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Contains fulltext : 249039.pdf (Publisher’s version ) (Open Access) Stress initiates a cascade of (neuro)biological, physiological, and behavioral changes, allowing us to respond to a challenging environment. The human response to acute stress can be studied in detail in controlled settings, usually in a laboratory environment. To this end, many studies employ acute stress paradigms to probe stress-related outcomes in healthy and patient populations. Though valuable, these studies in themselves often have relatively limited sample sizes. We established a data-sharing and collaborative interdisciplinary initiative, the STRESS-NL database, which combines (neuro)biological, physiological, and behavioral data across many acute stress studies in order to accelerate our understanding of the human acute stress response in health and disease (www.stressdatabase.eu). Researchers in the stress field from 12 Dutch research groups of 6 Dutch universities created a database to achieve an accurate inventory of (neuro)biological, physiological, and behavioral data from laboratory-based human studies that used acute stress tests. Currently, the STRESS-NL database consists of information on 5529 individual participants (2281 females and 3348 males, age range 6-99 years, mean age 27.7 ± 16 years) stemming from 57 experiments described in 42 independent studies. Studies often did not use the same stress paradigm; outcomes were different and measured at different time points. All studies currently included in the database assessed cortisol levels before, during and after experimental stress, but cortisol measurement will not be a strict requirement for future study inclusion. Here, we report on the creation of the STRESS-NL database and infrastructure to illustrate the potential of accumulating and combining existing data to allow meta-analytical, proof-of-principle analyses. The STRESS-NL database creates a framework that enables human stress research to take new avenues in explorative and hypothesis-driven data analyses with high statistical power. Future steps could be to incorporate new studies beyond the borders of the Netherlands; or build similar databases for experimental stress studies in rodents. In our view, there are major scientific benefits in initiating and maintaining such international efforts. 9 p.

Objective Using data from a randomized controlled trial on psychotherapy for posttraumatic stress disorder (PTSD) in older adults (aged >55), this study aimed at analysing the efficacy of two psychological interventions in terms of self-reported symptoms, comorbid psychopathology and resilience outcomes. Method Thirty-three outpatients (age 55–81) with PTSD were randomly assigned to eleven sessions of narrative exposure therapy or present-centered therapy. Self-reported symptom severity of PTSD, depression and general psychopathology, along with measures of resilience (self-efficacy, quality of life and posttraumatic growth cognitions), were target outcomes. Harvard Trauma Questionnaire, Beck Depression Inventory, Brief Symptom Inventory, General Efficacy Scale, World Health Organization Quality of Life Assessment and Meaning of War Scale (personal growth) were assessed pre-treatment, post-treatment and at four months follow-up. Because of variable inter-assessment intervals, a piecewise mixed effects growth model was used to investigate treatment effects. Results Neither post-treatment, nor at mean follow-up, between-group effects were found. At follow-up, significant medium to large within-group effect sizes were found in the NET-group for psychopathology (self-reported PTSD: Cohen’s d = 0.54, p, HIGHLIGHTS This study showed that recovering from trauma-related pathology in later life with help of narrative exposure therapy is not limited to PTSD symptoms but extends to comorbid pathology.

Contains fulltext : 221825.pdf (Publisher’s version ) (Closed access) What predicts how happy people are with their romantic relationships? Relationship science - an interdisciplinary field spanning psychology, sociology, economics, family studies, and communication - has identified hundreds of variables that purportedly shape romantic relationship quality. The current project used machine learning to directly quantify and compare the predictive power of many such variables among 11,196 romantic couples. People's own judgments about the relationship itself - such as how satisfied and committed they perceived their partners to be, and how appreciative they felt toward their partners - explained approximately 45% of their current satisfaction. The partner's judgments did not add information, nor did either person’s personalities or traits. Furthermore, none of these variables could predict whose relationship quality would increase versus decrease over time.Given the powerful implications of relationship quality for health and well-being, a central mission of relationship science is explaining why some romantic relationships thrive more than others. This large-scale project used machine learning (i.e., Random Forests) to 1) quantify the extent to which relationship quality is predictable and 2) identify which constructs reliably predict relationship quality. Across 43 dyadic longitudinal datasets from 29 laboratories, the top relationship-specific predictors of relationship quality were perceived-partner commitment, appreciation, sexual satisfaction, perceived-partner satisfaction, and conflict. The top individual-difference predictors were life satisfaction, negative affect, depression, attachment avoidance, and attachment anxiety. Overall, relationship-specific variables predicted up to 45% of variance at baseline, and up to 18% of variance at the end of each study. Individual differences also performed well (21% and 12%, respectively). Actor-reported variables (i.e., own relationship-specific and individual-difference variables) predicted two to four times more variance than partner-reported variables (i.e., the partner’s ratings on those variables). Importantly, individual differences and partner reports had no predictive effects beyond actor-reported relationship-specific variables alone. These findings imply that the sum of all individual differences and partner experiences exert their influence on relationship quality via a person's own relationship-specific experiences, and effects due to moderation by individual differences and moderation by partner-reports may be quite small. Finally, relationship-quality change (i.e., increases or decreases in relationship quality over the course of a study) was largely unpredictable from any combination of self-report variables. This collective effort should guide future models of relationships. 11 p.

