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]

A fundamental limit for integrated atom optics with Bose-Einstein condensates

The dynamical response of an atomic Bose-Einstein condensate manipulated by an integrated atom optics device such as a microtrap or a microfabricated waveguide is studied. We show that when the miniaturization of the device enforces a sufficiently high condensate density, three-body interactions lead to a spatial modulational instability that results in a fundamental limit on the coherent manipulation of Bose-Einstein condensates.Comment: 6 pages, 3 figure

Day hospital versus intensive outpatient mentalization-based treatment:3-year follow-up of patients treated for borderline personality disorder in a multicentre randomized clinical trial

Abstract Background Two types of mentalization-based treatment (MBT), day hospital MBT (MBT-DH) and intensive outpatient MBT (MBT-IOP), have been shown to be effective in treating patients with borderline personality disorder (BPD). This study evaluated trajectories of change in a multi-site trial of MBT-DH and MBT-IOP at 36 months after the start of treatment. Methods All 114 patients (MBT-DH n = 70, MBT-IOP n = 44) from the original multicentre trial were assessed at 24, 30 and 36 months after the start of treatment. The primary outcome was symptom severity measured with the Brief Symptom Inventory. Secondary outcome measures included borderline symptomatology, personality and interpersonal functioning, quality of life and self-harm. Data were analysed using multilevel modelling and the intention-to-treat principle. Results Patients in both MBT-DH and MBT-IOP maintained the substantial improvements made during the intensive treatment phase and showed further gains during follow-up. Across both conditions, 83% of patients improved in terms of symptom severity, and 97% improved on borderline symptomatology. No significant differences were found between MBT-DH and MBT-IOP at 36 months after the start of treatment. However, trajectories of change were different. Whereas patients in MBT-DH showed greater improvement during the intensive treatment phase, patients in MBT-IOP showed greater continuing improvement during follow-up. Conclusions Patients in both conditions showed similar large improvements over the course of 36 months, despite large differences in treatment intensity. MBT-DH and MBT-IOP were associated with different trajectories of change. Cost-effectiveness considerations and predictors of differential treatment outcome may further inform optimal treatment selection

Pain is a risk factor for common mental disorders. Results from the Netherlands Mental Health Survey and Incidence Study-2: a longitudinal, population-based study

Pain might be an important risk factor for common mental disorders. Insight into the longitudinal association between pain and common mental disorders in the general adult population could help improve prevention and treatment strategies. Data were used from the first 2 waves of the Netherlands Mental Health Survey and Incidence Study-2, a psychiatric epidemiological cohort study among the Dutch general population aged 18 to 64 years at baseline (N = 5303). Persons without a mental disorder 12 months before baseline were selected as the at-risk group (n = 4974 for any mood disorder; n = 4979 for any anxiety disorder; and n = 5073 for any substance use disorder). Pain severity and interference due to pain in the past month were measured at baseline using the Short Form Health Survey. DSM-IV mental disorders were assessed at both waves using the Composite International Diagnostic Interview version 3.0. Moderate to very severe pain was associated with a higher risk of mood (odds ratio [OR] = 2.10, 95% confidence interval [CI] = 1.33-3.29) or anxiety disorders (OR = 2.12, 95% CI = 1.27-3.55). Moderate to very severe interference due to pain was also associated with a higher risk of mood (OR = 2.14, 95% CI = 1.30-3.54) or anxiety disorders (OR = 1.92, 95% CI = 1.05-3.52). Pain was not significantly associated with substance use disorders. No interaction effects were found between pain severity or interference due to pain and a previous history of mental disorders. Moderate to severe pain and interference due to pain are strong risk factors for first-incident or recurrent mood and anxiety disorders, independent of other mental disorders. Pain management programs could therefore possibly also serve as a preventative program for mental disorders

