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Hebbrecht K, Dejaeger M, Giltay EJ, Birkenhäger T, Sabbe B, Verwijk E, Obbels J, Schrijvers D, Van Diermen L. Corrigendum to "Cognitive trajectories during and after electroconvulsive therapy in patients with MDE: Taking different perspectives" [J. Psychiatr. Res. 152 (2022) 132-140]. J Psychiatr Res 2023; 158:41. [PMID: 36565543 DOI: 10.1016/j.jpsychires.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Kaat Hebbrecht
- University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium; University Psychiatric Center KU Leuven, Department of Psychiatry, Leuven, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Belgium.
| | - Marijke Dejaeger
- University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium
| | - Erik J Giltay
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Belgium; Leiden University Medical Center, Department of Psychiatry, the Netherlands
| | - Tom Birkenhäger
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Belgium; Erasmus Medical Center, Department of Psychiatry, Rotterdam, the Netherlands
| | - Bernard Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Belgium
| | - Esmée Verwijk
- Department of Medical Psychology (EV), Neuropsychology Department, Amsterdam UMC, Amsterdam, the Netherlands; Department of Psychology (EV), Brain & Cognition, University of Amsterdam, Amsterdam, the Netherlands; ECT Department Haaglanden (EV), Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Jasmien Obbels
- University Psychiatric Center KU Leuven, Department of Psychiatry, Leuven, Belgium; Academic Center for ECT and Neuromodulation (AcCENT) University Psychiatric Center, KU Leuven-University of Leuven, Kortenberg, Belgium
| | - Didier Schrijvers
- University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Belgium
| | - Linda Van Diermen
- University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Belgium; Psychiatric Hospital Bethanië, Andreas Vesaliuslaan 39, 2980, Zoersel, Belgium
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Hebbrecht K, Stuivenga M, Birkenhäger T, van der Mast RC, Sabbe B, Giltay EJ. Symptom Profile and Clinical Course of Inpatients with Unipolar versus Bipolar Depression. Neuropsychobiology 2021; 79:313-323. [PMID: 31655820 DOI: 10.1159/000503686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/21/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although differences in symptom profiles and outcome between depressive patients with an underlying major depressive disorder (MDD) and bipolar depression (BD) have been reported, studies with sequential short-interval assessments in a real-life inpatient setting are scarce. OBJECTIVES To examine potential differences in symptom profile and course of depressive symptomatology in depressive inpatients with underlying MDD and BD. METHODS A cohort of 276 consecutive inpatients with MDD (n = 224) or BD (n = 52) was followed during their hospitalization using routine outcome monitoring (ROM), which included a structured diagnostic interview at baseline (Mini-International Neuropsychiatric Interview Plus [MINI-Plus]) and repeated 17-item Hamilton Depression Rating Scale every 2 weeks. MDD and BD were compared regarding their symptom profiles and time to response and remission. Furthermore, the concordance between the MINI-Plus and clinical diagnosis was analyzed. RESULTS Patients were on average 52 and 47 years old in the MDD and BD group, respectively, and 66 versus 64% were female. Compared to patients with BD, patients with MDD scored higher on weight loss (p = 0.02), whereas the BD group showed a higher long-term likelihood of response (hazard ratio = 1.93, 95% confidence interval 1.16-3.20, p for interaction with time = 0.04). Although the same association was seen for remission, the interaction with time was not significant (p = 0.48). Efficiency between the MINI-Plus and clinical diagnosis of BD was high (0.90), suggesting that the MINI-Plus is an adequate ROM diagnostic tool. CONCLUSIONS In routine clinical inpatient care, minor differences in the symptom profile and the course of depressive symptomatology may be helpful in distinguishing MDD and BD, particularly when using sequential ROM assessments.
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Affiliation(s)
- Kaat Hebbrecht
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium, .,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium,
| | - Mirella Stuivenga
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium
| | - Tom Birkenhäger
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium.,Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roos C van der Mast
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Bernard Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium
| | - Erik J Giltay
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Hebbrecht K, Stuivenga M, Birkenhäger T, Morrens M, Fried EI, Sabbe B, Giltay EJ. Understanding personalized dynamics to inform precision medicine: a dynamic time warp analysis of 255 depressed inpatients. BMC Med 2020; 18:400. [PMID: 33353539 PMCID: PMC7756914 DOI: 10.1186/s12916-020-01867-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) shows large heterogeneity of symptoms between patients, but within patients, particular symptom clusters may show similar trajectories. While symptom clusters and networks have mostly been studied using cross-sectional designs, temporal dynamics of symptoms within patients may yield information that facilitates personalized medicine. Here, we aim to cluster depressive symptom dynamics through dynamic time warping (DTW) analysis. METHODS The 17-item Hamilton Rating Scale for Depression (HRSD-17) was administered every 2 weeks for a median of 11 weeks in 255 depressed inpatients. The DTW analysis modeled the temporal dynamics of each pair of individual HRSD-17 items within each patient (i.e., 69,360 calculated "DTW distances"). Subsequently, hierarchical clustering and network models were estimated based on similarities in symptom dynamics both within each patient and at the group level. RESULTS The sample had a mean age of 51 (SD 15.4), and 64.7% were female. Clusters and networks based on symptom dynamics markedly differed across patients. At the group level, five dynamic symptom clusters emerged, which differed from a previously published cross-sectional network. Patients who showed treatment response or remission had the shortest average DTW distance, indicating denser networks with more synchronous symptom trajectories. CONCLUSIONS Symptom dynamics over time can be clustered and visualized using DTW. DTW represents a promising new approach for studying symptom dynamics with the potential to facilitate personalized psychiatric care.