Simple Summary If we want to use animal studies to predict what will happen if we give a drug to humans, it makes sense to perform the animal studies as similarly to human studies as possible. For example, if animal tests of a drug only look at the effect of injecting the drug in young healthy animals, we cannot expect the results to be similar in human tests giving tablets to older patients who may have other diseases besides the one for which they receive the drug. We did an in-depth analysis of how 147 animal and 512 human studies of the drug methotrexate for rheumatoid arthritis were performed. Important differences were present, for example, animal studies used more males, while rheumatoid arthritis occurs more in females. We calculated the human-equivalent age of the animals, and they were on average younger than humans. Many studies did not fully report the way the experiments were performed. In spite of these differences, the drug methotrexate works well against rheumatoid arthritis in animal models and humans. Further (literature) research is still needed; we do not yet understand when we can reliably predict human effects from animal studies. Abstract Increased awareness and understanding of current practices in translational research is required for informed decision making in drug development. This paper describes a systematic review of methotrexate for rheumatoid arthritis, comparing trial design between 147 animal and 512 human studies. Animal studies generally included fewer subjects than human studies, and less frequently reported randomisation and blinding. In relation to life span, study duration was comparable for animals and humans, but included animals were younger than included humans. Animal studies often comprised males only (61%), human studies always included females (98% included both sexes). Power calculations were poorly reported in both samples. Analyses of human studies more frequently comprised Chi-square tests, those of animal studies more frequently reported analyses of variance. Administration route was more variable, and more frequently reported in animal than human studies. Erythrocyte sedimentation rate and c-reactive protein were analysed more frequently in human than in animal studies. To conclude, experimental designs for animal and human studies are not optimally aligned. However, methotrexate is effective in treating rheumatoid arthritis in animal models and humans. Further evaluation of the available evidence in other research fields is needed to increase the understanding of translational success before we can optimise translational strategies.

BackgroundEvidence-based treatment and age-specific services are required to address the needs of trauma-affected older populations. Narrative exposure therapy (NET) may present an appropriate treatment approach for this population since it provides prolonged exposure in a lifespan perspective. As yet, however, no trial on this intervention has been conducted with older adults from Western Europe.AimsExamining the efficacy of NET in a sample of older adults.MethodOut-patients with post-traumatic stress disorder (PTSD), aged 55 years and over, were randomly assigned to either 11 sessions of NET (n = 18) or 11 sessions of present-centred therapy (PCT) (n = 15) and assessed on the Clinician-Administered PTSD Scale (CAPS) pre-treatment, post-treatment and at follow-up. Total scores as well as symptom scores (re-experience, avoidance and hyperarousal) were evaluated.ResultsUsing a piecewise mixed-effects growth model, at post-treatment a medium between-treatment effect size for CAPS total score (Cohen's d = 0.44) was found, favouring PCT. At follow-up, however, the between-treatment differences were non-significant. Drop-out rates were low (NET 6.7%, PCT 14.3%) and no participant dropped out of the study because of increased distress.ConclusionsBoth NET and PCT appear to be safe and efficacious treatments with older adults: PCT is non-intrusive and NET allows for imaginal exposure in a lifespan perspective. By selectively providing these approaches in clinical practice, patient matching can be optimised.Declaration of interestNone.

