Over de behandeling van angst : doen we de goede dingen en doen we de goede dingen goed?

Angststoornissen behoren met een lifetimeprevalentie van bijna 20% tot de meest voorkomende en beperkende psychische stoornissen. Ze zijn vaak chronisch van aard en (daardoor) geassocieerd met ernstige beperkingen in zowel interpersoonlijk als beroepsmatig functioneren. De comorbiditeit hebben van angststoornissen met andere psychische klachten is hoog, vooral met andere angststoornissen en stemmingsstoornissen, maar ook met misbruik of afhankelijkheid van alcohol en drugs. Gelukkig bestaan er effectieve behandelingen die bij de meeste patiënten tot klachtafname leiden. Zo is duidelijk geworden uit vele effectstudies naar op exposure gebaseerde interventies voor angststoornissen, waarbij patiënten blootgesteld worden aan beangstigende situaties, gedachten of lichamelijke sensaties met als doel disfunctionele verwachtingen over het optreden van negatieve gebeurtenissen te ontkrachten. Exposuretherapie wordt dan ook beschouwd als de psychologische behandeling van eerste voorkeur, zowel in internationale als in nationale multidisciplinaire richtlijnen voor de behandeling van angststoornissen. Maar ook medicamenteuze behandeling, of combinatiebehandelingen, zijn werkzaam in de behandeling van angstklachten. Goed nieuws dus. Angststoornissen zijn goed behandelbaar. Toch worden bewezen effectieve behandelingen nog te vaak niet aan patiënten aangeboden. Maar ook als dat wel het geval is, worden ze nog te vaak niet op een goede manier aangeboden. Maar zelfs als de goede dingen goed gedaan worden, wordt niet elke patiënt met een angststoornis beter. Door patiënten vaker de behandeling van voorkeur aan te bieden en in te zetten op het adequaat uitvoeren van interventies kan winst geboekt worden bij de behandeling van angst. Maar ook door het integreren van moderne technieken als behandeling via apps, internet en beeldbellen in-, of het toevoegen van interventies gericht op het vergroten van het welbevinden en het verbeteren van het functioneren aan bestaande werkzame behandelingen voor angststoornissen.Mijn oratie gaat over de behandeling van angst- en dwangstoornissen. Het terrein waar ik me de laatste 10 jaar het meest op gericht heb. We weten al heel veel over de behandeling van angst. Maar de boodschap van mijn verhaal is dat er nog genoeg winst te boeken is. Een aantal manieren waarop dat volgens mij kan, wil ik graag met u doornemen

De Doopsgezinde kerk in Haarlem

The classicist Baptist Church in Haarlem has almost completely escaped historiography of Dutch architecture, although its building history is very well documented. The first plans for the church date from 1672, after the joining together of two groups of Baptists. A plot between Grote Houtstraat, Peuzelaarsteeg, Frankestraat and Anegang was reserved as the building site. On December 26, 1674 the first design was completed, but for financial reasons the construction was postponed until 1682. Eventually it took place between May 1682 and March 1683. The building plans are illustrated with a series of thirteen design drawings. The earliest design, probably dating from 1674, shows a traditional, three-bay and axial clandestine church with galleries (ill. 2). The subsequent designs have a more modern, more centralizing character, in a 3 : 4 proportion (ill. 3, 4 and 5). This proportion corresponds to the proportions of the existing church, measured across the central lines of the walls. In three later designs, having a groundplan proportion of 4 : 5, this striving for centralization is worked out in greater detail (ill. 8, 9 and 10). The remaining five drawings concern the furnishing of the church and therefore probably date from the last phase of the design process (1681-1683): variations on pulpits, a plan for church pews with pulpit and baptismal garden, and a ground plan with four different positions of the pulpit (ill. l 1-15). The fact that one of the designs was signed by the Haarlem painter Jan de Bray (ill. 12) suggests the latter's involvement in the design and furnishing of the church building. An argument in favour of attributing the church to De Bray could be that since 1677 he is regularly mentioned as architect ('constmeester', 'constwerker', 'boumeester'). Moreover, the use of the Haarlem foot measure in the church building indicates a Haarlem architect. Finally, there is evidence that De Bray had contacts with a prominent Baptist citizen in Haarlem. Although there is no architectural work by him that we know of, so that comparison is not possible, the classicist De Bray is a serious candidate as the designer of the Baptist Church in Haarlem

