Urbanisation as a risk indicator for complex psychiatric disorders and forced admissions

Background To determine both prevalence and complexity of psychiatric disorders in the Amsterdam area in relation to other major cities and less urbanized areas in the Netherlands, and to assess whether this is related to higher levels of (coercive) admissions. Methods These associations were explored in a nationwide epidemiological study and the national admission register, and in a local study of the Amsterdam region examining health care use patterns. Results The admission rate for the whole of the Netherlands was twice as high in the group of most highly urbanized municipalities as in the group of least urbanized municipalities. The urban/rural variations in admission rates in the Netherlands are reflected in true psychiatric morbidity rates. The authors found an urban/rural difference in total annual prevalence figures for psychiatric disorders in the population. The difference was also found for the separate disorders, mood disorders and substance-induced disorders, but not for anxiety disorders. Both prevalence and complexity of psychopathology in terms of comorbidity and severity were significantly higher in Amsterdam compared to other larger cities in the Netherlands, as were the number of coercive admissions. Conclusion There is evidence regarding a link between urbanisation, the development of complex psychiatric disorders and the number of (forced) admissions to PICU's [1]

Mental health and urbanization: An investigation of urban-rural and inner-city differences in psychiatric morbidity

Dekker, J.J.M. [Promotor]Beekman, A.T. [Promotor]Schoevers, R.A. [Copromotor

Dose-effect relations in time-limited combined psycho-pharmacological treatment for depression

BACKGROUND: A limited number of psychotherapy sessions in combination with medication is preferable to pharmacotherapy only in the treatment of ambulatory patients with major depression. Whether there is a relation between the number of sessions and the efficacy of the treatment is uncertain. METHOD: Randomized clinical trial comparing two treatment conditions in outpatients with major depression. All patients studied had a baseline score of at least 14 points on the 17-item Hamilton Depression Rating Scale. The two conditions consist of 8-session or 16-session Short Psychodynamic Supportive Psychotherapy, both in combination with pharmacotherapy. Efficacy was assessed using the 17-item HDRS, the CGI of Severity and of Improvement, the depression subscale of the SCL-90 and the Quality of Life Depression Scale. RESULTS: The rate of change would seem to indicate that eight sessions are preferable for both moderately and severely depressed patients, although the results converged again at the end. Furthermore, in terms of satisfaction with the number of sessions and drop-out percentages during treatment, no differences were found between the conditions. CONCLUSION: In the light of the outcome analysis (faster remission after fewer sessions), a short version of the psychotherapy treatment in a combined course of treatment seems to be justifie

Patient preference compared with random allocation in short-term psychodynamic supportive psychotherapy with indicated addition of pharmacotherapy for depression.

Depressed patients randomized to psychotherapy were compared with those who had been chosen for psychotherapy in a treatment algorithm, including addition of an antidepressant in case of early nonresponse. There were no differences between randomized and by-preference patients at baseline in adherence and outcome. About half of the early nonresponders refused the additional medication. However, no clear effect of medication addition on ultimate outcome could be demonstrated. In total, 37% of the patients achieved remission. The study suggested that randomization of patients does not induce a great influence on outcome. It might be warranted to continue an initially ineffective psychotherapy for depression, because a considerable number of patients do have a pattern of delayed response

Behandeling van de depressieve stoornis en comorbide persoonlijkheidspathologie: gecombineerde therapie versus farmacotherapie

BACKGROUND: Comorbidity of depressive and personality disorder occurs frequently, in literature percentages of around 50 to nearly 80 percent are found. Also in the Mentrum depression study on which this article is grounded, high percentages of around 66% were found. There is no equivocal treatment method of choice in literature, and opinions differ as to whether personality pathology has an adverse influence on the efficacy of the treatment for depression. AIM: To compare the results of pharmacotherapy and combined therapy in the treatment of depressive disorders in patients with and without comorbid personality disorder. METHOD: A 6 month randomised clinical trial of antidepressants and combined therapy in ambulatory patients with major depressive disorder and a baseline score of at least 14 points on the 17-item Hamilton Rating Scale for Depression. Pharmacotherapy follows three subsequent steps in case of intolerance/inefficacy: fluoxetine, amitriptyline and moclobemide. In addition combination therapy includes 16 short-term sessions of psychodynamic supportive psychotherapy. Possible personality pathology is assessed by means of the 'Vragenlijst Kenmerken Persoonlijkheid' (a self report version of the International Personality Disorder Examination). Analyses of (co) variance and chi-squared tests were applied to assess the differences in both treatment conditions in the group with and without personality pathology. RESULTS: Combined therapy was significantly more effective than pharmacotherapy for depressed patients with personality disorders. For depressed patients without personality disorders, combined therapy was not more effective than pharmacotherapy alone. CONCLUSION: The combination of psychotherapy and pharmacotherapy seems to be the treatment of choice for depressed patients with comorbid personality pathology

How to select representative geographical areas in mental health service research

The original publication is available at www.springerlink.co

The burden of disease in patients eligible for mentalization-based treatment (MBT): Quality of life and costs

Background: Mentalization-Based Treatment (MBT) is a promising, though expensive treatment for severely ill patients with Borderline Personality Disorder (BPD). A high burden of disease in terms of quality of life (QoL) and life years lost can be a reason to prioritize mental health interventions, and specifically for BPD patients. Moreover, when the societal costs of the illness are high, spending resources on high treatment costs would be more easily legitimized. Therefore, the purpose of this study was to calculate the burden of disease of BPD patients eligible for MBT. Methods: The 403 patients included in this study were recruited from two mental health care institutes in the Netherlands. All patients were eligible for MBT. Burden of disease consisted of QoL, measured with the EuroQol EQ-5D-3L, and costs, calculated using the Trimbos and Institute for Medical Technology Assessment Questionnaire for Costs Associated with Psychiatric Illness. Results: The mean QoL index score was.48. The mean total costs in the year prior to treatment were €16,879 per patient, of which 21 % consisted of productivity costs. Conclusions: The burden of disease in BPD patients eligible for MBT is high, which makes it more likely that society is willing to invest in treatment for these patients. However, this finding should not be interpreted as a license to unlimitedly use resources to reimburse treatment for severe BPD patients, as these findings do not provide any information on the effectiveness of MBT or other available treatment programs for BPD. The effectiveness of available treatments should be evident by studies on the effectiveness of the treatment itself and by comparing the effectiveness of these treatments to treatment as usual and to other treatment options for BPD patients. Trial registration: The data on this paper came from two trials: NTR2175and NTR2292