Cognitive performance in both clinical and non-clinical burnout

Relatively little is known about cognitive performance in burnout. The aim of the present study was to further our knowledge on this topic by examining, in one study, cognitive performance in both clinical and non-clinical burnout while focusing on three interrelated aspects of cognitive performance, namely, self-reported cognitive problems, cognitive test performance, and subjective costs associated with cognitive test performance. To this aim, a clinical burnout patient group (n=33), a non-clinical burnout group (n=29), and a healthy control group (n=30) were compared on self-reported cognitive problems, assessed by a questionnaire, as well as on cognitive test performance, assessed with a cognitive test battery measuring both executive functioning and more general cognitive processing. Self-reported fatigue, motivation, effort and demands were assessed to compare the different groups on subjective costs associated with cognitive test performance. The results indicated that the clinical burnout patients reported more cognitive problems than the individuals with non-clinical burnout, who in turn reported more cognitive problems relative to the healthy controls. Evidence for impaired cognitive test performance was only found in the clinical burnout patients. Relative to the healthy controls, these patients displayed some evidence of impaired general cognitive processing, reflected in slower reaction times, but no impaired executive functioning. However, cognitive test performance of the clinical burnout patients was related to larger reported subjective costs. In conclusion, although both the clinical and the non-clinical burnout group reported cognitive problems, evidence for a relatively mild impaired cognitive test performance and larger reported subjective cost associated with cognitive test performance was only found for the clinical burnout group.</p

The cost-effectiveness of the Dutch clinical practice guidelines for anxiety disorders

Background: To examine whether adhering to the Dutch clinical practice guidelines for anxiety disorders is associated with a higher efficiency of care (i.e. cost-effective) compared to guideline-non-adherence. Methods: After the Dutch practice guidelines for anxiety disorders were implemented, adult patients diagnosed with anxiety disorder or hypochondria were approached for participation. Using medical files patients’ treatment was classified as guideline-adherent (N=81) or guideline-non-adherent (N=56). Patients completed questionnaires about severity of symptoms (SCL-90-R) and quality of life (WHOQOL-Bref) before the start of treatment and again one year later. Medical costs and productivity losses were assessed at one-year follow-up. Results: Data of 139 patients for whom the guidelines were applicable were analyzed. From a health care perspective, the guideline-adherent treatment group had lower costs (incremental costs: -€292) and higher effect on the SCL-90-R (incremental effect: 26.17), and therefore dominated guideline-non-adherent treatment on average. There was a 68% likelihood that guideline-adherent treatment was associated with more effects and lower costs. Furthermore, guideline-adherent treatment was associated with an additional 0.09 QALY, indicating that on average more QALYs were generated for fewer costs. Limitations: This study employed an uncontrolled design. Caution should be taken when making causal inferences. Conclusions: Patients who received guideline-adherent treatment are more likely to experience larger symptom reduction and fewer costs during follow-up than patients who do not receive guideline-adherent treatment. The results justify further investigation of the effectiveness of implementing multidisciplinary guidelines

Characteristics and stability of hallucinations and delusions in patients with borderline personality disorder

Background: Psychotic features have been part of the description of the borderline personality disorder (BPD) ever since the concept “borderline” was introduced. However, there is still much to learn about the presence and characteristics of delusions and about the stability of both hallucinations and delusions in patients with BPD. Methods: A follow-up study was conducted in 326 BPD outpatients (median time between baseline and follow-up = 3.16 years). Data were collected via telephone (n = 267) and face-to-face interviews (n = 60) including the Comprehensive Assessment of Symptoms and History interview, Positive And Negative Syndrome Scale and the Psychotic Symptom Rating Scale. Results: The point prevalence of delusions was 26%, with a median strong delusion conviction. For the group as a whole, the presence and severity of both hallucinations and delusions was found to be stable at follow-up. Participants with persistent hallucinations experienced more comorbid psychiatric disorders, and they differed from those with intermittent or sporadic hallucinations with their hallucinations being characterized by a higher frequency, causing a higher intensity of distress and more disruption in daytime or social activities. Conclusions: Delusions in patients with BPD occur frequently and cause distress. Contrary to tenacious beliefs, hallucinations and delusions in participants with BPD are often present in an intermittent or persistent pattern. Persistent hallucinations can be severe, causing disruption of life. Overall, we advise to refrain from terms such as “pseudo”, or assume transience when encountering psychotic phenomena in patients with BPD, but rather to carefully assess these experiences and initiate a tailor-made treatment plan