On the Diagnosis, Assessment, and Treatment of Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is increasingly recognized as a prevalent anxiety disorder with a chronic course and signifi cant impairment (APA, 2000; Ballenger et al., 2001; Weisberg, 2009). In the Netherlands, according to the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2; De Graaf, Ten Have, & Van Dorsselaar, 2010) GAD was found to have a 4.5% lifetime prevalence rate, and the 12-month prevalence rate was reported to be 1.7%. GAD is a long-term illness with a high likelihood of recurrence. For instance, during the 12 years of a large longitudinal study, the Harvard-Brown Anxiety Research Project (HARP; Bruce et al., 2005), the average amount of time that patients met diagnostic criteria of GAD was 74%. Further, GAD was found to have a probability of recovery of 0.58 in the 12 years the study lasted, and the probability of recurrence in patients who recovered was 0.45. GAD has been found to be associated with considerable impairment and severity. For instance, in one study GAD was the anxiety disorder with the highest rate of moderate to severe disability (Sanderson & Andrews, 2002). Further, lifetime and current GAD were found to be associated with decreased overall well-being (Stein & Heimberg, 2004) and with impairment that was equivalent in magnitude to the impairment caused by major depressive disorder (Kessler, Dupont, Berglund, & Wittchen, 1999)

Street-level bureaucrats and new modes of governance – how conflicting roles affect the implementation of the Swiss ordinance on veterinary medicinal products

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Lipsky’s seminal concept of street-level bureaucrats (SLB) focuses on their role as public servants. However, in the course of new modes of governance, private actors have gained an additional role as implementation agents. We explore the logic of private SLBs during the implementation of the Swiss Ordinance on Veterinary Medicinal Products (OVMP) where veterinarians are simultaneously implementing agents, policy addressees, and professionals with economic interests. We argue that, because of contradictory reference systems, it is problematic for the output performance if an actor is simultaneously the target group of a policy and its implementing agen

Associations between Depressive Symptoms, Rumination, Overgeneral Autobiographical Memory and Interpretation Bias within a Clinically Depressed Sample

__Abstract__ There is ample research demonstrating that biases in cognitive processes, such as a negative interpretation bias, rumination, and overgeneral autobiographical memory, are potential vulnerability factors for depression. However, a key limitation is that most studies conducted so far have studied cognitive biases in depression in isolation. Therefore our goal was to explore whether or not interpretation bias, overgeneral autobiographical memory, and rumination are present and interrelated in depressive outpatients. In this explorative study we examined the relationship between negative interpretation bias, rumination, overgeneral autobiographical memory, and severity of depression in clinically depressed outpatients. According to our expectations a negative interpretation bias and rumination were associated with severity of depression. Moreover, overgeneral autobiographical memory was not associated with severity of depression, but seemed to be associated with diagnosis of depression. A negative interpretation bias, overgeneral autobiographical memory, and rumination were not significantly related with each other in this study. This finding suggests they are not strongly related and might be largely distinct vulnerability factors for depression. The study presents an important yet preliminary finding which warrants further replication with a larger sample size

Contrast-enhanced micro-CT imaging in murine carotid arteries : a new protocol for computing wall shear stress

