The main objective of this thesis is to describe the epidemiology of long term BZD use as well as its long term consequences. This thesis is structured into three sections: In section one, the... Show moreThe main objective of this thesis is to describe the epidemiology of long term BZD use as well as its long term consequences. This thesis is structured into three sections: In section one, the correlates of BZD use, new use, chronic use, inappropriate use, and BZD dependence severity are investigated. The possible influence of the prescribing physicians on patient BZD use is also considered. In section two, the focus is on the physiological consequences of long-term BZDs use on the HPA axis and the ANS. In section three, cognitive effects of BZDs in long-term users are addressed Show less
The aim of this thesis was to clarify which aspects of depression and anxiety are related to an increased metabolic risk, and which factors contribute to these associations. Taken together, our... Show moreThe aim of this thesis was to clarify which aspects of depression and anxiety are related to an increased metabolic risk, and which factors contribute to these associations. Taken together, our findings indicate that people with more severe symptoms of depression and anxiety are at particular risk of progressive dyslipidemia and (abdominal) obesity. The higher rates of smoking and systemic inflammation among people with depression or anxiety partially accounted for their adverse metabolic profile. Dysregulations of the autonomic nervous system partly explained why users of tricyclic antidepressants displayed an increased risk of dyslipidemia and (abdominal) obesity as well, and also of hypertension. These important findings shed light on useful avenues for future research, and on preventive and therapeutic insights and directions. Show less
Jamal, M.; Does, A.J.W. van der; Cuijpers, P.; Penninx, B.W.J.H. 2012
In a clinical sample of 116 children and adolescents we studied the relation between the course of an anxiety disorder during treatment and the concomitant changes in cortisol levels. Assessments... Show moreIn a clinical sample of 116 children and adolescents we studied the relation between the course of an anxiety disorder during treatment and the concomitant changes in cortisol levels. Assessments at base-line, after three months, and at one-year follow-up were performed with the Anxiety Disorders Interview Schedule. When we compared cortisol levels at baseline and one-year follow-up, persistence of the anxiety disorder was associated with both increased daytime cortisol production (F = 3.2, p = 0.04) and a trend towards a decreased cortisol morning rise (F = 2.4, p = 0.09). At one-year follow-up daytime cor-tisol production was lowest in the early remitters (109.7 ± 29.2 h mmol/l), higher in the late remitters (121.0 ± 40.0 h mmol/l) and highest in the non-remitters (131.1 ± 48.9 h mmol/l). Early remitters had the highest cortisol morning rise (1.1 ± 1.5 h mmol/l), followed by the late remitters (0.8 ± 1.8 h mmol/l), the non-remitters had the lowest cortisol morning rise (0.07 ± 1.7 h mmol/l). Persistence of an anxiety disorder may thus lead to changes in HPA-axis functioning, underscoring the importance adequate treatment of anxiety disorders. Show less
The main objectives were to evaluate efficacy and acceptability of a developmentally sensitive cognitive behavioral therapy for anxiety-based school refusal in adolescence. Twenty school-refusing... Show moreThe main objectives were to evaluate efficacy and acceptability of a developmentally sensitive cognitive behavioral therapy for anxiety-based school refusal in adolescence. Twenty school-refusing adolescents meeting DSM-IV anxiety disorder criteria participated in a non-randomized trial, together with parents and school staff. Outcome was assessed at post-treatment and 2-month follow-up. Treated adolescents showed significant and maintained improvements across primary outcome variables (school attendance; school-related fear; anxiety), with medium to large effect sizes. Half of the adolescents were free of any anxiety disorder at follow-up. Additional improvements were observed across secondary outcome variables (depression; overall functioning; adolescent and parent self-efficacy). The treatment was rated as acceptable by adolescents, parents, and school staff, which may help explain the very low attrition rate. Social anxiety disorder was the most common disorder among adolescents still meeting anxiety disorder criteria at follow-up. Treatment modifications to improve efficacy for school-refusing adolescents presenting with social anxiety disorder are suggested. Show less
