåne University Hospital, Malmo, Sweden
| | - A Bewley
- Barts Health NHS Trust & Queen Mary University of London, London, UK
| | - A W M Evers
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Unit Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands
| | | | - L Lien
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - F Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - L Tomas Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
- Aragon Psychodermatology Research Group Zaragoza, Zaragoza, Spain
| | - N Vulink
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - G Titeca
- Clinique Notre Dame de Grâce, Gosselies, Belgium
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - C Szabó
- Institute of Psychology, University of Szeged, Szeged, Hungary
| | - V Grivcheva Panovska
- School of Medicine, PHI University Clinic of Dermatology, University St Cyril and Methodius, Skopje, North Macedonia
| | - S Spillekom van Koulil
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - F Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - A Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
| | - B R Ferreira
- Centre for Philosophy of Science of the University of Lisbon, Lisbon, Portugal
- Department of Dermatology, Coimbra Hospital and University Centre, Portugal
- University of Brest, Lien, France
| | - A Lvov
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia
- Medical Research and Educational Centre, Lomonosov Moscow State University, Moscow, Russia
| | - D Romanov
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Boundary Mental Conditions and Psychosomatic Disorders, Mental Health Research Centre, Moscow, Russia
- International Institute of Psychosomatic Health, Moscow, Russia
| | - S E Marron
- Aragon Psychodermatology Research Group Zaragoza, Zaragoza, Spain
- Department of Dermatology, University Hospital Miguel Servet, Zaragoza, Spain
| | - T Gracia Cazaña
- Department of Dermatology, University Hospital Miguel Servet, Zaragoza, Spain
| | - A Elyas
- Department of Dermatology, Skåne University Hospital, Malmö, Sweden
| | - I K Altunay
- Şişli Hamidiye Etfal Training and Research Hospital, Dermatology and Venereology Clinic, University of Health Sciences, Istanbul, Turkey
| | - A R Thompson
- South Wales Clinical Psychology Training Programme, Cardiff & Vale University Health Board & School of Psychology, Cardiff University, Cardiff, UK
| | - S van Beugen
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Unit Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - C Schut
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
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3
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Misery L, Schut C, Balieva F, Bobko S, Reich A, Sampogna F, Altunay I, Dalgard F, Gieler U, Kupfer J, Lvov A, Poot F, Szepietowski JC, Tomas-Aragones L, Vulink N, Zalewska-Janowska A, Bewley A. White paper on psychodermatology in Europe: A position paper from the EADV Psychodermatology Task Force and the European Society for Dermatology and Psychiatry (ESDaP). J Eur Acad Dermatol Venereol 2023; 37:2419-2427. [PMID: 37615377 DOI: 10.1111/jdv.19427] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
Psychodermatology is a subspecialty of dermatology that is of increasing interest to dermatologists and patients. The case for the provision of at least regional psychodermatology services across Europe is robust. Psychodermatology services have been shown to have better, quicker and more cost-efficient clinical outcomes for patients with psychodermatological conditions. Despite this, psychodermatology services are not uniformly available across Europe. In fact many countries have yet to establish dedicated psychodermatology services. In other countries psychodermatology services are in development. Even in countries where psychodermatolgy units have been established, the services are not available across the whole country. This is especially true for the provision of paediatric psychodermatology services. Also whilst most states across Europe are keen to develop psychodermatology services, the rate at which this development is being implemented is very slow. Our paper maps the current provision of psychodermatology services across Europe and indicates that there is still very much more work to be done in order to develop the comprehensive psychodermatology services across Europe, which are so crucial for our patients.
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Affiliation(s)
- Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
- Univ Brest, LIEN, Brest, France
| | - Christina Schut
- Institute of Medical Psychology, University of Giessen, Giessen, Germany
| | - Flora Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, Department of Public Health, University of Stavanger, Stavanger, Norway
| | - Svetlana Bobko
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | - Francesca Sampogna
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata IDI-IRCCS, Rome, Italy
| | - Ilknur Altunay
- Şişli Hamidiye Etfal Training and Research Hospital, Dermatology and Venereology Clinic, University of Health Sciences, Insatnbul, Turkey
| | - Florence Dalgard
- Department of Dermatology and Venereology, Skåne University Hospital, Lund University, Lund, Sweden
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
| | - Uwe Gieler
- Department of Dermatology, Justus Liebig University of Giessen, Giessen, Germany
| | - Jörg Kupfer
- Institute of Medical Psychology, University of Giessen, Giessen, Germany
| | - Andrey Lvov
- Department of Dermatovenereology and Cosmetology, Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia
- Medical Research and Educational Center, Lomonosov Moscow State University, Moscow, Russia
| | - Françoise Poot
- ULB-Erasme Hospital Department Dermatology, Brussels, Belgium
- IFTS, Charleroi, Belgium
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Nienke Vulink
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Anna Zalewska-Janowska
- Psychodermatology Department, Chair of Pulmonology, Rheumatology and Clinical Immunology, Medical University of Lodz, Poland
| | - Anthony Bewley
- Barts Health NHS Trust & Queen Mary University, London, UK
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4
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Graat I, Franken S, van Rooijen G, de Koning P, Vulink N, de Kroo M, Denys D, Mocking R. Cognitive behavioral therapy in patients with deep brain stimulation for obsessive-compulsive disorder: a matched controlled study. Psychol Med 2023; 53:5861-5867. [PMID: 37795687 DOI: 10.1017/s0033291722003130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is effective for refractory obsessive-compulsive disorder (OCD). Post-operative cognitive behavioral therapy (CBT) may augment the effects of DBS, but previous results are conflicting. Here, we investigated whether CBT augments the effect of DBS for OCD. METHOD Patients with and without CBT following DBS of the ventral anterior limb of the internal capsule were included. First, we analyzed Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Hamilton Depression Rating Scale (HAM-D) scores before, during and after CBT in all patients with CBT. Second, we matched patients with and without CBT based on clinical baseline variables and initial response to DBS and compared the course of Y-BOCS and HAM-D scores over the same timeframe. RESULTS In total, 36 patients with and 16 patients without CBT were included. Average duration of CBT was 10.4 months (s.d. 6.4). In the 36 patients with CBT, Y-BOCS scores decreased on average by 3.8 points (14.8%) from start until end of CBT (p = 0.043). HAM-D scores did not decrease following CBT. Second, 10 patients with CBT were matched to 10 patients without CBT. In both groups, Y-BOCS scores decreased equally from start until end of CBT or over a similar timeframe (10% in CBT group v. 13.1% in no-CBT group, p = 0.741). CONCLUSIONS Obsessive-compulsive symptoms decreased over time in patients with and without post-operative CBT. Therefore, further improvement may be attributed to late effects of DBS itself. The present study emphasizes the need for prospective randomized controlled studies, examining the effects of CBT.
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Affiliation(s)
- Ilse Graat
- Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | | | | | | | | | | | | | - Roel Mocking
- Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
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5
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Fridgeirsson EA, Bais MN, Eijsker N, Thomas RM, Smit DJA, Bergfeld IO, Schuurman PR, van den Munckhof P, de Koning P, Vulink N, Figee M, Mazaheri A, van Wingen GA, Denys D. Patient specific intracranial neural signatures of obsessions and compulsions in the ventral striatum. J Neural Eng 2023; 20. [PMID: 36827705 DOI: 10.1088/1741-2552/acbee1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 02/24/2023] [Indexed: 02/26/2023]
Abstract
Objective. Deep brain stimulation is a treatment option for patients with refractory obsessive-compulsive disorder. A new generation of stimulators hold promise for closed loop stimulation, with adaptive stimulation in response to biologic signals. Here we aimed to discover a suitable biomarker in the ventral striatum in patients with obsessive compulsive disorder using local field potentials.Approach.We induced obsessions and compulsions in 11 patients undergoing deep brain stimulation treatment using a symptom provocation task. Then we trained machine learning models to predict symptoms using the recorded intracranial signal from the deep brain stimulation electrodes.Main results.Average areas under the receiver operating characteristics curve were 62.1% for obsessions and 78.2% for compulsions for patient specific models. For obsessions it reached over 85% in one patient, whereas performance was near chance level when the model was trained across patients. Optimal performances for obsessions and compulsions was obtained at different recording sites.Significance. The results from this study suggest that closed loop stimulation may be a viable option for obsessive-compulsive disorder, but that intracranial biomarkers are patient and not disorder specific.Clinical Trial:Netherlands trial registry NL7486.