Background: Wall shear stress (WSS) is involved in the pathophysiology of atherosclerosis. The correlation between WSS and atherosclerosis can be investigated over time using a WSS-manipulated atherosclerotic mouse model. To determine WSS in vivo, detailed 3D geometry of the vessel network is required. However, a protocol to reconstruct 3D murine vasculature using this animal model is lacking. In this project, we evaluated the adequacy of eXIA 160, a small animal contrast agent, for assessing murine vascular network on micro-CT. Also, a protocol was established for vessel geometry segmentation and WSS analysis. Methods: A tapering cast was placed around the right common carotid artery (RCCA) of ApoE(-/-) mice (n = 8). Contrast-enhanced micro-CT was performed using eXIA 160. An innovative local threshold-based segmentation procedure was implemented to reconstruct 3D geometry of the RCCA. The reconstructed RCCA was compared to the vessel geometry using a global threshold-based segmentation method. Computational fluid dynamics was applied to compute the velocity field and WSS distribution along the RCCA. Results: eXIA 160-enhanced micro-CT allowed clear visualization and assessment of the RCCA in all eight animals. No adverse biological effects were observed from the use of eXIA 160. Segmentation using local threshold values generated more accurate RCCA geometry than the global threshold-based approach. Mouse-specific velocity data and the RCCA geometry generated 3D WSS maps with high resolution, enabling quantitative analysis of WSS. In all animals, we observed low WSS upstream of the cast. Downstream of the cast, asymmetric WSS patterns were revealed with variation in size and location between animals. Conclusions: eXIA 160 provided good contrast to reconstruct 3D vessel geometry and determine WSS patterns in the RCCA of the atherosclerotic mouse model. We established a novel local threshold-based segmentation protocol for RCCA reconstruction and WSS computation. The observed differences between animals indicate the necessity to use mouse-specific data for WSS analysis. For our future work, our protocol makes it possible to study in vivo WSS longitudinally over a growing plaque

Normative data for the Dutch version of the Penn State Worry Questionnaire.

Worry is a common symptom in various psychiatric problems and the key symptom of generalised anxiety disorder (GAD). The Penn State Worry Questionnaire (PSWQ) is the most widely used self-report scale for measuring worry. The present study provides normative data for the Dutch version of the PSWQ for a large community sample and a clinically referred sample of patients with GAD. Norms are not only provided for the original 16-item version, but also for an abbreviated 11-item version, which only consists of the positively worded items and has been shown to be a promising alternative to the full-length version. The percentile scores obtained for the community sample and the clinical GAD sample did not show much overlap, and this appeared true for the full-length as well as the abbreviated version of the PSWQ. These normative data seem suitable for differentiating between normal and abnormal manifestations of worrying and for evaluating the efficacy of treatments for GAD. (Netherlands Journal of Psychology, 65, 69-75.

Metacognitieve therapie voor de obsessieve-compulsieve stoornis

De obsessieve-compulsieve stoornis (OCS) is een veelvoorkomende en invaliderende stoornis. Cognitieve gedragstherapie (CGT) in de vorm van exposure met responspreventie (ERP) is de psychologische behandeling van eerste voorkeur. Ondanks de aangetoonde werkzaamheid van ERP is verbetering van de effectivitei

Hormone replacement therapy, mammography screening and changing age-specific incidence rates of breast cancer: an ecological study comparing two European populations

Background: In 2003, for the first time, US breast cancer incidence rates have fallen. Experts argue whether this is due to the reduced uptake of screening mammography or to lower use of Hormone Replacement Therapy (HRT). This study aims to disentangle the respective impact of screening and HRT on age-incidence rates and histology of breast cancer, by comparing two populations with comparably high levels of screening mammography, but with different prevalence of HRT. Methods: We included all invasive breast cancers recorded at the Geneva cancer registry (n=4,909) and the Netherlands Cancer Registry (n=152,428) between 1989-2003. We compared age-specific incidence rates and trends in histological subtyping between the two populations. Results: Between 1989-1991, incidence rates increased with age in both populations. In 2001-2003, women aged 60-64years showed highest incidence rates in Geneva, while in the Netherlands incidence rates continued to increase with age. The annual increase in ductal cancer incidence was similar in the Netherlands (2.3%) and Geneva (2.5%), but the annual increase in lobular cancer was sharper in Geneva (10%) than in the Netherlands (5%). Conclusion: The sharp differences in age distribution and histological subtyping of breast cancer between two European populations are not attributable to screening, since both populations have a high uptake of mammography screening. Since the prevalence of HRT use is very high in Geneva and rather low in the Netherlands, HRT may explain these discrepancies. However, other etiological factors and differences in histological assessment may also have played a rol