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A number of genomic conditions caused by copy number variants (CNVs) are associated with a high risk of neurodevelopmental and psychiatric disorders (ND-CNVs). Although these patients also tend to have cognitive impairments, few studies have investigated the range of emotion and behaviour problems in young people with ND-CNVs using measures that are suitable for those with learning difficulties.
A total of 322 young people with 13 ND-CNVs across eight loci (mean age: 9.79 years, range: 6.02–17.91, 66.5% male) took part in the study. Primary carers completed the Developmental Behaviour Checklist (DBC).
Of the total, 69% of individuals with an ND-CNV screened positive for clinically significant difficulties. Young people from families with higher incomes (OR = 0.71, CI = 0.55–0.91, p = .008) were less likely to screen positive. The rate of difficulties differed depending on ND-CNV genotype (χ2 = 39.99, p < 0.001), with the lowest rate in young people with 22q11.2 deletion (45.7%) and the highest in those with 1q21.1 deletion (93.8%). Specific patterns of strengths and weaknesses were found for different ND-CNV genotypes. However, ND-CNV genotype explained no more than 9–16% of the variance, depending on DBC subdomain.
Emotion and behaviour problems are common in young people with ND-CNVs. The ND-CNV specific patterns we find can provide a basis for more tailored support. More research is needed to better understand the variation in emotion and behaviour problems not accounted for by genotype.
Inflammation and metabolic dysregulation are age-related physiological changes and are associated with depressive disorder. We tried to identify subgroups of depressed older patients based on their metabolic-inflammatory profile and examined the course of depression for these subgroups.
This clinical cohort study was conducted in a sample of 364 depressed older (⩾60 years) patients according to DSM-IV criteria. Severity of depressive symptoms was monitored every 6 months and a formal diagnostic interview repeated at 2-year follow-up. Latent class analyses based on baseline metabolic and inflammatory biomarkers were performed. Adjusted for confounders, we compared remission of depression at 2-year follow-up between the metabolic-inflammatory subgroups with logistic regression and the course of depression severity over 2-years by linear mixed models.
We identified a ‘healthy’ subgroup (n = 181, 49.7%) and five subgroups characterized by different profiles of metabolic-inflammatory dysregulation. Compared to the healthy subgroup, patients in the subgroup with mild ‘metabolic and inflammatory dysregulation’ (n = 137, 37.6%) had higher depressive symptom scores, a lower rate of improvement in the first year, and were less likely to be remitted after 2-years [OR 0.49 (95% CI 0.26–0.91)]. The four smaller subgroups characterized by a more specific immune-inflammatory dysregulation profile did not differ from the two main subgroups regarding the course of depression.
Nearly half of the patients with late-life depressions suffer from metabolic-inflammatory dysregulation, which is also associated with more severe depression and a worse prognosis. Future studies should examine whether these depressed older patients benefit from a metabolic-inflammatory targeted treatment.
Nursing home residents with dementia are sensitive to detrimental auditory environments. This paper presents the first literature review of empirical research investigating (1) the (perceived) intensity and sources of sounds in nursing homes, and (2) the influence of sounds on health of residents with dementia and staff.
A systematic review was conducted in PubMed, Web of Science and Scopus. Study quality was assessed with the Mixed Methods Appraisal Tool. We used a narrative approach to present the results.
We included 35 studies. Nine studies investigated sound intensity and reported high noise intensity with an average of 55–68 dB(A) (during daytime). In four studies about sound sources, human voices and electronic devices were the most dominant sources. Five cross-sectional studies focused on music interventions and reported positives effects on agitated behaviors. Four randomized controlled trials tested noise reduction as part of an intervention. In two studies, high-intensity sounds were associated with decreased nighttime sleep and increased agitation. The third study found an association between music and less agitation compared to other stimuli. The fourth study did not find an effect of noise on agitation. Two studies reported that a noisy environment had negative effects on staff.
The need for appropriate auditory environments that are responsive to residents’ cognitive abilities and functioning is not yet recognized widely. Future research needs to place greater emphasis on intervention-based and longitudinal study design.
