Blije gezichten en andere beloningen:aandacht voor positieve informatie als beschermend mechanisme tegen depressie

Dit artikel is een bewerkte versie van de Nederlandse samenvatting van het proefschrift “Happy faces and other rewards. Different perspectives on a bias away from positive and toward negative information as an underlying mechanism of depression” van Charlotte Vrijen [1]; Promotores: Albertine J. Oldehinkel, Catharina A. Hartman en Peter de Jonge. Doorgaans laten mensen sterke reacties zien op positieve informatie, maar sommige mensen reageren hier minder sterk op; zij hebben een zogenaamde lage positieve bias. In dit proefschrift werd het verband tussen lage positieve bias en depressie onderzocht. We onderzochten of een lage positieve bias tijdens de adolescentie een voorspeller was van latere depressie en wat de implicaties van een lage positieve bias waren in het dagelijks leven. Met een interventiestudie onderzochten we of op de persoon toegesneden leefstijladvies en een vrije-val-ervaring voor meer plezier en een positievere bias konden zorgen bij jongvolwassenen die last hadden van verlies van plezier. Een belangrijke uitkomst van ons onderzoek is dat een lage positieve bias gedurende de adolescentie een latere depressie voorspelde en daarmee mogelijk een indicator is van vatbaarheid voor depressie. In het dagelijks leven hielden jongeren met een hoge positieve bias het goede gevoel dat ze van positieve ervaringen kregen langer vast dan jongeren met een lage bias. Dit zou kunnen verklaren waarom jongeren met een lage positieve bias meer kans hebben om depressief te worden. In de interventiestudie werden aanwijzingen gevonden dat op de persoon toegesneden leefstijladvies resulteerde in een toename in plezier, maar niet in een positievere bias

Lower Sensitivity to Happy and Angry Facial Emotions in Young Adults with Psychiatric Problems

Many psychiatric problem domains have been associated with emotion-specific biases or general deficiencies in facial emotion identification. However, both within and between psychiatric problem domains, large variability exists in the types of emotion identification problems that were reported. Moreover, since the domain-specificity of the findings was often not addressed, it remains unclear whether patterns found for specific problem domains can be better explained by co-occurrence of other psychiatric problems or by more generic characteristics of psychopathology, for example, problem severity. In this study, we aimed to investigate associations between emotion identification biases and five psychiatric problem domains, and to determine the domain-specificity of these biases. Data were collected as part of the 'No Fun No Glory' study and involved 2,577 young adults. The study participants completed a dynamic facial emotion identification task involving happy, sad, angry, and fearful faces, and filled in the Adult Self-Report Questionnaire, of which we used the scales depressive problems, anxiety problems, avoidance problems, Attention-Deficit Hyperactivity Disorder (ADHD) problems and antisocial problems. Our results suggest that participants with antisocial problems were significantly less sensitive to happy facial emotions, participants with ADHD problems were less sensitive to angry emotions, and participants with avoidance problems were less sensitive to both angry and happy emotions. These effects could not be fully explained by co-occurring psychiatric problems. Whereas this seems to indicate domain-specificity, inspection of the overall pattern of effect sizes regardless of statistical significance reveals generic patterns as well, in that for all psychiatric problem domains the effect sizes for happy and angry emotions were larger than the effect sizes for sad and fearful emotions. As happy and angry emotions are strongly associated with approach and avoidance mechanisms in social interaction, these mechanisms may hold the key to understanding the associations between facial emotion identification and a wide range of psychiatric problems

Spread the Joy:How High and Low Bias for Happy Facial Emotions Translate into Different Daily Life Affect Dynamics

There is evidence that people commonly show a bias toward happy facial emotions during laboratory tasks, that is, they identify other people’s happy facial emotions faster than other people’s negative facial emotions. However, not everybody shows this bias. Individuals with a vulnerability for depression, for example, show a low happy bias compared to healthy controls. The main aim of this study was to acquire a better understanding of laboratory measures of happy bias by studying how these translate to people’s daily life. We investigated whether stable high and low happy bias during a laboratory task were associated with different daily life affect dynamics (i.e., effects from one time interval of 6 hours to the next). We compared the daily life affect dynamics of young adults (age 18–24) with a high bias toward happy facial emotions () to the affect dynamics of young adults with a low bias toward happy emotions (). Affect and related measures were assessed three times per day during 30 days. We used multilevel vector autoregressive (VAR) modelling to estimate lag 1 affect networks for the high and low happy bias groups and used permutation tests to compare the two groups. Compared to their peers with a low happy bias, individuals with a high happy bias more strongly sustained the effects of daily life reward experiences over time. Individuals with a high happy bias may use their reward experiences more optimally in daily life to build resources that promote well-being and mental health. Low reward responsiveness in daily life may be key to why individuals who show a low happy bias during laboratory tasks are vulnerable for depression. This study illustrates the potential benefits of a network approach for unraveling psychological mechanisms

Incidence and outcomes of poor healing and poor squamous regeneration after radiofrequency ablation therapy for early Barrett's neoplasia