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Affiliation(s)
- Egill A Fridgeirsson
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Melisse N Bais
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Nadine Eijsker
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Rajat M Thomas
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Dirk J A Smit
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Isidoor O Bergfeld
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Pelle de Koning
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn Figee
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Ali Mazaheri
- School of Psychology, University of Birmingham, Birmingham, United Kingdom.,Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Guido A van Wingen
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,The Netherlands institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
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6
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Schut C, Dalgard FJ, Bewley A, Evers AWM, Gieler U, Lien L, Sampogna F, Ständer S, Tomás-Aragonés L, Vulink N, Finlay AY, Legat FJ, Titeca G, Jemec GB, Misery L, Szabó C, Grivcheva-Panovska V, Spillekom-van Koulil S, Balieva F, Szepietowski JC, Reich A, Roque Ferreira B, Lvov A, Romanov D, Marron SE, Gracia-Cazaña T, Svensson A, Altunay IK, Thompson AR, Zeidler C, Kupfer J. BI24: An insight into the protective role of biologics in
COVID
‐19 infections: a single‐centre case series. Br J Dermatol 2022. [PMID: 35041211 PMCID: PMC9349390 DOI: 10.1111/bjd.21366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Christina Schut
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
| | - Florence J Dalgard
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Dermatology and Venereology, Skåne University Hospital, Malmo, Sweden
| | - Anthony Bewley
- Barts Health NHS Trust & Queen Mary University of London, London, UK
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Department, Leiden University, Leiden, the Netherlands
| | | | - Lars Lien
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | | | - Sonja Ständer
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Lucía Tomás-Aragonés
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
- Aragon Psychodermatology Research Group Zaragoza, Zaragoza, Spain
| | - Nienke Vulink
- Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Franz J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | | | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Csanád Szabó
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Vesna Grivcheva-Panovska
- University St Cyril and Methodius, School of Medicine, PHI University Clinic of Dermatology, Skopje, North Macedonia
| | - Saskia Spillekom-van Koulil
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Flora Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
| | - Bárbara Roque Ferreira
- Centre for Philosophy of Science of the University of Lisbon, Lisbon, Portugal
- Department of Dermatology, Centre Hospitalier de Mouscron, Mouscron, Belgium
- University of Brest, Lien, France
| | - Andrey Lvov
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia
- Medical Research and Educational Centre, Lomonosov Moscow State University, Moscow, Russia
| | - Dmitry Romanov
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Boundary Mental Conditions and Psychosomatic Disorders, Mental Health Research Centre, Moscow, Russia
- Moscow Scientific and Practical Centre of Dermatology, Venereology and Cosmetology of Moscow City Health Department, Moscow, Russia
| | - Servando E Marron
- Aragon Psychodermatology Research Group Zaragoza, Zaragoza, Spain
- Department of Dermatology, University Hospital Miguel Servet, Zaragoza, Spain
| | | | - Ake Svensson
- Department of Dermatology, Skåne University Hospital, Malmö, Sweden
| | - Ilknur K Altunay
- University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Dermatology and Venereology Clinic, Istanbul, Turkey
| | - Andrew R Thompson
- South Wales Clinical Psychology Training Programme, Cardiff & Vale University Health Board & School of Psychology, Cardiff University, Cardiff, UK
| | - Claudia Zeidler
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Joerg Kupfer
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
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7
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Chavez-Baldini U, Verweij K, de Beurs D, Bockting C, Lok A, Sutterland AL, van Rooijen G, van Wingen G, Denys D, Vulink N, Nieman D. The interplay between psychopathological symptoms: transdiagnostic cross-lagged panel network model. BJPsych Open 2022; 8:e116. [PMID: 35758630 PMCID: PMC9301766 DOI: 10.1192/bjo.2022.516] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Recent paradigm shifts suggest that psychopathology manifests through dynamic interactions between individual symptoms. AIMS To investigate the longitudinal relationships between symptoms in a transdiagnostic sample of patients with psychiatric disorders. METHOD A two-wave, cross-lagged panel network model of 15 nodes representing symptoms of depression, (social) anxiety and attenuated psychotic symptoms was estimated, using baseline and 1-year follow-up data of 222 individuals with psychiatric disorders. Centrality indices were calculated to determine important predictors and outcomes. RESULTS Our results demonstrated that the strongest relationships in the network were between (a) more suicidal ideation predicting more negative self-view, and (b) autoregressive relationships of social anxiety symptoms positively reinforcing themselves. Negative self-view was the most predictable node in the network as it had the highest 'in-expected influence' centrality, and may be an important transdiagnostic outcome symptom. CONCLUSIONS The results give insight into longitudinal interactions between symptoms, which interact in ways that do not adhere to broader diagnostic categories. Our results suggest that self-view can also be a transdiagnostic outcome of psychopathology rather than just a predictor, as is normally posited, and may especially have an important relationship with suicidal ideation. Overall, our study demonstrates the dynamic complexity of psychopathology, and further supports the importance of investigating symptom interactions of different psychopathological dimensions over time and across disorders.
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Affiliation(s)
- UnYoung Chavez-Baldini
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, The Netherlands
| | - Karin Verweij
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, The Netherlands
| | - Derek de Beurs
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), The Netherlands
| | - Claudi Bockting
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, The Netherlands
| | - Anja Lok
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, The Netherlands
| | - Arjen L Sutterland
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, The Netherlands
| | - Geeske van Rooijen
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, The Netherlands
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, The Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, The Netherlands
| | - Dorien Nieman
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, The Netherlands
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8
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van Wingen G, Bergfeld I, de Koning P, Graat I, Luigjes J, Mocking R, Namavar Y, Ooms P, van Rooijen G, Vulink N, Mantione M, Figee M, Denys D. Comment to: Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy? Mol Psychiatry 2022; 27:1276-1277. [PMID: 34992236 DOI: 10.1038/s41380-021-01411-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/03/2021] [Revised: 11/21/2021] [Accepted: 11/26/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Guido van Wingen
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Isidoor Bergfeld
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pelle de Koning
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ilse Graat
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Judy Luigjes
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roel Mocking
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Yasmin Namavar
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter Ooms
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Geeske van Rooijen
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariska Mantione
- Department of Neurology & Neurosurgery, UMC Utrecht, Utrecht, The Netherlands
| | - Martijn Figee
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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9
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Graat I, Balke S, Prinssen J, de Koning P, Vulink N, Mocking R, van Rooijen G, Munckhof PVD, Schuurman R, Denys D. Effectiveness and safety of deep brain stimulation for patients with refractory obsessive compulsive disorder and comorbid autism spectrum disorder; A case series. J Affect Disord 2022; 299:492-497. [PMID: 34952108 DOI: 10.1016/j.jad.2021.12.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/15/2021] [Accepted: 12/19/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is effective for patients with treatment refractory obsessive-compulsive disorder (OCD). Autism spectrum disorder (ASD) is present in up to a third of all patients with OCD, but it is unknown whether effectiveness of DBS for OCD also applies for patients with comorbid ASD. The present case series is the first to examine effectiveness on OCD symptoms and safety of DBS in patients with OCD and ASD specifically. METHODS Six consecutive patients with treatment-refractory OCD and comorbid ASD received DBS of the ventral anterior limb of the internal capsule (vALIC) or medial forebrain bundle (MFB). We examined effectiveness of DBS on symptoms of OCD and depression with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Hamilton Depression Rating Scale (HAM-D), respectively. We included qualitative data to describe the course of treatment in individual patients with OCD and ASD. RESULTS We found that DBS significantly decreased symptoms of OCD (p < .001) and depression (p = .007). Four out of six patients with OCD and comorbid ASD were responders (decrease ≥ 35% in Y-BOCS), one patient was partial-responder (decrease 25-35% in Y-BOCS) and one patient did not respond (decrease ≤ 25% in Y-BOCS). Serious adverse events were an infection of the DBS system, and a suicide attempt. CONCLUSIONS Though present results are preliminary, DBS reduced symptoms of OCD and depression in patients with OCD and comorbid ASD. Comorbid ASD should therefore not be seen as a contra-indication for DBS in OCD.
