Aanhoudende depressieve klachten vergroten risico op beroerte’

Item does not contain fulltex

Cardiac Anxiety - When the heart is (thought to be) in danger-

Contains fulltext : 160782.pdf (publisher's version ) (Open Access)When the heart is (thought to be) in danger - like after a myocardial infarction (MI) or in patients with Non Cardiac Chest Pain (NCCP)- , this may provoke specific fears related to the heart: cardiac anxiety. This anxiety is often not acknowledged nor treated. The present thesis showed that cardiac anxiety in fact really matters. Even when other factors are taken into account, like the severity of the heart condition or depression, which has been described previously as relevant in this context. Cardiac anxiety after a heart attack leads to a worse outcome. More anxiety is not only associated with a worse quality of life, but also with poorer physical outcome, i.e. a higher risk of a new heart attack or death. Three independent Dutch samples were used; two cohorts of MI-patients and a sample of NCCP patients who presented themselves at the emergency department and were diagnosed with a panic and/ or depressive disorder. In short, the six studies described in this thesis showed that cardiac anxiety post-MI can be reliably assessed with the self-rated Cardiac Anxiety Questionnaire, that patients report different trajectories of cardiac anxiety over time following a MI, and that higher cardiac anxiety is associated with more general anxiety and depressive symptoms, a worse quality of life one year post-MI, and a worse cardiac prognosis up to five years post-MI. To approximate cardiac anxiety when it is not explicitly assessed, is difficult. Finally, a randomized controlled trial found that Cognitive Behavioral Therapy (CBT) in NCCP-patients with a co morbid panic and/or depressive disorder assumed to suffer from cardiac anxiety can significantly reduce disease severity, anxiety and depressive symptoms. A logical follow-up would be to investigate treatment of cardiac anxiety post-MI.Radboud University, 03 november 2016Promotores : Speckens, A.E.M., Balkom, A.J.L.M. van, Oude Voshaar, R.C

What a neurologist should know about depression in Parkinson's disease

Item does not contain fulltextDepression is a frequent non-motor symptom of Parkinson's disease. Its prevalence varies widely across studies (between 2.7% and 90%); around 35% have clinically significant depressive symptoms. Although depression can have an immense impact on the quality of life of affected patients and their caregivers, depressive symptoms in Parkinson's disease frequently remain unrecognised and, as a result, remain untreated. Here we overview the diagnostic challenges and pitfalls, including the factors contributing to the underdiagnosis of depression. We also discuss current ideas on the underlying pathophysiology. Finally, we offer a treatment approach based on currently available evidence

Iatrogenic opioid use disorder, chronic pain and psychiatric comorbidity: A systematic review

Contains fulltext : 209020.pdf (Publisher’s version ) (Closed access)OBJECTIVE: A systematic review of the literature on the risks of developing iatrogenic opioid use disorders in chronic pain patients with psychiatric comorbidity. METHODS: We conducted literature searches on Pubmed with key subjects: "chronic pain", "psychiatry", "opioids" and "opioid use disorder" and for original, English written articles published from 2000 until the first of September 2017. Final selection of the articles for review was made in a consensus between three reviewers. RESULTS: Longitudinal studies showed a significant association between psychiatric comorbidity, especially depression and anxiety disorders and the development of problematic opioid use, more severe opioid craving and poor opioid treatment outcome (analgesia and side effects) in chronic pain patients. Cross-sectional studies showed a similar association between psychiatric disorders and problematic opioid use, where studies in specialized pain settings showed a higher prevalence of psychiatric disorders, compared to non-specialized settings. CONCLUSIONS: This systematic review showed a significant association between psychiatric comorbidity, especially depression and anxiety disorders and the development of problematic opioid use in chronic pain patients. We therefore recommend psychiatric screening in chronic pain management. Chronic pain patients with comorbid psychiatric disorders need a multidisciplinary approach and monitoring opioid use is warranted in these patients.14 p

Putting mindfulness-based cognitive therapy to the test in routine clinical practice: A transdiagnostic panacea or a disorder specific intervention?