Classic theories posit that depression is driven by a negative learning bias. Most studies supporting this proposition used small and selected samples, excluding patients with comorbidities. However, comorbidity between psychiatric disorders occurs in up to 70% of the population. Therefore, the generalizability of the negative bias hypothesis to a naturalistic psychiatric sample as well as the specificity of the bias to depression, remain unclear. In the present study, we tested the negative learning bias hypothesis in a large naturalistic sample of psychiatric patients, including depression, anxiety, addiction, attention-deficit/hyperactivity disorder, and/or autism. First, we assessed whether the negative bias hypothesis of depression generalized to a heterogeneous (and hence more naturalistic) depression sample compared with controls. Second, we assessed whether negative bias extends to other psychiatric disorders. Third, we adopted a dimensional approach, by using symptom severity as a way to assess associations across the sample.
We administered a probabilistic reversal learning task to 217 patients and 81 healthy controls. According to the negative bias hypothesis, participants with depression should exhibit enhanced learning and flexibility based on punishment v. reward. We combined analyses of traditional measures with more sensitive computational modeling.
In contrast to previous findings, this sample of depressed patients with psychiatric comorbidities did not show a negative learning bias.
These results speak against the generalizability of the negative learning bias hypothesis to depressed patients with comorbidities. This study highlights the importance of investigating unselected samples of psychiatric patients, which represent the vast majority of the psychiatric population.
Comorbidity has profound implications in both the clinical field and research, yet little is known about the prevalence and structure of comorbid mental disorders. This article aims not only to present data on the prevalence of mental disorders and comorbidity, but also to explore relationships between comorbid mental disorders by using a network approach.
Data used in this cross-sectional study are part of a prospective cohort study within penitentiary psychiatric centers (PPCs) in the Netherlands. It includes DSM diagnoses of 5,257 unique male patients incarcerated in one of the PPC's. Prevalence rates of mental disorders and comorbidity were calculated, the network of comorbid DSM diagnoses was constructed using regression coefficients.
Schizophrenia spectrum and substance-related disorders were most prevalent within this sample (56.7 and 43.1%, respectively), and over half of all patients were diagnosed with a comorbid disorder (56.9%). Four distinctive groups of disorders emerged from the network analysis of DSM diagnoses: substance use, impulsivity, poor social skills, and disruptive behaviors. Psychotic disorders were considered as a separate group as it was unconnected to other disorders.
Comorbid mental disorders can be described, at least in part, as connected networks. Underlying attributes as well as direct influences of mental disorders on one another seem to be affecting the presence of comorbidity. Results could contribute to the understanding of a possible causal relation between psychopathology and criminal behavior and the development of treatment programs targeting groups of disorders.
This presentation will compare preliminary results from the first two European studies being carried out on acupuncture and schizophrenia, one in the UK and one in Germany. Statistical comment will be made on comparable study outcomes and there will be discussion on the methodological successes and challenges of the studies. Implications for future research on acupuncture on acupuncture and schizophrenia in European mental health settings will be explored.
Both studies are using a case study approach, incorporating a wide range of methods, in order to explore the possible effects that acupuncture may have on schizophrenia. Amongst the methods used to explore the possible effect that acupuncture might have, both studies are using the Positive and Negative Symptom Scale (PANSS), and the Pittsburgh Sleep Quality Index (PSQI).
The intervention phase of both studies is currently underway. First results of the PANSS and the PSQI will be presented.
These are the first attempts to carry out research on the possibility of acupuncture as a treatment or an adjunct treatment for schizophrenia in Europe. It is hoped that these results will indicate the way forward in terms of analysis of the remainder of the outcomes of the study and there will be some indication for the possibility for future research in this area.
The new standard computerized reading span test (RST), which is a complex verbal working memory test, was used for the first time in the assessment of verbal working memory capacity (Van den Noort et al., 2008) in two clinical populations.
Sixty participants, divided over three different groups; 20 patients with chronic schizophrenia, 20 patients with chronic depression, and 20 healthy participants, entered the study. The selection of the participants was based on strict inclusion and exclusion criteria. There was no comorbid depression in the patients with schizophrenia, as measured by the BDI-II. A comparison was made between the 3 different groups with respect to their verbal working memory capacity. The new standard computerized RST (Van den Noort et al., 2008) was used.