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Affiliation(s)
- Ilse Graat
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 Amsterdam, the Netherlands.
| | - Sofie Balke
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 Amsterdam, the Netherlands
| | - Janine Prinssen
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 Amsterdam, the Netherlands
| | - Pelle de Koning
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 Amsterdam, the Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 Amsterdam, the Netherlands
| | - Roel Mocking
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 Amsterdam, the Netherlands
| | - Geeske van Rooijen
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 Amsterdam, the Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Rick Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 Amsterdam, the Netherlands
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10
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Schut C, Dalgard FJ, Bewley A, Evers AWM, Gieler U, Lien L, Sampogna F, Ständer S, Tomas-Aragones L, Vulink N, Finlay AY, Legat FJ, Titeca G, Jemec GB, Misery L, Szabó C, Grivcheva-Panovska V, Spillekom-van Koulil S, Balieva F, Szepietowski JC, Reich A, Roque Ferreira B, Lvov A, Romanov D, Marron SE, Gracia-Cazaña T, Svensson Å, Altunay IK, Thompson A, Zeidler C, Kupfer J. Body dysmorphia in common skin diseases: Results of an observational, cross-sectional multi-centre study among dermatological out-patients in 17 European countries. Br J Dermatol 2022; 187:115-125. [PMID: 35041211 DOI: 10.1111/bjd.21021] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/20/2021] [Accepted: 01/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is a common psychiatric disorder associated with high costs for healthcare systems as patients may repeatedly ask for different, often not effective interventions. BDD symptoms are more prevalent in patients with dermatological conditions than the general population, but there are no large sample studies comparing the prevalence of BDD symptoms between patients with dermatological conditions and healthy skin controls. OBJECTIVES To compare the prevalence of BDD symptoms between patients with different dermatological conditions and healthy skin controls and to describe sociodemographic, physical and psychological factors associated with BDD symptoms to identify patients who may have a particularly high chance of having this condition. METHODS This observational cross-sectional, comparative multi-centre study included 8295 participants: 5487 consecutive patients with different skin diseases (56% female) recruited among dermatological out-patients at 22 clinics in 17 European countries and 2808 healthy skin controls (66% female). All patients were examined by a dermatologist. BDD symptoms were assessed by the Dysmorphic Concern Questionnaire (DCQ). Sociodemographic data, information on psychological factors and physical conditions were collected. Each patient was given a dermatological diagnosis according to ICD-10 by a dermatologist. RESULTS The participation rate of invited dermatological patients was 82.4% on average across all centres. BDD symptoms were five times more prevalent in patients with dermatological conditions than in healthy skin controls (10.5% vs. 2.1%). Patients with hyperhidrosis, alopecia and vitiligo had a more than eleven-fold increased chance (adjusted Odds Ratio (OR) > 11) of having BDD symptoms compared to healthy skin controls, and patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo and bullous diseases had a more than six-fold increased chance (adjusted OR > 6) of having BDD symptoms. Using a logistic regression model, BDD symptoms were significantly related to lower age, female sex, higher psychological stress and feelings of stigmatisation. CONCLUSIONS This study reveals that clinical BDD symptoms are significantly associated with common dermatological diseases. As such symptoms are associated with higher levels of psychological distress and multiple unhelpful consultations, general practitioners and dermatologists should consider BDD and refer patients when identified to an appropriate service for BDD screening and management.
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Affiliation(s)
- Christina Schut
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
| | - Florence J Dalgard
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Dermatology and Venereology, Skåne University Hospital, Malmo, Sweden
| | - Anthony Bewley
- Barts Health NHS Trust & Queen Mary University of London, UK
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Department, Leiden University, The Netherlands
| | | | - Lars Lien
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | | | - Sonja Ständer
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Lucia Tomas-Aragones
- Department of Psychology, University of Zaragoza, Spain.,Aragon Psychodermatology Research Group Zaragoza, Spain
| | - Nienke Vulink
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Franz J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | | | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Csanád Szabó
- Department of Dermatology and Allergology, University of Szeged, Hungary
| | - Vesna Grivcheva-Panovska
- University St. Cyril and Methodius, School of Medicine, PHI University Clinic of Dermatology Skopje, N. Macedonia
| | - Saskia Spillekom-van Koulil
- Radbout Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Flora Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Poland
| | - Bárbara Roque Ferreira
- Centre for Philosophy of Science of the University of Lisbon, Portugal.,Department of Dermatology, Centre Hospitalier de Mouscron, Belgium.,University of Brest, Lien, France
| | - Andrey Lvov
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia.,Medical Research and Educational Centre, Lomonosov Moscow State University, Moscow, Russia
| | - Dmitry Romanov
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Department of Boundary Mental Conditions and Psychosomatic Disorders, Mental Health Research Centre, Moscow, Russia.,Moscow Scientific and Practical Centre of Dermatology, Venereology and Cosmetology of Moscow City Health Department, Moscow, Russia
| | - S E Marron
- Aragon Psychodermatology Research Group Zaragoza, Spain.,Department of Dermatology, University Hospital Miguel Servet, Zaragoza, Spain
| | | | - Å Svensson
- Department of Dermatology, Skane University Hospital, Malmö, Sweden
| | - Ilknur K Altunay
- University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Dermatology and Venereology Clinic, Istanbul, Turkey
| | - Andrew Thompson
- South Wales Clinical Psychology Training Programme, Cardiff & Vale University Health Board & School of Psychology, Cardiff University, Cardiff, UK
| | - Claudia Zeidler
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Joerg Kupfer
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
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11
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Jager I, Vulink N, van Loon A, van der Pol M, Schröder A, Slaghekke S, Denys D. Synopsis and Qualitative Evaluation of a Treatment Protocol to Guide Systemic Group-Cognitive Behavioral Therapy for Misophonia. Front Psychiatry 2022; 13:794343. [PMID: 35836662 PMCID: PMC9275669 DOI: 10.3389/fpsyt.2022.794343] [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: 10/13/2021] [Accepted: 06/08/2022] [Indexed: 11/19/2022] Open
Abstract
Misophonia is a disorder in which patients suffer from anger or disgust when confronted with specific sounds such as those associated with eating or breathing, causing avoidance of cue related situations resulting in significant functional impairment. Functional magnetic resonance imaging studies suggest misophonia is associated with increased activity in the auditory cortex and salience network, which might reflect increased vigilance toward specific misophonia triggers. New treatments have been developed and investigated in the last years in which this vigilance plays an important role. This is a synopsis of the first group protocol for systemic Cognitive Behavioral Therapy (G-CBT) for misophonia. We discuss the model of CBT for misophonia, provide a detailed guide to the treatment illustrated with a case study, discuss advantages, limitations, and possible pitfalls by a qualitative evaluation of the protocol, and review evidence for the protocol.
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Affiliation(s)
- Inge Jager
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.,GGZ inGeest, Amsterdam, Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Arnoud van Loon
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Marthe van der Pol
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | - Simone Slaghekke
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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12
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Smit DJA, Bakker M, Abdellaoui A, Hoetink AE, Vulink N, Denys D. A genome-wide association study of a rage-related misophonia symptom and the genetic link with audiological traits, psychiatric disorders, and personality. Front Neurosci 2022; 16:971752. [PMID: 36760791 PMCID: PMC9902885 DOI: 10.3389/fnins.2022.971752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/21/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction People with misophonia experience strong negative emotional responses to sounds and associated stimuli-mostly human produced-to an extent that it may cause impairment in social functioning. The exact nature of the disorder remains a matter of ongoing research and debate. Here, we investigated the genetic etiology of misophonia to understand contributing genetic factors and shed light on individual differences in characteristics that are related to the disorder. Methods For misophonia, we used an unpublished genome-wide association study (GWAS) from genetic service provider 23andMe, Inc., on a self-report item probing a single common misophonic symptom: the occurrence of rage when others produce eating sounds. First, we used gene-based and functional annotation analyses to explore neurobiological determinants of the rage-related misophonia symptom. Next, we calculated genetic correlations (r G) of this rage-related misophonia symptom GWAS with a wide range of traits and disorders from audiology (tinnitus, hearing performance, and hearing trauma), psychiatry, neurology, and personality traits. Results The rage-related misophonia symptom was significantly correlated with tinnitus, major depression disorder (MDD), post-traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD; 0.12 < r G < 0.22). Stronger genetic correlations (0.21 < r G < 0.42) were observed for two clusters of personality traits: a guilt/neuroticism and an irritability/sensitivity cluster. Our results showed no genetic correlation with attention deficit and hyperactivity disorder, obsessive-compulsive disorder, and psychotic disorders. A negative correlation with autism spectrum disorder (ASD) was found, which may be surprising given the previously reported comorbidities and the sensory sensitivity reported in ASD. Clustering algorithms showed that rage-related misophonia consistently clustered with MDD, generalized anxiety, PTSD, and related personality traits. Discussion We conclude that-based on the genetics of a common misophonia symptom-misophonia most strongly clusters with psychiatric disorders and a personality profile consistent with anxiety and PTSD.