Prins, M.; Meadows, G.; Bobevski, I.; Graham, A.; Verhaak, P.; Meer, K. van der; ... ; Bensing, J. 2011
The Children’s Negative Cognitive Error Questionnaire (CNCEQ) is commonly used to measure four errors in young people’s thinking, but research has failed to support the factorial validity of the... Show moreThe Children’s Negative Cognitive Error Questionnaire (CNCEQ) is commonly used to measure four errors in young people’s thinking, but research has failed to support the factorial validity of the measure. The primary objective of the present study was to examine the factor structure of a refined and extended version of the CNCEQ. Revision of the CNCEQ involved the exclusion of items rated as contaminated, and the addition of items measuring cognitive errors closely associated with anxiety (‘threat conclusion’ and ‘underestimation of the ability to cope’). A secondary objective was to determine the relation between the negative cognitive errors and anxiety. Principal component analysis of data from 481 children and adolescents indicated five distinct negative cognitive error subscales labeled ‘underestimation of the ability to cope’, ‘personalizing without mind reading’, ‘selective abstraction’, ‘overgeneralizing’, and ‘mind reading’ which contained the new ‘threat conclusion’ items. Confirmatory factor analysis in an independent sample of 295 children and adolescents yielded further support for the five-factor solution. All cognitive errors except ‘selective abstraction’ were correlated with anxiety. Multiple regression analysis indicated that the strongest predictors of anxiety were the two subscales containing new items, namely ‘underestimation of the ability to cope’ and ‘mind reading’. The results are discussed with respect to further development of the instrument so as to advance the assessment of distorted cognitive processing in young people with internalizing symptoms. Show less
The main purpose of this dissertation was to highlight and address seven challenges related to the measurement of youth cognition, understanding the role of cognitive constructs in anxiety and... Show moreThe main purpose of this dissertation was to highlight and address seven challenges related to the measurement of youth cognition, understanding the role of cognitive constructs in anxiety and school refusal, and the examination of cognitive mediators of cognitive-behavioural treatment outcomes. The studies presented in this dissertation contributed to the empirically valid assessment of constructs of cognitive processing in youth which were until now only present in cognitive theories of Aron Beck. Now, constructs of cognitive processing coming from the cognitive theories of depression and anxiety of Beck and colleagues can be assessed in youth using one single measure. Further, cognitive dimensions of cognitive products and cognitive processes from Beck and colleagues cognitive theories of emotional disorders were found to be important in the etiology of school refusal. The belief that positive treatment outcomes can be achieved through changes in cognition received support. Using innovative statistical approaches to mediation, it was found that enhanced levels of self-efficacy following cognitive-behavioural treatment for school refusal were associated with increased levels of school attendance and decreased levels of school fear. Show less
Doublecortin (DCX) and DCX-domain containing Doublecortin-Like Kinase (DCLK) gene splice variants function during embryonic development, where they play a role in microtubule binding. Although a... Show moreDoublecortin (DCX) and DCX-domain containing Doublecortin-Like Kinase (DCLK) gene splice variants function during embryonic development, where they play a role in microtubule binding. Although a role for the DCLK gene during embryogenesis is clearly established, it encodes multiple, different transcripts, some of which are expressed in the adult brain or in response to neuronal activity. This suggests that the DCLK gene may have additional functions beyond neuronal development. Strikingly, the roles of two DCLK gene products, DCLK-short and CaMK-related peptide (CARP), remain largely elusive. Therefore, we have generated transgenic mice with over-expression of either CARP or a constitutively active form of DCLK-short, called _C-DCLK-short, in the brain. This has opened up the possibility to study the effect of over-expression of these DCLK transcripts in the brain during adulthood. To gain more insight in DCLK gene function in the adult brain we aimed to study and describe the phenotypes of these transgenic mice at different functional levels, such as the genetic, network and behavioural level. Show less
