Institute for Mental Health Care

Den Dolder, Netherlands

Institute for Mental Health Care

Den Dolder, Netherlands
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Van Wingen G.A.,Radboud University Nijmegen | Van Wingen G.A.,University of Amsterdam | Ossewaarde L.,Radboud University Nijmegen | Ossewaarde L.,Institute for Mental Health Care | And 4 more authors.
Neuroscience | Year: 2011

Gonadal hormones are known to influence the regulation of emotional responses and affective states. Whereas fluctuations in progesterone and estradiol are associated with increased vulnerability for mood disorders, testosterone is mainly associated with social dominance, aggressive, and antisocial behavior. Here, we review recent functional neuroimaging studies that have started to elucidate how these hormones modulate the neural circuitry that is important for emotion regulation, which includes the amygdala and the medial prefrontal (mPFC) and orbitofrontal cortex (OFC). The amygdala is thought to generate emotional responses, and the prefrontal brain regions to regulate those responses. Overall, studies that have investigated women during different phases of the menstrual cycle suggest that progesterone and estradiol may have opposing actions on the amygdala and prefrontal cortex. In addition, the influence of exogenous progesterone appears to be dose-dependent. Endogenous testosterone concentrations are generally positively correlated to amygdala and OFC responses, and exogenous testosterone increases amygdala reactivity. Whereas the administration of progesterone increases amygdala reactivity and its connectivity with the mPFC, testosterone administration increases amygdala reactivity but decreases its connectivity with the OFC. We propose that this opposing influence on amygdala-prefrontal coupling may contribute to the divergent effects of progesterone and testosterone on emotion regulation and behavioral inhibition, respectively, which may promote the differential vulnerability to various psychiatric disorders between women and men. © 2011 IBRO.


Backstrom T.,Umeå University | Bixo M.,Umeå University | Johansson M.,Umeå University | Nyberg S.,Umeå University | And 7 more authors.
Progress in Neurobiology | Year: 2014

Certain women experience negative mood symptoms during the menstrual cycle and progesterone addition in estrogen treatments. In women with PMDD increased negative mood symptoms related to allopregnanolone increase during the luteal phase of ovulatory menstrual cycles. In anovulatory cycles no symptom or sex steroid increase occurs. This is unexpected as positive modulators of the GABA-A receptor are generally increasing mood. This paradoxical effect has brought forward a hypothesis that the symptoms are provoked by allopregnanolone the GABA-A receptor system. GABA-A is the major inhibitory system in the brain. Positive modulators of the GABA-A receptor include the progesterone metabolites allopregnanolone and pregnanolone, benzodiazepines, barbiturates, and alcohol. GABA-A receptor modulators are known, in low concentrations to induce adverse, anxiogenic effects whereas in higher concentrations show beneficial, calming properties. Positive GABA-A receptor modulators induce strong paradoxical effects e.g. negative mood in 3-8% of those exposed, while up to 25% have moderate symptoms thus similar as the prevalence of PMDD, 3-8% among women in fertile ages, and up to 25% have moderate symptoms of premenstrual syndrome (PMS). The mechanism behind paradoxical reaction might be similar among them who react on positive GABA-A receptor modulators and in women with PMDD. In women the severity of these mood symptoms are related to the allopregnanolone serum concentrations in an inverted U-shaped curve. Negative mood symptoms occur when the serum concentration of allopregnanolone is similar to endogenous luteal phase levels, while low and high concentrations have less effect on mood. Low to moderate progesterone/allopregnanolone concentrations in women increases the activity in the amygdala (measured with fMRI) similar to the changes seen during anxiety reactions. Higher concentrations give decreased amygdala activity similar as seen during benzodiazepine treatment with calming anxiolytic effects. Patients with PMDD show decreased sensitivity in GABA-A receptor sensitivity to diazepam and pregnanolone while increased sensitivity to allopregnanolone. This agrees with findings in animals showing a relation between changes in alpha4 and delta subunits of the GABA-A receptor and anxiogenic effects of allopregnanolone. Conclusion: These findings suggest that negative mood symptoms in women with PMDD are caused by the paradoxical effect of allopregnanolone mediated via the GABA-A receptor. © 2013 Elsevier Ltd.


