Accelerated intermittent theta burst stimulation for suicide risk in therapy-resistant depressed patients : a randomized, sham-controlled trial

Objectives: We aimed to examine the effects and safety of accelerated intermittent Theta Burst Stimulation (iTBS) on suicide risk in a group of treatment-resistant unipolar depressed patients, using an extensive suicide assessment scale. Methods: In 50 therapy-resistant, antidepressant-free depressed patients, an intensive protocol of accelerated iTBS was applied over the left dorsolateral prefrontal cortex (DLPFC) in a randomized, sham-controlled crossover design. Patients received 20 iTBS sessions over 4 days. Suicide risk was assessed using the Beck Scale of Suicide ideation (BSI). Results: The iTBS protocol was safe and well tolerated. We observed a significant decrease of the BSI score over time, unrelated to active or sham stimulation and unrelated to depression-response. No worsening of suicidal ideation was observed. The effects of accelerated iTBS on mood and depression severity are reported in Duprat et al. (2016). The decrease in suicide risk lasted up to 1 month after baseline, even in depression non-responders. Conclusions: This accelerated iTBS protocol was safe. The observed significant decrease in suicide risk was unrelated to active or sham stimulation and unrelated to depression response. Further sham-controlled research in suicidal depressed patients is necessary. (Clinicaltrials.gov identifier: NCT01832805)

Denken anorexia nervosa patiënten anders?: resultaten uit neuropsychologisch onderzoek

Recente onderzoeksbevindingen suggereren dat het neuropsychologisch functioneren van personen met anorexia nervosa (AN) enkele specifieke kenmerken vertoont, kenmerken die trekgebonden en niet louter toestandsgebonden blijken te zijn. De dysfuncties waar in recent neuropsychologisch onderzoek bij AN veel aandacht voor is, zijn de zwakke centrale coherentie en de verminderde mentale flexibiliteit. Een zwakke centrale coherentie betekent concreet een superieure detailverwerking gecombineerd met een verminderde globale informatieverwerking, een cognitieve stijl die in zowel klinische settings als onderzoekssettings wordt bevestigd. De verminderde mentale flexibiliteit (of set shifting) houdt in dat de inhibitie van een stimulus-respons associatie en een verschuiving naar een nieuw gedefinieerde associatie bemoeilijkt wordt. Ook deze rigiditeit wordt herkend in de klinische praktijk. In de mededeling worden deze recente neuropsychologische onderzoeksresultaten toegelicht en samengebracht met eigen onderzoeksbevindingen. Op basis van data uit de eigen onderzoeksgroep wordt de relatie van deze cognitieve variabelen met klinische en persoonlijkheidsvariabelen besproken. Ten slotte worden op basis van de onderzoeksresultaten suggesties gedaan voor de klinische praktijk in het algemeen en de behandeling van AN in het bijzonder

Are there differences in central coherence and set shifting across the subtypes of anorexia nervosa?: a systematic review

Anorexia nervosa (AN) has been associated with weaknesses in central coherence and set shifting. In this line, it has been proposed to directly address these neuropsychological features in treatment (e.g., cognitive remediation therapy). It is not clear, however, whether the 2 subtypes of AN, the restricting (AN-R) and bingeing/purging (AN-BP) type, have the same amount of problems in these domains. A systematic search of the literature was conducted, using the databases Web of Science and PubMed, looking for studies on the comparison of AN-R and AN-BP in performing central coherence/set-shifting tasks. Notably, very few authors describe the results of a direct comparison of the performance of patients with AN-R and AN-BP. In summary, the available indications for possible group differences are not strong enough to draw definitive conclusions

Informatieverwerking bij anorexia nervosa: is ze verstoord?