Item does not contain fulltex

Sustainable energy system pathways : Development and assessment of an indicator-based model approach to enhance sustainability of future energy technology pathways in Germany (SEnSys)

After the nuclear fallout in Japan, Germany decided to back out from nuclear energy while at the same time changing the energy supply from fossil to renewable sources. This elaborate plan, known as Energiewende, will require significant economic and structural efforts that will have profound impacts on the environment and society itself. It is therefore crucial to identify possible technological pathways that can lead to a renewable energy supply, while reducing negative impacts on a holistic scope. In order to analyse alternative energy technology scenarios in Germany, this thesis focuses on the development of an indicator-based numerical Sustainable Energy Systems (SEnSys) model approach. Other than previous approaches, the SEnSys model considers full aggregated impacts of technological pathways leading to future configurations. With the help of an exemplary case study on two alternative energy technology scenarios (Trieb1 and Trieb2), the feasibility of the SEnSys model in evaluating sustainability is subsequently assessed. The results can affirm the findings of previous studies concerning lower economic and environ- mental impacts for scenario Trieb2, with small shares of renewable energy imports, compared to scenario Trieb1 based on only local but fluctuating renewables. Additionally, the results are in accordance with other relevant studies, while offering new valuable insights to the topic. Given a comprehensive revision of the identified uncertainties and limitations, it can be stated that the SEnSys model bares the potential for further analysing and improving sustainability of energy technology scenarios in Germany and other countries

Experiences of Clinical Clerkship Students With Mindfulness-Based Stress Reduction: A Qualitative Study on Long-Term Effects

PURPOSE: To explore the mindfulness practice, its long-term effects, facilitators and barriers, in clinical clerkship students 2 years after participation in an 8-week mindfulness-based stress reduction (MBSR) training. METHOD: A qualitative study was performed by semi-structured in-depth interviews with 16 clinical clerkship students selected by purposive sampling. Students had participated in a MBSR training 2 years before and were asked about their current mindfulness practice, and the long-term effects of the MBSR training. Thematic analysis was conducted using the constant comparison method. Data saturation was reached after 16 interviews. RESULTS: Most interviewees were still engaged in regular, predominantly informal, mindfulness practice, although some discontinued mindfulness practice and reported an "unchanged lifestyle." Three main themes came forward; (1) "focused attention and open awareness" during daily activities as core elements of long-term mindfulness practice; (2) "changes in behavior and coping" that resulted from taking a pause, reflecting, recognizing automatic behavioral patterns and making space for a conscious response; (3) "integration in personal and professional life" by enhanced enjoyment of daily activities, improved work-life-balance and making different career choices. Barriers and facilitators in starting and maintaining mindfulness practice were (1) understanding and intention as "pre-conditions"; (2) practical, personal, and professional factors of students in maintaining practice. CONCLUSION: Two years after participation in a MBSR training, many interviewees were still engaged in (mostly informal) mindfulness practice contributing to both personal and professional changes. In light of the high clerkship demands, MBSR training could be a valuable addition to medical curricula, supporting medical students in developing necessary competencies to become well-balanced professionals

Bilateral ECT induces bilateral increases in regional cortical thickness

Electroconvulsive therapy (ECT) is the most effective treatment for patients suffering from severe or treatment-resistant major depressive disorder (MDD). Unfortunately its underlying neurobiological mechanisms are still unclear. One line of evidence indicates that the seizures produced by ECT induce or stimulate neuroplasticity effects. Although these seizures also affect the cortex, the effect of ECT on cortical thickness is not investigated until now. We acquired structural magnetic resonance imaging data in 19 treatment-resistant MDD patients before and after a bilateral ECT course, and 16 healthy controls at 2 time points, and compared changes in cortical thickness between the groups. Our results reveal that ECT induces significant, bilateral increases in cortical thickness, including the temporal pole, inferior and middle temporal cortex and the insula. The pattern of increased cortical thickness was predominant in regions that are associated with seizure onset in ECT. Post hoc analyses showed that the increase in thickness of the insular cortex was larger in responders than in non-responders, which may point to a specific relationship of this region with treatment effects of ECT