Late-life depression : issues for the general practitioner

Late-life depression (LLD) is both a prevalent and life-threatening disorder, affecting up to 13.3% of the elderly population. LLD can be difficult to identify because patients mainly consult their general practitioner (GP) for somatic complaints. Moreover, patients may be hesitant to express the problem to their GP. Increased vigilance on the part of the GP can only benefit older people with depression. To recognize the risk of LLD, screening tools are provided in addition to treatment options for LLD. This review aims to provide the GP with guidance in recognizing and treating LLD. It tries to connect mainstream etiologies of LLD (e.g., vascular, inflammation, hypothalamo-pituitary-adrenal axis) with risk factors and current therapies. Therefore, we provide a basis to the GP for decision-making when choosing an appropriate therapy for LLD

Is twice daily LF-rTMS a viable treatment option for treatment-resistant OCD? Results from an open-label feasibility study

Several reports point to the beneficial effects of repetitive transcranial magnetic stimulation (rTMS) in the treatment of resistant obsessive-compulsive disorder (OCD). This study aimed to evaluate the safety and efficacy of rTMS targeting the dmPFC in the treatment of treatment-resistant OCD patients.Twelve patients received 20 sessions of low-frequency (LF) rTMS (1 Hz, 1200 pulses) in a twice daily protocol during 10 weekdays. Y-BOCS and IDS scores modestly but significantly decreased after treatment and at follow-up and HADS anxiety improved at follow-up. LF rTMS may improve OCD, anxiety, and depressive symptoms in treatment-resistant OCD and was a safe and well-tolerated treatment

How are OCD Patients and Family Members Dealing with the Waxing and Waning Pattern of the COVID-19 Pandemic? Results of a Longitudinal Observational Study

The current study aimed to investigate the impact of the COVID-19 pandemic on the mental health of people with OCD and the degree of family accommodation (FA) by live-in family members across phases of the lockdown measures imposed by the Belgian government. Forty-nine OCD patients and 26 live-in family members participated in the study. We assessed OCD symptom severity and FA of the live-in family members, as well as depressive symptoms, anxiety and stress levels and COVID-19 related psychological distress of patients and family members at four different timepoints: one month after the start of the lockdown (T(1)), during the gradual relaxation (T(2)), between the two waves (T(3)) and during the second wave (T(4)). Results showed that although COVID-19 related stress increased and decreased in accordance with the waxing and waning pattern of the pandemic, OCD symptoms showed an initial slight increase followed by a decrease at T(3) and again at T(4). Changes in family members’ accommodation of symptoms followed the same course as the OCD symptoms. Furthermore, OCD symptoms correlated with depressive symptoms, anxiety and stress levels and COVID-19 related distress at all timepoints. It is important to involve family members in the treatment of OCD even during a pandemic. Clinicians should also pay attention to symptoms of depression, anxiety and stress during OCD treatment. Further research is necessary to entangle the causal relationship between OCD symptoms, FA and symptoms of depression, anxiety and stress

Cognitive remediation following electroconvulsive therapy in patients with treatment resistant depression : randomized controlled trail of an intervention for relapse prevention : study protocol

Background: Major depressive episode (MDE) is worldwide one of the most prevalent and disabling mental health conditions. In cases of persistent non-response to treatment, electroconvulsive therapy (ECT) is a safe and effective treatment strategy with high response rates. Unfortunately, longitudinal data show low sustained response rates with 6-month relapse rates as high as 50% using existing relapse prevention strategies. Cognitive side effects of ECT, even though transient, might trigger mechanisms that increase relapse in patients who initially responded to ECT. Among these side effects, reduced cognitive control is an important neurobiological driven vulnerability factor for depression. As such, cognitive control training (CCT) holds promise as a non-pharmacological strategy to improve long-term effects of ECT (i.e., increase remission, and reduce depression relapse). Method/design: Eighty-eight patients aged between 18 and 70 years with MDE who start CCT will be included in this randomized controlled trial (RCT). Following (partial) response to ECT treatment (at least a 25% reduction of clinical symptoms), patients will be randomly assigned to a computer based CCT or active placebo control. A first aim of this RCT is to assess the effects of CCT compared to an active placebo condition on depression symptomatology, cognitive complaints, and quality of life. Secondly, we will monitor patients every 2 weeks for a period of 6 months following CCT/active placebo, allowing the detection of potential relapse of depression. Thirdly, we will assess patient evaluation of the addition of cognitive remediation to ECT using qualitative interview methods (satisfaction, acceptability and appropriateness). Finally, in order to further advance our understanding of the mechanisms underlying effects of CCT, exploratory analyses will be conducted using video footage collected during the CCT/active control phase of the study. Discussion: Cognitive remediation will be performed following response to ECT, and an extensive follow-up period will be employed. Positive findings would not only benefit patients by decreasing relapse, but also by increasing acceptability of ECT, reducing the burden of cognitive side-effects

