Epidemiology of late life depression : longitudinal findings from the Amsterdam Study of the Elderly

Beekman, A.T.F. [Promotor]Tilburg, W. van [Promotor]Deeg, D.J.H. [Copromotor

Erfelijkheid en omgevingsinvloeden bij psychiatrische stoornissen

BACKGROUND: In recent years quantitative genetic research has addressed all the major psychiatric disorders. In order to interpret the results of this type of research one needs to be aware of its potential and its limitations. AIM: To discuss the basic concepts and the main results of quantitative genetic research and to consider how this can help us to better understand the aetiology of psychiatric disorders. METHODS: Using Medline (1990-February 2006) we reviewed the literature on the subject of quantitative genetic and psychiatric disorders. In addition we studied the standard books on the subject. RESULTS: A fairly large number of psychiatric disorders, namely about 30 to 85%, can be inherited. In addition, the non-shared environment has a considerable influence on the phenotype. The influence of the shared environment seems to have only a limited influence or it is totally absent. The results of quantitative genetic research are specific to a particular time or environment and therefore may not be applicable to other populations. There may be a correlation or interaction between genetic factors and the environment while the phenotype is being formed. However, because of the analytical methods used, this is only partly visible in the results. CONCLUSION: Quantitative genetic research has made an impressive contribution to our knowledge about the heritability of psychiatric disorders. By definition quantitative genetic research always provides information about environmental influences

Verandering in crisisinterventie en acute psychiatrie: Amsterdamse consulten in 1983 en 2005.

achtergrond Sinds 1992 stijgt het aantal inbewaringstellingen (ibs'en) in Nederland opvallend. In Amsterdam is er zelfs sprake van een verdrievoudiging. Psychiatrische behandeling in de Amsterdamse klinieken dreigt gedomineerd te worden door dwang. doel Een beeld krijgen van de veranderingen in de acute psychiatrie die hebben bijgedragen aan de stijging van het aantal dwangopnames met ibs. methode Vergelijken van een cohort (n = 460) consulten verricht door de stedelijke crisisdienst in 1983 met een cohort (n = 436) consulten verricht in 2004-2005 op de volgende variabelen: werkwijze van de crisisdienst, kenmerken van de patiënten, diagnose en uitkomst van de consulten. resultaten Vergeleken met 1983 waren er in 2004-2005 meer diensten betrokken bij psychiatrische patiënten in acute situaties in het publieke domein. Het aantal patiënten dat via de politie kwam, verdubbelde. De consulten, die in 1983 uitsluitend werden gedaan op de plek waar de patiënt verbleef, werden in 2004-2005 voor 60% op het bureau van de dienst gedaan. Het aantal patiënten met een psychose in de cohort nam toe van 52,0 naar 63,3%. Er was een toename van ibs opnames (van 16,7 naar 20,0% van de interventies) en een scherpe daling van vrijwillige opnames (van 25,7 naar 7,6%). Het totale aantal opnames na een consult daalde van 42 naar 28%. conclusie De outreachende dienst met een eerstelijnskarakter van 1983 is veranderd in een gespecialiseerde psychiatrische ehbo met een bescheiden outreachende functie. De vrijwillige opname is vrijwel verdwenen bij de crisisdienst. Nader onderzoek naar de kenmerken van de consulten en naar de variabelen die een rol spelen bij het toepassen van dwang is noodzakelijk

Bridging the gap between complexity science and clinical practice by formalizing idiographic theories: a computational model of functional analysis

Background: The past decades of research have seen an increase in statistical tools to explore the complex dynamics of mental health from patient data, yet the application of these tools in clinical practice remains uncommon. This is surprising, given that clinical reasoning, e.g., case conceptualizations, largely coincides with the dynamical system approach. We argue that the gap between statistical tools and clinical practice can partly be explained by the fact that current estimation techniques disregard theoretical and practical considerations relevant to psychotherapy. To address this issue, we propose that case conceptualizations should be formalized. We illustrate this approach by introducing a computational model of functional analysis, a framework commonly used by practitioners to formulate case conceptualizations and design patient-tailored treatment. Methods: We outline the general approach of formalizing idiographic theories, drawing on the example of a functional analysis for a patient suffering from panic disorder. We specified the system using a series of differential equations and simulated different scenarios; first, we simulated data without intervening in the system to examine the effects of avoidant coping on the development of panic symptomatic. Second, we formalized two interventions commonly used in cognitive behavioral therapy (CBT; exposure and cognitive reappraisal) and subsequently simulated their effects on the system. Results: The first simulation showed that the specified system could recover several aspects of the phenomenon (panic disorder), however, also showed some incongruency with the nature of panic attacks (e.g., rapid decreases were not observed). The second simulation study illustrated differential effects of CBT interventions for this patient. All tested interventions could decrease panic levels in the system. Conclusions: Formalizing idiographic theories is promising in bridging the gap between complexity science and clinical practice and can help foster more rigorous scientific practices in psychotherapy, through enhancing theory development. More precise case conceptualizations could potentially improve intervention planning and treatment outcomes. We discuss applications in psychotherapy and future directions, amongst others barriers for systematic theory evaluation and extending the framework to incorporate interactions between individual systems, relevant for modeling social learning processes. With this report, we hope to stimulate future efforts in formalizing clinical frameworks

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

Impact of loneliness and depression on mortality: Results from the Longitudinal Ageing Study Amsterdam

Background Loneliness is highly prevalent among older people, has serious health consequences and is an important predictor of mortality. Loneliness and depression may unfavourably interact with each other over time but data on this topic are scarce. Aims To determine whether loneliness is associated with excess mortality after 19 years of follow-up and whether the joint effect with depression confers further excess mortality. Method Different aspects of loneliness were measured with the De Jong Gierveld scale and depression with the Centre for Epidemiologic Studies Depression Scale in a cohort of 2878 people aged 55-85 with 19 years of follow-up. Excess mortality hypotheses were tested with Kaplan-Meier and Cox proportional hazard analyses controlling for potential confounders. Results At follow-up loneliness and depression were associated with excess mortality in older men and women in bivariate analysis but not in multivariate analysis. In multivariate analysis, severe depression was associated with excess mortality in men who were lonely but not in women. Conclusions Loneliness and depression are important predictors of early death in older adults. Severe depression has a strong association with excess mortality in older men who were lonely, indicating a lethal combination in this group