Effect of Terbinafine on the Pharmacokinetics of Cyclosporin in Humans

Cyclosporin is largely metabolized by hepatic cytochrome P450 enzymes, and azole drugs that inhibit cytochrome P450 may precipitate cyclosporin toxicity. The allylamine terbinafine binds to a small subfraction of hepatic cytochrome P450 in type I fashion, and has no effect upon hepatic metabolism of cyclosporin in vitro. The purpose of this study was to determine whether oral terbinafine alters the pharmacokinetics of oral cyclosporin in vivo.Twenty male volunteers (age 19–44 years), were randomly allocated to two groups. The first group received three single oral doses of cyclosporin 300mg at intervals of 21 d. The second and third doses of cyclosporin were preceded by a 6-d course of oral terbinafine 250mg each morning. A further 250mg of terbinafine was taken with the second and third doses of cyclosporin. Blood levels of cyclosporin and terbinafine were monitored for 36h after each dose. The second group received a 7-d course of terbinafine 250mg each morning. On the seventh day a single dose of cyclosporin 300mg was taken together with the terbinafine. Blood levels of both cyclosporin and terbinafine were monitored for 36kh. Two further single doses of cyclosporin 300mg were given at intervals of 2 weeks and the cyclosporin levels again monitored. In both groups each cyclosporin dose was preceded by an 8-h fast.The mean peak blood concentration of cyclosporin when taken alone was 958 μg/I, and 822 when taken with terbinafine. The mean area under the curve for cyclosporin was 4207 μg/l/h when taken alone and 3665 when taken with terbinafine. The mean absorption half-life for cyclosporin when taken alone was 0.29 h, and 0.33 when taken with terbinafine. The mean time of maximum concentration and elimination half-life of cyclosporin were unaltered by terbinafine. The results suggest that terbinafine is likely to prove a safe systemic anti-fungal treatment for patients who are taking cyclosporin

Preventive cognitive therapy versus treatment as usual in preventing recurrence of depression:Protocol of a multi-centered randomized controlled trial

Background Major depressive disorder (MDD) is projected to rank second on a list of 15 major diseases in terms of burden in 2030. The contribution of MDD to disability and health care costs is largely due to its highly recurrent nature. Therefore, part of the efforts to reduce the disabling effects of depression should focus on preventing recurrence, especially in patients at high risk of recurrence. The best established effective psychological intervention is cognitive therapy, with indications for prophylactic effects after remission. Methods/Design In this randomized controlled trial (cost-) effectiveness of Preventive Cognitive Therapy (PCT) after response to Acute Cognitive Therapy (A-CT) will be evaluated in comparison with Treatment As Usual (TAU). Remitted patients that responded to A-CT treatment with at least two previous depressive episodes will be recruited. Randomization will be stratified for number of previous episodes. Follow-ups are at 3, 6, 12 and 15 months. The primary outcome measure will be the time to relapse or recurrence of depression meeting DSM-IV criteria for a major depressive episode on the Structured Clinical Interview for DSM-VI Axis I Disorders (SCID-I). Costs will be measured from a societal perspective. Discussion This study is the first to examine the addition of PCT to TAU, compared to TAU alone in patients that recovered from depressive disorder with A-CT. Alongside this effect study a cost effectiveness analysis will be conducted. Furthermore, the study explores potential moderators to examine what works for whom. Trial registration Netherlands Trial Register (NTR): 2599, date of registration: 11-11-2010. Keywords Depression Relapse Recurrence Cognitive Therapy Preventio

Weed Seed Bank Emergence across the Corn Belt

Field experiments, conducted from 1991 to 1994, generated information on weed seedbank emergence for 22 site-years from Ohio to Colorado and Minnesota to Missouri. Early spring seedbank densities were estimated through direct extraction of viable seeds from soil cores. Emerged seedlings were recorded periodically, as were daily values for air and soil temperature, and precipitation. Percentages of weed seedbanks that emerged as seedlings were calculated from seedbank and seedling data for each species, and relationships between seedbank emergence and microclimatic variables were sought. Fifteen species were found in 3 or more site-years. Average emergence percentages (and coefficients of variation) of these species were as follows: giant foxtail, 31.2 (84%); velvetleaf, 28.2 (66); kochia, 25.7 (79); Pennsylvania smartweed, 25.1 (65); common purslane, 15.4 (135); common ragweed, 15.0 (110); green foxtail, 8.5 (72); wild proso millet, 6.6 (104); hairy nightshade, 5.2 (62); common sunflower, 5.0 (26); yellow foxtail, 3.4 (67); pigweed species, 3.3 (103); common lambsquarters, 2.7 (111); wild buckwheat, 2.5 (63), and prostrate knotweed, 0.6 (79). Variation among site-years, for some species, could be attributed to microclimate variables thought to induce secondary dormancy in spring. For example, total seasonal emergence percentage of giant foxtail was related positively to the 1st date at which average daily soil temperature at 5 to 10 cm soil depth reached 16 C. Thus, if soil warmed before mid April, secondary dormancy was induced and few seedlings emerged, whereas many seedlings emerged if soil remained cool until June