OBJECTIVES: To characterize reported adverse drug reactions (ADRs) in children and adolescents treated with antipsychotics and determine differences in relative reporting frequency between genders, age classes, and reporter types. METHODS: Individual case safety reports of children ages 1 - 17 years in whom an antipsychotic drug was the suspected or interacting drug from the worldwide database, VigiBase, from 1968 until March 2017, were included. Reported ADRs were categorized based on the Standardized Medical Dictionary for Regulatory Activities (MedDRA) Queries and clinical reasoning. Proportional reporting ratios (PRRs) and 95% confidence intervals (95% CIs) were calculated for genders, age classes, and reporter types. RESULTS: In total, 45,201 reported ADRs were included. The most frequently reported were ADRs related to extrapyramidal syndrome (14.7%), breast disorders or blood prolactin level changes (4.7%), and cardiac arrhythmias (4.6%). Differences in relative reporting frequencies were observed between age classes and reporter types, and less prominent between genders. For example, ADRs related to hyperglycemia/new-onset diabetes mellitus were less frequently reported in children ages 1 - 5 than in children ages 12 - 17 (PRR: 0.4, 95% CI: 0.2 - 0.5). ADRs related to cardiac arrhythmias were less frequently reported by consumers compared with health care professionals (PRR: 0.5, 95% CI: 0.5 - 0.6), whereas ADRs related to a change in weight/body mass index were more frequently reported by consumers (PRR: 3.2, 95% CI: 2.9 - 3.5). CONCLUSION: A wide spectrum of ADRs were reported in children treated with antipsychotics. The relative differences in reporting frequency between age classes and reporter types can be of help to tailor information about possible ADRs and to monitor for ADRs.

Background Acute involuntary psychiatric admissions (AIPA) tend to be applied more often in urban areas. Objective The current study aims to describe AIPA prevalence differences between the subdistricts in an urban area, and to identify which district characteristics are associated with a higher AIPA district density. Methods Information was collected on consecutive AIPAs over a 64-month period (2005–2010) in 49 subdistricts in and around the city of Utrecht, the Netherlands, including 1098 AIPAs. District characteristics included several demographic and economical factors and health care characteristics such as number of sheltered living facilities. Results The AIPA density (mean 4.4/10,000 inhabitants/y) was four to five times higher in the most urbanized subdistrict (around 12) compared to the suburban subdistricts (2.5–3). On the district level, the main correlates with AIPA density per district were unemployment rate and small household size. Other correlates were percentage of non-Western immigrants and number of facilities of sheltered living. Conclusions The considerable AIPA density variation between subdistricts in this urban environment reflects that people who are prone to psychiatric admissions live in economically less prosperous environments. Impaired social networks and economic concerns may also contribute to an environment representing social defeat, increased demoralization, or social fragmentation.

Chapter 2: Persons with somatic symptom disorder can have disturbed body awareness. Bodyoriented interventions such as psychomotor therapy can treat body awareness problems on the level of basic body signals, giving meaning in the here and now, or in the context of personal history. Such experience-based interventions offer a variety of learning opportunities that focus on the body with symptoms and seem to add to verbal interventions. The scientific base for these interventions, however, is still poor. Chapter 3: According to clients with somatic symptom disorders and their therapists, bodyrelatedness includes awareness of the body and self by understanding, accepting and adjusting to bodily signals, by respecting and regulating the body, by trusting and esteeming oneself and by being autonomous. This definition and structure of body-relatedness may help professionals to improve interdisciplinary communication, assessment, and treatment, and it may help clients to better understand their symptoms and treatment. Chapter 4: The mostly large differences in self-reports of body image between clients with somatic symptom disorder and a comparison sample from the general population as well as differences between diagnostic subgroups underline the importance of body image in clients with somatic symptom disorder. The results indicate the usefulness of assessing body image and treating negative body image in clients with somatic symptom disorder. Chapter 5: Own body drawings were studied as a form of assessment for body experience and several objective ratings were indicated to be reliable. Two internally consistent constructs, “details” and “basic elements”, summarized these objective ratings. Correlation of objective ratings with ratings of the drawings by experts as well as sensitivity to change indicated potential clinical significance and the absence of correlation with a self-report measure suggested that analyses of body drawings yield information other than body-related questionnaires. These findings indicate that analyses of body drawings may be a promising assessment tool in somatic symptom disorder. Chapter 6: The study of body drawings in a matched general population sample indicated that clients with somatic symptom disorder and people from the general population picture a similar mean number of details in drawings of their own body. Analysis in the general population sample tentatively suggested that the perspective of the drawer potentially influenced observation scores. Because both the factor structure and the association with self-report measures differed between the groups, scorings of body drawings appear to reflect a different meaning for the two groups. Assessments using the scoring template that was found in chapter five may be more useful in the context of somatic symptoms than in the general population. Chapter 7: In the initial analysis of a structured physical therapeutic observation for people with somatic symptom disorder modestly sound psychometric quality of observations of execution of instructions, muscle tension and behavioral adaptation were found, however not of clients’ ability to perceive the body adequately. This shows that these observations are feasible when restricted to observable behavior and it indicates the viability of further validation of the body-relatedness observation scale (BROS).

