Long-term morbidity and health after early menopause due to oophorectomy in women at increased risk of ovarian cancer: Protocol for a nationwide cross-sectional study with prospective follow-up (HARMOny Study)

Background: BRCA1/2 mutation carriers are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO) at 35 to 45 years of age. RRSO substantially decreases ovarian cancer risk, but at the cost of immediate menopause. Knowledge about the potential adverse effects of premenopausal RRSO, such as increased risk of cardiovascular disease, osteoporosis, cognitive dysfunction, and reduced health-related quality of life (HRQoL), is limited. Objective: The aim of this study is to assess the long-term health effects of premenopausal RRSO on cardiovascular disease, bone health, cognitive functioning, urological complaints, sexual functioning, and HRQoL in women with high familial risk of breast or ovarian cancer. Methods: We will conduct a multicenter cross-sectional study with prospective follow-up, nested in a nationwide cohort of women at high familial risk of breast or ovarian cancer. A total of 500 women who have undergone RRSO before 45 years of age, with a follow-up period of at least 10 years, will be compared with 250 women (frequency matched on current age) who have not undergone RRSO or who have undergone RRSO at over 55 years of age. Participants will complete an online questionnaire on lifestyle, medical history, cardiovascular risk factors, osteoporosis, cognitive function, urological complaints, and HRQoL. A full cardiovascular assessment and assessment of bone mineral density will be performed. Blood samples will be obtained for marker analysis. Cognitive functioning will be assessed objectively with an online neuropsychological test battery. Results: This study was approved by the institutional review board in July 2018. In February 2019, we included our first participant. As of November 2020, we had enrolled 364 participants in our study. Conclusions: Knowledge from this study will contribute to counseling women with a high familial risk of breast/ovarian cancer about the long-term health effects of premenopausal RRSO. The results can also be used to offer health recommendations after RRSO

Prevalence, correlates and treatment of nightmares in secondary mental healthcare

Nightmares are associated with psychopathology. The prevalence of nightmares in the general population is 2-5%. However, the impact of nightmares when comorbid mental disorders are present is unknown. We investigated the prevalence of nightmares in a population with diverse mental disorders. Over the course of eighteen months all patients who started their treatment at GGz Centraal de Meregaard (secondary mental healthcare) in Almere (NL), filled out validated questionnaires about nightmares. About 30% met the criteria for nightmare disorder according to strict DSM-IV-TR criteria. None of these patients had a DSM-IV-TR diagnosis of nightmare disorder in their medical files. Furthermore we compared patients with and without nightmare disorder regarding their psychopathology symptoms. The patients with nightmare disorder had higher rates of general psychopathology and personality pathology symptoms. Although this was a correlational study and therefore the direction of the effect remains an open question, the data strongly suggests that nightmares are indicative of more severe forms of psychopathology. Currently ‘imagery rehearsal therapy’ (IRT) is the recommended treatment for nightmares. With IRT the script of the recurring nightmare is changed into a new dream, which is imagined during the day. However the effects of IRT in a population with comorbid mental disorders remains unknown. We did a randomized controlled trial (RCT) on IRT in a patient sample with diverse mental disorders and nightmares from GGz Centraal in Amersfoort, Hilversum and Almere (NL). We administered six sessions of individual IRT bi-weekly as an add-on to treatment as usual (TAU). We found that IRT diminished nightmare frequency and distress, as well as general psychopathology and posttraumatic stress disorder (PTSD) symptoms, to a moderate degree when compared to TAU. The effects were largely sustained at the three-month follow-up. The effect sizes in our current study were smaller than in most previous RCTs, which may be explained by the fact that our sample was heterogeneous regarding psychopathology symptoms and comorbidity. Another reason may be that in our study recording of nightmares –which has known beneficial effects – was done in both the IRT and TAU conditions. The effects of IRT in our study exceeded those of recording by itself. We reported a follow-up study addressing the long-term effects six months and nine months after the end of the treatment for the IRT group. We found that the positive effects of IRT were sustained at follow-up. In summary, nightmare disorder is highly prevalent in patients with mental disorders in secondary mental healthcare, although none of the patients had a DSM-IV-TR diagnosis of nightmare disorder in their medical files. One in every three patients suffers from nightmares and these patients report more severe psychopathology in comparison to patients without nightmare disorder. Our study stresses the importance of careful assessment of nightmares in patients with diverse mental disorders. IRT successfully ameliorated nightmare frequency, nightmare distress and overall mental health complaints and psychopathology symptoms in this sample. IRT is effective and feasible to use in addition to treatment as usual in secondary mental healthcare

Prevalence, correlates and treatment of nightmares in secondary mental healthcare