Hardeveld F.,Institute for Mental Health Care | Hardeveld F.,Netherlands Institute of Mental Health and Addiction | Spijker J.,Institute for Mental Health Care | Spijker J.,Netherlands Institute of Mental Health and Addiction | And 3 more authors.
Psychological Medicine | Year: 2013

Background Knowledge of the risk of recurrence after recovery from major depressive disorder (MDD) in the general population is scarce. Method Data were derived from 687 subjects in the general population with a lifetime DSM-III-R diagnosis of MDD but without a current major depressive episode (MDE) or dysthymia. Participants had to be at least 6 months in remission, and were recruited from The Netherlands Mental Health Survey and Incidence Study (NEMESIS), using the Composite International Diagnostic Interview (CIDI). Recency and severity of the last MDE were assessed retrospectively at baseline. Recurrence of MDD was measured prospectively during the 3-year follow-up. Kaplan-Meier survival curves were used to measure time to recurrence. Determinants of time to recurrence were analyzed using proportional hazard models. Results The estimated cumulative recurrence of MDD was 13.2% at 5 years, 23.2% at 10 years and 42.0% at 20 years. In bivariate analysis, the following variables predicted a shorter time to recurrence: younger age, younger age of onset, higher number of previous episodes, a severe last depressive episode, negative youth experiences, ongoing difficulties before recurrence and high neuroticism. Multivariably, younger age, a higher number of previous episodes, a severe last depressive episode, negative youth experiences and ongoing difficulties remained significant. Conclusions In this community sample, the long-term risk of recurrence was high, but lower than that found in clinical samples. Subjects who had had an MDE had a long-term vulnerability for recurrence. Factors predicting recurrence included illness-and stress-related factors. © 2012 Cambridge University Press.


Hardeveld F.,Institute for Mental Health Care | Hardeveld F.,Netherlands Institute of Mental Health and Addition | Spijker J.,Institute for Mental Health Care | Spijker J.,Netherlands Institute of Mental Health and Addition | And 3 more authors.
Acta Psychiatrica Scandinavica | Year: 2010

Objective: Knowledge of the risk of recurrence after recovery of a major depressive disorder (MDD) is of clinical and scientific importance. The purpose of this paper was to provide a systematic review of the prevalence and predictors of recurrence of MDD. Method: Studies were searched in Medline en PsychINFO using the search terms 'recur*', 'relaps*', 'depress*', 'predict*' and course. Results: Recurrence of MDD in specialised mental healthcare settings is high (60% after 5 years, 67% after 10 years and 85% after 15 years) and seems lower in the general population (35% after 15 years). Number of previous episodes and subclinical residual symptoms appear to be the most important predictors. Gender, civil status and socioeconomic status seem not related to the recurrence of MDD. Conclusion: Clinical factors seem the most important predictors of recurrence. Data from studies performed in the general population and primary care on the recurrent course of MDD are scarce. © 2009 John Wiley & Sons A/S.


Wekking E.M.,Institute for Mental Health Care | Wekking E.M.,University of Amsterdam | Bockting C.L.H.,University of Groningen | Koeter M.W.J.,University of Amsterdam | Schene A.H.,University of Amsterdam
Journal of Affective Disorders | Year: 2012

Background: Cognitive impairment seems to persist during the euthymic phase of recurrent depression but its relationship with future relapses as with prior course of the disease has to be elucidated. The purpose of this study is to investigate the presence and prognostic value of cognitive dysfunctions for relapse in high risk euthymic patients and to identify relevant associations between cognitive functioning and prior course of illness. Methods: Standardized neuropsychological tests of mental speed, memory and executive functioning were assessed in 137 remitted patients and compared with clinically used published normative data. Previous episodes and relapses within 24 months were measured using the Structured Clinical Interview for DSM-IV. Results: Cognitive performance was significantly impaired on 12 of the 14 variables indicating deficits in the domain of speed of information processing and memory. With Cox regression no significant neuropsychological predictors for relapse or recurrence were identified. Furthermore, Pearson correlations between neuropsychological test scores and number of previous episodes, residual depressive symptoms and duration of remission were non-significant. Later age of onset was correlated with a slower speed of information processing and lower verbal memory performance. Limitations: Published test reference data were used but no healthy control group. Conclusion: Presence of mild cognitive impairment in remitted patients was demonstrated but did not predict future relapses nor was it related with prior course of disease except for age of onset. Though, mild cognitive impairment after remission might have an impact on the quality of life, adding techniques from cognitive rehabilitation might prove to be a treatment option. © 2012 Elsevier B.V.


