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Background: Evidence-based therapies for major depression, as described in the clinical guidelines, are based on results from randomised controlled trials (RCTs). So far, it is not known to what extent results of RCTs on major depression can be generalised to 'real life' clinical practice., Aim: To compare treatment results for major depression from RCTs (efficacy) and results from daily practice (effectiveness); furthermore, to assess to what extent eligibility criteria and (un)intended selection by recruitment procedures influences treatment outcomes in daily practice., Method: In a 'real life' patient population (n=1653) suffering from major depression (established by the MINIplus) and assessed in routine outcome monitoring at baseline, we explored how many patients met the eligibility criteria for antidepressant and psychotherapy efficacy trials. Furthermore we explored to what extent RCT participants differed in socio-demographic and socio-economic status from 'daily practice' patients. 626 of the ROM patients had at least one follow-up assessment. In this follow-up group we compared the treatment outcome (assessed by the MADRS and BDI-II) to the results of 15 meta-analyses of RCTs. We also explored to what extent patient selection based on eligibility criteria and socio-demographic/socio-economic status influenced treatment outcome., Results: Remission percentages (21-27% in ROM versus 34-58% in RCTs) and effect sizes (0.85 in ROM versus 1.71 in RCTs, within-group data) were lower in daily practice than in RCTs. ROM patients differed from RCT participants in many disease-specific and socio-economic features. These differences are due to patient selection in RCTs. However, the influence of patient selection based on eligibility criteria and socio-demographic differences in treatment outcome were very modest (explained variances 1-11%)., Conclusion: Treatment success for major depression is lower in daily practice than in RCTs and 'real life' patients differ in many features from RCT participants. However, these differences cannot explain the difference between efficacy and effectiveness. The generalisability of the results of depression trials to daily practice might not be jeopardised by the use of eligibility criteria and recruitment procedures to the extent suggested in earlier research.

Background: Routine outcome monitoring (rom) is a method for the systematic monitoring of treatment-progression. Because rom data are collected regularly and systematically, we believe it should be possible to use these data in clinical epidemiological research., Aim: To describe, on the basis of publications of the Leiden Routine Outcome Monitoring Study, a number of potential research topics in which rom data can play a role., Method: We used rom data of patients referred, between 2004 and 2009, to secondary or tertiary care for treatment of a mood, anxiety or somatoform disorder., Results: We describe three cross-sectional studies and one prospective study in which we aimed to identify predictors of outcome., Conclusion: These studies demonstrate clearly that it is feasible to use rom data to supplement clinical epidemiological research done on patients. Together these findings can be a useful addition to data derived from randomised clinical trials.

Background: Routine Outcome Monitoring ROM is an important instrument for measuring the effectiveness of treatment and has been implemented in the Dutch mental health care system., Aim: To review the effectiveness of ROM with regard to diagnosis, treatment, and other outcomes., Method: The literature study focused on randomised controlled trials RCT's of ROM performed on patients of all age groups, some being general patients, others being psychiatric patients. The main search words were 'routine outcome monitoring' or 'routine outcome measurement'., Results: 52 RCTs on adult patients were included in the study; 45 of these trials were performed on patients with mental health problems, but not always in a psychiatric setting or as primary outcome measure. rom appears to have positive effects on diagnosis and treatment and on the communication between patient and therapist. Other results were less clear., Conclusion: ROM seems to be particularly effective for the monitoring of treatments which have not been entirely successful. Further research needs to be done into the clinical and cost-effectiveness of ROM when used with adults and children who have mental health problems.