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Affiliation(s)
- K Hebbrecht
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Stationsstraat 22c, 2570, Duffel, Belgium. .,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium.
| | - M Stuivenga
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Stationsstraat 22c, 2570, Duffel, Belgium.,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium
| | - T Birkenhäger
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Stationsstraat 22c, 2570, Duffel, Belgium.,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium.,Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Morrens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Stationsstraat 22c, 2570, Duffel, Belgium.,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium
| | - E I Fried
- Department of Clinical Psychology, Leiden University, 2300 RA, Leiden, The Netherlands
| | - B Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Stationsstraat 22c, 2570, Duffel, Belgium.,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium
| | - E J Giltay
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Department of Biomedical Sciences, University of Antwerp, Stationsstraat 22c, 2570, Duffel, Belgium. .,University Psychiatric Hospital Duffel, VZW Emmaüs, Duffel, Belgium. .,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
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van Diermen L, Poljac E, Van der Mast R, Plasmans K, Van den Ameele S, Heijnen W, Birkenhäger T, Schrijvers D, Kamperman A. Toward Targeted ECT: The Interdependence of Predictors of Treatment Response in Depression Further Explained. J Clin Psychiatry 2020; 82. [PMID: 33326710 DOI: 10.4088/jcp.20m13287] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Several clinical variables assumed to be predictive of electroconvulsive therapy (ECT) outcome in major depressive disorder show substantial interrelations. The current study tries to disentangle this interdependence to distill the most important predictors of treatment success to help improve patient-treatment matching. METHODS We constructed a conceptual framework of interdependence capturing age, episode duration, and treatment resistance, all variables associated with ECT outcome, and the clinical symptoms of what we coin core depression, ie, depression with psychomotor agitation, retardation, psychotic features, or a combination of the three. The model was validated in a sample of 73 patients with a major depressive episode according to DSM-5 treated twice weekly with ECT (August 2015-January 2018) using path analyses, with the size and direction of all direct and indirect paths being estimated using structural equation modeling. Reduction in Montgomery-Asberg Depression Rating Scale (MADRS) scores during treatment was the ECT outcome measure. RESULTS The baseline presence of psychomotor agitation, retardation, and/or psychotic symptoms strongly correlated with beneficial ECT outcome (z = 0.84 [SE = 0.17]; P < .001), and the association between age and the effect of ECT appears to be mediated by their presence (z = 0.53 [SE = 0.18]; P = .004). There was no direct correlation between age and ECT response (P = .479), but there was for episode duration and ECT outcome (z = -0.38 [SE = 0.08]; P < .001). CONCLUSIONS ECT is a very effective treatment option for severe depressive disorder, especially for patients suffering from severe depression characterized by the presence of psychomotor agitation, psychomotor retardation, psychotic symptoms, or a combination of these 3 features, with the chance of a beneficial outcome being reduced in patients with a longer episode duration. Age may heretofore have been given too much weight in ECT decision making. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02562846.
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Affiliation(s)
- Linda van Diermen
- PC Bethanië, Andreas Vesaliuslaan 39, 2980 Zoersel, Belgium. .,University Psychiatric Center (UPC) Duffel, Duffel, Belgium.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Psychiatric Center Bethanië, Zoersel, Belgium
| | - Ervin Poljac
- University Psychiatric Center (UPC) Duffel, Duffel, Belgium.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Roos Van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Seline Van den Ameele
- University Psychiatric Center (UPC) Duffel, Duffel, Belgium.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Psychiatry, University Hospital Brussels (UZ-VUB), Brussels, Belgium
| | - Willemijn Heijnen
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tom Birkenhäger
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Didier Schrijvers
- University Psychiatric Center (UPC) Duffel, Duffel, Belgium.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Astrid Kamperman
- Epidemiological and Social Psychiatric Research Institute (ESPRi), Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Breeksema JJ, Schoevers RA, Vermetten E, Van R, Destoop M, Birkenhäger T, van den Brink W. [Psychedelics and psychiatry]. Tijdschr Psychiatr 2020; 62:606-609. [PMID: 32816288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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van Diermen L, Vanmarcke S, Walther S, Moens H, Veltman E, Fransen E, Sabbe B, van der Mast R, Birkenhäger T, Schrijvers D. Can psychomotor disturbance predict ect outcome in depression? J Psychiatr Res 2019; 117:122-128. [PMID: 31382133 DOI: 10.1016/j.jpsychires.2019.07.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/18/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
Psychomotor symptoms are core features of melancholic depression. This study investigates whether psychomotor disturbance predicts the outcome of electroconvulsive therapy (ECT) and how the treatment modulates psychomotor disturbance. In 73 adults suffering from major depressive disorder psychomotor functioning was evaluated before, during and after ECT using the observer-rated CORE measure and objective measures including accelerometry and a drawing task. Regression models were fitted to assess the predictive value of melancholic depression (CORE ≥ 8) and the psychomotor variables on ECT outcome, while effects on psychomotor functioning were evaluated through linear mixed models. Patients with CORE-defined melancholic depression (n = 41) had a 4.9 times greater chance of reaching response than those (n = 24) with non-melancholic depression (Chi-Square = 7.5, P = 0.006). At baseline, both higher total CORE scores (AUC = 0.76; P = 0.001) and needing more cognitive (AUC = 0.78; P = 0.001) and motor time (AUC = 0.76; P = 0.003) on the drawing task corresponded to superior ECT outcomes, as did lower daytime activity levels (AUC = 0.76) although not significantly so after Bonferroni correction for multiple testing. A greater CORE-score reduction in the first week of ECT was associated with higher ECT effectiveness. ECT reduced CORE-assessed psychomotor symptoms and improved activity levels only in those patients showing the severer baseline retardation. Although the sample was relatively small, psychomotor symptoms were clearly associated with beneficial outcome of ECT in patients with major depression, indicating that monitoring psychomotor deficits can help personalise treatment.
