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Background: Although attrition is inevitable in longitudinal epidemiological studies, psychiatric studies are thought to be especially sensitive to attrition. This study aimed to evaluate the sociodemographic and psychiatric determinants of attrition at 2-year follow-up in the Netherlands Study of Depression and Anxiety. Methods: Logistic regression was used to examine sociodemographic and psychiatric determinants of attrition and the influence of clinical psychiatric characteristics on attrition. In addition, differences in determinants between 3 types of attrition (refusal, noncontact, and not able to participate) were evaluated. Results: The attrition rate at the 2-year follow-up assessment was 12.9% (385/2981), representing 6 deceased persons, 250 refusers, 51 noncontacts, and 78 persons unable to participate because of health reasons. Determinants of attrition were younger age, less years of education, not being of North European descent, being recruited in Amsterdam, no previous participation in research, and having major depressive disorder. Only the effects of age, sampling site, and previous participation in research differed between types of attrition. Furthermore, comorbid depressive and anxiety disorders and higher symptom severity were associated with attrition. Conclusions: In contrast to the view that psychiatric epidemiological research is more prone to high attrition rates, this study revealed a relatively low attrition rate. Furthermore, both sociodemographic and psychiatric variables were independent determinants of attrition. Oversampling of subgroups that are at higher risk of dropout may be advisable for future psychiatric cohort studies.

AbstractBackground:Although several forms of effective therapy exist for outpatients suffering from major depressive disorder, many patients do not profit from treatment. Combining psychotherapy and medication may be an effective strategy. However, earlier studies have rarely found a clear advantage for the combination. Where an advantage was found, a possible placebo effect of adding 2 types of treatment could not be ruled out as cause for the superior effect of the combination. Methods:A total of 353 patients were screened, of whom 193 were randomized over 4 conditions: nefazodone plus clinical management, interpersonal psychotherapy (IPT), the combination of the two or the combination of IPT and pill-placebo. All patients suffered from major depressive disorder and had a score of at least 14 on the 17-item Hamilton Rating Scale (HAMD). The patients were treated for 12–16 weeks. At baseline, at 6 weeks and on completion of treatment, ratings were performed by independent raters. The primary outcome measure was the HAMD, and the Montgomery-Asberg Depression Rating Scale (MADRS) the secondary outcome measure. Results:Of the 193 patients included, 138 completed the trial. All treatments were effective. Using a random regression model, no differences between treatments were found on the HAMD. On the MADRS, however, the combination of medication with psychotherapy was more effective in reducing depressive symptoms compared to medication alone, but not to psychotherapy alone or IPT with pill-placebo. Conclusions:The results of this study yield support for the use of combining medication with psychotherapy instead of using medication only in the treatment of depressed outpatients. Combination treatment does not have an advantage over psychotherapy alone in the present study.Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

AbstractBackground: Beliefs about the controllability of a disorder may be relevant in the causation, maintenance and treatment of disorders. We investigated whether congruence between patients’ beliefs about controllability of a panic disorder and the type of treatment provided predicted outcome. Methods: The differential effectiveness of cognitive therapy and antidepressant treatment (paroxetine or clomipramine) was investigated in a sample of 129 panic disorder patients in a 12-week, pretest posttest placebo-controlled study. Panic frequency, agoraphobic avoidance, anxiety, depression, and disability were measured with various validated interviewer and self-report measures. Beliefs about controllability were measured with the Multidimensional Anxiety Locus of Control Scale measuring an internal, chance, therapist and medication locus of control. In order to analyze aptitude-treatment interactions a new strategy called the Regression Trunk Approach was used in addition to classical hierarchical multiple regression analysis. Results: Using the Regression Trunk Approach we found that locus of control orientation (LOC) predicted the differential effectiveness of cognitive therapy. Those patients with a medium internal LOC who received cognitive therapy performed significantly better than all patients who received a placebo pill on 8 of the 10 outcome variables. We did not find a differential LOC effect for antidepressant treatment. No evidence for aptitude-treatment interactions using hierarchical multiple regression analysis was found. Conclusions: Moderately strong beliefs about self-control of panic disorder congruent with the cognitive intervention provided seem to moderate treatment effectiveness. Future studies must be more attentive to the nonlinear effects of patient characteristics on the outcome of different types of treatments.Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background. Memory functioning has been highlighted as a central issue in pathological dissociation. In non-pathological dissociation, evidence for enhanced working memory has been found, together with greater task-load related activity. So far, no imaging studies have investigated working memory in dissociative patients.Method. To assess working memory in dissociative patients functional magnetic resonance imaging was used during performance of a parametric, verbal working-memory task in patients with a dissociative disorder (n=16) and healthy controls (n=16).Results. Imaging data showed that both groups activated brain regions typically involved in working memory, i.e. anterior, dorsolateral and ventrolateral prefrontal cortex (PFC), and parietal cortex. Dissociative patients showed more activation in these areas, particularly in the left anterior PFC, dorsolateral PFC and parietal cortex. In line with these findings, patients made fewer errors with increasing task load compared to controls, despite the fact that they felt more anxious and less concentrated during task performance.Conclusions. These results extend findings in non-pathological high dissociative individuals, suggesting that trait dissociation is associated with enhanced working-memory capacities. This may distinguish dissociative patients from patients with post-traumatic stress disorder, who are generally characterized by impaired working memory. [ABSTRACT FROM AUTHOR]