Background: Most mental health providers in the Netherlands have implemented programmes of care. However, little is known about the extent to which care programmes are adhered to in routine clinical practice., Aim: To investigate the extent to which care programmes are adhered to in routine clinical practice., Method: For three consecutive years we randomly selected 100 patients with a unipolar mood disorder, anxiety disorder or somatoform disorder and investigated retrospectively the extent to which care programmes were actually implemented in the first phase of treatment. We used a set of clinical process indicators based on the care programmes. The investigation took place on the premises of one of the 'Rivierduinen' mental health providers. We used patient records and data collected by means of routine outcome monitoring (ROM)., Results: Over the three years under study scores for most of the indicators ranged from fair to good. Scores were lower for the indicators 'ROM follow-up measurements' and 'frequency of psychotherapy'. Only the number of routine measurements of the severity of the psychopathology in the diagnostic phase appeared to have increased significantly over the three years under study., Conclusion: On the premises of the mental health care provider Rivierduinen where the study was conducted, care programmes during the first phase of treatment for mood disorder, anxiety disorder and somatoform disorders were adhered to reasonably well. Further research will have to concentrate on the subsequent phases of treatment. Another important matter that requires investigation is the relationship between the use of care programmes in daily practice and treatment outcomes.

Background: Both genetics and neuroimaging have developed rapidly in the past few years. Recently the two methods have been combined in a new technique called genetic neuroimaging., Aim: To provide an overview of the backgrounds and the possibilities of genetic neuroimaging., Method: In this review we first discuss genetic and neuroimaging research methods that are currently in use and then discuss their synergistic combination. Finally we analyse two recent cases in which genetic neuroimaging was used to study an individual's vulnerability to affective and psychotic symptoms. results Results are very promising, particularly with regard to research into vulnerability to psychiatric disorders. It is expected that the use of genetic neuroimaging procedures will increase. Genetic and neuroimaging methods are often exceedingly complex, which means they cannot be easily accessed by the general public., Conclusion: Genetic neuroimaging is an important method to study the relation between candidate genes and variations in cognitive and emotional functioning and the vulnerability to psychiatric disorders.

Background: This article focuses on two patients with psychiatric symptoms arising from systemic lupus erythematosus (SLE). Affective and psychotic symptoms frequently occur in SLE, often in combination with cognitive disturbances, and can be a first manifestation of the disorder. The diagnosis and treatment of a possible case of neuropsychiatric SLE should preferably take place in a multidisciplinary setting.

Background: Body dysmorphic disorder (BDD) is a somatoform disorder, characterized by a patient's preoccupation with the belief that some aspect of his/her physical appearance is abnormal. The prevalence of BDD in the general population is 0.7 - 1.7%. The prevalence of BDD in patients attending a Dutch general outpatient clinic has never been examined., Aim: Examine the prevalence of BDD in patients attending a Dutch general outpatient clinic., Method: All patients aged 18 to 65 who were referred between September 2003 and July 2007 to six general outpatients clinics for treatment of a depressive disorder, an anxiety disorder, or a somatoform disorder were assessed with the Mini International Neuropsychiatric Interview (mini). Patients with BDD were also assessed by means of the Body Dysmorphic Disorder - Yale- Brown Obsessive Compulsive Scale (BDD-YBOCS). results BDD was diagnosed in 45 out of 5848 patients (0.8% (0.6-1.0%)). The average age of these patients was 31.1. years and 69% were female. A comorbid depressive disorder was present in 35 patients (78%) and a comorbid anxiety disorder in 26 patients (58%). Of the anxiety disorders, social phobia was the most common, with a prevalence of 27%. The average score on the BDD-YBOCS was 22.5 points. The BDD-YBOCS score was significantly higher in patients with a comorbid obsessive-compulsive disorder (35.7 points; p = 0.01)., Conclusion: The prevalence of BDD in psychiatric outpatients who were referred for treatment of a depressive disorder, an anxiety disorder, or a somatoform disorder was 0.8%. There was a high comorbidity of BDD with depressive and anxiety disorders.

A 45-year-old patient with a medication-resistant obsessive-compulsive disorder was treated successfully by topiramate augmentation. Obsessive-compulsive disorder is associated neurobiologically with overactivation of the cortico-striato-thalamo-cortical circuit. Because the neurotransmitter glutamate plays an important role in this circuit, medication that has glutamate antagonism, such as the antiepileptic drug topiramate, may reduce the symptoms of obsessive-compulsive disorder. Further study is needed to find out whether topiramate augmentation is more effective than placebos in patients with a medication-resistant obsessive-compulsive disorder.