Background Patients with anorexia nervosa (AN) demonstrate aberrations in choice behavior, including impairments in laboratory measures of decision making. Although a wealth of studies suggest that these aberrations arise from alterations in value processing, it remains unclear by which core component of value processing this is mediated. Methods We fit trial-by-trial data of patients with AN (n = 60 first cohort, n = 216 second cohort) and healthy control participants (n = 55) performing the Iowa Gambling Task to a computational model based on prospect utility theory. We determined, per participant, the best-fit model parameters and compared these between the groups. Results Analyses revealed a decreased estimate of model parameter λ in patients with AN, indicative of an attenuation of loss-aversive behavior in the Iowa Gambling Task. In comparison, measures of reward sensitivity, value-based learning, and exploration versus exploitation were unaltered in patients with AN. A measurement in a second independent cohort replicated the finding that loss aversion, typically observed in healthy individuals, is reduced in patients with AN. Conclusions We show that patients with AN, in contrast to healthy control participants, demonstrate reduced loss-aversive behavior. This finding provides important fundamental insights into the decision-making capacity of patients with AN, suggesting alterations in the mechanisms involved in value processing related to negative feedback.

We study the index of refraction of an ultracold bosonic gas in the dilute regime. Using phase-contrast imaging with light detuned from resonance by several tens of linewidths, we image a single cloud of ultracold atoms for 100 consecutive shots, which enables the study of the scattering rate as a function of temperature and density using only a single cloud. We observe that the scattering rate is increased below the critical temperature for Bose-Einstein condensation by a factor of 3 compared to the single-atom scattering rate. We show that current atom-light interaction models to second order of the density show a similar increase, where the magnitude of the effect depends on the model that is used to calculate the pair-correlation function. This confirms that the effect of quantum statistics on the index of refraction is dominant in this regime.

Anorexia nervosa (AN) is a severe mental illness impacting on all life domains and one of the leading causes of burden of disease in young females. Lifetime prevalence is 1 to 4 % in Europe indicating that AN is not uncommon. Central features are an intense fear of weight gain, body image disturbance and altered cognitive and emotional functioning. In extreme cases patients can die of AN.Mortality rates are amongst the highest in psychiatric disorders. Not only are mortality rates high, prognosis is also unfavourable with only 50% of adults recovering completely, 30% reaching partial recovery and 20% remaining severely ill. Surprisingly, given this unfavourable outcome and the severe consequences, many patients resist treatment. This calls into question whether or not patients are able to decide adequately regarding treatment, or in other words, have adequate mental capacity. Clinicians assess mental capacity by checking understanding, reasoning, appreciation and the ability to choose in a patient. However, this assessment is notably unreliable. A semi-structured interview has been designed to aid the clinician in this assessment (the MacCAT-T) and has good interrater reliability. In AN there is a lack of studies regarding mental capacity. The present thesis describes the results of the first large longitudinal study into mental capacity in adults with severe AN. As in the scientific literature doubts are voiced regarding the use of the MacCAT-T, in the thesis this instrument is compared to clinical judgment and suggestions regarding use in clinical practice are provided. Next to questions regarding mental capacity, discussion surrounds the use of compulsory treatment in AN. In this thesis a literature review of the published studies comparing compulsory and voluntary treatment is presented. Decision making on a neuropsychological level is also assesses longitudinally in relation to depressive symptoms. Results show that mental capacity problems occur in about a third of the population in the study. This is associated with a lower weight, more previous treatment for AN and lesser appreciation of the illness. Decision making, as assessed neuropsychologically, is less advantageous in patients with diminished mental capacity and does not improve in the course of two years. Patients with diminished mental capacity at baseline do less well in treatment; their weight does rise, but a larger proportion of patients remains severely ill after two years. They are admitted more often than patients with adequate mental capacity. Compulsory treatment is understudied, only 5 publications have been identified in the review. Compulsorily treated patients do equally well at discharge, but their stay was longer. The therapeutic alliance was not hindered by the invocation of compulsory treatment, which is reassuring. This suggests that there is no need to shy away from compulsory treatment in severe cases. Further research should focus on emotion regulation in relation to mental capacity, as it is hypothesized that inadequate emotion regulation has a detrimental effect on decision making and hence on mental capacity. Concerning compulsory treatment, qualitative studies are suggested to unravel underlying themes in patients and clinicians regarding the invocation of legal measures.