AbstractBackground: Patients with persistent medically unexplained symptoms often exhibit general dysfunction and psychiatric comorbidity and frequently resist psychiatric referral. The aim of this study was to evaluate the efficacy of a collaborative care model including training for general practitioners (GPs) and a psychiatric consultation model for patients with persistent medically unexplained symptoms in general practice. Method: Randomised controlled trial. Cluster randomisation at GP practices and multilevel analysis were performed. A total of 81 patients from 36 general practices completed the study. A collaborative care model of training and psychiatric consultation in general practice in the presence of the GP was compared with training plus care as usual by the GP. Outcome assessment on the patients’ well-being, functioning and utilisation of health care services was performed 6 weeks and 6 months later. Results: All the patients had somatoform disorders (Whitely Index 7.46), and 86% had comorbid psychiatric disorders. In the intervention group, the severity of the main medically unexplained symptoms decreased by 58%. The patients’ social functioning improved. The utilization of health care was lower than in the care as usual group. Conclusions: A collaborative care model combining training with psychiatric consultation in the general practice setting is an effective intervention in the treatment of persistent medically unexplained symptoms. Anxiety and depressive disorders are highly comorbid in this group. The findings warrant a larger study.Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background. Dissociation, defined as a disruption in usually integrated mental functions, is found not only in DSM-IV dissociative disorders, but also in post-traumatic stress disorder and eating disorders. Dissociative phenomena are also common in the general population, and may reflect a constitutionally determined cognitive style rather than a pathological trait acquired through experiencing adverse life events. In pathological dissociation, evidence has been presented for episodic memory dysfunction. In contrast, in high-dissociative subjects increased performance has been found for episodic memory and dual task performance. These findings have been linked to changes in working memory capacity.Method. In the present study, the authors sought to extend these findings by using functional magnetic resonance imaging during performance of two parametric working memory tasks. We tested 21 healthy low- and high-dissociative participants.Results. High-dissociative participants performed slightly better during both tasks. Imaging data showed that both groups activated similar networks for both tasks, i.e. (bilateral) dorsolateral (DL) and ventrolateral prefrontal cortex (PFC), parietal cortex, and supplementary motor area. Group×task interactions were found in the high-dissociative group in L DLPFC and L parietal cortex; in the low-dissociative group in R fusiform gyrus. The differences in the high-dissociative group were independent from performance differences, implying that high-dissociative subjects generally recruit this network to a greater extent.Conclusions. These results confirm earlier findings using a verbal WM task in high-dissociative participants, and are compatible with the conceptualization of non-pathological dissociation as an information-processing style, characterized by distinct attentional and mnemonic abilities. [ABSTRACT FROM AUTHOR]

Objetivo: Este estudio, por lo que saben los autores, es el primer ensayo aleatorizado con grupo de control que comparó la eficacia de la terapia cognitivo-conductual (TCC), la paroxetina y un placebo (administrado con enmascaramlento doble) en el tratamiento de la hipocondría. Método: Los autores asignaron al azar a 112 individuos con hipocondría según los criterios del DSM-IV a un tratamiento ambulatorio de 16 semanas con TCC, paroxetina o placebo. El criterio de valoración principal rue el Índice de Whiteley. Los a utores efectua ron eva lua ci on es pretest y p ostest y analizaron todos los criterios de valoración utilizando un análisis de varianza con medidas repetidas mediante un modelo lineal general 3 x 2 con contrastes de Helmert. Los autores consideraron respondedores a los individuos queen el Índice de Whiteley obtuvieron una puntuación por lo menos una desviación estándar por debajo de la puntuación media en el pretest. Los análisis se efectuaron basándose en la intención de tratar yen los individuos que completaron el tratamiento. Resultados: En el Índice de Whiteley, los contrastes de Helmert en las cohortes de intención detratar y de los que completaron el tratamiento revelaron que la TCC y la paroxetina agrupadas eran significativa mente superiores al placebo, pero que no diferían significativamente entre elias. El análisis de los respondedores de la cohorte de intención de tratar y de la cohorte que completó el tratamiento, respectivamente, constato los siguientes porcentajes de respondedores por grupo: grupo con TCC, 45 y 54 %; grupo con paroxetina, 30 y 38 %, y grupo con un placebo, 14 y 12 %, respectivamente. En el análisis por intención de tratar, sólo laTCCfuesignificativamentediferente del placebo. En el análisis de los que completaron el tratamiento, tanto la paroxetina como la TCC fueron significativamente diferentes del placebo. Conclusiones: La TCC o la paroxetina son opciones terapéuticas eficaces a corto plazo para individuos con hipocondria. [ABSTRACT FROM AUTHOR]