The relationship between generalized anxiety disorder, depression and mortality in old age.

after adjustment for the different variables. Conclusions In elderly persons depression increases the risk of death in men. Neither generalized anxiety nor mixed anxiety-depression are associated with excess mortality. Generalized anxiety disorder may even predict less mortality in depressive elderly people. The relation between generalized anxiety disorder and its possibly protective effect on mortality has to be further explored

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]

Морфологічні аспекти реакції тиротропів аденогіповіза, як наслідок хронічної інтоксикації малими дозами пестициду 2,4 Д

В работе представлены результаты исследований структурно-функциональных изменений тиротропных клеток аденогипофиза в условиях пестицидной интоксикации различной длительности.In this work we prove the presente the results of structural estimation of the functional state of the adenohypophysis in different periods of pesticide intoxication increase

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

Design of the Lifestyle Interventions for severe mentally ill Outpatients in the Netherlands (LION) trial; a cluster randomised controlled study of a multidimensional web tool intervention to improve cardiometabolic health in patients with severe mental illness

Background: The cardiometabolic health of persons with a severe mental illness (SMI) is alarming with obesity rates of 45-55% and diabetes type 2 rates of 10-15%. Unhealthy lifestyle behaviours play a large role in this. Despite the multidisciplinary guideline for SMI patients recommending to monitor and address patients' lifestyle, most mental health care professionals have limited lifestyle-related knowledge and skills, and (lifestyle) treatment protocols are lacking. Evidence-based practical lifestyle tools may support both patients and staff in improving patients' lifestyle. This paper describes the Lifestyle Interventions for severe mentally ill Outpatients in the Netherlands (LION) trial, to investigate whether a multidimensional lifestyle intervention using a web tool can be effective in improving cardiometabolic health in SMI patients. Methods/Design: The LION study is a 12-month pragmatic single-blind multi-site cluster randomised controlled trial. 21 Flexible Assertive Community Treatment (ACT) teams and eight sheltered living teams of five mental health organizations in the Netherlands are invited to participate. Per team, nurses are trained in motivational interviewing and use of the multidimensional web tool, covering lifestyle behaviour awareness, lifestyle knowledge, motivation and goal setting. Nurses coach patients to change their lifestyle using the web tool, motivational interviewing and stages-of-change techniques during biweekly sessions in a) assessing current lifestyle behaviour using the traffic light method (healthy behaviours colour green, unhealthy behaviours colour red), b) creating a lifestyle plan with maximum three attainable lifestyle goals and c) discussing the lifestyle plan regularly. The study population is SMI patients and statistical inference is on patient level using multilevel analyses. Primary outcome is waist circumference and other cardiometabolic risk factors after six and twelve months intervention, which are measured as part of routine outcome monitoring using standard protocols. Secondary outcomes include depressive and negative symptoms, cost-effectiveness, and barriers and facilitators in intervention implementation. Discussion: Adequate health care should target both mental health and lifestyle behaviours in SMI patients. This trial contributes by studying a 12-month multidimensional lifestyle intervention as a potential evidence based (nursing) tool for targeting multiple lifestyle behaviours in SMI patients

Risk of criminal victimisation in outpatients with common mental health disorders

Crime victimisation is a serious problem in psychiatric patients. However, research has focused on patients with severe mental illness and few studies exist that address victimisation in other outpatient groups, such as patients with depression. Due to large differences in methodology of the studies that address crime victimisation, a comparison of prevalence between psychiatric diagnostic groups is hard to make. Objectives of this study were to determine and compare one-year prevalence of violent and non-violent criminal victimisation among outpatients from different diagnostic psychiatric groups and to examine prevalence differences with the general population.Criminal victimisation prevalence was measured in 300 outpatients living in Amsterdam, The Netherlands. Face-to-face interviews were conducted with outpatients with depressive disorder (n = 102), substance use disorder (SUD, n = 106) and severe mental illness (SMI, n = 92) using a National Crime Victimisation Survey, and compared with a matched general population sample (n = 10865).Of all outpatients, 61% reported experiencing some kind of victimisation over the past year; 33% reported violent victimisation (3.5 times more than the general population) and 36% reported property crimes (1.2 times more than the general population). Outpatients with depression (67%) and SUD (76%) were victimised more often than SMI outpatients (39%). Younger age and hostile behaviour were associated with violent victimisation, while being male and living alone were associated with non-violent victimisation. Moreover, SUD was associated with both violent and non-violent victimisation.Outpatients with depression, SUD, and SMI are at increased risk of victimisation compared to the general population. Furthermore, our results indicate that victimisation of violent and non-violent crimes is more common in outpatients with depression and SUD than in outpatients with SMI living independently in the community

Relative efficacy of psychotherapy and pharmacotherapy in the treatment of depression; a meta-analysis,

Abstract We investigated the efficacy of pharmacotherapy and psychotherapy for depression by searching for RCT's. Studies were classified according to chronicity and severity and a meta-analysis was applied. Ten studies were included. Remission did not differ between psychotherapy (38%) and pharmacotherapy (35%). No differences were found in chronic, or in non-chronic depression, and in mild or in moderate depression. Both treatments performed better in mild than in moderate depression. Dropout was larger in pharmacotherapy (28%) than in psychotherapy (24%). At follow-up relapse in pharmacotherapy (57%) was higher than in psychotherapy (27%). Psychotherapy and pharmacotherapy appear equally efficacious in depression. Both treatments have larger effects in mild than in moderate depression, but similar effects in chronic and non-chronic depression and at follow-up psychotherapy outperforms pharmacotherapy