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The Hague, Netherlands

Staring A.B.P.,Altrecht Psychiatric Institute | Ter Huurne M.-A.B.,Mediant Psychiatric Institute | Van Der Gaag M.,Parnassia Psychiatric Institute | Van Der Gaag M.,VU University Amsterdam
Journal of Behavior Therapy and Experimental Psychiatry | Year: 2013

Background and objectives: The treatment of negative symptoms in schizophrenia is a major challenge for mental health care. One randomized controlled trial found that cognitive therapy for low-functioning patients reduced avolition and improved functioning, using an average of 50.5 treatment sessions over the course of 18 months. The aim of our current pilot study was to evaluate whether 20 sessions of Cognitive Behavioral Therapy for negative symptoms (CBT-n) would reduce negative symptoms within 6 months. Also, we wanted to test the cognitive model of negative symptoms by analyzing whether a reduction in dysfunctional beliefs mediated the effects on negative symptoms. Method: In an open trial 21 adult outpatients with a schizophrenia spectrum disorder with negative symptoms received an average of 17.5 sessions of CBT-n. At baseline and end-of-treatment, we assessed negative symptoms (PANSS) and dysfunctional beliefs about cognitive abilities, performance, emotional experience, and social exclusion. Bootstrap analysis tested mediation. Results: The dropout rate was 14% (three participants). Intention-to-treat analyses showed a within group effect size of 1.26 on negative symptoms (t = 6.16, | Sig = 0.000). Bootstrap analysis showed that dysfunctional beliefs partially mediated the change. Limitations: The uncontrolled design induced efficacy biases. Also, the sample was relatively small, and there were no follow-up assessments. Conclusions: CBT-n may be effective in reducing negative symptoms. Also, patients reported fewer dysfunctional beliefs about their cognitive abilities, performance, emotional experience, and social exclusion, and this reduction partially mediated the change in negative symptoms. The reductions were clinically important. However, larger and controlled trials are needed. © 2013 Elsevier Ltd. All rights reserved.


Kok R.M.,Parnassia Psychiatric Institute
Psychiatric Clinics of North America | Year: 2013

In this article, the efficacy and side effects of antidepressants in the elderly are discussed. In addition, whether the elderly in general should be treated with lower doses of antidepressants, and whether the elderly have a slower response to antidepressant treatment, are also discussed. © 2013 Elsevier Inc.


Oostervink F.,GGZ Haagstreek Rivierduinen | Nolen W.A.,University of Groningen | Kok R.M.,Parnassia Psychiatric Institute
International Journal of Geriatric Psychiatry | Year: 2015

Background: Information about differences between younger and older patients with bipolar disorder and between older patients with early and late age of onset of illness during long-term treatment is scarce. Objectives: This study aimed to investigate the differences in treatment and treatment outcome between older and younger manic bipolar patients and between early-onset bipolar (EOB) and late-onset bipolar (LOB) older patients. Method: The European Mania in Bipolar Longitudinal Evaluation of Medication study was a 2-year prospective, observational study in 3459 bipolar patients on the treatment and outcome of patients with an acute manic or mixed episode. Patients were assessed at 6, 12, 18, and 24 months post-baseline. We calculated the number of patients with a remission, recovery, relapse, and recurrence and the mean time to achieve this. Results: Older patients did not differ from younger bipolar patients in achieving remission and recovery or suffering a relapse and in the time to achieve this. However, more older patients recurred and in shorter time. Older patients used less atypical antipsychotics and more antidepressants and other concomitant psychiatric medication. Older EOB and LOB patients did not differ in treatment, but more older LOB patients tended to recover than older EOB patients. Conclusion: Older bipolar manic patients did not differ from younger bipolar patients in short-term treatment outcome (remission and recovery), but in the long term, this may be more difficult to maintain. Distinguishing age groups in bipolar study populationsmay be useful when considering treatment and treatment outcome and warrants further study. Copyright © 2014 John Wiley & Sons, Ltd.


Kok R.M.,Parnassia Psychiatric Institute | Nolen W.A.,University of Groningen | Heeren T.J.,Symfora Group Centers of Mental Health Care
Journal of Affective Disorders | Year: 2012

Background: This systematic review evaluated all published double-blind, randomized controlled antidepressant trials (RCTs) of acute phase treatment of older depressed patients. Methods: Meta-analyses were conducted in 51 double-blind RCTs of antidepressants in older patients. The results were also compared with 29 double-blind RCTs that did not produce extractable data to enter the meta-analysis. Results: All classes of antidepressant (TCA's, SSRIs and other antidepressants) were more effective than placebo in achieving response. In achieving remission however, only pooling all 3 classes of antidepressants together showed a statistically significant difference from placebo. No differences were found in remission or response rates between classes of antidepressants. TCAs were also equally effective compared with SSRIs in achieving response in more severely depressed patients. The numbers needed to treat (NNT) were 14.4 (95% CI 8.3-50) for one additional remission to antidepressants compared with placebo and 6.7 (95% CI 4.8-10) for response. The results of the double-blind RCTs that did not produce extractable data to enter the meta-analysis were in concordance with the RCTs that were included in the meta-analysis. Limitations: Only 4 RCTs were found that have not been published. Few studies have focused on severely depressed older people. Conclusions: Antidepressant treatment in older depressed patients is efficacious. We could not demonstrate differences in effectiveness between different classes of antidepressants; this was also the case in more severely depressed patients. © 2012 Elsevier B.V.


Veling W.,Parnassia Psychiatric Institute | Susser E.,Columbia University
Expert Review of Neurotherapeutics | Year: 2011

The incidence of psychotic disorders is extremely high in several immigrant groups in Europe. This article describes the epidemiological evidence for increased incidence rates among immigrants compared with nonimmigrant populations and explores possible explanations for this excess risk. Potential causes not only involve factors acting at the level of the individual, but encompass the broader social context of neighborhoods and ethnic groups. Growing up and living in a disadvantaged ethnic minority position, characterized by a low social status, high degree of discrimination against the group and low neighborhood ethnic density, may lead to an increased risk of psychotic disorders, especially when individuals reject their minority status and when their social resources are insufficient to buffer the impact of adverse social experiences. Future research should refine measures of the social context, adopt a life-course perspective and should integrate social and neurobiological pathways.

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