Anorexia nervosa (AN) is a major health problem with an unfavourable prognosis. More than half of AN patients struggle with chronic problems, desspite treatment. The identification of endophenotypes, such as information processing biases, may contribute to a better understanding of the disease and to the development of a tailor-made treatment. AN is found to be associated with a cognitive style characterised by a reduced mental flexibility, a weak central coherence and a selective attentional bias for disease relevant information. These deficits are found in AN and bulimia nervosa, as well as in recovered eating disorder patients and healthy relatives. The management of neuropsychological problems is not the primary focus of most current therapeutic approaches for AN. However, preliminary research findings suggest that purposeful cognitive training may influence the cognitive functioning in AN. In this article, results of neuropsychological research are summarised and implications for clinical practice discussed as well as preliminary findings about the effectiveness of cognitive remediation therapy

Suïcidaal gedrag: epidemiologie en risicofactoren

Uit epidemiologische studies blijkt dat zelfdoding een belangrijke doodsoorzaak is bij jongeren en volwassenen in Vlaanderen en dat de Vlaamse incidentie van suïcidaal gedrag hoog is. Conform de internationale gegevens is er ook in Vlaanderen sprake van een ‘ontgrijzende’ trend waarbij de hoge suïcidecijfers bij oudere mannen aan het dalen zijn. Dit neemt echter niet weg dat oudere mannen een belangrijke risicogroep blijven voor zelfdoding. Naast ouderen is er evidentie voor een verhoogd risico op suïcidaal gedrag bij homoseksuelen, nabestaanden, patiënten die recentelijk ontslagen zijn na een psychiatrische opname en patiënten die eerder een suïcidepoging hebben ondernomen. De oorzaken en risicofactoren van suïcidaal gedrag kunnen aan de hand van het biopsychosociaal verklaringsmodel worden toegelicht. Dit model is gebaseerd op de empirische evidentie dat suïcidaal gedrag multifactorieel bepaald is door predispositie (biologische en psychologische ‘traits’) in combinatie met toestandsgebonden, tijdelijke stressoren (sociale en psychiatrische ‘states’) en drempelverlagende of uitlokkende factoren. De hoge suïcidecijfers in Vlaanderen hebben duidelijk gemaakt dat de preventie van suïcidaal gedrag noodzakelijk is. Vanuit de Vlaamse overheid is er dan ook werk gemaakt van een Vlaams actieplan ‘suïcidepreventie’ dat loopt van 2006 tot 2010, waarna geëvalueerd zal worden welke verdere preventiestrategieën toegepast moeten worden

The role of set shifting and central coherence in differentiating bingeing/purging and restrictive eating disorder subtypes

Objective : Eating disorders (ED) have been associated with dysfunctions in set shifting and central coherence. This association has been repeatedly confirmed with regard to anorexia nervosa (AN), while the evidence for bulimia nervosa (BN) remains inconclusive. A small amount of neuropsychological studies focuses on the distinction between AN and BN, whereas research about differences between restrictive ED and bingeing/purging ED is lacking. From personality research there is however growing evidence for the usefulness of this latter distinction. The aim of this study is to further investigate these dysfunctions across ED subtypes, with special attention to the differences between restrictive ED patients and bingeing/purging ED patients. We hypothesize that the first group will exhibit lower levels of set shifting ability and that central coherence will not discriminate both groups. In addition, we sought to examine the relationship with personality characteristics and clinical features. Methods : This ongoing study contains 41 inpatients (17 with AN restrictive type, 9 with AN bingeing/purging type and 15 with BN) and 19 healthy controls, until now. All participants individually complete a neuropsychological test battery including three measures of set shifting ability (a designed task-switching paradigm, the Wisconsin Card Sorting Test and the Trail Making Test), and two measures of central coherence (Picture Completion and Block Design). Personality-related characteristics are examined with the Temperament and Character Inventory; clinical characteristics are assessed using self report questionnaires, including the Beck Depression Inventory, the State-Trait Anxiety Inventory, and the Frost Multidimensional Perfectionism Scale. A General Linear Model repeated measures ANOVA is employed to test our major hypothesis. Results & Conclusions : Results will be presented and conclusions and implications for clinical practice and further research will be discussed

Are there differences in bingeing/purging and restrictive subtypes of anorexia nervosa on central coherence and set shifting?

