Long-Stay Psychiatric Patients: A Prospective Study Revealing Persistent Antipsychotic-Induced Movement Disorder

OBJECTIVE: The purpose of this study was to assess the frequency of persistent drug-induced movement disorders namely, tardive dyskinesia (TD), parkinsonism, akathisia and tardive dystonia in a representative sample of long-stay patients with chronic severe mental illness. METHOD: Naturalistic study of 209, mainly white, antipsychotic-treated patients, mostly diagnosed with psychotic disorder. Of this group, the same rater examined 194 patients at least two times over a 4-year period, with a mean follow-up time of 1.1 years, with validated scales for TD, parkinsonism, akathisia, and tardive dystonia. RESULTS: The frequencies of persistent movement disorders in the sample were 28.4% for TD, 56.2% for parkinsonism, 4.6% for akathisia and 5.7% for tardive dystonia. Two-thirds of the participants displayed at least one type of persistent movement disorder. CONCLUSIONS: Persistent movement disorder continues to be the norm for long-stay patients with chronic mental illness and long-term antipsychotic treatment. Measures are required to remedy this situation

The bidirectional relationship between physical activity and sleep in depressed versus non-depressed individuals

ACHTERGRONDBeweging en slaap zijn aan elkaar gerelateerd. Onduidelijk is wat de richting van het verband is tussen beweging en slaap en of dit verschillend is voor personen met en zonder depressieve stoornis.DOELOnderzoeken van de bidirectionele relatie tussen beweging en slaap in het dagelijks leven met herhaalde metingen bij personen met en zonder depressieve stoornis.METHODEAlle deelnemers met (n = 27) en zonder depressie (n = 27) vulden 30 opeenvolgende dagen 3 keer per dag een elektronische vragenlijst in met vragen over subjectieve slaapkwaliteit en slaapduur en droegen gedurende deze periode 24 uur per dag een bewegingsmeter die fysieke activiteit registreerde.RESULTATENMultilevelanalyses toonden dat toename van de subjectieve slaapduur afname van beweging tot gevolg had. De verschillen tussen de individuen in de richting en sterkte van dit verband waren significant. Veranderingen in beweging waren niet voorspellend voor veranderingen in slaapkwaliteit en slaapduur. De gevonden verbanden verschilden niet tussen deelnemers met en zonder depressie.CONCLUSIEVerandering in slaapduur voorspelt verandering in beweging, met een significante heterogeniteit tussen individuen. De bevindingen onderstrepen het belang van onderzoek en het ontwikkelen van interventies op het niveau van de individuele patiëntBACKGROUND: Sleep and physical activity are related, but the direction of this relationship is unclear and it is not known whether the direction differs in depressed and non-depressed persons.AIM: To study the bidirectional relationship between physical activity and sleep in daily life by making repeated measurements in depressed and non-depressed people.METHOD: Every day for 30 consecutive days each depressed (N = 27) and non-depressed (N = 27) participant in our study had to complete an electronic questionnaire relating to subjective sleep quality and sleep duration and were required to wear an accelerometer that recorded physical activity.RESULTS: Multi-level analysis showed that an increase in subjective sleep duration resulted in a decrease in physical activity. The differences between individuals with regard to the direction and strength of this relationship were significant. Changes in physical activity did not predict changes in sleep quality or sleep duration. We did not find any differences in the relationships for depressed and non-depressed participants.CONCLUSION: Change in sleep duration predicts change in physical activity, although there was significant heterogeneity in the results for individuals. Our findings underline the importance of further research and of the development of interventions that are tailored to the precise needs of the individual patient.</p

De bidirectionele relatie tussen beweging en slaap bij personen met en zonder depressie1

ACHTERGROND Beweging en slaap zijn aan elkaar gerelateerd. Onduidelijk is wat de richting van het verband is tussen beweging en slaap en of dit verschillend is voor personen met en zonder depressieve stoornis. DOEL Onderzoeken van de bidirectionele relatie tussen beweging en slaap in het dagelijks leven met herhaalde metingen bij personen met en zonder depressieve stoornis. METHODE Alle deelnemers met (n = 27) en zonder depressie (n = 27) vulden 30 opeenvolgende dagen 3 keer per dag een elektronische vragenlijst in met vragen over subjectieve slaapkwaliteit en slaapduur en droegen gedurende deze periode 24 uur per dag een bewegingsmeter die fysieke activiteit registreerde. RESULTATEN Multilevelanalyses toonden dat toename van de subjectieve slaapduur afname van beweging tot gevolg had. De verschillen tussen de individuen in de richting en sterkte van dit verband waren significant. Veranderingen in beweging waren niet voorspellend voor veranderingen in slaapkwaliteit en slaapduur. De gevonden verbanden verschilden niet tussen deelnemers met en zonder depressie. CONCLUSIE Verandering in slaapduur voorspelt verandering in beweging, met een significante heterogeniteit tussen individuen. De bevindingen onderstrepen het belang van onderzoek en het ontwikkelen van interventies op het niveau van de individuele patiën