Contains fulltext : 155600.pdf (Publisher’s version ) (Closed access) Background: Psychotropic drugs are prescribed to approximately 30-40% of adults with intellectual disability (ID) and challenging behaviour, despite the limited evidence of effectiveness and the potential of adverse events. Aims: To assess the prevalence of adverse events in association with psychotropic drug use in adults with ID and challenging behaviour and to examine the relation of these adverse events with the person's quality of life. Method: The presence of adverse events was measured with a questionnaire that had to be filled in by the physicians of the participants. Movement disorders were measured separately with a standardised protocol. The strength of the association between adverse events and Intellectual Disability Quality of Life-16 (IDQOL-16), and daily functioning was investigated using linear regression analyses, taking into account the severity of disease (CGI-S) as potential confounder. Results: Virtually all of 103 adults with ID and challenging behaviour had at least one adverse event (84.4%) and almost half had >= 3 adverse events (45.6%) across different subclasses. Using psychotropic drugs increased the prevalence of adverse events significantly. Respectively 13% of the patients without psychotropic drugs and 61% of the patients with >= 2 psychotropic drugs had >= 3 adverse events. Having adverse events had a significantly negative influence on the quality of life. Conclusions: A large majority of all patients had at least one adverse event associated with psychotropic drug use. More attention is needed for these adverse events and their negative influence on the quality of life of these patients, taking into account the lack of evidence of effectiveness of psychotropic drugs for challenging behaviour. 9 p.

This thesis focuses on problematic severe asthma in children and its treatment from a biopsychosocial perspective. Asthma is a chronic inflammatory disease of the airways. In children with problematic severe asthma, asthma is not under control despite optimal medical treatment. Asthma control is the main goal of asthma treatment in these children. This study is guided by a biopsychosocial model, assuming that both disease activity and psychosocial variables influence asthma control and quality of life. In the first part of the thesis, children’s behavioral problems and parenting stress are investigated in relation to asthma control and quality of life in children with problematic severe asthma. In the second part, the effects of multidisciplinary treatment on a broad set of biopsychosocial outcome variables are evaluated. This thesis stimulates multilevel investigations promoting understanding and treatment of the complex biopsychosocial phenomena of problematic severe asthma. This will ultimately reduce the burden, morbidity, and mortality of problematic severe asthma in children.

An important part of inpatient treatment for adolescents with anorexia nervosa is to restore normal eating behaviour. Health-care professionals play a significant role in this process, but little is known about their interventions during patients' meals. The purpose of the present study was to describe nursing interventions aimed at restoring normal eating behaviour in patients with anorexia nervosa. The main research question was: 'Which interventions aimed at restoring normal eating behaviour do health-care professionals in a specialist eating disorder centre use during meal times for adolescents diagnosed with anorexia nervosa? The present study was a qualitative, descriptive study that used video recordings made during mealtimes. Thematic data analysis was applied. Four categories of interventions emerged from the data: (i) monitoring and instructing; (ii) encouraging and motivating; (iii) supporting and understanding; and (iv) educating. The data revealed a directive attitude aimed at promoting behavioural change, but always in combination with empathy and understanding. In the first stage of clinical treatment, health-care professionals focus primarily on changing patients' eating behaviour. However, they also address the psychosocial needs that become visible in patients as they struggle to restore normal eating behaviour. The findings of the present study can be used to assist health-care professionals, and improve multidisciplinary guidelines and health-care professionals' training programmes.

BACKGROUND: Anorexia nervosa (AN), which is the most serious of the eating disorders, starts earlier in life and often continues into adulthood. AIM: To discuss the typical features of AN in adolescents. METHOD: We present an overview based on the literature about AN in adolescents and on analysis performed by experts. RESULTS: Youngsters with AN run considerable physical risks because their bodies are less well developed and are more easily injured. These injuries can be a lifelong handicap if the patient's body weight does not rapidly return to normal. However, if the body weight recovers satisfactory, this can point to the possibility of a full psychological recovery. The best route to recovery is to start dining again with the family, to go back to school and to participate in social activities. So far, no other types of treatment have proved to be entirely successful. CONCLUSION: Further research is needed into matters such as an ideal weight for the patient and the best ways of increasing his or her food-intake. We need to find out how best to deal with a patient's disturbed body image and how to treat any comorbid disease that often accompanies AN.