In this study, in line with previous studies, a significant decrease in verbal working memory capacity and a general slowing down was found in chronic patients with schizophrenia and chronic patients with depression in comparison with healthy participants. In addition, patients with schizophrenia showed a nearly significant higher reading span score but were significantly slower than the chronic patients with depression.
The new standard computerized RST (Van den Noort et al., 2008) is a suitable complex verbal working memory test that could be used for clinical applications, for instance, for the assessment of verbal working memory capacity in patients with chronic schizophrenia and chronic depression.
Recent surveys show a steady increase in infectious syphilis incidence among sexual transmitted infection clinic visitors in many industrialized countries. Untreated, 30% of patients develop symptomatic neurosyphilis, possibly presenting with a variety of behavioral en neurological symptoms. Neurosyphilis is diagnosed on specific abnormalities in cerebrospinal fluid (CSF).
Case reports on neurosyphilis in Dutch patients prompted us to explore the epidemiology of neurosyphilis with psychiatric co morbidity.
To estimate the incidence of neurosyphilis and psychiatric co morbidity in the Netherlands based on data of hospitalizations in general hospitals from 1999-2007.
Hospitalization data were collected from the Dutch National Medical Register. We included all records on hospitalizations with any kind of neurosyphilis, except congenital neurosyphilis, as discharge- or secondary diagnosis (ICD9-code 094 and subcategory codes).
Between 1999 and 2007, 542 cases of neurosyphilis were registered, approximately 60 cases per year. Of all cases, 76% were male. Co-infection with HIV was seen in 74 (14%) of hospitalized cases of whom 91% were male. In 35 (6%) cases one or more concurrent psychiatric disorders were diagnosed, including 10 organic psychiatric disorders, 8 dementia cases, 6 substance abuses, 4 affective disorders, 7 psychotic disorders, 2 personality disorders and 8 miscellaneous diagnoses.
Neurosyphilis is still diagnosed in patients admitted to Dutch general hospitals. Under diagnosis due to unfamiliarity with the recent syphilis surge is possible. Over reporting is also possible due to incorrect diagnosis not based on CSF results. The reemerging syphilis epidemic may result in an increasing neurosyphilis incidence.
Le mind-wandering est ce phénomène connu de tous, où l’attention décroche et « vagabonde » au gré de pensées sans lien avec la tâche en cours . Dans une tâche de go/no-go, les épisodes de déconcentration entrainent une diminution des performances et une augmentation de la variabilité des temps de réponse, par rapport aux périodes où l’attention est soutenue . Mais le déficit d’attention n’est pas spécifique du TDA/H (Trouble Déficit d’Attention avec ou sans Hyperactivité) car il est présent dans d’autres pathologies comme par exemple la dépression . Dans cette étude nous recherchons une différence de profils attentionnels liés au « mind wandering », qui serait spécifique au TDA/H.
Au moyen d’un go/no-go interrompu par des rapports subjectifs du contenu de la pensée, nous avons mené la même expérience, à la fois dans des populations d’enfants et d’adultes, en comparant des groupes de sujets TDA/H, des groupes de sujets contrôles cliniques et sains.
Nous mettons en évidence une augmentation significative de pensées floues ou vides (mind-blanking), chez les sujets TDA/H enfants et adultes.
Cette augmentation de pensées impossibles à rapporter, semble spécifique du TDA/H. Pour maintenir l’attention focalisée comme pour prolonger un épisode de rêverie éveillée, de bonnes fonctions exécutives semblent nécessaires . Or le TDA/H se caractérise par un déficit de fonctions exécutives , ce qui impliquerait donc une alternance plus rapide entre cours externe et interne de pensées soit une durée moyenne des épisodes de focus attentionnel ou de rêverie, plus brève. Un stimulus qui ne dure pas suffisamment longtemps ne peut faire l’objet d’un rapport verbal car non accessible à la conscience . Le mind-blanking pourrait être un marqueur indirect d’un fil de pensées trop labile pour être accessible à la conscience.
In this study, a summary of the main functional Magnetic Resonance Imaging (fMRI) findings in the field of schizophrenia will be given in order to get a better understanding of this disorder.