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Affiliation(s)
- Dirk J A Smit
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Melissa Bakker
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Abdel Abdellaoui
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Alexander E Hoetink
- Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Neuroscience, Amsterdam, Netherlands
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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 Outcome of Deep Brain Stimulation of the Ventral Part of the Anterior Limb of the Internal Capsule in a Cohort of 50 Patients With Treatment-Refractory Obsessive-Compulsive Disorder. Biol Psychiatry 2021; 90:714-720. [PMID: 33131717 DOI: 10.1016/j.biopsych.2020.08.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is an effective intervention for patients with severe treatment-refractory obsessive-compulsive disorder (OCD). Our aim was to examine long-term effectiveness and tolerability of DBS and its impact on functioning and well-being. METHODS Fifty patients with severe treatment-refractory OCD received DBS of the ventral part of the anterior limb of the internal capsule and were followed for at least 3 years following implantation (mean 6.8 ± 3 years). Primary effectiveness was assessed by change in Yale-Brown Obsessive Compulsive Scale scores. Secondary effectiveness measures included Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, World Health Organization Quality of Life Scale-Brief Version, Global Assessment of Functioning, and a scale assessing functioning in work, family, and social life. Adverse effects of DBS were examined with a structured interview (n = 38). RESULTS At long-term follow-up, OCD symptoms decreased by 39% (p < .001), and half of the patients were responders (≥35% decrease of Yale-Brown Obsessive Compulsive Scale score). Anxiety and depressive symptoms decreased significantly, with reductions of 48% and 50%, respectively. The World Health Organization Quality of Life Scale-Brief Version general score improved significantly, as did 3 of 4 subdomains. Both clinician- and patient-rated functioning improved substantially (p < .001). The unemployment rate decreased from 78% at baseline to 58% at last follow-up (z = -1.90, p = .058), and 21 patients stopped or decreased psychotropic medication (z = -2.887, p = .004). Long-term adverse effects included cognitive complaints and fatigue. Serious adverse events included 1 suicide attempt, related to comorbid depression. CONCLUSIONS Our results provide evidence that DBS of the ventral part of the anterior limb of the internal capsule is effective and tolerable for treatment-refractory OCD in the long term and improves functioning and overall well-being.
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Affiliation(s)
- Ilse Graat
- Department of Psychiatry, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam, the Netherlands.
| | - Roel Mocking
- Department of Psychiatry, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam, the Netherlands
| | - Martijn Figee
- Department of Psychiatry, Mount Sinai Hospital, New York, New York
| | - Nienke Vulink
- Department of Psychiatry, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam, the Netherlands
| | - Pelle de Koning
- Department of Psychiatry, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam, the Netherlands
| | - Pieter Ooms
- Department of Psychiatry, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam, the Netherlands
| | - Mariska Mantione
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam, the Netherlands
| | - Rick Schuurman
- Department of Neurosurgery, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam, the Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam, the Netherlands
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14
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Graat I, Mocking RJT, de Koning P, Vulink N, Figee M, van den Munckhof P, Schuurman PR, Denys D. Predicting Response to vALIC Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder. J Clin Psychiatry 2021; 82. [PMID: 34727424 DOI: 10.4088/jcp.20m13754] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Deep brain stimulation (DBS) for treatment-refractory obsessive-compulsive disorder (OCD) is effective in half of patients, but also is invasive and labor-intensive. Objective: Selecting probable responders beforehand would more optimally allocate treatment resources and prevent patients' disappointment. Some centers use clinical and demographic predictors to exclude patients from DBS treatment, but the evidence base remains uncertain. Methods: This observational cohort study examined the association of baseline demographic and disease characteristics with a 1-year prospective course of OCD and depressive symptoms in a cohort of 70 consecutive patients who received DBS of the ventral anterior limb of the internal capsule (vALIC-DBS) for OCD according to DSM-IV or DSM-5 criteria between April 2005 and October 2017. Baseline characteristics and symptom decrease were analyzed using Fisher exact tests and binary logistic regression to examine whether they could predict individual response (> 35% reduction in Yale-Brown Obsessive Compulsive Scale score and 50% reduction in Hamilton Depression Rating Scale score, respectively). Results: Insight into illness was the only significant predictor of individual response, with a positive predictive value of 84.4%, while the negative predictive value was 44.0% (b = 0.247, χ21 = 5.259, P = .022). Late-onset OCD was associated with more symptom decrease (β = -0.29; 95% CI, -0.53 to -0.04; P = .023) and comorbid personality disorder with less symptom decrease over time (β = 0.88; 95% CI -0.29 to 1.47; P = .004), but they could not significantly predict vALIC-DBS response. A later age at onset, comorbid personality disorder, and insight into illness were associated with clinical outcomes after vALIC-DBS, but predictive values were not large enough to facilitate clinical patient selection. Conclusions: Clinical and demographic factors cannot yet predict outcome and should not be used to exclude patients from treatment with vALIC-DBS. These first individual prediction analyses for vALIC-DBS response in OCD are important, given that some centers up until now still exclude patients based on clinical characteristics such as comorbid personality disorders.
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Affiliation(s)
- Ilse Graat
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Corresponding author: Ilse Graat, MD, Amsterdam UMC, Meibergdreef 9 1105 AZ Amsterdam, The Netherlands
| | - Roel J T Mocking
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Pelle de Koning
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn Figee
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - P Rick Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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15
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Abstract
BACKGROUND Misophonia is a disorder in which patients suffer from anger or disgust when confronted with specific sounds such as loud chewing or breathing, causing avoidance of cue-related situations resulting in significant functional impairment. Though the first treatment studies with cognitive behavioural therapy (CBT) showed promising results, an average of 50% of the patients has not improved much clinically. OBJECTIVE The aim of this pilot study was to assess the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy as a trauma-focused approach in treating misophonia symptoms. METHOD A sample of 10 adult participants with misophonia was studied at the outpatient clinic of the Academic Medical Center in Amsterdam. Participants were either on the waiting list for CBT or non-responders to CBT. EMDR was focused on misophonia-related emotionally disturbing memories and delivered in a mean of 2.6 sessions of 60-90 minutes. Pre- and post-treatment self-assessed ratings of misophonia symptoms (AMISOS-R, primary outcome), of general psychopathology (SCL-90-R) and of quality of life (SDS) were administered. The co-primary outcome was the Clinical Global Impression Improvement scale (CGI-I). RESULTS A paired t-test (n = 8) showed improvement on the primary outcome (-6.14 [MD], 5.34 [SD]) on the AMISOS-R (P = .023). Three of the eight patients showed clinically significant improvement measured with the CGI-I. No significant effect on secondary outcomes was found. CONCLUSIONS These preliminary results suggest that EMDR therapy focused on emotionally disturbing misophonia-related memories can reduce misophonia symptoms. RCTs with sufficient sample sizes are required to firmly establish the value of EMDR therapy for misophonia.
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Affiliation(s)
- Inge Jager
- Department of Psychiatry, Amsterdam UMC (Location AMC), Amsterdam, The Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Amsterdam UMC (Location AMC), Amsterdam, The Netherlands
| | - Carlijn de Roos
- Department of Child and Adolescent Psychiatry, Amsterdam UMC (Location AMC), Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC (Location AMC), Amsterdam, The Netherlands
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Jager I, de Koning P, Bost T, Denys D, Vulink N. Misophonia: Phenomenology, comorbidity and demographics in a large sample. PLoS One 2020; 15:e0231390. [PMID: 32294104 PMCID: PMC7159231 DOI: 10.1371/journal.pone.0231390] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [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: 12/27/2019] [Accepted: 03/23/2020] [Indexed: 12/18/2022] Open
Abstract
Objective Analyze a large sample with detailed clinical data of misophonia subjects in order to determine the psychiatric, somatic and psychological nature of the condition. Methods This observational study of 779 subjects with suspected misophonia was conducted from January 2013 to May 2017 at the outpatient-clinic of the Amsterdam University Medical Centers, location AMC, the Netherlands. We examined DSM-IV diagnoses, results of somatic examination (general screening and hearing tests), and 17 psychological questionnaires (e.g., SCL-90-R, WHOQoL). Results The diagnosis of misophonia was confirmed in 575 of 779 referred subjects (74%). In the sample of misophonia subjects (mean age, 34.17 [SD = 12.22] years; 399 women [69%]), 148 (26%) subjects had comorbid traits of obsessive-compulsive personality disorder, 58 (10%) mood disorders, 31 (5%) attention-deficit (hyperactivity) disorder, and 14 (3%) autism spectrum conditions. Two percent reported tinnitus and 1% hyperacusis. In a random subgroup of 109 subjects we performed audiometry, and found unilateral hearing loss in 3 of them (3%). Clinical neurological examination and additional blood test showed no abnormalities. Psychological tests revealed perfectionism (97% CPQ>25) and neuroticism (stanine 7 NEO-PI-R). Quality of life was heavily impaired and associated with misophonia severity (rs (184) = -.34 p = < .001, p = < .001). Limitations This was a single site study, leading to possible selection–and confirmation bias, since AMC-criteria were used. Conclusions This study with 575 subjects is the largest misophonia sample ever described. Based on these results we propose a set of revised criteria useful to diagnose misophonia as a psychiatric disorder.
