Twin studies on obsessive-compulsive disorder: a review

Genetic factors have historically been thought of as important in the development of obsessive-compulsive disorder (OCD). For the estimation of the relative importance of genetic and environmental factors, twin studies are an obvious approach. Twin studies of OCD have a long history, starting in 1929. In this review, over 70 years of twin research of OCD is presented, using four different approaches that represent the steps in the twin research of OCD from past to present. These steps include (1) case-studies of twins with OCD from the old literature; (2) twin studies of OCD using Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria; (3) twin studies of OCD using a dimensional approach, comparing resemblances in monozygotic and dizygotic twins; and (4) twin studies of OCD using a dimensional approach, analyzing the data with Structural Equation Modeling. It is concluded that only the studies using the last method have convincingly shown that, in children, obsessive-compulsive (OC) symptoms are heritable, with genetic influences in the range of 45% to 65%. In adults, studies are suggestive for a genetic influence on OC symptoms, ranging from 27% to 47%, but a large twin study using a biometrical approach with continuous data is still needed to provide conclusive evidence. Strategies for future twin studies of OCD are discusse

Opportunities for cost-effective prevention of late-life depression: An epidemiological approach.

Context: Clinically relevant late-life depression has a prevalence of 16% and is associated with substantial societal costs through its disease burden and unfavorable prognosis. From the public health perspective, depression prevention may be an attractive, if not imperative, means to generate health gains and reduce future costs. Objective: To target high-risk groups for depression prevention such that maximum health gains are generated against the lowest cost. Design: Population-based cohort study over 3 years. Setting: General population in the Netherlands. Participants: Twenty-two hundredcommunityresidents aged 55 to 85 years. Of these, 1925 were not depressed at baseline. Main Outcome Measure: The onset of clinically relevant depression was measured with the Center for Epidemiological Studies Depression Scale. For each of the risk factors (and their combinations), we calculated indices of potential health gain and the effort (costs) required to generate those health gains. Results: One in every 5 cases of clinically relevant latelife depression is a new case. Consequently, depression prevention has to play a key role in reducing the influx of new cases. This is best done by directing prevention effortstowardelderly peoplewhohavedepressivesymptoms, experience functional impairment, and have a small social network, in particular women, as well as people who have attained only a low educational level or who suffer from chronic diseases. Conclusions: Directing prevention efforts toward selected high-risk groups could help reduce the incidence of depression and is likely to be more cost-effective than alternative approaches. This article further shows that we have the methodology at our disposal to conduct ante hoc cost-benefit analysis in preventive psychiatry. This helps set a rational research and development agenda before testing the cost-effectiveness of interventions in timeconsuming and expensive trials

The development and psychometric evaluation of the Questionnaire Epistemic Trust (QET):A self-report assessment of epistemic trust

Epistemic trust (ET) refers to the predisposition to trust information as authentic, trustworthy and relevant to the self. Epistemic distrust - resulting from early adversity - may interfere with openness to social learning within the therapeutic encounter, reducing the ability to benefit from treatment. The self-report Questionnaire Epistemic Trust (QET) is a newly developed instrument that aims to assess ET. This study presents the first results on the psychometric properties of the QET in both a community and a clinical sample. Our findings indicate that the QET is composed of four meaningful subscales with good to excellent internal consistency. The QET shows relevant associations with related constructs like personality functioning, symptom distress and quality of life. QET scores clearly distinguish between a clinical and community sample and are associated with the quality of the therapeutic alliance. The QET provides a promising, brief and user-friendly instrument that could be used for a range of clinical and research purposes. Future studies with larger samples are needed to strengthen construct validity and to investigate the value of the QET to predict differential treatment responses or to study mechanisms of change

Construction and validation of a patient- and user-friendly nursing home version of the Geriatric Depression Scale.

