Purpose: Most of the network approaches in eating disorders found the highest degree of centrality for symptoms related to weight and shape concerns. However, longitudinal analyses are scarce and... Show morePurpose: Most of the network approaches in eating disorders found the highest degree of centrality for symptoms related to weight and shape concerns. However, longitudinal analyses are scarce and may increase our insight of the complex characteristics and dynamics over time. In the current study, an alternative non-linear method to perform longitudinal network analyses, the dynamic time warp approach, was used to examine whether robust dimensions of eating disorder psychopathology symptoms could be found based on the individual dynamic interplay of eating disorder symptoms co-occurrence patterns in time. Methods: The study sample included a naturalistic cohort of patients (N = 255) with all eating disorder subtypes who were assessed with the eating disorder examination questionnaire (EDE-Q) at a minimum of four times during treatment. Dynamic time warp analyses yielded distance matrices within each individual patient, which were subsequently aggregated into symptom networks and dimensions at the group level. Results: Aggregation of the individual distance matrices at the group level yielded four robust symptom dimensions: 1. restraint/rules, 2. secret eating/fasting, 3. worries/preoccupation, and 4. weight and shape concern. The items 'fear of weight gain' and 'guilt' were bridge symptoms between the dimensions 1, 3 and 4. Conclusion: Dynamic time warp could capture the within-person dynamics of eating disorder symptoms. Sumscores of the four dimensions could be used to follow patients over time. This approach could be applied in the future to visualize eating disorder symptom dynamics and signal the central symptoms within an individual and groups of patients. Show less
Hebbrecht, K.; Stuivenga, M.; Birkenhager, T.; Morrens, M.; Fried, E.I.; Sabbe, B.; Giltay, E.J. 2020
BackgroundMajor depressive disorder (MDD) shows large heterogeneity of symptoms between patients, but within patients, particular symptom clusters may show similar trajectories. While symptom... Show moreBackgroundMajor depressive disorder (MDD) shows large heterogeneity of symptoms between patients, but within patients, particular symptom clusters may show similar trajectories. While symptom clusters and networks have mostly been studied using cross-sectional designs, temporal dynamics of symptoms within patients may yield information that facilitates personalized medicine. Here, we aim to cluster depressive symptom dynamics through dynamic time warping (DTW) analysis.MethodsThe 17-item Hamilton Rating Scale for Depression (HRSD-17) was administered every 2weeks for a median of 11weeks in 255 depressed inpatients. The DTW analysis modeled the temporal dynamics of each pair of individual HRSD-17 items within each patient (i.e., 69,360 calculated "DTW distances"). Subsequently, hierarchical clustering and network models were estimated based on similarities in symptom dynamics both within each patient and at the group level.ResultsThe sample had a mean age of 51 (SD 15.4), and 64.7% were female. Clusters and networks based on symptom dynamics markedly differed across patients. At the group level, five dynamic symptom clusters emerged, which differed from a previously published cross-sectional network. Patients who showed treatment response or remission had the shortest average DTW distance, indicating denser networks with more synchronous symptom trajectories.ConclusionsSymptom dynamics over time can be clustered and visualized using DTW. DTW represents a promising new approach for studying symptom dynamics with the potential to facilitate personalized psychiatric care. Show less
Hebbrecht, K.; Stuivenga, M.; Birkenhager, T.; Mast, R.C. van der; Sabbe, B.; Giltay, E.J. 2020
Background:Although differences in symptom profiles and outcome between depressive patients with an underlying major depressive disorder (MDD) and bipolar depression (BD) have been reported,... Show moreBackground:Although differences in symptom profiles and outcome between depressive patients with an underlying major depressive disorder (MDD) and bipolar depression (BD) have been reported, studies with sequential short-interval assessments in a real-life inpatient setting are scarce.Objectives:To examine potential differences in symptom profile and course of depressive symptomatology in depressive inpatients with underlying MDD and BD.Methods:A cohort of 276 consecutive inpatients with MDD (n= 224) or BD (n= 52) was followed during their hospitalization using routine outcome monitoring (ROM), which included a structured diagnostic interview at baseline (Mini-International Neuropsychiatric Interview Plus [MINI-Plus]) and repeated 17-item Hamilton Depression Rating Scale every 2 weeks. MDD and BD were compared regarding their symptom profiles and time to response and remission. Furthermore, the concordance between the MINI-Plus and clinical diagnosis was analyzed.Results:Patients were on average 52 and 47 years old in the MDD and BD group, respectively, and 66 versus 64% were female. Compared to patients with BD, patients with MDD scored higher on weight loss (p= 0.02), whereas the BD group showed a higher long-term likelihood of response (hazard ratio = 1.93, 95% confidence interval 1.16-3.20,pfor interaction with time = 0.04). Although the same association was seen for remission, the interaction with time was not significant (p= 0.48). Efficiency between the MINI-Plus and clinical diagnosis of BD was high (0.90), suggesting that the MINI-Plus is an adequate ROM diagnostic tool.Conclusions:In routine clinical inpatient care, minor differences in the symptom profile and the course of depressive symptomatology may be helpful in distinguishing MDD and BD, particularly when using sequential ROM assessments. Show less
To assess (feasibility) of adherence to treatment guidelines among outpatients with common mental disorders in a routine Dutch clinical outpatient setting for common mental disorders with clinical... Show moreTo assess (feasibility) of adherence to treatment guidelines among outpatients with common mental disorders in a routine Dutch clinical outpatient setting for common mental disorders with clinical treatment data. Also,we studied patient- and therapistfactors influencing guideline-adherence in clinical practice.We established certain characteristics that might hamper tretamnet according to guidelines and more research is needed to assess whether patient in clinical practice do benefit from guidelines. Show less