Eikelboom E.M.,University of Groningen | Tak L.M.,University of Groningen | Tak L.M.,Institute for Mental Health Care | Roest A.M.,University of Groningen | Rosmalen J.G.M.,University of Groningen
Journal of Psychosomatic Research | Year: 2016

Background Functional somatic symptoms (FSS) are bodily complaints of unclear etiology, which are (currently) not fully explained by well-recognized somatic pathology. Doctors are often hesitant to diagnose FSS, due to the risk to miss a somatic disease. The purpose of this study is to review available literature on the percentage of patients diagnosed with FSS reported to have an underlying somatic disease that explains their symptoms previously labeled as FSS. Methods We performed a systematic search of Medline, Embase and PsycINFO databases and reference lists of selected articles. We included studies published between January 1980 and July 2014 without language restrictions. Studies that measured the percentage of underlying somatic diseases after a diagnostic evaluation or naturalistic follow-up period in adult patients initially diagnosed with FSS were included. As primary outcome measure the weighted percentage of revised diagnoses was calculated using meta-analyses. Results Six diagnostic evaluation studies (total N = 1804 patients) and 16 follow-up studies (total N = 2440 patients) were included. The percentage of revised diagnosis in patients initially diagnosed with FSS was 8.8% (95% CI 1.0 to 22.2, p = 0.007) in diagnostic evaluation studies and 0.5% (95% CI 0.01 to 1.5, p = 0.03) in follow-up studies. Partially or possibly related diagnoses were rarely found. No specific somatic diagnosis seemed to be missed systematically. Conclusions The percentage of underlying somatic diseases in patients previously diagnosed with FSS is relatively small but unneglectable. © 2016 Elsevier Inc.


Zandi T.,Institute for Mental Health Care | Havenaar J.M.,Institute for Mental Health Care | Laan W.,University Utrecht | Kahn R.S.,University Utrecht | van den Brink W.,University of Amsterdam
Schizophrenia Research | Year: 2011

Previous research has shown discrepancies between a standard diagnostic interview for schizophrenia (CASH) and a culture sensitive version of this instrument (CASH-CS) in Moroccan patients. More specifically we showed that among Moroccan immigrants the CASH-CS resulted in fewer patients with a diagnosis of schizophrenia compared with diagnoses based on the CASH, whereas for Native Dutch patients there was no difference between the CASH and the CASH-CS. The aim of the current study was to compare the predictive validity of a diagnosis of schizophrenia according to the CASH and CASH-CS. Method: Thirty months after referral, 26 Moroccan and 26 native Dutch patients with a suspected first psychotic episode were compared with regard to 30-month diagnostic stability, symptom development, psychosocial functioning, medication use and hospitalization using baseline diagnoses based on the two versions of the CASH. Results: Moroccan patients who were diagnosed with schizophrenia using the standard CASH at baseline had a significantly better 30-month prognosis than native Dutch patients with the same CASH diagnosis. Prognosis of schizophrenia according to the CASH-CS was similar for Moroccans and native Dutch patients. Diagnostic stability according to the CASH was high for native Dutch (92%), but low for Moroccan patients (27%), whereas diagnostic stability according to the CASH-CS was high for both groups (85% and 81%, respectively). Conclusion: These data raise questions regarding the validity of the standard CASH in Moroccan immigrants in The Netherlands and support the validity of the CASH-CS. As a consequence, there are serious doubts about the validity of previous studies showing an increased incidence of schizophrenia in immigrants using standard diagnostic procedures. © 2011 Elsevier B.V.


Sanders J.B.,Institute for Mental Health Care | Sanders J.B.,EMGO Institute for Health and Care Research | Bremmer M.A.,EMGO Institute for Health and Care Research | Bremmer M.A.,VU University Amsterdam | And 4 more authors.
Journal of the American Geriatrics Society | Year: 2012