Background Many refugees resettled in Western countries struggle to attain a level of psychological well-being. Heavily burdened by pre- and post-migration stressors, refugees are at considerable risk of developing posttraumatic stress disorder (PTSD). The accumulation of stressors is also what makes them, in the eyes of many clinicians, complex and difficult to treat. Although trauma-focused treatment, such as trauma-focused cognitive behavioural therapy (TF-CBT) and eye movement desensitisation and reprocessing therapy (EMDR), is recommended as first-line treatment for adults who suffer from PTSD, in refugees this recommendation is often contended. Instead, clinicians are advised to focus on psychosocial stabilisation as direct trauma-focused treatment is feared to be ineffective and even harmful. The contradictions between the two approaches have been subject of recent debate. Aims An eye for complexity contributes to a clarification of this debate by presenting the outcomes of several studies with refugees. The overall aim of this thesis is to contribute to an improvement of mental health care offered to treatment-seeking refugees. To this end, the thesis addresses three main research questions: What is the safety and efficacy of EMDR compared to that of stabilisation in traumatised asylum seekers and refugees? What is the applicability of the complex PTSD construct to refugees? Can traumatised asylum seekers and refugees be safely and effectively treated with trauma-focused therapy? Method These questions are answered through six studies: a systematic review of treatment outcome studies of EMDR in refugees; a pilot study of EMDR (11 sessions) versus stabilisation (11 sessions) with 20 traumatised refugees treated at a specialised institute; a randomised controlled trial of EMDR (12 hours) versus stabilisation (12 hours) in 72 refugees who suffer from PTSD; a multilevel analysis of the trial data to identify predictors for treatment response in refugees; a naturalistic study comparing the effectiveness of treatment as usual in refugees and non-refugees; and a systematic review of the prevalence of complex PTSD in refugee populations. Results In this thesis it is shown that although the acceptability, safety and efficacy of EMDR with refugees are matters of interest, very little research in this area has been done. A pilot study showed EMDR to be safe and efficacious enough with treatment-seeking refugees to warrant the conduct of a full randomised controlled trial. Consequently, in a randomised controlled trial both EMDR and stabilisation were shown to be safe and limitedly efficacious with refugees who suffer from PTSD. Two predictor studies showed that treatment-response in refugee participants appears related to depressive symptom severity and diagnosis as well as PTSD symptom severity at intake. Finally, prevalence of complex PTSD in refugees was shown to be relatively low. Conclusions Refugees may be safely treated with a short course of EMDR (9 sessions), but efficacy may be limited. Treatment response may be hampered by depressive symptoms. The construct of complex PTSD may only limitedly apply to traumatised refugees. Current research supports a recommendation of trauma-focused rather than phase-based treatment in refugees who seek treatment for PTSD, including asylum seekers.

Item does not contain fulltext Background: Antipsychotic drugs are prescribed to approximately 30% to 40% of adults with intellectual disability (ID) and behavioral problems despite lack of evidence of effectiveness and potential adverse effects, including movement disorders. Aims: The aim of this study was to examine the prevalence of movement disorders (dyskinesia, akathisia, dystonia, and parkinsonism) in in-patient adults with mild to borderline ID and behavioral problems associated with use of antipsychotics. Methods: Prevalence of movement disorders was measured with a standardized protocol. The strength of the association between antipsychotic drug use and movement disorders was assessed using logistic regression analysis. Results: Almost half (44.0%) of 134 in-patient adults with ID and behavioral problems had any movement disorder. Parkinsonism, dyskinesia, akathisia, and dystonia were present in, respectively, 36.6%, 11.2%, 9.0%, and 0.7% of patients with ID. It appeared that current use of any antipsychotic drug (odds ratio, 3.0; 95% confidence interval, 1.0-8.4) and a dose in target range (odds ratio, 5.5; 95% confidence interval, 1.5-20.4) were significantly associated with the risk of having movement disorders. Conclusions: The prevalence of movement disorders in people with ID and behavioral problems is high, especially in ID patients using antipsychotics. More attention is needed for these movement disorders and their potential impact. 6 p.