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Affiliation(s)
- Linda van Diermen
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Simon Vanmarcke
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Herman Moens
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium
| | - Eveline Veltman
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik Fransen
- StatUa Center for Statistics, University of Antwerp, Antwerp, Belgium
| | - Bernard Sabbe
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Roos van der Mast
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Tom Birkenhäger
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Didier Schrijvers
- University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Birkenhäger T. [Not Available]. Tijdschr Psychiatr 2019; 61:292-293. [PMID: 31180565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Simoons M, Seldenrijk A, Mulder H, Birkenhäger T, Groothedde-Kuyvenhoven M, Kok R, Kramers C, Verbeeck W, Westra M, van Roon E, Bakker R, Ruhé H. Limited Evidence for Risk Factors for Proarrhythmia and Sudden Cardiac Death in Patients Using Antidepressants: Dutch Consensus on ECG Monitoring. Drug Saf 2018; 41:655-664. [PMID: 29484613 PMCID: PMC5990562 DOI: 10.1007/s40264-018-0649-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Currently, there is a lack of international and national guidelines or consensus documents with specific recommendations for electrocardiogram (ECG) screening and monitoring during antidepressant treatment. To make a proper estimation of the risk of cardiac arrhythmias and sudden (cardiac) death during antidepressant use, both the drug and patient-specific factors should be taken into account; however, solid evidence on how this should be done in clinical practice is lacking. Available recommendations on the management of QT(c) prolongation (with antidepressant treatment) emphasize that special attention should be given to high-risk patients; however, clinicians are in need of more concrete suggestions about how to select patients for ECG screening and monitoring. Based on a review of the literature, a Dutch multidisciplinary expert panel aimed to formulate specific guidelines to identify patients at risk for cardiac arrhythmias and sudden death by developing a consensus statement regarding ECG screening before, and monitoring during, antidepressant use. We first reviewed the literature to identify the relative risks of various risk factors on cardiac arrhythmia and sudden (cardiac) death during antidepressant use. These relative contributions of risk factors could not be determined since no systematic reviews or meta-analyses quantitatively addressed this topic. Because evidence was insufficient, additional expert opinion was used to formulate recommendations. This resulted in readily applicable recommendations for clinical practice for selection of high-risk patients for ECG screening and monitoring. ECG screening and monitoring is recommended before and following the start of QTc-prolonging antidepressants in the presence of vulnerability to QTc prolongation or two or more risk factors (age > 65 years, female sex, concomitant use of a QTc-prolonging drug or concomitant use of a drug that influences the metabolism of a QTc-prolonging drug, cardiac disease, excessive dosing and specific electrolyte disturbances).
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Affiliation(s)
- Mirjam Simoons
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands.,Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,Unit of Pharmacotherapy, -Epidemiology and -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Adrie Seldenrijk
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,Department of Research and Innovation, GGZ InGeest, Amsterdam, The Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands.,Psychiatric Hospital GGZ Drenthe, Assen, The Netherlands
| | - Tom Birkenhäger
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | | | - Rob Kok
- Department of Old Age Psychiatry, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Cornelis Kramers
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Wim Verbeeck
- Vincent van Gogh Institute for Psychiatry, ADHD and Autism Circuit, Venray, The Netherlands.,Department of Pharmacology and Toxicology, Radboudumc, Nijmegen, The Netherlands
| | - Mirjam Westra
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Eric van Roon
- Unit of Pharmacotherapy, -Epidemiology and -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy and Clinical Pharmacology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Roberto Bakker
- Psychiatric Centre GGz Centraal, Amersfoort, The Netherlands.,Department of Psychiatry and Psychology, South Limburg Mental Health and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Henricus Ruhé
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. .,Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK. .,Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands.
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