The authors conducted an extensive literature review on fMRI and schizophrenia, using PubMed, the internet in general, and research contacts in order to avoid important literature to be left out.
In general, fMRI research on schizophrenia has demonstrated widespread deficits affecting a range of cognitive functions distributed throughout the brain. In addition, schizophrenia is associated with frontal and temporal brain dysfunction (e.g., Van den Noort & Bosch, 2008). This dysfunction is thought to be irreversible, or even worsen over time; even when optimal treatment is given (Lund et al., 2002). However, it is important to note that there is a degree of inconsistency in reported findings, and a pattern of brain dysfunction that would serve as a biological trait marker or predict treatment response has not emerged to date (e.g., Van den Noort & Bosch, 2008).
In this study, it was found that patients with schizophrenia show widespread deficits affecting a range of cognitive functions distributed throughout the brain, but there is a degree of inconsistency in reported findings. Although the development of fMRI has provided the technological advance necessary to examine schizophrenia; the scientific challenge will be to incorporate this technique appropriately through prudent experimental design (e.g., Honey & Bullmore, 2002).
Psychiatric services providing care for patients and their families confronted with a first psychotic episode need to be sensitive towards patients’ and families’ preferences. Ten patients, ten family members and ten professional caregivers composed a list of 42 preferences in the treatment for a first psychotic episode. In total 99 patients, 100 family members and 263 professional caregivers evaluated these preferences, thus producing an order of priorities. There appears to be considerable agreement among the groups of respondents regarding their top ten priorities, especially concerning information on diagnosis and medication. However, we found important differences between groups of respondents. The results suggest that in psychiatric services great attention should be given to psycho-education and early outpatient intervention.
Mental health-related visits to emergency departments are growing. Research on the decision making process in psychiatric emergency services (PES) has focused on the severity of symptoms and dangerousness as predictors of admission or discharge. Patient requests have been understudied in this predominantly medical approach.
The main objective of this study was a standardized evaluation of patient requests in PES.
The ‘Hulpvragenlijst’ (HVL), a 61-item self-rating questionnaire was administered to 102 consecutive patients attending the PES of a general hospital. The HVL assesses 7 different components of patient requests: psychological, relational, problem-oriented, medical, information-oriented, and psychiatric. Exclusion criteria were disturbed consciousness and severe psychomotor agitation.
Data processing following the rules of HVL aggregation was performed. Ridit analysis was further used for refined data aggregation. This is a method for comparing ordinal-scale responses. Patient requests were looked at in different subgroups (according to diagnosis and disposition).
Data processing following the rules of HVL aggregation showed that the main request of patients was information-oriented, less relational or medical. Ridit analysis showed a more refined pattern of requests in different diagnostic and dispositional categories: each category characterized by a distinct profile of requests.
Patient requests, besides the severity of symptoms and dangerousness, are a supplemental view on the needs of patients attending PES. These different components should be entered into a “negotiation” that ultimately results in a treatment decision. If confirmed in other studies these data could be used for the future development of PES service delivery.
The new standard computerized reading span test (RST), which is a complex verbal working memory test, was tested.
Sixty native Dutch speakers, divided over four different groups (average age of 20, 26, 51, 75), entered the study. The selection of the participants was based on strict (clinical) criteria. A comparison was made between the 4 different age groups with respect to their verbal working memory capacity. The new standard computerized RST (Van den Noort et al., 2006a; 2008) was used.
In this study, in line with previous aging studies, a significant decrease in verbal working memory capacity over time and a significant slowing down in mental processing were found. In addition, it was found that older adults made significantly more intrusion errors than young adults thereby confirming the inhibition theory (Hasher & Zacks, 1988). The analysis of the memory-pattern showed a clear recency-effect for the young-, but not for the old adults. Interestingly, the results of this study show that there are larger age-related effects in verbal working memory span than was expected on the basis of aging theories so far (Van den Noort et al., 2006b).
The new standard computerized RST (Van den Noort et al., 2006a; 2008) is a suitable complex verbal working memory test that could be used for clinical applications, for instance, for the early detection of dementia. This is important since most psychological tests so far are not sensitive enough to detect this early deterioration.