Objective To construct a patient- and user-friendly shortened version of the Geriatric Depression Scale (GDS) that is especially suitable for nursing home patients. Methods The study was carried out on two different data bases including 23 Dutch nursing homes. Data on the GDS (n¼410), the Mini Mental State Examination (n¼410) and a diagnostic interview (SCAN; n¼333), were collected by trained clinicians. Firstly, the items of the GDS-15 were judged on their clinical applicability by three clinical experts. Subsequently, items that were identified as unsuitable were removed using the data of the Assess project (n¼77), and internal consistency was calculated. Secondly, with respect to criterion validity (sensitivity, specitivity, area under ROC and positive and negative predictive values), the newly constructed shortened GDS was validated in the AGED data set (n¼333), using DSM-IV diagnosis for depression as measured by the SCAN as ‘gold standard’. Results The eight-item GDS that resulted from stage 1 showed good internal consistency in both the Assess data set (a¼0.86) and the AGED dataset (a¼0.80). In the AGED dataset, high sensitivity rates of 96.3% for major depression and 83.0% for minor depression were found, with a specificity rate of 71.7% at a cut-off point of 2/3. Conclusion The GDS-8 has good psychometric properties. Given that the GDS-8 is less burdening for the patient, more comfortable to use and less time consuming, it may be a more feasible screening test for the frail nursing home population

Verandering in crisisinterventie en acute psychiatrie: Amsterdamse consulten in 1983 en 2005.

achtergrond Sinds 1992 stijgt het aantal inbewaringstellingen (ibs'en) in Nederland opvallend. In Amsterdam is er zelfs sprake van een verdrievoudiging. Psychiatrische behandeling in de Amsterdamse klinieken dreigt gedomineerd te worden door dwang. doel Een beeld krijgen van de veranderingen in de acute psychiatrie die hebben bijgedragen aan de stijging van het aantal dwangopnames met ibs. methode Vergelijken van een cohort (n = 460) consulten verricht door de stedelijke crisisdienst in 1983 met een cohort (n = 436) consulten verricht in 2004-2005 op de volgende variabelen: werkwijze van de crisisdienst, kenmerken van de patiënten, diagnose en uitkomst van de consulten. resultaten Vergeleken met 1983 waren er in 2004-2005 meer diensten betrokken bij psychiatrische patiënten in acute situaties in het publieke domein. Het aantal patiënten dat via de politie kwam, verdubbelde. De consulten, die in 1983 uitsluitend werden gedaan op de plek waar de patiënt verbleef, werden in 2004-2005 voor 60% op het bureau van de dienst gedaan. Het aantal patiënten met een psychose in de cohort nam toe van 52,0 naar 63,3%. Er was een toename van ibs opnames (van 16,7 naar 20,0% van de interventies) en een scherpe daling van vrijwillige opnames (van 25,7 naar 7,6%). Het totale aantal opnames na een consult daalde van 42 naar 28%. conclusie De outreachende dienst met een eerstelijnskarakter van 1983 is veranderd in een gespecialiseerde psychiatrische ehbo met een bescheiden outreachende functie. De vrijwillige opname is vrijwel verdwenen bij de crisisdienst. Nader onderzoek naar de kenmerken van de consulten en naar de variabelen die een rol spelen bij het toepassen van dwang is noodzakelijk

Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subject in the Netherlands

The Center for Epidemiologic Studies Depression scale (CES-D) has been widely used in studies of late-life depression. Psychometric properties are generally favourable, but data on the criterion validity of the CES-D in elderly community-based samples are lacking. In a sample of older (55-85 years) inhabitants of the Netherlands, 487 subjects were selected to study criterion validity of the CES-D. Using the 1-month prevalence of major depression derived from the Diagnostic Interview Schedule (DIS) as criterion, the weighted sensitivity of the CES-D was 100%; specificity 88%; and positive predictive value 13.2%. False positives were not more likely among elderly with physical illness, cognitive decline or anxiety. We conclude that the criterion validity of the CES-D for major depression was very satisfactory in this sample of older adults

Psychometric properties of an interviewer-administered version of the Kessler Psychological Distress scale (K10) among Dutch, Moroccan and Turkish respondents

Sons, Lt

Is alcohol consumption irrelevant to outcome in anxiety and depression? Reply

Stress-related psychiatric disorders across the life spa