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Apeldoorn, Netherlands

Perneczky R.,Technische Ismaninger Str. | Drzezga A.,TU Munich | Boecker H.,TU Munich | Boecker H.,University of Bonn | And 7 more authors.
Psychiatry Research - Neuroimaging

The clock drawing test (CDT) is a widely used dementia screening instrument that assesses executive and visuospatial abilities; studies in patients with Alzheimer's disease (AD) suggest frontoposterior networks to be involved in clock drawing. Clock drawing errors are also often observed in dementia with Lewy bodies (DLB), but the functional neuroanatomical substrate of impaired clock drawing has not been firmly established in this disorder. The present study was designed to provide initial evidence for brain metabolic alterations associated with CDT performance in DLB. Twenty-one patients with DLB were enrolled. CDT ratings were correlated with the regional cerebral metabolic rate of glucose (rCMRglc) measured by 18F-fluoro-2-deoxy-glucose positron emission tomography (18F-FDG PET) in the statistical parametric mapping software package SPM5, controlling for overall cognitive impairment as measured by the Mini-Mental-State Examination (MMSE) score. There was a significant negative association between test scores and rCMRglc in a left-hemispheric posterofrontal network including the temporoparietal and dorsal pre-motor cortices and the precuneus. The present study provides evidence for a direct association between frontoparietal dysfunction and impaired CDT performance in DLB. These findings also suggest that the CDT is an appropriate screening instrument for this disorder and that metabolic dysfunction, and therefore disease severity, is mirrored by performance on the test. © 2009 Elsevier Ireland Ltd. All rights reserved. Source

Meijer A.,University of Groningen | Conradi H.J.,University of Groningen | Conradi H.J.,University of Amsterdam | Bos E.H.,University of Groningen | And 4 more authors.
General Hospital Psychiatry

Objective: A meta-analysis of over 25 years of research into the relationship between post-myocardial infarction (MI) depression and cardiac prognosis was conducted to investigate changes in this association over time and to investigate subgroup effects. Method: A systematic literature search was performed (Medline, Embase and PsycINFO; 1975-2011) without language restrictions. Studies investigating the impact of post-MI depression on cardiovascular outcome, defined as all-cause mortality, cardiac mortality and cardiac events within 24 months after the index MI, were identified. Depression had to be assessed within 3 months after MI using established instruments. Pooled odds ratios (ORs) were calculated using a random effects model. Results: A total of 29 studies were identified, resulting in 41 comparisons. Follow-up (on average 16 months) was described for 16,889 MI patients. Post-MI depression was associated with an increased risk of all-cause mortality [(OR), 2.25; 95% confidence interval [CI], 1.73-2.93; P<.001], cardiac mortality (OR, 2.71; 95% CI, 1.68-4.36; P<.001) and cardiac events (OR, 1.59; 95% CI, 1.37-1.85; P<.001). ORs proved robust in subgroup analyses but declined over the years for cardiac events. Conclusions: Post-MI depression is associated with a 1.6- to 2.7-fold increased risk of impaired outcomes within 24 months. This association has been relatively stable over the past 25 years. © 2011 Elsevier Inc. Source

Hartogs B.M.,Center for Integrative Psychiatry
BMJ case reports

A 23-year-old woman with anorexia nervosa (AN) and a strong need for control was offered an integrative treatment, empowering the patient to be an active participant and advocating shared decision-making. To emphasise this, both the therapist and patient describe their views on the therapy. The integrative treatment resulted in more psychological flexibility and behavioural improvements, as is evident from an increased weight, a decreased dietary restriction and an increased valued action. The strength of this integrative treatment is based on accepting and encouraging patient's self-chosen treatment method, within healthy limits, and thereby creating a flexible, supportive and empowering therapeutic alliance. More research is needed to test the efficacy of combining complementary therapies within conventional treatments of AN. Source

de Vries R.M.,University of Groningen | Hartogs B.M.A.,Center for Integrative Psychiatry | Morey R.D.,University of Groningen
Behavior Therapy

When researchers are interested in the effect of certain interventions on certain individuals, single-subject studies are often performed. In their most simple form, such single-subject studies require that a subject is measured on relevant criterion variables several times before an intervention and several times during or after the intervention. Scores from the two phases are then compared in order to investigate the intervention effect. Since observed scores typically consist of a mixture of true scores and random measurement error, simply looking at the difference in scores can be misleading. Hence, de Vries & Morey (2013) developed models and hypothesis tests for single-subject data, quantifying the evidence in data for the size and presence of an intervention effect. In this paper we give a non-technical overview of the models and hypothesis tests and show how they can be applied on real data using the BayesSingleSub R package, with the aid of an empirical data set. © 2014. Source

Sarris J.,University of Melbourne | Sarris J.,Swinburne University of Technology | Lake J.,Arizona Center for Integrative Medicine | Hoenders R.,Center for Integrative Psychiatry
Journal of Alternative and Complementary Medicine

Background: Bipolar disorder (BD) is a debilitating syndrome that is often undiagnosed and undertreated. Population surveys show that persons with BD often self-medicate with complementary and alternative medicine (CAM) or integrative therapies in spite of limited research evidence supporting their use. To date, no review has focused specifically on nonconventional treatments of BD. Objectives: The study objectives were to present a review of nonconventional (complementary and integrative) interventions examined in clinical trials on BD, and to offer provisional guidelines for the judicious integrative use of CAM in the management of BD. Methods: PubMed, CINAHL, ® Web of Science, and Cochrane Library databases were searched for human clinical trials in English during mid-2010 using Bipolar Disorder and CAM therapy and CAM medicine search terms. Effect sizes (Cohen's d) were also calculated where data were available. Results: Several positive high-quality studies on nutrients in combination with conventional mood stabilizers and antipsychotic medications in BD depression were identified, while branched-chain amino acids and magnesium were effective (small studies) in attenuating mania in BD. In the treatment of bipolar depression, evidence was mixed regarding omega-3, while isolated studies provide provisional support for a multinutrient formula, n-acetylcysteine, and l-tryptophan. In one study, acupuncture was found to have favorable but nonsignificant effects on mania and depression outcomes. Conclusions: Current evidence supports the integrative treatment of BD using combinations of mood stabilizers and select nutrients. Other CAM or integrative modalities used to treat BD have not been adequately explored to date; however, some early findings are promising. Select CAM and integrative interventions add to established conventional treatment of BD and may be considered when formulating a treatment plan. It is hoped that the safety issues and clinical considerations addressed in this article may encourage the practice of safety-conscious and evidence-based integrative management of BD. © 2011 Mary Ann Liebert, Inc. Source

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