Weed Seed Bank Emergence across the Corn Belt

Field experiments, conducted from 1991 to 1994, generated information on weed seedbank emergence for 22 site-years from Ohio to Colorado and Minnesota to Missouri. Early spring seedbank densities were estimated through direct extraction of viable seeds from soil cores. Emerged seedlings were recorded periodically, as were daily values for air and soil temperature, and precipitation. Percentages of weed seedbanks that emerged as seedlings were calculated from seedbank and seedling data for each species, and relationships between seedbank emergence and microclimatic variables were sought. Fifteen species were found in 3 or more site-years. Average emergence percentages (and coefficients of variation) of these species were as follows: giant foxtail, 31.2 (84%); velvetleaf, 28.2 (66); kochia, 25.7 (79); Pennsylvania smartweed, 25.1 (65); common purslane, 15.4 (135); common ragweed, 15.0 (110); green foxtail, 8.5 (72); wild proso millet, 6.6 (104); hairy nightshade, 5.2 (62); common sunflower, 5.0 (26); yellow foxtail, 3.4 (67); pigweed species, 3.3 (103); common lambsquarters, 2.7 (111); wild buckwheat, 2.5 (63), and prostrate knotweed, 0.6 (79). Variation among site-years, for some species, could be attributed to microclimate variables thought to induce secondary dormancy in spring. For example, total seasonal emergence percentage of giant foxtail was related positively to the 1st date at which average daily soil temperature at 5 to 10 cm soil depth reached 16 C. Thus, if soil warmed before mid April, secondary dormancy was induced and few seedlings emerged, whereas many seedlings emerged if soil remained cool until June

Treatment of chronically depressed patients: A multisite randomized controlled trial testing the effectiveness of \u27Cognitive Behavioral Analysis System of Psychotherapy\u27 (CBASP) for chronic depressions versus usual secondary care

Background \u27Cognitive Behavioral Analysis System of Psychotherapy\u27 (CBASP) is a form of psychotherapy specifically developed for patients with chronic depression. In a study in the U.S., remarkable favorable effects of CBASP have been demonstrated. However, no other studies have as yet replicated these findings and CBASP has not been tested outside the United States. This protocol describes a randomized controlled trial on the effectiveness of CBASP in the Netherlands. Methods/Design The purpose of the present paper is to report the study protocol of a multisite randomized controlled trial testing the effectiveness of \u27Cognitive Behavioral Analysis System of Psychotherapy\u27 (CBASP) for chronic depression in the Netherlands. In this study, CBASP in combination with medication, will be tested versus usual secondary care in combination with medication. The aim is to recruit 160 patients from three mental health care organizations. Depressive symptoms will be assessed at baseline, after 8 weeks, 16 weeks, 32 weeks and 52 weeks, using the 28-item Inventory for Depressive Symptomatology (IDS). Effect modification by co morbid anxiety, alcohol consumption, general and social functioning and working alliance will be tested. GEE analyses of covariance, controlling for baseline value and center will be used to estimate the overall treatment effectiveness (difference in IDS score) at post-treatment and follow up. The primary analysis will be by \u27intention to treat\u27 using double sided tests. An economic analysis will compare the two groups in terms of mean costs and cost-effectiveness from a societal perspective. Discussion The study will provide an answer to the question whether the favorable effects of CBASP can be replicated outside the US. Trial Registration The Dutch Cochrane Center, NTR1090

Economic evaluation of day hospital versus intensive outpatient mentalization-based treatment alongside a randomized controlled trial with 36-month follow-up

Mentalization-based treatment (MBT) has demonstrated robust effectiveness in the treatment of borderline personality disorder (BPD) in both day hospital (MBT-DH) and intensive outpatient MBT (MBT-IOP) programs. Given the large differences in intensity and associated treatment costs, there is a need for studies comparing their cost-effectiveness. A health economic evaluation of MBT-DH versus MBT-IOP was performed alongside a multicenter randomized controlled trial with a 36-month follow-up. In three mental health-care institutions in the Netherlands, 114 patients were randomly allocated to MBT-DH (n = 70) or MBT-IOP (n = 44) and assessed every 6 months. Societal costs were compared with quality-adjusted life years (QALYs) gained and the number of months in remission over 36 months. The QALY gains over 36 months were 1.96 (SD = 0.58) for MBT-DH and 1.83 (SD = 0.56) for MBT-IOP; the respective number of months in remission were 16.0 (SD = 11.5) and 11.1 (SD = 10.7). Societal costs were €106,038 for MBT-DH and €91,368 for MBT-IOP. The incremental cost for one additional QALY with MBT-DH compared with MBT-IOP was €107,000. The incremental cost for 1 month in remission was almost €3000. Assuming a willingness-to-pay threshold of €50,000 for a QALY, there was a 33% likelihood that MBT-DH is more cost-effective than MBT-IOP in terms of costs per QALY. Although MBT-DH leads to slightly more QALYs and remission months, it is probably not cost-effective when compared with MBT-IOP for BPD patients, as the small additional health benefits in MBT-DH did not outweigh the substantially higher societal costs