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Affiliation(s)
- Inge Jager
- Department of Psychiatry, Amsterdam UMC (location AMC), Amsterdam, The Netherlands
- * E-mail:
| | - Pelle de Koning
- Department of Psychiatry, Amsterdam UMC (location AMC), Amsterdam, The Netherlands
| | - Tim Bost
- Department of Otorhinolaryngology, Clinical and Experimental Audiology, Amsterdam Public Health, Amsterdam UMC (location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC (location AMC), Amsterdam, The Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Amsterdam UMC (location AMC), Amsterdam, The Netherlands
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17
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Denys D, Graat I, Mocking R, de Koning P, Vulink N, Figee M, Ooms P, Mantione M, van den Munckhof P, Schuurman R. Efficacy of Deep Brain Stimulation of the Ventral Anterior Limb of the Internal Capsule for Refractory Obsessive-Compulsive Disorder: A Clinical Cohort of 70 Patients. Am J Psychiatry 2020; 177:265-271. [PMID: 31906709 DOI: 10.1176/appi.ajp.2019.19060656] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is an effective treatment option for patients with refractory obsessive-compulsive disorder (OCD). However, clinical experience with DBS for OCD remains limited. The authors examined the tolerability and effectiveness of DBS in an open study of patients with refractory OCD. METHODS Seventy consecutive patients, including 16 patients from a previous trial, received bilateral DBS of the ventral anterior limb of the internal capsule (vALIC) between April 2005 and October 2017 and were followed for 12 months. Primary effectiveness was assessed by the change in scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) from baseline until the 12-month follow-up. Response was defined by a ≥35% decrease in Y-BOCS score, partial response was defined by a 25%-34% decrease, and nonresponse was defined by a <25% decrease. Secondary effectiveness measures were the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D). RESULTS Y-BOCS, HAM-A, and HAM-D scores all decreased significantly during the first 12 months of DBS. Twelve months of DBS resulted in a mean Y-BOCS score decrease of 13.5 points (SD=9.4) (40% reduction; effect size=1.5). HAM-A scores decreased by 13.4 points (SD=9.7) (55%; effect size=1.4), and HAM-D scores decreased by 11.2 points (SD=8.8) (54%; effect size=1.3). At the 12-month follow-up, 36 of the 70 patients were categorized as responders (52%), 12 patients as partial responders (17%), and 22 patients as nonresponders (31%). Adverse events included transient symptoms of hypomania, agitation, impulsivity, and sleeping disorders. CONCLUSIONS These results confirm the effectiveness and safety of DBS of the vALIC for patients with treatment-refractory OCD in a regular clinical setting.
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Affiliation(s)
- Damiaan Denys
- The Department of Psychiatry, University of Amsterdam (Denys, Graat, Mocking, de Koning, Vulink, Ooms); the Department of Psychiatry, Mount Sinai Hospital, New York (Figee); the Department of Neurosurgery, University of Amsterdam (van den Munckhof, Schuurman); and the Department of Neurology and Neurosurgery, University of Amsterdam Utrecht, Utrecht, the Netherlands (Mantione)
| | - Ilse Graat
- The Department of Psychiatry, University of Amsterdam (Denys, Graat, Mocking, de Koning, Vulink, Ooms); the Department of Psychiatry, Mount Sinai Hospital, New York (Figee); the Department of Neurosurgery, University of Amsterdam (van den Munckhof, Schuurman); and the Department of Neurology and Neurosurgery, University of Amsterdam Utrecht, Utrecht, the Netherlands (Mantione)
| | - Roel Mocking
- The Department of Psychiatry, University of Amsterdam (Denys, Graat, Mocking, de Koning, Vulink, Ooms); the Department of Psychiatry, Mount Sinai Hospital, New York (Figee); the Department of Neurosurgery, University of Amsterdam (van den Munckhof, Schuurman); and the Department of Neurology and Neurosurgery, University of Amsterdam Utrecht, Utrecht, the Netherlands (Mantione)
| | - Pelle de Koning
- The Department of Psychiatry, University of Amsterdam (Denys, Graat, Mocking, de Koning, Vulink, Ooms); the Department of Psychiatry, Mount Sinai Hospital, New York (Figee); the Department of Neurosurgery, University of Amsterdam (van den Munckhof, Schuurman); and the Department of Neurology and Neurosurgery, University of Amsterdam Utrecht, Utrecht, the Netherlands (Mantione)
| | - Nienke Vulink
- The Department of Psychiatry, University of Amsterdam (Denys, Graat, Mocking, de Koning, Vulink, Ooms); the Department of Psychiatry, Mount Sinai Hospital, New York (Figee); the Department of Neurosurgery, University of Amsterdam (van den Munckhof, Schuurman); and the Department of Neurology and Neurosurgery, University of Amsterdam Utrecht, Utrecht, the Netherlands (Mantione)
| | - Martijn Figee
- The Department of Psychiatry, University of Amsterdam (Denys, Graat, Mocking, de Koning, Vulink, Ooms); the Department of Psychiatry, Mount Sinai Hospital, New York (Figee); the Department of Neurosurgery, University of Amsterdam (van den Munckhof, Schuurman); and the Department of Neurology and Neurosurgery, University of Amsterdam Utrecht, Utrecht, the Netherlands (Mantione)
| | - Pieter Ooms
- The Department of Psychiatry, University of Amsterdam (Denys, Graat, Mocking, de Koning, Vulink, Ooms); the Department of Psychiatry, Mount Sinai Hospital, New York (Figee); the Department of Neurosurgery, University of Amsterdam (van den Munckhof, Schuurman); and the Department of Neurology and Neurosurgery, University of Amsterdam Utrecht, Utrecht, the Netherlands (Mantione)
| | - Mariska Mantione
- The Department of Psychiatry, University of Amsterdam (Denys, Graat, Mocking, de Koning, Vulink, Ooms); the Department of Psychiatry, Mount Sinai Hospital, New York (Figee); the Department of Neurosurgery, University of Amsterdam (van den Munckhof, Schuurman); and the Department of Neurology and Neurosurgery, University of Amsterdam Utrecht, Utrecht, the Netherlands (Mantione)
| | - Pepijn van den Munckhof
- The Department of Psychiatry, University of Amsterdam (Denys, Graat, Mocking, de Koning, Vulink, Ooms); the Department of Psychiatry, Mount Sinai Hospital, New York (Figee); the Department of Neurosurgery, University of Amsterdam (van den Munckhof, Schuurman); and the Department of Neurology and Neurosurgery, University of Amsterdam Utrecht, Utrecht, the Netherlands (Mantione)
| | - Rick Schuurman
- The Department of Psychiatry, University of Amsterdam (Denys, Graat, Mocking, de Koning, Vulink, Ooms); the Department of Psychiatry, Mount Sinai Hospital, New York (Figee); the Department of Neurosurgery, University of Amsterdam (van den Munckhof, Schuurman); and the Department of Neurology and Neurosurgery, University of Amsterdam Utrecht, Utrecht, the Netherlands (Mantione)
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Graat I, van Rooijen G, Mocking R, Vulink N, de Koning P, Schuurman R, Denys D. Is deep brain stimulation effective and safe for patients with obsessive compulsive disorder and comorbid bipolar disorder? J Affect Disord 2020; 264:69-75. [PMID: 31846903 DOI: 10.1016/j.jad.2019.11.152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/07/2019] [Revised: 11/07/2019] [Accepted: 11/30/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is an effective treatment for refractory obsessive-compulsive disorder (OCD). Bipolar disorder (BD) is generally considered a contra-indication for DBS due to frequently reported transient impulsivity or (hypo)mania. OBJECTIVE The present study is the first study to examine effectiveness and safety of DBS for patients with OCD and BD. METHODS Five consecutive patients suffering from treatment-refractory OCD with comorbid BD (I or II) underwent DBS of the ventral anterior limb of the internal capsule (vALIC). We examined effectiveness of DBS on symptoms of OCD and depression, using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Hamilton Depression Rating Scale (HAM-D). We monitored side-effects, in particular DBS-induced (hypo)manic symptoms, using the Young mania rating scale (YMRS). RESULTS Follow-up time ranged between 15 and 68 months. vALIC-DBS led to a significant improvement of OCD and depressive symptoms. Mean Y-BOCS score decreased from 36.8 (SD 2.4) to 22.4 (SD 9.4). Mean HAM-D score dropped from 24.2 (SD 8.6) to 16.5 (SD 11.3). Transient hypomanic symptoms were observed in 4 out of 5 patients and in 1 patient, hypomanic symptoms resolved by adjusting stimulation and medication. Changes in YMRS scores were not significant. Hypomanic symptoms did not result in admission or lasting adverse consequences. CONCLUSION DBS effectively alleviates symptoms of OCD and depression in patients with OCD and BD but there is a large risk of developing transient hypomanic symptoms. Altogether, comorbid BD should not be considered as an absolute contra-indication for DBS in OCD patients with comorbid BD, but patients should be monitored carefully during optimization and follow-up of DBS.