Addiction, or Substance Use Disorder (SUD), among adults with Autism Spectrum Disorders (ASD) has never been studied before, contrary to SUD in ADHD. However, we know from clinical practice that comorbid SUD in ASD can present with a considerable impairment. Distinguishing between ASD and ADHD can be challenging, but becomes increasingly so in case of comorbid SUD.
The main objective of this study was to gain insight into the aspects of comorbid SUD in ASD on three levels: a phenotypical, an endophenotypical, and a genetic level. A second objective was to determine how ASD differs from ADHD in adult patients on these three levels, with and without comorbid SUD.
We studied 130 patients with ASD (n = 75) or ADHD (n = 55) with or without SUD. We looked at risk factors for developing SUD, prevalence, and outcome. Furthermore, we studied personality profiles and autism spectrum profiles (AQ). We assembled neuropsychological and genetic data.
Comorbidity of SUD with ASD is less common than in ADHD, but the consequences are just as severe. Comorbid SUD is not always associated with a negative outcome, at least in the perception of the individual. Assessment of adults with ASD and SUD can be misleading when the neuropsychological functioning is not also taken into consideration. Finally, in the absence of SUD, ASD and ADHD in adults share many features on the (endo-)phenotypical level, but may be distinguishable at a genetic level. In the presence of SUD, differences between ASD and ADHD are more pronounced.
To assess the comorbidity rates of alcohol use disorders (AUDs) in bipolar disorder (BD) and to explore possible sources of heterogeneity.
Studies were identified through database searches. Meta-analytic techniques were employed to aggregate data on lifetime comorbidity and to explore possible sources of heterogeneity. Funnel plots were used to detect publication bias.
In clinical studies, AUDs affected more than one in three subjects with BD. Significant heterogeneity was found, which was largely explained by the geographical location of study populations and gender ratio of participants. AUDs affected more than one in five women and two in five men.
AUDs are highly prevalent in BD. Our study revealed a substantial heterogeneity across studies. Further research including control groups is needed. Patients with BD should be assessed for current and previous AUDs.
Studies in the general population show cannabis use has a beneficial effect on metabolic disorders. Given the increased cardiometabolic risk in patients with psychotic disorders, as well as their prevalent use of cannabis, we aim to investigate whether such effects are also evident in these patients.
3176 patients with chronic psychotic disorders from mental health institutions in the Netherlands were included in the study. With multivariate regression analyses we examined the effects of cannabis use on metabolic risk factors; BMI, waist circumference, blood pressure (BP), cholesterol, HDL-C, LDL-C, triglycerides, glucose and HbA1c. Age, sex, smoking, alcohol use and antipsychotic drugs were included as confounders. Next, we examined change in metabolic risk factors after one-year follow up for cannabis users, non-users, discontinuers and starters.
We found a significant negative association between cannabis use and BMI (p=0.003), waist circumference (p>0.001), diastolic BP (p=0.015) and HbA1c (0.004). One year later, patients who had discontinued their cannabis use had a greater increase of BMI (p=0.002) and waist circumference (p=0.011) than other patients. They also had a greater increase of diastolic BP than non-users (p=0.036) or starters (p=0.004).
Discontinuation of cannabis use increased metabolic risk. To stop cannabis use is often an important treatment goal, because it reduces psychotic symptoms. However, physicians should be aware of the increased metabolic risk in patients who discontinue the use of cannabis. Extra attention should be paid to monitoring and treatment of metabolic parameters in these patients to prevent cardiovascular diseases and premature cardiovascular mortality.
Depression is associated with the metabolic syndrome (MS). Recently, the concept of ‘metabolic depression’ has been proposed based on a protracted course of depressive symptoms over time.
Objective and aims
Within the Netherlands study of depression in older persons, we examined whether metabolic dysregulation predicted the two-year course of depression.
A cohort study (n = 285) of depressed persons (≥60 years) with two-year follow up. Depression was classified according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Severity of depression was assessed with sum score as well as subscale scores of the Inventory of Depressive Symptomatology (IDS) at six-month intervals. The metabolic syndrome was defined according the National Cholesterol Education Program (NCEP-ATP III). We applied logistic regression and linear mixed models adjusted for a wide range of confounders and severity of depression at baseline.