Dryness and fatigue are prevalent and debilitating symptoms in Sjögren’s syndrome. In this thesis, consequences of dryness for patients’ well-being and daily life functioning, and possible targets for treatment were described. In the first part of this thesis, an encompassing overview of the consequences of dryness from the perspective of the patients was revealed. The hierarchical overview comprised generic psychosocial consequences and disease-specific consequences including primary symptoms of eyes and mouth and hindered participation in social activities, intimacy problems, and somatic (systemic) symptoms. Second, the consequences of dryness with respect to crying problems were studied. Compared with demographically matched control participants, patients with Sjögren’s syndrome reported lower crying sensibility and capability to cry with tears, a higher presence of bodily symptoms after crying, and a higher severity of suffering from a reduced capability to cry. The crying dimensions generally showed significant but weak associations with ocular dryness and mental well-being in patients. Third, consequences for emotional well-being of the hampered ability to cry are described. It was found that processing and regulating emotions generally did not deviate from normal with one exception: a relatively large number of patients, 22%, were alexithymic (i.e., had difficulty identifying and describing feelings and focusing on external events rather than inner experiences). Processing emotions more intensely or more deficiently and regulating emotions by more suppression was associated with worse mental well-being; virtually alike in patients and control participants. The second part of this thesis describes possible targets for treatment of fatigue in Sjögren’s syndrome. Physical activity and physical activity cognitions were found to be independently associated with fatigue. Moreover, the combination of low physical activity and high activity avoidance was associated with both fatigue. These results suggest that fatigue in patients with Sjögren’s syndrome might be reduced by targeting both physical activity and physical activity cognitions. In another study, we examined whether there were different psychological profiles (subgroups) in patients with Sjögren’s syndrome, and how these profiles were related to fatigue. Four psychological profiles were identified using cluster analyses, a functional profile (in which 39% of the patients were grouped), an alexithymic profile (27%), a self-reliant profile (23%), and a dysfunctional profile (11%). Irrespective of the psychological profile of patients, the level of fatigue was substantially higher than in the general population. Patients with a dysfunctional or an alexithymic profile reported more fatigue than those with a self-reliant profile. Since cognitive behavioural therapy and graded exercise therapy are promising treatments in reducing fatigue, this thesis describes the development and feasibility of such an intervention for patients with Sjögren’s syndrome. This intervention seemed convenient for people to follow and the participants in the first intervention group noted that it had changed their way of coping with fatigue. The next, ongoing, step is to conduct a randomised controlled trial examining whether a combination of cognitive behavioural group therapy and exercise therapy are effective in reducing fatigue in Sjögren’s syndrome. Using information about psychological profiles of patients, treatment might be customized to make it effective and suitable for a large group of patients. This could improve the quality of life of patients with Sjögren’s syndrome.

Introduction: To explore ethnic differences in psychopathology, this study examined the prevalence of depressive and anxiety disorders among different ethnic groups in Amsterdam and determined whether ethnic differences can be explained by socio-demographic differences. Methods: A population-based sample of 321 Dutch, 231 Turkish, 191 Moroccan, 87 Surinamese/Antilleans was interviewed by well-trained bilingual interviewers, using the CIDI 2.1. Educational level and income were used as indicators of socio-economic status. Results: The weighed 1-month prevalence of depressive and/or anxiety disorders was 6.6% (Dutch), 18.7% (Turkish), 9.8% (Moroccans) and 1.2 % (Surinamese/Antilleans). Among Moroccans, the prevalence of affective disorders seemed higher in men than in women, among the Turkish the opposite was observed. Ethnic differences in prevalence could not be explained by socioeconomic differences. Conclusion: Turkish women and men and Moroccan men in Amsterdam seem to have a higher risk of current affective disorders. Ethnicity is an independent predictor of common mental disorders in the Netherlands. © Springer-Verlag 2008.

Aims and methodThis study aimed to identify predictors of symptom severity for post-traumatic stress disorder (PTSD) and depression in asylum seekers and refugees referred to a specialised mental health centre. Trauma exposure (number and domain of event), refugee status and severity of PTSD and depression were assessed in 688 refugees.ResultsSymptom severity of PTSD and depression was significantly associated with lack of refugee status and accumulation of traumatic events. Four domains of traumatic events (human rights abuse, lack of necessities, traumatic loss, and separation from others) were not uniquely associated with symptom severity. All factors taken together explained 11% of variance in PTSD and depression.Clinical implicationsTo account for multiple predictors of symptom severity including multiple traumatic events, treatment for traumatised refugees may need to be multimodal and enable the processing of multiple traumatic memories within a reasonable time-frame.