Nightmares are associated with psychopathology. The prevalence of nightmares in the general population is 2-5%. However, the impact of nightmares when comorbid mental disorders are present is unknown. We investigated the prevalence of nightmares in a population with diverse mental disorders. Over the course of eighteen months all patients who started their treatment at GGz Centraal de Meregaard (secondary mental healthcare) in Almere (NL), filled out validated questionnaires about nightmares. About 30% met the criteria for nightmare disorder according to strict DSM-IV-TR criteria. None of these patients had a DSM-IV-TR diagnosis of nightmare disorder in their medical files. Furthermore we compared patients with and without nightmare disorder regarding their psychopathology symptoms. The patients with nightmare disorder had higher rates of general psychopathology and personality pathology symptoms. Although this was a correlational study and therefore the direction of the effect remains an open question, the data strongly suggests that nightmares are indicative of more severe forms of psychopathology. Currently ‘imagery rehearsal therapy’ (IRT) is the recommended treatment for nightmares. With IRT the script of the recurring nightmare is changed into a new dream, which is imagined during the day. However the effects of IRT in a population with comorbid mental disorders remains unknown. We did a randomized controlled trial (RCT) on IRT in a patient sample with diverse mental disorders and nightmares from GGz Centraal in Amersfoort, Hilversum and Almere (NL). We administered six sessions of individual IRT bi-weekly as an add-on to treatment as usual (TAU). We found that IRT diminished nightmare frequency and distress, as well as general psychopathology and posttraumatic stress disorder (PTSD) symptoms, to a moderate degree when compared to TAU. The effects were largely sustained at the three-month follow-up. The effect sizes in our current study were smaller than in most previous RCTs, which may be explained by the fact that our sample was heterogeneous regarding psychopathology symptoms and comorbidity. Another reason may be that in our study recording of nightmares –which has known beneficial effects – was done in both the IRT and TAU conditions. The effects of IRT in our study exceeded those of recording by itself. We reported a follow-up study addressing the long-term effects six months and nine months after the end of the treatment for the IRT group. We found that the positive effects of IRT were sustained at follow-up. In summary, nightmare disorder is highly prevalent in patients with mental disorders in secondary mental healthcare, although none of the patients had a DSM-IV-TR diagnosis of nightmare disorder in their medical files. One in every three patients suffers from nightmares and these patients report more severe psychopathology in comparison to patients without nightmare disorder. Our study stresses the importance of careful assessment of nightmares in patients with diverse mental disorders. IRT successfully ameliorated nightmare frequency, nightmare distress and overall mental health complaints and psychopathology symptoms in this sample. IRT is effective and feasible to use in addition to treatment as usual in secondary mental healthcare

Long-term treatment effects of imagery rehearsal therapy for nightmares in a population with diverse mental disorders

Nightmares are a common problem with debilitating consequences. Meta-analyses have revealed that imagery rehearsal therapy (IRT), in which the storyline of the recurring nightmare is changed, is the treatment of choice for nightmares. In a randomized clinical trial, we recently demonstrated that IRT was also effective in a population of patients with diverse mental disorders. In this trial, IRT showed moderate additional benefits over treatment as usual on nightmare distress, general psychopathology, and posttraumatic stress symptoms. In the current paper we report on the six- and nine month follow-up measurements of the IRT group of this trial. In the six- and nine-month follow-up the moderate improvements observed at post-treatment were sustained for all measures. This means that IRT has long-lasting effects, also in a sample with severe co-morbid psychopathology. IRT could be considered at an early stage in addition to the usual mental health treatment

Imagery rehearsal therapy in addition to treatment as usual for patients with diverse psychiatric diagnoses suffering from nightmares: A randomized controlled trial

Objective: Nightmares are associated with psychopathology and daily distress. They are highly prevalent in a psychiatric population (30%). Currently, imagery rehearsal therapy (IRT) is the treatment of choice for nightmares. With IRT, the script of the nightmare is changed into a new dream, which is imagined during the day. However, the effects of IRT in a psychiatric population remain unknown. The aim of this study was to determine the effectiveness of IRT in a heterogeneous psychiatric population. Method: Between January 2006 and July 2010, 90 patients with psychiatric disorders (DSM-IV-TR) were randomized to IRT or treatment-as-usual conditions. IRT consisted of 6 individual sessions added to the treatment as usual. Nightmare frequency was assessed using daily nightmare logs and the Nightmare Frequency Questionnaire. Nightmare distress was assessed using the Nightmare Distress Questionnaire and the Nightmare Effects Survey. General psychiatric symptoms were assessed using the Symptom Checklist-90 and a PTSD symptom questionnaire. Assessments were administered at the start of the trial, after the IRT and at follow-up 3 months later. Results: IRT showed a moderate effect (Cohen d = 0.5-0.7, P < .05) on nightmare frequency, nightmare distress, and psychopathology measures compared with treatment as usual. These effects were largely sustained at the 3-month follow-up (Cohen d = 0.4-0.6, P < .10). Conclusions: IRT is an effective treatment for nightmares among patients with comorbid psychiatric disorders and can be employed in addition to the on-going treatment