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Affiliation(s)
- Ilse Graat
- Department of Psychiatry, Amsterdam Universitair Medisch Centrum, Amsterdam, the Netherlands.
| | - Geeske van Rooijen
- Department of Psychiatry, Amsterdam Universitair Medisch Centrum, Amsterdam, the Netherlands
| | - Roel Mocking
- Department of Psychiatry, Amsterdam Universitair Medisch Centrum, Amsterdam, the Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Amsterdam Universitair Medisch Centrum, Amsterdam, the Netherlands
| | - Pelle de Koning
- Department of Psychiatry, Amsterdam Universitair Medisch Centrum, Amsterdam, the Netherlands
| | - Rick Schuurman
- Department of Neurosurgery, Academic Medical Centre (Amsterdam UMC), Amsterdam, the Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam Universitair Medisch Centrum, Amsterdam, the Netherlands
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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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Graat I, Bergfeld IO, de Koning P, Vulink N, Schuurman PR, Denys D, Figee M. Delusions following deep brain stimulation of the nucleus accumbens. Brain Stimul 2019; 12:770-771. [PMID: 30606642 DOI: 10.1016/j.brs.2018.12.973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Ilse Graat
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Isidoor O Bergfeld
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Pelle de Koning
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - P Richard Schuurman
- Amsterdam Neuroscience, Amsterdam, the Netherlands; Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands; Netherlands Institute for Neurosciences, an Institute of the Royal Dutch Academy of Science, Amsterdam, the Netherlands
| | - Martijn Figee
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
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Menchón JM, van Ameringen M, Dell'Osso B, Denys D, Figee M, Grant JE, Hollander E, Marazziti D, Nicolini H, Pallanti S, Ruck C, Shavitt R, Stein DJ, Andersson E, Bipeta R, Cath DC, Drummond L, Feusner J, Geller DA, Hranov G, Lochner C, Matsunaga H, McCabe RE, Mpavaenda D, Nakamae T, O'Kearney R, Pasquini M, Pérez Rivera R, Poyurovsky M, Real E, do Rosário MC, Soreni N, Swinson RP, Vulink N, Zohar J, Fineberg N. Standards of care for obsessive-compulsive disorder centres. Int J Psychiatry Clin Pract 2016; 20:204-8. [PMID: 27359333 PMCID: PMC4950405 DOI: 10.1080/13651501.2016.1197275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In recent years, many assessment and care units for obsessive-compulsive disorder (OCD) have been set up in order to detect, diagnose and to properly manage this complex disorder, but there is no consensus regarding the key functions that these units should perform. The International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) together with the Obsessive Compulsive and Related Disorders Network (OCRN) of the European College of Neuropsychopharmacology (ECNP) and the Anxiety and Obsessive Compulsive Disorders Section of the World Psychiaric Association (WPA) has developed a standards of care programme for OCD centres. The goals of this collaborative initiative are promoting basic standards, improving the quality of clinical care and enhance the validity and reliability of research results provided by different facilities and countries.
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Affiliation(s)
- José M Menchón
- a Psychiatry Department , Bellvitge University Hospital_IDIBELL , Barcelona , Spain ;,b Carlos III Health Institute_CIBERSAM , Spain ;,c Department of Clinical Sciences, School of Medicine , University of Barcelona , Barcelona , Spain
| | - Michael van Ameringen
- d Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada
| | - Bernardo Dell'Osso
- e Department of Psychiatry , University of Milan , Milan , Italy ;,f Fondazione IRCCS Ca' Granda Policlinico , Milan , Italy
| | - Damiaan Denys
- g Academic Medical Center , Department of Psychiatry , University of Amsterdam , Amsterdam , The Netherlands ;,h Brain and Cognition , Amsterdam , The Netherlands ;,i Netherlands Institute for Neuroscience , Amsterdam , The Netherlands ;,j Royal Netherlands Academy of Arts and Sciences , Amsterdam , The Netherlands
| | - Martijn Figee
- g Academic Medical Center , Department of Psychiatry , University of Amsterdam , Amsterdam , The Netherlands
| | - Jon E Grant
- k Department of Psychiatry and Behavioral Neuroscience , University of Chicago , Chicago , IL , USA
| | - Eric Hollander
- l Department of Psychiatry and Behavioral Sciences , Albert Einstein College of Medicine , NY , USA ;,m Montefiore Medical Center , NY , USA
| | - Donatella Marazziti
- n Dipartimento di Medicina Clinica e Sperimentale, Sezione di Psichiatria , University of Pisa , Pisa , Italy
| | - Humberto Nicolini
- o National Institute of Genomic Medicine , Mexico City , Mexico ;,p Carracci Medical Group , Mexico City , Mexico
| | - Stefano Pallanti
- q Psychiatry and Behavioral Sciences , UC Davis Health System , Sacramento , CA , USA ;,r Istituto di Neuroscienze , Florence , Italy
| | - Christian Ruck
- s Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Roseli Shavitt
- t Department and Institute of Psychiatry , University of São Paulo School of Medicine , São Paulo , Brazil
| | - Dan J Stein
- u Psychiatry and Mental Health Department , University of Cape Town , Cape Town , South Africa ;,v Groote Schuur Hospital , Cape Town , South Africa ;,w MRC Unit on Anxiety and Stress Disorders , South Africa
| | - Erik Andersson
- s Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | | | - Danielle C Cath
- y Department of Clinical Psychology , Utrecht University , Utrecht , The Netherlands
| | - Lynne Drummond
- z South West London and St George's Mental Health NHS Trust , London , United Kingdom ;,aa St George's, University of London , London , United Kingdom
| | - Jamie Feusner
- ab Semel Institute for Neuroscience and Human Behavior , Los Angeles , CA , USA ;,ac David Geffen School of Medicine at UCLA University of California , Los Angeles , CA , USA
| | - Daniel A Geller
- ad Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA ;,ae Harvard Medical School , Boston , MA , USA
| | | | - Christine Lochner
- w MRC Unit on Anxiety and Stress Disorders , South Africa ;,ag Department of Psychiatry , Stellenbosch University , South Africa
| | - Hisato Matsunaga
- ah Department of Neuropsychiatry , Hyogo College of Medicine , Nishinomiya , Hyogo , Japan
| | - Randy E McCabe
- d Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada ;,ai Anxiety Treatment and Research Center , St. Joseph's Healthcare Hamilton , Hamilton , Canada
| | - Davis Mpavaenda
- aj Hertfordshire Partnership University NHS Foundation Trust , Hertfordshire , United Kingdom
| | - Takashi Nakamae
- ak Department of Psychiatry, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Richard O'Kearney
- al The Australian National University , Research School of Psychology , Canberra , Australia
| | - Massimo Pasquini
- am Department of Neurology and Psychiatry , Sapienza University of Rome , Rome , Italy
| | | | | | - Eva Real
- a Psychiatry Department , Bellvitge University Hospital_IDIBELL , Barcelona , Spain ;,b Carlos III Health Institute_CIBERSAM , Spain
| | - Maria Conceição do Rosário
- ap Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | - Noam Soreni
- d Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada ;,aq Pediatric OCD Consultation Service, Anxiety Treatment and Research Center , St. Joseph's HealthCare , Hamilton , Ontario , Canada
| | - Richard P Swinson
- d Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada
| | - Nienke Vulink
- g Academic Medical Center , Department of Psychiatry , University of Amsterdam , Amsterdam , The Netherlands
| | - Joseph Zohar
- ar Tel Aviv University , Sackler School of Medicine , NY , USA
| | - Naomi Fineberg
- aj Hertfordshire Partnership University NHS Foundation Trust , Hertfordshire , United Kingdom
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Zantvoord JB, Vulink N, Denys D. Cognitive Behavioral Therapy for Olfactory Reference Syndrome: A Case Report. J Clin Psychiatry 2016; 77:e1144. [PMID: 27454416 DOI: 10.4088/jcp.15cr10451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/12/2015] [Accepted: 12/21/2015] [Indexed: 10/21/2022]
Affiliation(s)
- Jasper B Zantvoord
- Department of Psychiatry, Academic Medical Centre, Meibergdreef 5, Room PA2-226, 1105 AZ, Amsterdam, The Netherlands. .,Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands.,The Bascule Academic Centre for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands.,Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
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Feenstra MGP, Klompmakers A, Figee M, Fluitman S, Vulink N, Westenberg HGM, Denys D. Prazosin addition to fluvoxamine: A preclinical study and open clinical trial in OCD. Eur Neuropsychopharmacol 2016; 26:310-319. [PMID: 26712326 DOI: 10.1016/j.euroneuro.2015.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/01/2015] [Accepted: 12/01/2015] [Indexed: 11/30/2022]
Abstract
The efficacy of selective serotonin reuptake inhibitors (SRIs) in psychiatric disorders may be "augmented" through the addition of atypical antipsychotic drugs. A synergistic increase in dopamine (DA) release in the prefrontal cortex has been suggested to underlie this augmentation effect, though the mechanism of action is not clear yet. We used in vivo microdialysis in rats to study DA release following the administration of combinations of fluvoxamine (10 mg/kg) and quetiapine (10 mg/kg) with various monoamine-related drugs. The results confirmed that the selective 5-HT1A antagonist WAY-100635 (0.05 mg/kg) partially blocked the fluvoxamine-quetiapine synergistic effect (maximum DA increase dropped from 325% to 214%). A novel finding is that the α1-adrenergic blocker prazosin (1 mg/kg), combined with fluvoxamine, partially mimicked the effect of augmentation (maximum DA increase 205%; area-under-the-curve 163%). As this suggested that prazosin augmentation might be tested in a clinical study, we performed an open clinical trial of prazosin 20 mg addition to SRI in therapy-resistant patients with obsessive-compulsive disorder applying for neurosurgery. A small, non-significant reduction in Yale Brown Obsessive Compulsive Scale (Y-BOCS) scores was observed in 10 patients and one patient was classified as a responder with a reduction in Y-BOCS scores of more than 25%. We suggest that future clinical studies augmenting SRIs with an α1-adrenergic blocker in less treatment resistant cases should be considered. The clinical trial "Prazosin in combination with a serotonin reuptake inhibitor for patients with Obsessive Compulsive disorder: an open label study" was registered at 24/05/2011 under trial number ISRCTN61562706: http://www.controlled-trials.com/ISRCTN61562706.