BACKGROUND: Although endoscopic eradication therapy with radiofrequency ablation (RFA) is effective in most Barrett's Esophagus (BE) patients, some might experience poor healing (PH) and/or poor squamous regeneration (PSR). We aimed to evaluate PH/PSR incidence and treatment outcomes. METHODS: We included all patients treated with RFA for early BE neoplasia, from a nationwide Dutch registry based on a joint treatment protocol. PH was defined as active inflammatory changes or visible ulcerations ≥3 months post-RFA, PSR as <50% squamous regeneration, and treatment success as complete eradication of BE (CE-BE). Results 1,386 patients (median BE C2M5) underwent RFA with baseline low-grade dysplasia (27%), high-grade dysplasia (30%), or early cancer (43%). In all 134 patients with PH (10%), additional time and acid suppression resulted in complete esophageal healing. 67/134 (50%) had normal regeneration with 97% CE-BE. In total, 74 patients had PSR (5%). As compared to patients with normal squamous regeneration, PSR patients had a higher risk for treatment failure (64% versus 2%, RR 27 [95% CI 18-40]) and progression to advanced disease (15% versus <1%, RR 30 [95% CI 12-81]). Higher BMI, longer BE, reflux esophagitis, and <50% squamous regeneration after baseline endoscopic resection were independently associated with PSR in multivariable logistic regression. Conclusions In half of the patients with PH, additional time and acid suppression may lead to normal squamous regeneration and excellent treatment outcomes. However, if patients experience PSR, the risk for treatment failure and progression to advanced disease is significantly increased with a relative risk of 27 and 30, respectively

Making knowledge clips with patients: What learning mechanisms are triggered in medical students?

Objective: To prepare medical students for a rapidly changing healthcare landscape, where new means of communication emerge, innovative teaching methods are needed. We developed a project-based learning course in which medical students design audiovisual patient information in collaboration with patients and with students in Communication and Information Sciences (CIS). We studied what learning mechanisms are triggered in medical students by elements of a project-based-learning course. Methods: In this qualitative study, twelve sixth year medical students that participated in the course were individually interviewed. Data were analyzed according to the principles of qualitative template analysis. Results: We identified four learning mechanisms: Challenging assumptions about patients’ information needs; Becoming aware of the origin of patients’ information needs; Taking a patient's perspective; Analyzing language to adapt to patients’ needs. These learning mechanisms were activated by making a knowledge clip, collaborating with patients, and collaborating with CIS students. Conclusion: Collaborating with patients helped students to recognize and understand patients’ perspectives. Working on a tangible product in partnership with patients and CIS students, triggered students to apply their understanding in conveying information back to patients. Practice implication: Based on our findings we encourage educators to involve patients as collaborators in authentic assignments for students so they can apply what they learned from taking patients’ perspectives

Successful dietary therapy in paediatric Crohn’s disease is associated with shifts in bacterial dysbiosis and inflammatory metabotype towards healthy controls

Background and aims: Nutritional therapy with the Crohn’s Disease Exclusion Diet + Partial Enteral Nutrition [CDED+PEN] or Exclusive Enteral Nutrition [EEN] induces remission and reduces inflammation in mild-to-moderate paediatric Crohn’s disease [CD]. We aimed to assess if reaching remission with nutritional therapy is mediated by correcting compositional or functional dysbiosis. Methods: We assessed metagenome sequences, short chain fatty acids [SCFA] and bile acids [BA] in 54 paediatric CD patients reaching remission after nutritional therapy [with CDED + PEN or EEN] [NCT01728870], compared to 26 paediatric healthy controls. Results: Successful dietary therapy decreased the relative abundance of Proteobacteria and increased Firmicutes towards healthy controls. CD patients possessed a mixture of two metabotypes [M1 and M2], whereas all healthy controls had metabotype M1. M1 was characterised by high Bacteroidetes and Firmicutes, low Proteobacteria, and higher SCFA synthesis pathways, and M2 was associated with high Proteobacteria and genes involved in SCFA degradation. M1 contribution increased during diet: 48%, 63%, up to 74% [Weeks 0, 6, 12, respectively.]. By Week 12, genera from Proteobacteria reached relative abundance levels of healthy controls with the exception of E. coli. Despite an increase in SCFA synthesis pathways, remission was not associated with increased SCFAs. Primary BA decreased with EEN but not with CDED+PEN, and secondary BA did not change during diet. Conclusion: Successful dietary therapy induced correction of both compositional and functional dysbiosis. However, 12 weeks of diet was not enough to achieve complete correction of dysbiosis. Our data suggests that composition and metabotype are important and change quickly during the early clinical response to dietary intervention. Correction of dysbiosis may therefore be an important future treatment goal for CD

Diagnosis and treatment of exocrine pancreatic insufficiency in chronic pancreatitis: An international expert survey and case vignette study.

Despite evidence-based guidelines, exocrine pancreatic insufficiency is frequently underdiagnosed and undertreated in patients with chronic pancreatitis. Therefore, the aim of this study is to provide insight into the current opinion and clinical decision-making of international pancreatologists regarding the management of exocrine pancreatic insufficiency. An online survey and case vignette study was sent to experts in chronic pancreatitis and members of various pancreatic associations: EPC, E-AHPBA and DPSG. Experts were selected based on publication record from the past 5 years. Overall, 252 pancreatologists participated of whom 44% had ≥ 15 years of experience and 35% treated ≥ 50 patients with chronic pancreatitis per year. Screening for exocrine pancreatic insufficiency as part of the diagnostic work-up for chronic pancreatitis is performed by 69% and repeated annually by 21%. About 74% considers nutritional assessment to be part of the standard work-up. Patients are most frequently screened for deficiencies of calcium (47%), iron (42%), vitamin D (61%) and albumin (59%). In case of clinically steatorrhea, 71% prescribes enzyme supplementation. Of all pancreatologists, 40% refers more than half of their patients to a dietician. Despite existing guidelines, 97% supports the need for more specific and tailored instructions regarding the management of exocrine pancreatic insufficiency. This survey identified a lack of consensus and substantial practice variation among international pancreatologists regarding guidelines pertaining the management of exocrine pancreatic insufficiency. These results highlight the need for further adaptation of these guidelines according to current expert opinion and the level of available scientific evidence