Obsessieve-compulsieve stoornis : praktische handvatten voor de huisarts

Obsessive-compulsive disorder (OCD) is a relatively prevalent complex psychiatricdisorder associated with signi"cant impairment and distress. OCD remains oftenundetected because of the reluctance of patients to discuss their symptoms and the lackof recognizing OCD symptoms by the physicians. #e general practitioner (GP) should be able to recognize OCD symptoms since achronic course is associated with poor prognosis. #e GP has a key role to play in therecognition, diagnosis, treatment and referral of patients with OCD. An early detectionin all patients at higher risk of OCD provides timely access to evidence-based therapies.Psychoeducation about the disorder is an important step for improving recovery.Treatment of choice is cognitive behavioral therapy with exposure and responseprevention combined with or without a selective serotonin reuptake inhibitor (SSRI).#e required medication doses are often higher and duration to response longer thanthose for depression. In- and exclusion criteria for deep brain stimulation (DBS) arecarefully de"ned in Belgium by the committee peer review OCD for therapy refractoryOCD. #e GP has also a critical role in the follow-up of patients with OCD over time bymonitoring the relapse risk, therapy compliance and side e$ects of the medication

SSRI'S en suïcide bij kinderen, adolescenten en jongvolwassenen

BACKGROUND: There is considerable controversy about the possible link between suicidal behaviour and antidepressants. Since ethical and methodological problems prevent direct research, discussion has to draw largely on indirect evidence. AIM: To review randomised controlled trials (rcts), observational studies, ecological studies and recommendations of the Food and Drug Administration (fda) regarding the risk of suicidality linked to the use of ssris. METHOD: We summarised and reviewed critically the literature on suicidality and ssris via the PubMed database up till March 2008. RESULTS: Various analyses, most of which were meta-analyses, showed that in adults ssris increase the risk of suicidal ideation and suicide attempts. However, neither observational studies nor the findings of the fda gave any indication of an increased risk of suicide in adults being treated with ssris. On the other hand, if patients were on antidepressants, the younger they were, the greater was the risk of suicidal thoughts or suicide attempts. Children, adolescents and young adults who were on ssris ran an increased risk of suicidal ideation and suicide attempts. One observational study did not show this association. CONCLUSION: Treatment with ssris does not increase the risk of suicide in adults, but it is difficult to make a firm pronouncement about the effect of ssris on suicidal behaviour (ideation and suicide attempts). However, in children, adolescents and young adults being treated with ssris, there is an increased risk of attempted suicide

Excoriatiestoornis in de klinische praktijk

Excoriatiestoornis (skin picking disorder; SPD) is een aandoening die sinds de DSM-5 in de classificatie van psychische stoornissen werd opgenomen. Ondanks een prevalentie van 1,4 tot 5,7% in de algemene populatie, is dit onder dermatologen en psychiaters een weinig bekende aandoening. We beschrijven de casus van een man die ten gevolge van een ernstige vorm van SPD alle bovenste snij- en hoektanden verloor. We geven een overzicht van de behandelmogelijkheden en roepen op tot een verhoogde aandacht voor deze aandoenin

Multi‐family therapy for adult outpatients with obsessive‐compulsive disorder and their family members, targeting family accommodation

This paper describes a multi-family therapy (MFT) group for adult outpatients with obsessive-compulsive disorder and their family members. Since family accommodation (FA) is known to maintain OCD symptoms by preventing exposure and response prevention (ERP), reduction of FA is a major focus of the treatment. Furthermore, psychoeducation, conjoint ERP and (re)discovering resources and strengths of families are also important therapeutic foci of the family group. The organisation of MFT is explained and involvement of family is illustrated with clinical vignettes. Finally, some reflections about MFT are provided. On the basis of initial clinical impressions, MFT seems a promising approach. A clinical trial is currently underway