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Affiliation(s)
- Matthijs G P Feenstra
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands; Netherlands Institute for Neuroscience, an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - André Klompmakers
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands; Netherlands Institute for Neuroscience, an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Martijn Figee
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Sjoerd Fluitman
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Herman G M Westenberg
- Department of Psychiatry, UMC Utrecht, Rudolf Magnus Institute of Neuroscience, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, The Netherlands; Netherlands Institute for Neuroscience, an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
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Abstract
A 47-year-old man presented to our outpatient clinic, preoccupied with hoarding of digital pictures, which severely interfered with his daily functioning. He was formerly diagnosed with autism and hoarding of tactile objects. As of yet, digital hoarding has not been described in the literature. With this case report, we would like to introduce 'digital hoarding' as a new subtype of hoarding disorder. We conclude with differential diagnostic considerations and suggestions for treatment.
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Affiliation(s)
| | - Rianne M Blom
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Damiaan Denys
- Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Science, Amsterdam
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Schröder A, van Diepen R, Mazaheri A, Petropoulos-Petalas D, Soto de Amesti V, Vulink N, Denys D. Diminished n1 auditory evoked potentials to oddball stimuli in misophonia patients. Front Behav Neurosci 2014; 8:123. [PMID: 24782731 PMCID: PMC3988356 DOI: 10.3389/fnbeh.2014.00123] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 03/24/2014] [Indexed: 11/13/2022] Open
Abstract
Misophonia (hatred of sound) is a newly defined psychiatric condition in which ordinary human sounds, such as breathing and eating, trigger impulsive aggression. In the current study, we investigated if a dysfunction in the brain’s early auditory processing system could be present in misophonia. We screened 20 patients with misophonia with the diagnostic criteria for misophonia, and 14 matched healthy controls without misophonia, and investigated any potential deficits in auditory processing of misophonia patients using auditory event-related potentials (ERPs) during an oddball task. Subjects watched a neutral silent movie while being presented a regular frequency of beep sounds in which oddball tones of 250 and 4000 Hz were randomly embedded in a stream of repeated 1000 Hz standard tones. We examined the P1, N1, and P2 components locked to the onset of the tones. For misophonia patients, the N1 peak evoked by the oddball tones had smaller mean peak amplitude than the control group. However, no significant differences were found in P1 and P2 components evoked by the oddball tones. There were no significant differences between the misophonia patients and their controls in any of the ERP components to the standard tones. The diminished N1 component to oddball tones in misophonia patients suggests an underlying neurobiological deficit in misophonia patients. This reduction might reflect a basic impairment in auditory processing in misophonia patients.
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Affiliation(s)
- Arjan Schröder
- Department of Psychiatry, Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands
| | - Rosanne van Diepen
- Department of Psychiatry, Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands
| | - Ali Mazaheri
- Department of Psychiatry, Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands
| | | | - Vicente Soto de Amesti
- Department of Psychiatry, Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam , Amsterdam , Netherlands ; Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences , Amsterdam , Netherlands
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Denys D, de Vries F, Cath D, Figee M, Vulink N, Veltman DJ, van der Doef TF, Boellaard R, Westenberg H, van Balkom A, Lammertsma AA, van Berckel BNM. Dopaminergic activity in Tourette syndrome and obsessive-compulsive disorder. Eur Neuropsychopharmacol 2013; 23:1423-31. [PMID: 23876376 DOI: 10.1016/j.euroneuro.2013.05.012] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 05/22/2013] [Accepted: 05/24/2013] [Indexed: 11/26/2022]
Abstract
Tourette syndrome (TS) and obsessive-compulsive disorder (OCD) both are neuropsychiatric disorders associated with abnormalities in dopamine neurotransmission. Aims of this study were to quantify striatal D2/3 receptor availability in TS and OCD, and to examine dopamine release and symptom severity changes in both disorders following amphetamine challenge. Changes in [(11)C]raclopride binding potential (BP(ND)) were assessed using positron emission tomography before and after administration of d-amphetamine (0.3 mg kg(-1)) in 12 TS patients without comorbid OCD, 12 OCD patients without comorbid tics, and 12 healthy controls. Main outcome measures were baseline striatal D2/3 receptor BP(ND) and change in BP(ND) following amphetamine as a measure of dopamine release. Voxel-based analysis revealed significantly decreased baseline [(11)C]raclopride BP(ND) in bilateral putamen of both patient groups vs. healthy controls, differences being more pronounced in the TS than in the OCD group. Changes in BP(ND) following amphetamine were not significantly different between groups. Following amphetamine administration, tic severity increased in the TS group, which correlated with BP(ND) changes in right ventral striatum. Symptom severity in the OCD group did not change significantly following amphetamine challenge and was not associated with changes in BP(ND). This study provides evidence for decreased striatal D2/3 receptor availability in TS and OCD, presumably reflecting higher endogenous dopamine levels in both disorders. In addition, it provides the first direct evidence that ventral striatal dopamine release is related to the pathophysiology of tics.
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Affiliation(s)
- Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; The Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands.
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27
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Figee M, Luigjes J, Smolders R, Valencia-Alfonso CE, van Wingen G, de Kwaasteniet B, Mantione M, Ooms P, de Koning P, Vulink N, Levar N, Droge L, van den Munckhof P, Schuurman PR, Nederveen A, van den Brink W, Mazaheri A, Vink M, Denys D. Deep brain stimulation restores frontostriatal network activity in obsessive-compulsive disorder. Nat Neurosci 2013; 16:386-7. [PMID: 23434914 DOI: 10.1038/nn.3344] [Citation(s) in RCA: 292] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 01/28/2013] [Indexed: 12/21/2022]
Abstract
Little is known about the underlying neural mechanism of deep brain stimulation (DBS). We found that DBS targeted at the nucleus accumbens (NAc) normalized NAc activity, reduced excessive connectivity between the NAc and prefrontal cortex, and decreased frontal low-frequency oscillations during symptom provocation in patients with obsessive-compulsive disorder. Our findings suggest that DBS is able to reduce maladaptive activity and connectivity of the stimulated region.
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Affiliation(s)
- Martijn Figee
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands.
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Abstract
BACKGROUND Some patients report a preoccupation with a specific aversive human sound that triggers impulsive aggression. This condition is relatively unknown and has hitherto never been described, although the phenomenon has anecdotally been named misophonia. METHODOLOGY AND PRINCIPAL FINDINGS 42 patients who reported misophonia were recruited by our hospital website. All patients were interviewed by an experienced psychiatrist and were screened with an adapted version of the Y-BOCS, HAM-D, HAM-A, SCL-90 and SCID II. The misophonia patients shared a similar pattern of symptoms in which an auditory or visual stimulus provoked an immediate aversive physical reaction with anger, disgust and impulsive aggression. The intensity of these emotions caused subsequent obsessions with the cue, avoidance and social dysfunctioning with intense suffering. The symptoms cannot be classified in the current nosological DSM-IV TR or ICD-10 systems. CONCLUSIONS We suggest that misophonia should be classified as a discrete psychiatric disorder. Diagnostic criteria could help to officially recognize the patients and the disorder, improve its identification by professional health carers, and encourage scientific research.