Psychological distress is highly prevalent in patients with rheumatic diseases. It is associated with a variety of negative outcomes, including pain, fatigue, disability, and maladaptive cognitive behavioural coping strategies. In this thesis, psychological distress was studied both as an outcome measure and as a therapeutic target in the context of multidisciplinary rehabilitation. The longitudinal role of coping in psychological distress was systematically reviewed, a questionnaire to assess coping flexibility was described and initially validated, and the effectiveness of multidisciplinary rehabilitation programmes for selected patients with rheumatic diseases and high levels of psychological distress were evaluated. Various coping strategies were categorised into a hierarchical taxonomy to systematically examine the longitudinal association between coping and psychological distress in rheumatoid arthritis (RA). The evidence for the prognostic value of coping strategies for subsequent changes in psychological distress in RA turned out to be weak. Contrary to previous cross-sectional findings, active-oriented engagement strategies (e.g., problem solving) were not associated with a decrease in psychological distress over time. Some support was found for the usefulness of identifying avoidant-oriented coping strategies (e.g., helplessness, resting, wishful thinking) among patients in routine clinical practice as these coping strategies may forecast poor adjustment to RA. The coping flexibility questionnaire (COFLEX) was developed to assess coping flexibility. Evaluation of conventional multidisciplinary treatment programmes indicated that poor psychological well-being is common among patients in multidisciplinary rehabilitation and that psychological distress was under-recognised and not adequately considered in treatment. Programmes to target psychological distress through a group-based cognitive-behavioural therapy (CBT) within a multidisciplinary rehabilitation setting are, however, scarce. Because of the potentially fluctuating disease course of rheumatic diseases and because of the weak evidence for the prognostic value of separate coping strategies for subsequent changes in psychological distress, a CBT was developed promoting coping flexibility. The development of the CBT was further guided by evidence-based cognitive therapy principles, by the dual-process coping model that stresses the fit between characteristics of the situation and the employed coping strategy, and by empirical evidence on the role of acceptance in the adjustment to a chronic illness. The integration and feasibility of this acceptance-oriented CBT within multidisciplinary rehabilitation is extensively described in this thesis. The potential effectiveness of the CBT to decrease psychological distress and to improve acceptance and coping flexibility was examined in a longitudinal observational proof-of-concept study. The acceptance-oriented CBT was effective in improving patient’s psychological well-being and quality of life, but coping flexibility did not significantly change. The majority of the highly distressed patients showed decreased levels of psychological distress, large improvements in illness acceptance, and improved quality of life. In conclusion, psychological distress is prevalent among patients with rheumatic diseases in multidisciplinary rehabilitation. The proof-of-concept intervention study suggested the reversibility of distress by yielding preliminary support for the beneficial effects of an acceptance-oriented CBT embedded in multidisciplinary rehabilitation for selected patient with rheumatic diseases and high levels of psychological distress.

All too often it is assumed that the differing priorities, values and ethics of practitioners and researchers are irreconcilable. This article describes the long, sometimes difficult and ultimately fruitful process of setting up an evaluation of the efficacy of the bereavement support service offered by Cruse Bereavement Care Scotland (CBCS). CBCS invited researchers from Utrecht University's Centre for Bereavement Research and Intervention to work with them to design and deliver a controlled trial that would compare outcomes for recipients of each of its three modes of 'stepped care' with those of a group of bereaved people receiving no care. The proposal raised a number of major ethical and practical issues, which were successfully resolved through open discussion and negotiation, providing a positive example of practitioner/ researcher collaboration in a research endeavour.

Affect regulation is often compromised as a result of early life interpersonal traumatization and disruption in caregiving relationships like in situations where the caretaker is emotionally, sexually or physically abusing the child. Prior studies suggest a clear relationship between early childhood attachment-related psychological trauma and affect dysregulation. We evaluated the relationship of retrospectively recalled childhood traumatization by primary caretaker(s) (TPC) and affect dysregulation in 472 adult psychiatric patients diagnosed with borderline personality disorder (BPD), somatoform disorder (SoD), both BPD and SoD, or disorders other than BPD or SoD, using the Bermond-Vorst Alexithymia Questionnaire, the self-report version of the Structured Interview for Disorders of Extreme Stress, the Self-Rating Inventory for Posttraumatic Stress Disorder (SRIP) and the Traumatic Experiences Checklist. Almost two-thirds of participants reported having experienced childhood TPC, ranging from approximately 50% of patients with SoD or other psychiatric disorders to more than 75% of patients with comorbid BPD+SoD. Underregulation of affect was associated with emotional TPC and TPC occurring in developmental epoch 0-6 years. Over-regulation of affect was associated with physical TPC. Childhood trauma by a primary caretaker is prevalent among psychiatric patients, particularly those with BPD, and differentially associated with underand over-regulation of affect depending on the type of traumatic exposure. Keywords: Borderline personality disorder; somatoform disorders; child abuse; affect dysregulation (Published: 28 March 2011) Citation: European Journal of Psychotraumatology 2011, 2: 5628 - DOI: 10.3402/ejpt.v2i0.5628 For the abstract or full text in other languages, please see Supplementary files in the column to the right (under Reading Tools).