The Effect of EMDR and CBT on Low Self-esteem in a General Psychiatric Population: A Randomized Controlled Trial

Although low self-esteem has been found to be an important factor in the development and maintenance of psychopathology, surprisingly little is known about its treatment. This study investigated the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) therapy and Cognitive Behavioural Therapy (CBT), regarding their capacities in enhancing self-esteem in a general psychiatric secondary health care population. A randomized controlled trial with two parallel groups was used. Participants were randomly allocated to either 10 weekly sessions of EMDR (n = 15) or CBT (n = 15). They were assessed pre-treatment, after each session, post treatment and at 3 months follow-up on self-esteem (Rosenberg Self-esteem Scale and Credibility of Core Beliefs), psychological symptoms (Brief Symptom Inventory), social anxiety, and social interaction (Inventory of Interpersonal Situations) (IIS). The data were analyzed using repeated measures ANOVA for the complete cases (n = 19) and intention-to-treat (n = 30) to examine differences over time and between conditions. Both groups, EMDR as well as CBT, showed significant improvements on self-esteem, increasing two standard deviations on the main parameter (RSES). Furthermore, the results showed significant reductions in general psychiatric symptoms. The effects were maintained at 3 months follow-up. No between-group differences could be detected. Although the small sample requires to exercise caution in the interpretation of the findings, the results suggest that, when offering an adequate number of sessions, both EMDR and CBT have the potential to be effective treatments for patients with low self-esteem and a wide range of comorbid psychiatric conditions. This study was registered at www.trialregister.nl with identifier NTR4611

Period frequency^a of persistent drug-induced movement disorder^b in 194 patients, by tertile age group.

a<p>Mean period was 1.1 year (SD 0.6).</p>b<p>Persistent movement disorder: 2 consecutive positive assessments with an interval of at least 3 months.</p>c<p>Nonparametric test for trend across ordered groups (extension of the Wilcoxon rank-sum test).</p

Period frequency^a of persistent drug-induced movement disorders^b^,^c (N = 194, men = 114, women = 80).

a<p>Mean period was 1.1 year (SD 0.6).</p>b<p>Persistent movement disorder: 2 consecutive positive assessments with an interval of at least 3 months.</p>c<p>132 (68.0%) had at least one type of movement disorder.</p>d<p>Tardive dyskinesia.</p

Imagery Rehearsal Therapy in Addition to Treatment as Usual for Patients With Diverse Psychiatric Diagnoses Suffering From Nightmares: A Randomized Controlled Trial

OBJECTIVE: Nightmares are associated with psychopathology and daily distress. They are highly prevalent in a psychiatric population (30%). Currently, imagery rehearsal therapy (IRT) is the treatment of choice for nightmares. With IRT, the script of the nightmare is changed into a new dream, which is imagined during the day. However, the effects of IRT in a psychiatric population remain unknown. The aim of this study was to determine the effectiveness of IRT in a heterogeneous psychiatric population. METHOD: Between January 2006 and July 2010, 90 patients with psychiatric disorders (DSM-IV-TR) were randomized to IRT or treatment-as-usual conditions. IRT consisted of 6 individual sessions added to the treatment as usual. Nightmare frequency was assessed using daily nightmare logs and the Nightmare Frequency Questionnaire. Nightmare distress was assessed using the Nightmare Distress Questionnaire and the Nightmare Effects Survey. General psychiatric symptoms were assessed using the Symptom Checklist-90 and a PTSD symptom questionnaire. Assessments were administered at the start of the trial, after the IRT and at follow-up 3 months later. RESULTS: IRT showed a moderate effect (Cohen d = 0.5-0.7, P < .05) on nightmare frequency, nightmare distress, and psychopathology measures compared with treatment as usual. These effects were largely sustained at the 3-month follow-up (Cohen d = 0.4-0.6, P < .10). CONCLUSIONS: IRT is an effective treatment for nightmares among patients with comorbid psychiatric disorders and can be employed in addition to the on-going treatment. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00291031