The fact that most healthcare resources are spend on a small subgroup of patients with an unfavourable prognosis has long been recognized. Therefore change is needed in terms of an improved... Show moreThe fact that most healthcare resources are spend on a small subgroup of patients with an unfavourable prognosis has long been recognized. Therefore change is needed in terms of an improved identification of patients with an unfavourable prognosis, early in their treatment course, which may facilitate proactive approaches to improve outcomes. We discussed two conceptually distinct constructs of predictors of prognosis in order to improve the identification of patients with an unfavourable prognosis. First, the level of control of the chronic condition as a predictor could reflect to some extent the presence of a multitude of other risk factors. Second, information on early treatment response had better predictive ability for long-term outcomes and so acts as a proxy for treatment effectiveness. Treatment effectiveness depends on different aspects e.g. adequateness of initial treatment and/or drugs, the mutual trust between clinician and patient and behavioral aspects such as treatment adherence. Treatment response adds an insight that can be acted upon; guiding personalized decisions in the treatment plan. In conclusion, this thesis leads to improvement of personalized medicine and thereby could increase the efficient use of healthcare resources, with the early identification of patients at risk of an unfavourable prognosis. Show less
Ballegooijen, W. van; Eikelenboom, M.; Fokkema, M.; Riper, H.; Hemert, A.M. van; Kerkhof, A.J.F.M.; ... ; Smit, J.H. 2019
Background: Suicidality could be associated with specific combinations of biological, social and psychologicalfactors. Therefore, depressive episodes with suicidal ideation could be different from... Show moreBackground: Suicidality could be associated with specific combinations of biological, social and psychologicalfactors. Therefore, depressive episodes with suicidal ideation could be different from depressive episodeswithout suicidal ideation in terms of latent variable structures.Methods: In this study we compared latent variable structures between suicidal and non-suicidal depressedpatients using confirmatory factor analysis (CFA), following a measurement invariance test procedure. Patients(N = 919) suffering from major depressive disorder were selected from the Netherlands Study of Depression andAnxiety (NESDA) and split into a group that showed no symptoms of suicidal ideation (non-SI; N = 691) and asuicidal ideation (SI) group that had one or more symptoms of suicidal ideation (N = 228). Depression andanxiety symptoms were measured using the short form of the Mood and Anxiety Symptoms Questionnaire(MASQ-D30).Results: CFA implied a difference in latent variable structures between the non-SI sample (CFI 0.957; RMSEA0.041) and the SI sample (CFI 0.900; RMSEA 0.056). Subsequent multiple-group CFA showed violations ofmeasurement invariance. The General distress and Anhedonic depression subscales were best indicated byhopelessness and lack of optimism in the SI sample and by dissatisfaction and not feeling lively in the non-SIsample. Overall, the SI sample had higher scores and lower inter-item correlations on the Anhedonic depressionitems.Limitations: We have included very mild cases of suicidal ideation in our SI sample.Conclusions: On a latent variable level, depression with suicidal ideation differs from depression without suicidalideation. Results encourage further research into the symptom structure of depression among suicidal patients Show less
Paans, N.P.G.; Bot, M.; Gibson-Smith, D.; Does, W. van der; Spinhoven, P.; Brouwer, I.; ... ; Penninx, B.W.J.H. 2016
The aim of this thesis was to investigate the effect of childhood trauma and childhood life-events on the development and course of depressive and anxiety disorders, and to identify risk factors... Show moreThe aim of this thesis was to investigate the effect of childhood trauma and childhood life-events on the development and course of depressive and anxiety disorders, and to identify risk factors contributing to these associations. In brief, our findings indicate that childhood trauma is an important risk factor for the development of depressive and/or anxiety disorders, especially depressive and comorbid disorders, and predicts a more chronic course of illness. Emotional neglect, as core component of childhood trauma, is of particular relevance and has a predominant and strong negative impact on onset and course of depressive and anxiety disorders. Our mediation analyses demonstrate the lifelong scarring through which childhood trauma may affect cognitive style, personality traits and ultimately psychopathology in adulthood. The findings of this thesis are keys to increased awareness of the negative impact of childhood trauma on psychosocial functioning, personality profile, and psychopathology. Based on our findings, recommendations for Chapter 7 Summary 136 clinical practice and future research have been formulated. Show less
Leeuw, G. van der; Gerrits, M.J.; Terluin, B.; Numans, M.E.; Feltz-Cornelis, C.M. van der; Horst, H.E. van der; ... ; Marwijk, H.W.J. van 2015
In this thesis, we provide evidence in research on endophenotypes of psychopathology that it is fruitful not to take the clinical picture central, but the hypothalamus-pituitary-adrenal (HPA) axis... Show moreIn this thesis, we provide evidence in research on endophenotypes of psychopathology that it is fruitful not to take the clinical picture central, but the hypothalamus-pituitary-adrenal (HPA) axis as a core stress system underlying psychopathophysiology in stress-related disorders. Homeostatic systems, including the HPA axis, are by nature nonlinear in their function, with suboptimal states of function at both sides of the curve, e.g. hyper- versus hypofunction. By taken the HPA axis as starting point, we were able redefine the clinical phenotype in relation to both dysfunctional states, i.e., hyper- and hypocortisolism. Furthermore, starting with the stress system enabled us to investigate the effects of HPA axis dysfunction on the metabolic and immune system. Based on the studies presented in this thesis, we hypothesize that the nonlinear aspect of HPA axis function reflects different time points during the stress process, from a hyperactive HPA axis when the stress begins to, eventually, a hypoactive HPA axis when stress holds on. Secondly, we hypothesize that both dysfunctional states of the HPA axis, i.e., hyper- and hypocortisolism, differ in their effects on the metabolic and immune system. Show less
Arnold, Ingrid Antonette; Waal, Margaretha Wilhelmina Maria de 2006
De huisarts ziet veel patienten met onverklaarde lichamelijke klachten, vaak in combinatie met angst- en depressieve klachten. Dit proefschrift beschrijft de resultaten van een prevalentie studie... Show moreDe huisarts ziet veel patienten met onverklaarde lichamelijke klachten, vaak in combinatie met angst- en depressieve klachten. Dit proefschrift beschrijft de resultaten van een prevalentie studie met een prospectieve follow-up en een daarop volgende behandelstudie. De prevalentie van somatoforme stoornissen (DSM-IV) was 16,1%: één op de zes patienten die de huisarts bezoekt had tenminste zes maanden last van onverklaarde lichamelijk klachten met aanzienlijke beperkingen. De overlap met angst en depressie was substantieel en vergrootte de ernst van de ziektelast. Deze bevindingen onderstrepen het belang van een brede diagnostiek in de huisartspraktijk die zowel angst en depressie als somatoforme stoornissen omvat. Het aantal symptomen, zowel lichamelijk als psychisch, kan een nuttig instrument zijn bij het identificeren van de ernstigste patiënten. Het gegeven dat bijna driekwart van alle patiënten met een somatoforme stoornis langdurig klachten houdt impliceert een grote behoefte aan behandeling. In een gecontroleerde behandelstudie konden we echter niet aantonen dat een cognitief-gedragsmatige interventie volgens het gevolgenmodel door getrainde huisartsen effectiever was dan gebruikelijke zorg. Aangezien de behandelde patiënten vaak ernstige klachten hadden stellen de auteurs voor om een stapsgewijze behandelmethode te ontwikkelen zodat zowel kortdurende als chronische klachten goed aangepakt kunnen worden. Show less
