Ouderenpsychiatrie

1 Inleiding 2 Het melancholieconcept bij ouderen in relatie tot religie 3 Rouw in relatie tot religie 4 Ouderen met cognitieve stoornissen in relatie tot religie 5 Enkele voorlopige conclusies over de relatie ouderenpsychiatrie en religi

Effect of a pharmacological intervention on quality of life in patients with obsessive-compulsive disorder

Patients with obsessive-compulsive disorder (OCD) not only suffer from obsessive-compulsive symptoms, but also the disorder is associated with aberrant social functioning and a diminished quality of life (QoL). Although studies concerning the effect of treatment interventions on symptoms are common, studies with regard to the effect of treatment interventions on QoL are scarce. We examined the effect of a pharmacological intervention on QoL in 150 patients with OCD. Furthermore, we studied whether two different drugs, venlafaxine and paroxetine, differed in their effect on QoL. Finally, we examined whether any found improvement in QoL was related to improvement in symptoms and/or the baseline self-directedness score, which is one of the character dimensions of the psychobiological model of Cloninger. We demonstrated that QoL, as assessed with the Lancashire Quality of Life Profile, improved following pharmacological intervention, for which paroxetine and venlafaxine appeared to be equally effective. Furthermore, neither improvement in symptoms, nor baseline self-directedness, was associated with the improvement in QoL

Examining the factor structure of the self-report Yale-Brown Obsessive Compulsive Scale Symptom Checklist

Obsessive-compulsive symptom dimensions are important in studies about the pathogenesis and treatment of obsessive-compulsive disorder. More than 30 factor analytic studies using the Yale-Brown Obsessive Compulsive Scale Symptom Checklist (Y-BOCS-SC) interview version have been published. However, a drawback of the Y-BOCS-SC interview is that it is time-consuming for the clinician. Baer's self-report version of the Y-BOCS-SC could be a less time-consuming alternative. The purpose of this study was to examine the factor structure of Baer's self-report Y-BOCS-SC. In a sample of 286 patients, we performed two factor analyses, one using categories and one using items of the Y-BOCS-SC. Using category-level data, we identified four factors; when using items we identified six factors. Symptom dimensions for contamination/cleaning, symmetry/repeating/counting/ordering and hoarding were found in both analyses. The impulsive aggression, pathological doubt, sexual, religious somatic and checking categories formed one factor in the analysis using category-level data and divided into three factors using item-level data. These factors correspond with studies using the interview version and support our hypothesis that the self-report version of the Y-BOCS-SC could be an alternative for the interview version

Influence of religion on obsessive-compulsive disorder: Comparisons between dutch nonreligious, Roman Catholic, and Protestant patients

Previous studies have suggested that specific features of religion such as religious denomination and level of religiosity might influence the severity of obsessive- compulsive disorder (OCD) and the occurrence of obsessive- compulsive (OC) cognitions, whereas others could not confirm these findings. The purpose of this study was to elucidate the relation between religion, OCD, and the occurrence of OC cognitions in a Dutch sample of OCD patients. Data were drawn from the baseline assessment of the Netherlands Obsessive Compulsive Disorder Association (NOCDA; Schuurmans et al., 2012) study, which is an ongoing, multicenter, 6-year, longitudinal naturalistic cohort study examining the course of OCD. Participants were 377 outpatients, age 18 years and over, with a lifetime diagnosis of OCD. Neither being religious nor religiosity critically influenced the severity of OCD or the occurrence of OC cognitions. Roman Catholic patients scored significantly higher on anxiety and depression than nonreligious patients, and Roman Catholic patients endorsed significantly more OC cognitions than nonreligious and Protestant patients. These ratings of OC cognitions were not mediated by religious denomination or level of religiosity, but by severity of anxiety and depression, as well as age. The relationship between religious denomination, level of religiosity, and clinical aspects of OCD, which have been described before in the literature, may be spurious and mediated by comorbid psychiatric symptoms, such as anxiety and depression

Clinical relevance of comorbidity in anxiety disorders: A report from the Netherlands Study of Depression and Anxiety (NESDA)

AbstractBackgroundTo study the clinical relevance of type of comorbidity and number of comorbid disorders in anxiety disorders. Four groups were compared according to sociodemographic-, vulnerability- and clinical factors: single anxiety disorder, anxiety–anxiety comorbidity, anxiety–depressive comorbidity and “double” comorbidity (i.e. anxiety and depressive comorbidity).MethodsData were obtained from the Netherlands Study of Anxiety and Depression (NESDA). A sample of 1004 participants with a current anxiety disorder was evaluated.ResultsAs compared with single anxiety, anxiety–anxiety comorbidity was associated with higher severity, greater chronicity and more treatment. Anxiety–anxiety comorbidity was associated with an earlier age of onset and a more chronic course compared with anxiety–depressive comorbidity, while anxiety–depressive comorbidity was associated with more severe symptoms and more impaired functioning than anxiety–anxiety comorbidity. “Double” comorbidity was associated with higher severity, greater chronicity, more treatment and increased disability. Sociodemographic and vulnerability factors were comparable among the four groups.LimitationsA prospective design would be more appropriate to study the outcome. In this study no distinction was made between whether depression or anxiety disorder preceded the current anxiety disorder.ConclusionsIt is clinical relevant to diagnose and treat comorbidity among anxiety disorders as it is associated with higher severity and more chronicity. Whereas anxiety–anxiety comorbidity has an earlier age of onset and a more chronic course, anxiety–depressive comorbidity leads to more treatment and impaired functioning. “Double” comorbidity leads to even more severity, chronicity and impairment functioning compared with both anxiety–anxiety and anxiety–depressive comorbidity