Objectives To investigate whether gait speed predicts incident depressive symptoms and whether depressive symptoms predict incident gait speed impairment; to ascertain the presence of shared risk factors for these associations. Design The Longitudinal Aging Study Amsterdam, a prospective cohort study with five follow-up cycles over 16 years. Setting Population based. Participants One thousand nine hundred twenty-eight respondents for incident depressive symptoms (mean age 68.9 ± 8.5) and 1,855 respondents for incident gait speed impairment (mean age 68.0 ± 8.2). Measurements Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale; gait speed was measured, back and forth, during a 3-m walk as quickly as possible, with a 180° turn. Multivariate analyses were performed for both sexes using Cox regression. Results Incident depressive symptoms occurred in 24% of respondents. In univariate analyses, gait speed at baseline predicted incident depressive symptoms in men and women; after adjustment for covariates, this association persisted in men only. Examining the reverse association, 34% of respondents developed gait speed impairment. Depressive symptoms at baseline were univariately associated with incident gait speed impairment in women but not in men; this association did not persist after adjustment. The bidirectional associations did not share the same explanatory variables. Conclusion Gait speed predicts depressive symptoms in men. The geriatric giants of depressive symptoms and slowed gait speed in late life appear to result from different pathologies, both of which therefore require their own treatment strategies. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.


Aziz N.A.,Leiden University | Rozing M.P.,Institute for Mental Health Care
PLoS ONE | Year: 2013

Current metrics for estimating a scientist's academic performance treat the author's publications as if these were solely attributable to the author. However, this approach ignores the substantive contributions of co-authors, leading to misjudgments about the individual's own scientific merits and consequently to misallocation of funding resources and academic positions. This problem is becoming the more urgent in the biomedical field where the number of collaborations is growing rapidly, making it increasingly harder to support the best scientists. Therefore, here we introduce a simple harmonic weighing algorithm for correcting citations and citation-based metrics such as the h-index for co-authorships. This weighing algorithm can account for both the nvumber of co-authors and the sequence of authors on a paper. We then derive a measure called the 'profit (p)-index', which estimates the contribution of co-authors to the work of a given author. By using samples of researchers from a renowned Dutch University hospital, Spinoza Prize laureates (the most prestigious Dutch science award), and Nobel Prize laureates in Physiology or Medicine, we show that the contribution of co-authors to the work of a particular author is generally substantial (i.e., about 80%) and that researchers' relative rankings change materially when adjusted for the contributions of co-authors. Interestingly, although the top University hospital researchers had the highest h-indices, this appeared to be due to their significantly higher p-indices. Importantly, the ranking completely reversed when using the profit adjusted h-indices, with the Nobel laureates having the highest, the Spinoza Prize laureates having an intermediate, and the top University hospital researchers having the lowest profit adjusted h-indices, respectively, suggesting that exceptional researchers are characterized by a relatively high degree of scientific independency/originality. The concepts and methods introduced here may thus provide a more fair impression of a scientist's autonomous academic performance. © 2013 Aziz, Rozing.


Knook L.M.E.,University Utrecht | Konijnenberg A.Y.,University Utrecht | Van Der Hoeven J.,Institute for Mental Health Care | Kimpen J.L.L.,University Utrecht | And 3 more authors.
European Child and Adolescent Psychiatry | Year: 2011

The prevalence of psychiatric disorders among children with unexplained chronic pain (UCP) is high in unselected populations and pain clinics, yet the clinical relevance of these disorders in children referred for unexplained pain is not known. This study assessed the prevalence of clinically relevant psychiatric disorders and their predictors in children referred to a children's hospital for UCP. Psychiatry morbidity was assessed in 134 children, aged 8-17 years, using the Diagnostic Interview Schedule for Children-parent version (DISC-P) and the Semi-structured Clinical Interview for Children and Adolescents (SCICA). Clinical relevance was determined using a maladjustment criterion of 61 or lower on the Children's Global Assessment Scale (CGAS). Pain parameters were measured with standardized questionnaires. Results were analysed by logistic regression. According to the DISC-P, 21% of the children had clinically relevant psychiatric disorders, predominantly anxiety disorders (18%). According to the SCICA, 28% of the children had clinically relevant psychiatric disorders, consisting of anxiety, affective, and disruptive disorders (12, 19, and 9%, respectively). Headache (compared to musculoskeletal pain) was an independent clinical predictor of psychiatric morbidity (OR = 3.10; 95% CI 1.07-8.92, p = 0.04/adjusted OR 2.99; 95% CI 1.02-8.74, p = 0.04). In conclusion, clinically relevant psychiatric disorders are common among children and adolescents referred for UCP. Adding a child psychiatrist assessment, treatable affective and disruptive disorders become identifiable. Children with an additional risk are those presenting with headache. © 2010 The Author(s).

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