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Affiliation(s)
- Arjan Schröder
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- The Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
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Polak AR, Witteveen AB, Visser RS, Opmeer BC, Vulink N, Figee M, Denys D, Olff M. Comparison of the effectiveness of trauma-focused cognitive behavioral therapy and paroxetine treatment in PTSD patients: design of a randomized controlled trial. BMC Psychiatry 2012; 12:166. [PMID: 23046608 PMCID: PMC3539952 DOI: 10.1186/1471-244x-12-166] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [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: 05/31/2012] [Accepted: 09/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The two most common interventions for Posttraumatic Stress Disorder (PTSD) are pharmacological treatment with SSRIs such as paroxetine and psychological treatment such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). International guidelines recommend trauma-focused psychological interventions for all PTSD patients as first-line treatment (NICE). However, no clear-cut evidence is available to support this recommendation. METHODS/DESIGN In order to compare pharmacological treatment (paroxetine) and psychological treatment (TF-CBT) in (cost-) effectiveness on the short and the long term, we will randomize 90 patients with chronic PTSD to either paroxetine (24 weeks) or TF-CBT (10-12 weeks). We will assess symptom severity and costs before and after the intervention with the Clinician Administered PTSD Scale (CAPS), the Clinical Global Impression Scale (CGI) and the Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness (TiC-P). DISCUSSION This study is unique for its direct comparison of the most commonly used psychological intervention (TF-CBT) and pharmacological intervention (paroxetine) on (cost-) effectiveness on the short and the long term. The anticipated results will provide relevant evidence concerning long-term effects and relapse rates and will be beneficial in reducing societal costs. It may also provide information on who may benefit most from which type of intervention. Some methodological issues will be discussed. TRIAL REGISTRATION Dutch Trial registration: NTR2235.
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Affiliation(s)
- A Rosaura Polak
- Academic Medical Center, Department of Anxiety Disorders, University of Amsterdam, Meibergdreef 5, Amsterdam 1105 AZ, The Netherlands.
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Polak AR, van der Paardt JW, Figee M, Vulink N, de Koning P, Olff M, Denys D. Compulsive carnival song whistling following cardiac arrest: a case study. BMC Psychiatry 2012; 12:75. [PMID: 22759699 PMCID: PMC3545985 DOI: 10.1186/1471-244x-12-75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 06/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compulsivity is the repetitive, irresistible urge to perform a behavior, the experience of loss of voluntary control over this intense urge and the tendency to perform repetitive acts in a habitual or stereotyped manner. Compulsivity is part of obsessive-compulsive disorder (OCD), but may occasionally occur as stand-alone symptom following brain damage induced by cardiac arrest. In this case report, we describe a patient who developed compulsivity following cardiac arrest. We review diagnostic options, underlying mechanisms and possible treatments. CASE PRESENTATION A 65-year-old man presented at our clinic with continuous compulsive whistling following cardiac arrest. Neither obsessive-compulsive symptoms, nor other psychiatric complaints were present prior to the hypoxic incident. An EEG showed diffuse hypofunction, mainly in baso-temporal areas. Treatment with clomipramine resulted in a decrease of whistling. DISCUSSION This case report illustrates de novo manifestation of compulsivity following cardiac arrest and subsequent brain damage and gives additional information on diagnostic options, mechanisms and treatment options. Differential diagnosis between stereotypies, punding, or OCD is difficult. Compulsivity following brain damage may benefit from treatment with serotonin reuptake inhibitors. This finding enhances our knowledge of treatments in similar cases.
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Affiliation(s)
- A Rosaura Polak
- Department of Anxiety Disorders, Academic Medical Center (AMC), University of Amsterdam (UvA), Meibergdreef 5, Amsterdam, 1105 AZ, the Netherlands.
| | - Jasper W van der Paardt
- Emergency psychiatric hospital, Arkin Mental Health Care, 1e Constantijn Huygensstraat, 38, Amsterdam, 1054 BR, the Netherlands
| | - Martijn Figee
- Department of Anxiety Disorders, Academic Medical Center (AMC), University of Amsterdam (UvA), Meibergdreef 5, Amsterdam, 1105 AZ, the Netherlands
| | - Nienke Vulink
- Department of Anxiety Disorders, Academic Medical Center (AMC), University of Amsterdam (UvA), Meibergdreef 5, Amsterdam, 1105 AZ, the Netherlands
| | - Pelle de Koning
- Department of Anxiety Disorders, Academic Medical Center (AMC), University of Amsterdam (UvA), Meibergdreef 5, Amsterdam, 1105 AZ, the Netherlands
| | - Miranda Olff
- Department of Anxiety Disorders, Academic Medical Center (AMC), University of Amsterdam (UvA), Meibergdreef 5, Amsterdam, 1105 AZ, the Netherlands,Arq Psychotrauma Expert Group, Nienoord 5, Diemen, 1112 XE, the Netherlands
| | - Damiaan Denys
- Department of Anxiety Disorders, Academic Medical Center (AMC), University of Amsterdam (UvA), Meibergdreef 5, Amsterdam, 1105 AZ, the Netherlands,The Netherlands Institute for Neuroscience (NIN), an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, Amsterdam, 1105 BA, the Netherlands
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Figee M, Vink M, de Geus F, Vulink N, Veltman DJ, Westenberg H, Denys D. Dysfunctional reward circuitry in obsessive-compulsive disorder. Biol Psychiatry 2011; 69:867-74. [PMID: 21272861 DOI: 10.1016/j.biopsych.2010.12.003] [Citation(s) in RCA: 205] [Impact Index Per Article: 15.8] [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] [Received: 06/08/2010] [Revised: 12/08/2010] [Accepted: 12/08/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is primarily conceived as an anxiety disorder but has features resembling addictive behavior. Patients with OCD may develop dependency upon compulsive behaviors because of the rewarding effects following reduction of obsession-induced anxiety. Reward processing is critically dependent on ventral striatal-orbitofrontal circuitry and brain imaging studies in OCD have consistently shown abnormal activation within this circuitry. This is the first functional imaging study to investigate explicitly reward circuitry in OCD. METHODS Brain activity during reward anticipation and receipt was compared between 18 OCD patients and 19 healthy control subjects, using a monetary incentive delay task and functional magnetic resonance imaging. Reward processing was compared between OCD patients with predominantly contamination fear and patients with predominantly high-risk assessment. RESULTS Obsessive-compulsive disorder patients showed attenuated reward anticipation activity in the nucleus accumbens compared with healthy control subjects. Reduced activity of the nucleus accumbens was more pronounced in OCD patients with contamination fear than in patients with high-risk assessment. Brain activity during reward receipt was similar between patients and control subjects. A hint toward more dysfunctional reward processing was found in treatment-resistant OCD patients who subsequently were successfully treated with deep brain stimulation of the nucleus accumbens. CONCLUSIONS Obsessive-compulsive disorder patients may be less able to make beneficial choices because of altered nucleus accumbens activation when anticipating rewards. This finding supports the conceptualization of OCD as a disorder of reward processing and behavioral addiction.
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Affiliation(s)
- Martijn Figee
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands.
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Fluitman S, Denys D, Vulink N, Schutters S, Heijnen C, Westenberg H. Lipopolysaccharide-induced cytokine production in obsessive-compulsive disorder and generalized social anxiety disorder. Psychiatry Res 2010; 178:313-6. [PMID: 20452055 DOI: 10.1016/j.psychres.2009.05.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [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] [Received: 02/01/2008] [Revised: 05/12/2009] [Accepted: 05/12/2009] [Indexed: 11/29/2022]
Abstract
The immune system is implicated in the pathophysiology of various psychiatric disorders. In anxiety disorders such as obsessive-compulsive disorder (OCD) and generalized social anxiety disorder (GSAD), immunological findings are equivocal and sparse. In this study, we investigated the lipopolysaccharide (LPS)- stimulated cytokine levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and interleukin-8 (IL-8) by peripheral blood leukocytes in 26 OCD patients, 26 GSAD patients, and 52 healthy controls. We found that leukocytes of OCD patients produced less IL-6 compared with matched controls, whereas no cytokine differences were found between GSAD patients and matched controls. When both patient groups were compared, a trend toward lower IL-6 levels in OCD patients was observed. This supports the idea of immunological involvement in the pathophysiology of OCD and suggests that GSAD and OCD might be different in immunological respect.
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Affiliation(s)
- Sjoerd Fluitman
- The Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
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