The number of MS-components predicted non-remission at two-years (OR = 1.28 [95% CI: 1.00–1.58], P = 0.047), which was driven by waist-circumference, HDL-cholesterol and triglycerides. MS was only associated with the somatic symptom subscale score of the IDS over time, but not with its sum score (interaction time × somatic subscale, P = 0.002). This effect was driven by waist circumference, elevated fasting glucose level and hypertension.
Metabolic dysregulation predicts the course of late-life depression. This effect seems to be driven by visceral obesity (as indicated by the waist circumference) and lipid dysregulations and with respect to the somatic symptoms of depression.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In the Netherlands, seclusion is historically the measure of first choice in dealing with aggressive incidents. In 2010, the Mediant Mental Health Trust in Eastern Netherlands introduced a policy prioritising the use of enforced medication to manage aggressive incidents over seclusion. The main goal of the study was to investigate whether prioritising enforced medication over seclusion leads to a change of aggressive incidents and coercive measures.
The study was carried out with data from 2764 patients admitted between 2007 and 2013 to the hospital locations of the Mediant Mental Health Trust in Eastern Netherlands, with a catchment area of 500,000 inhabitants. Seclusion, restraint and enforced medications as well as other coercive measures were gathered systematically. Aggressive incidents were assessed with the SOAS-R. An event sequence analysis was preformed, to assess the whether seclusion, restraint or enforced medication were used or not before or after aggressive incidents.
Enforced medication use went up by 363% from a very low baseline. There was a marked reduction of overall coercive measures by 44%. Seclusion hours went down by 62%. Aggression against staff or patients was reduced by 40%.
When dealing with aggression, prioritising medication significantly reduces other coercive measures and aggression against staff, while within principles of subsidiarity, proportionality and expediency.
To investigate the impact of childhood trauma on the clinical course of panic disorder.
Longitudinal data of 539 participants with a current panic disorder were collected from the Netherlands Study of Depression and Anxiety (NESDA). Childhood trauma was assessed with a structured interview and clinical course after two years with a DSM-IV-based diagnostic interview and the Life Chart Interview.
At baseline, 56.3% reported childhood trauma, but this was not predictive of persistence of panic disorder. Emotional neglect and psychological abuse were associated with higher occurrence of anxiety disorders other than panic disorder (social phobia) and with higher chronicity of general anxiety symptoms (anxiety attacks or episodes and avoidance). Baseline clinical features (duration and severity of anxiety and depressive symptoms) and personality traits (neuroticism and extraversion) accounted for roughly 30 to 60% of the total effect of childhood trauma on chronicity of anxiety symptoms and on occurrence of other anxiety disorders.
After two years, childhood trauma is associated with chronicity of anxiety symptoms and occurrence of social phobia, rather than persistence of panic disorder. These relationships are partially accounted for by duration and severity of anxiety and depressive symptoms, and neuroticism and extraversion.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
There is a large consensus concerning the important aetiological role of childhood trauma in chronic fatigue syndrome (CFS). In the current study, we examine the differential effect of childhood trauma subtypes on fatigue and physical functioning in patients with CFS.
One hundred and fifty-five participants receiving treatment at the outpatient clinic for CFS of the Antwerp University Hospital in Belgium were included in this study. Stepwise regression analyses were conducted with the outcomes of the total score of the Checklist Individual Strength (CIS) measuring fatigue and the physical functioning subscale of the medical outcomes short form-36 health status survey (SF-36) as the dependent variables, and the scores on the five Traumatic Experiences Checklist (TEC) subscales as the independent variables.
Fatigue and physical functioning scores in CFS patients were significantly predicted by sexual harassment only. A significant effect of emotional neglect, emotional abuse and bodily threat during childhood on elevated fatigue or reduced physical functioning levels could not be found.
There is a differential effect of childhood trauma subtypes on fatigue and physical functioning in CFS patients. Sexual harassment emerged as the most important predictor variable. Therefore, childhood (sexual) trauma has to be taken into account in assessment and treatment of chronic fatigue syndrome.
Disclosure of interest
The authors have not supplied their declaration of competing interest.