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In dit artikel reageren we op de reactie van Karbouniaris en collega’s (2023). We delen het doel om de zorg voor patiënten zo effectief mogelijk maken, waarbij de patiënt optimale zelfregie heeft en kan kiezen uit een breed palet aan effectieve behandelingen. De huidige zorgstandaard voor traumagerelateerde stoornissen bevat een breder palet dan CGT en EMDR, houdt rekening met ervaringskennis van de patiënt en is gebaseerd op goed onderzoek naar effectiviteit. We zien het als taak van de behandelaar om de patiënt goed voor te lichten over de behandelingen die opgenomen staan in de zorg- standaard, inclusief de voor- en nadelen, de mate van bewezen effecten en de doelmatigheid van die behandelingen. Tegelijkertijd dient voorlichting de patiënt te beschermen tegen behandelingen die (nog) niet (voldoende) be-wezen effectief of – erger nog – schadelijk kunnen zijn. Met de juiste kennis op zak staat de patiënt het sterkst en komt zelfregie het meest tot zijn recht. Trefwoorden: zorgstandaard traumagerelateerde stoornissen, evidence-based (be)handelen, zelfregie, voorlichting

Item does not contain fulltext, In dit artikel reageren we op de reactie van Karbouniaris en collega’s (2023). We delen het doel om de zorg voor patiënten zo effectief mogelijk maken, waarbij de patiënt optimale zelfregie heeft en kan kiezen uit een breed palet aan effectieve behandelingen. De huidige zorgstandaard voor traumagerelateerde stoornissen bevat een breder palet dan CGT en EMDR, houdt rekening met ervaringskennis van de patiënt en is gebaseerd op goed onderzoek naar effectiviteit. We zien het als taak van de behandelaar om de patiënt goed voor te lichten over de behandelingen die opgenomen staan in de zorg- standaard, inclusief de voor- en nadelen, de mate van bewezen effecten en de doelmatigheid van die behandelingen. Tegelijkertijd dient voorlichting de patiënt te beschermen tegen behandelingen die (nog) niet (voldoende) be-wezen effectief of – erger nog – schadelijk kunnen zijn. Met de juiste kennis op zak staat de patiënt het sterkst en komt zelfregie het meest tot zijn recht. Trefwoorden: zorgstandaard traumagerelateerde stoornissen, evidence-based (be)handelen, zelfregie, voorlichting, 8 p.

De vraag hoe traumatische ervaringen, zoals seksueel misbruik, worden herinnerd, behoort tot een van de meest verhitte debatten in de psychologie. Het gaat dan met name om de kwestie van verdringing en/of traumatische ervaringen onbewust kunnen worden opgeslagen. Henry Otgaar c.s. laten zien dat het debat hierover aan een stevige opmars bezig is. Aannemen dat verdringing bestaat, kan bijdragen aan het ontstaan van pseudo-herinneringen die tot valse beschuldigingen en onterechte veroordelingen kunnen leiden.

This symposium brings together studies on mechanisms of posttraumatic stress disorder (PTSD) development that may offer clues for therapeutic interventions. Sensory-rich, intrusive trauma memories are a key symptom of PTSD. Cognitive theories posit that these intrusions result from dysfunctions in the encoding and the subsequent consolidation into memory. The studies in the current symposium examine whether sleep and tonic immobility may affect these processes. To maximize experimental control, all studies used an analogue design with aversive stimuli as a model for trauma and intrusive memories as an outcome measure. The questions addressed include whether behavioural control may mitigate detrimental effects of tonic mobility (Hagenaars and colleagues); what aspects of sleep may be important for trauma memory (Sopp and colleagues) and whether brief sleep episodes (naps) 18 ESTSS 2019 Rotterdam Symposium Abstract Book may protect against intrusions (Kleim &Wilhelm). The symposium will be concluded with a general discussion (Hagenaars) on how the results may inform intervention strategies.

PURPOSE: The purpose of this study was to assess the use of 18F-FDG PET/CT scans for detecting distant metastases in patients with recurrent head and neck squamous cell carcinoma (HNSCC) and investigate the treatment and survival of patients with recurrence.METHODS: In this retrospective study, consecutive head and neck cancer patients referred for FDG PET/CT scan between 2012 and 2014 were included. Patient records were reviewed and only patients with recurrence of HNSCC were enrolled for further analysis. Information on distant metastases, surgery and survival was collected. A Kaplan-Meier analysis was used to report survival.RESULTS: Overall 275 PET/CT scans were performed due to suspected recurrence, and in 166 scans (144 patients), recurrence of HNSCC was confirmed, making them eligible for further analysis. Distant metastases were revealed in 29.8% of the scans (n = 51) and the proportion of revealed metastases remained constant at approximately 30% each year. Although the number of performed scans increased twofold each year, there was no statistically significant change in the proportion of scans with distant metastasis (p = 0.55). The distant metastases were most often seen in the lungs (n = 44) and bone (n = 15). A few patients had widespread dissemination to other areas. Salvage surgery was performed following 81 of the 166 PET/CT scans. Seven of the patients who underwent salvage surgery had M-site oligo-metastases. Patients who underwent salvage surgery had a median survival of 22 months whereas patients not treated with salvage surgery had a median survival of 6 months. After 5 years, 21% of the patients selected for salvage surgery were alive.CONCLUSIONS: Distant metastases occur frequently in patients with recurrent HNSCC disease and the proportion of revealed distant metastases remained the same (30%). Imaging with FDG PET/CT can be recommended in patients with recurrent HNSCC prior to putative salvage surgery.