Background: Anorexia nervosa (AN) has been associated with dysfunctions in central coherence (CC) and set shifting (SS). These associations have been repeatedly confirmed for the total group of AN, while eventual differences between the subtypes of AN (restrictive and bingeing/purging types) have not been profoundly investigated up to now. The aim of this study is to further examine this topic. We hypothesize that the restrictive AN patients will exhibit lower levels of performance than the bingeing/purging AN patients. In addition, we sought to examine the relationship between performance on CC/SS measures and clinical/demographical features. Methods: Sample: This study contains 83 participants: 31 with AN restrictive type (AN-R), 21 with AN bingeing/purging type (AN-BP) and 31 healthy controls (HC). Measures: All participants completed a neuropsychological test battery individually, including two measures of CC (Picture Completion and Block Design) and three measures of SS (a designed task-switching paradigm, the Wisconsin Card Sorting Test and the Trail Making Test). Clinical characteristics were assessed using self report questionnaires, including the Beck Depression Inventory, the State-Trait Anxiety Inventory, and the Frost Multidimensional Perfectionism Scale. Interviewing was used to gather demographical characteristics. Statistics: Groups were compared on neuropsychological functioning using one-way ANOVA’s with Tukey correction for multiple comparison. The Kruskal-Wallis statistic was employed when data were not normally distributed. Pearson’s correlations were used to investigate links with clinical and demographical variables. Results: Significant differences between the subtypes of AN were found on the two measures of CC, more precisely on Block Design (F(2)=16,14; p=.008) and Object Assembly (F(2)=5,79; p=.008). A worse performance was found for the AN-R patients compared to the results of the AN-BP patients, while these had comparable results with the HC subjects (with p>.05). These group differences persist, adding age as a covariate (F(1)=5,88; p=.019). On SS measures, no group differences could be demonstrated among clinical groups or with HC subjects. Age, current BMI, lowest BMI after the age of 16, education (in years) and level of depressive and anxiety symptoms were not correlated with performance on CC and SS measures (p>0.5). Conclusions: AN-R patients seem to differ from AN-BP patients on CC, with AN-R performing worse, while the AN-BP patients did not show a CC deficit. No deficit on SS was found for any AN subtype. These results support the idea that the two subtypes of AN need a different approach in cognitive remediation

Strategies for managing grief after suicide: a systematic review of controlled studies

Background. Bereavement trough suicide is potentially more difficult to cope with than through other causes due to an interaction of social and psychological factors. These include less social support, family disruption and specific themes, which makes suicide survivors more vulnerable for physical complaints and emotional problems, such as depression, anxiety, complicated grief and suicidal ideation. However, there is a paucity of studies of interventions to reduce maladaptive grief reactions and emotional problems after loss through suicide. Method and objectives. A systematic review of the literature was undertaken to examine the current evidence on the effects of psychosocial interventions for the bereaved and to elucidate the factors that influence these effects. Resources of the review were electronic databases and reference lists of existing review articles. Results. The majority of intervention studies suffer from limitations regarding methodology, recruitment and treatment, including lack of control group or randomization. Due to a lack of long-term results, primary interventions are not recommended. In addition, there are some studies that even show negative results. Secondary and tertiary interventions for the bereaved show modest to relatively positive results. Interventions appear to be most effective when grief is more complicated and when the bereaved are self-referred. Conclusion. Cognitive-behavioural interventions for the bereaved appear to be promising, particularly when they aim at increasing adaptive coping with grief-related problems. Consequently, the results of this systematic review where used for the design of a cognitive-behavioural intervention for suicide survivors, which will be studied in a randomised clinical trial. This intervention is based on the cognitive-behavioural conceptualization of complicated grief, which was recently developed

A CBT-based psychoeducational intervention for suicide survivors

Background: Bereavement following suicide is associated with an increased vulnerability for depression, complicated grief, suicidal ideation, and suicide. There is, however, a paucity of studies of the effects of interventions in suicide survivors. Aims: This study therefore examined the effects of a cognitive behavioral therapy (CBT)-based psychoeducational intervention on depression, complicated grief, and suicide risk factors in suicide survivors. Method: In total, 83 suicide survivors were randomized to the intervention or the control condition in a cluster randomized controlled trial. Primary outcome measures included maladaptive grief reactions, depression, suicidal ideation, and hopelessness. Secondary outcome measures included grief-related cognitions and coping styles. Results: There was no significant effect of the intervention on the outcome measures. However, the intensity of symptoms of grief, depressive symptoms, and passive coping styles decreased significantly in the intervention group but not in the control group. Conclusion: The CBT-based psychoeducational intervention has no significant effect on the development of complicated grief reactions, depression, and suicide risk factors among suicide survivors. The intervention may, however, serve as supportive counseling for suicide survivors