The primary aim of the NormQuest study described in this thesis was to generate evidencebased, reference values for 19 self-report and observational questionnaires. The focus was on questionnaires... Show moreThe primary aim of the NormQuest study described in this thesis was to generate evidencebased, reference values for 19 self-report and observational questionnaires. The focus was on questionnaires measuring mood, anxiety, and somatoform (MAS) disorders used in Routine Outcome Monitoring (ROM). The set of cut-off values of the ROM reference group (__healthy__) can be used in specialized mental health care by therapists to support the decision whether a patient is sufficiently recovered to be considered as a member of the healthy population, and no longer as a member of the patient population. These reference values are suitable as decision support for referral back to primary care physicians. Additionally, the set of the ROM patient group (__clinically ill__) cut-off values can be used by primary care physicians as decision support for referral to the specialized mental health care. To allow determination of cut-off points for skewed distributions, percentile scores were used. In addition, we assessed the discriminative power of the questionnaire scores by means of Receiver Operating Characteristics (ROC) analyses. Finally, we calculated reference values in separate strata of gender and age. The secondary aim of the NormQuest study concerned the need for the development of public domain questionnaires. In the NormQuest study, the generic Symptom Questionnaire-48 (SQ-48), aimed at broad applicability in patients with MAS disorders, was developed. Also, for the SQ-48 reference values were calculated Show less
Research into the relation between psychopathology and etiological factors has not yet resulted in clear findings. One of the probable causes is that most researchers use the categorical DSM-IV... Show moreResearch into the relation between psychopathology and etiological factors has not yet resulted in clear findings. One of the probable causes is that most researchers use the categorical DSM-IV Classification of mental disorders. A dimensional system has several advantages compared to categorical systems: comorbidity, lack of diagnostic agreement and arbitrary nature of used boundaries are no longer a problem. Our aim was to develop a model with dimensions that can adequately describe patients with mood- and anxiety disorders. This project used data collected through Routine Outcome Monitoring (ROM), a monitoring system for patient care. First, we validated a Dutch adaptation of an instrument based on the tripartite model. Next, we formulated an extension of this model with 5 dimensions. Consequently we presented a second model with 6 dimensions: feelings of worthlessness, fatigue, somatic arousal, anxious apprehension, phobic fear and tension. We used several analysis techniques to create a valid and reliable dimensional model. Each individual factor and the total of factors can be regarded as unidimensional measurement scales. This model can describe the clinical state of patients more specifically than the tripartite model, and can be used in subsequent research into etiological factors of psychopathology (e.g. endophenotype, genotype, trauma's, personality). Show less
In this project we investigated the difference between efficacy (treatment outcome investigated in randomized clinical trials, RCTs) and effectiveness (treatment outcome when these treatments are... Show moreIn this project we investigated the difference between efficacy (treatment outcome investigated in randomized clinical trials, RCTs) and effectiveness (treatment outcome when these treatments are applied in daily psychiatric practice) for major depressive disorder. Treatment outcome and patient features in daily practice were assessed with routine outcome monitoring. We found that effectiveness is significantly lower than efficacy. In RCTs, a stringent patient selection is applied bij inclusion/exclusion criteria. We found that patients in daily practice do differ significantly from participants in RCTs with respect to baseline severity, comorbid disorders, suicidality and employment status. However, we found that these differences have very little influence on treatment outcome. In other words, if, hypothetically, only patients who are eligible for participation in RCTs for major depressive disorder would be tre ated, treatment success would not improve dramatically. Show less
Lem, R. van der; Wee, N.J.A. van der; Veen, T. van; Zitman, F.G. 2012
The principal aim of this thesis was to develop an outcome monitoring feedback model for Dutch outpatient mental health care in the Netherlands and to test whether providing feedback to therapists... Show moreThe principal aim of this thesis was to develop an outcome monitoring feedback model for Dutch outpatient mental health care in the Netherlands and to test whether providing feedback to therapists and patients can improve treatment outcomes. Data on patient progress collected in outpatient centers in the Netherlands were used to predict the functioning of patients at the end of treatment and the rate of change. In addition, two feedback studies were conducted. In the first study the effect of therapist feedback was compared with no feedback. The results showed no significant effect of feedback for the full group, but did show an effect for therapists that actively used the feedback in therapy. Therapist factors mediated the effectiveness of feedback: in therapists with higher self-efficacy the feedback had a more positive effect. The second study had three treatment conditions, a control group, a group with feedba ck to therapists alone and a group in which both therapists and patients received feedback about the patient’s progress. The results showed that feedback to both therapists and patients was more effective than feedback to therapists alone. The feedback effect was strongest in short-term therapy, for cases that were not progressing well. Show less