BACKGROUND: Otitis media (OM) and associated hearing problems may be side effects to radiotherapy of the head and neck region and affect patient quality of life. The condition is associated with the tumor location.OBJECTIVE: To perform a systematic review concerning the present knowledge of the risk of OM after radiotherapy of the head and neck.METHODS: A comprehensive search of PubMed and Embase was carried out between 1 October 2015 and 6 February 2017. The search strategy followed the PRISMA guideline for systematic reviews.RESULTS: Of 597 articles 11 fulfilled the inclusion criteria. Seven were retrospective and four prospective. There were no randomized controlled trials. Eight studies concerned nasopharyngeal cancer. One study concerned cancer of the parotid gland and two studies concerned other locations of head and neck cancer. Meta-analysis could not be done due to heterogeneity between the studies. The incidence of OM varied considerably (range 8-29%).CONCLUSIONS: The incidence of OM is high after radiotherapy of cancer of the upper head and neck area and the Eustachian tube (ET) irradiation dosage seems associated with development of OM, but the literature is poor. Research is needed to designate patients at risk of developing OM after radiotherapy. Preferably through analysis of dosage relationships between the ET and middle ear, and development of OM. Reporting of OM should be per ear and follow standardized protocols of middle ear assessment before and after radiotherapy. Furthermore, there is a need to find new ways to prevent and treat radiation-induced OME, preferably through randomized controlled trials.

The list-method directed forgetting (DF) paradigm has attracted the attention of clinical psychologists because it is widely believed that a retrieval inhibition mechanism underlies its effects. Thus, the idea is that people are capable of intentionally forgetting negative emotional material. On the other hand, there are reasons to believe that negative stimuli are relatively resistant to forgetting. The present experiment compared listwise DF of emotional and neutral words in healthy college students. A modified procedure (i.e., a simulated computer crash) showed a reliable DF-effect in that list I recall was larger under remember than forget instructions whereas the reverse was true for list 2 recall. Emotionality did not modulate the magnitude of this effect. Thus, negative emotional material is not resistant to forgetting. Although overall, the present findings are in line with a retrieval inhibition interpretation (i.e., decreased access to list I material), attentional focusing during list 2 learning may provide a sufficient explanation.

Item does not contain fulltext, This study examined the content of self-defining autobiographical memories in different identities in patients with Dissociative Identity Disorder (DID) and comparison groups of patients with PTSD, healthy controls, and DID simulators. Consistent with the DID trauma model, analyses of objective ratings showed that DID patients in trauma identities retrieved more negative and trauma-related self-defining memories than DID patients in avoidant identities. Inconsistent with the DID trauma model, DID patients' self-rated trauma-relatedness of self-defining memories and future life goals did not differ between trauma identities and trauma avoidant identities. That is, the DID patients did not seem to be "shut off" from their trauma while in their avoidant identity. Furthermore, DID patients in both identities reported a higher proportion of avoidance goals compared to PTSD patients, with the latter group scoring comparably to healthy controls. The simulators behaved according to the instructions to respond differently in each identity (i.e., to report memories and goals consistent with the identity tested). The discrepant task behavior by DID patients and simulators indicated that DID patients did not seem to intentionally produce the hypothesized differences in performance between identities. In conclusion, for patients with DID (i.e., in both identities) and patients with PTSD, trauma played a central role in the retrieval of self-defining memories and in the formulation of life goals.

Tumors of the salivary glands are a heterogeneous group of diseases most often originating in the major salivary glands. Only a minor proportion of mainly malignant tumors arise in the sublingual gland. Due to the rarity of sublingual gland tumors (SGTs), little is known about the clinicopathologic characteristics, prognostic factors, and clinical course. We present a large national series of histopathologically revised SGTs from the past 35 years in Denmark with clinicopathologic correlation. Twenty nine cases were identified, of which 96.6 % were malignant and 16/28 (57.1 %) were adenoid cystic carcinomas (ACC). Patient demography was similar to salivary gland tumors in other locations. All fine needle aspiration cytologies (FNACs) interpreted as benign were from ACCs. Metastatic disease was found in 12.5 % of ACCs at diagnosis with one third of all ACC patients having metastases at the end of follow-up. Stage >II and T-stage >2 were significantly associated with shortened disease-specific survival (DSS) (p = 0.005 and <0.001, respectively), whereas perineural invasion and involved margins was not. No parameters were associated with disease-free survival. In conclusion, the majority of SGTs are malignant, most frequently ACC with a high rate of metastatic spread. The diagnostic value of FNAC in SGTs seems inferior to what is found for other major salivary glands. DSS is determined by stage and T-stage and not by histopathological parameters. International collaboration is warranted to confirm and elaborate these findings in larger materials.

The present study examined the role of childhood trauma, major depressive disorder (MDD), and anxiety disorder (AD) in overgeneral autobiographical memory. Ninety-three outpatients and 24 healthy controls completed a childhood trauma questionnaire and an autobiographical memory test (AMT), Results showed that MDD diagnosis rather than trauma history predicted AMT-performance. Memory specificity was not related to AD diagnosis, recovered MDD, or self-rated depression severity. The present findings cast doubts on theories that emphasize the role of childhood trauma in overgeneral autobiographical memory.