[show abstract][hide abstract] ABSTRACT: Childhood trauma is associated with the onset and recurrence of major depressive disorder (MDD). The thermolabile T variant of the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism (rs1801133) is associated with a limited (oxidative) stress defense. Therefore, C677T MTHFR could be a potential predictor for depressive symptomatology and MDD recurrence in the context of traumatic stress during early life. We investigated the interaction between the C677T MTHFR variant and exposure to traumatic childhood events (TCEs) on MDD recurrence during a 5.5-year follow-up in a discovery sample of 124 patients with recurrent MDD and, in an independent replication sample, on depressive symptomatology in 665 healthy individuals from the general population. In the discovery sample, Cox regression analysis revealed a significant interaction between MTHFR genotype and TCEs on MDD recurrence (P=0.017). Over the 5.5-year follow-up period, median time to recurrence was 191 days for T-allele carrying patients who experienced TCEs (T+ and TCE+); 461 days for T- and TCE+ patients; 773 days for T+ and TCE- patients and 866 days for T- and TCE- patients. In the replication sample, a significant interaction was present between the MTHFR genotype and TCEs on depressive symptomatology (P=0.002). Our results show that the effects of TCEs on the prospectively assessed recurrence of MDD and self-reported depressive symptoms in the general population depend on the MTHFR genotype. In conclusion, T-allele carriers may be at an increased risk for depressive symptoms or MDD recurrence after exposure to childhood trauma.
[show abstract][hide abstract] ABSTRACT: Depressie wordt in de volksmond wel afgedaan als ‘dipje’ of ‘psychisch griepje’. Velen realiseren zich echter onvoldoende
dat achter het begrip depressie vaak langdurige, recidiverende en invaliderende aandoeningen schuil gaan. Deze gaan niet alleen
gepaard met veel persoonlijk leed, maar ook met belangrijke consequenties voor naasten en werk. Binnen het Programma Stemmingsstoornissen
en de afdeling Ergotherapie van het AMC houden wij ons inmiddels tien jaar bezig met de complexe relatie tussen depressie
en arbeid. In deze bijdrage ‘Voor de praktijk’ geven we aan wat depressie betekent voor arbeid en wat arbeid kan impliceren
depressieve stoornissen-ergotherapie-arbeidsgerelateerde psychische stoornissen
Tijdschrift voor Bedrijfs- en Verzekeringsgeneeskunde 05/2012; 15(7):338-341.
[show abstract][hide abstract] ABSTRACT: To investigate what patients themselves think they can contribute to recovery from depression, and what they find to be effective. The patients' perspective is necessary to improve treatment for depression.
Qualitative, hypothesis-generating study.
The experiences and opinions of 20 patients who had recently recovered from a depressive episode were investigated using the 'concept mapping' method. In the first stage, patients generated statements during group discussions around the question: 'What can people themselves do to recover from depression?' In the second stage, patients individually graded the statements by relevance and grouped them by common characteristics. In the third stage, the statements were analysed and positioned in a concept map.
In the first stage, the patients generated 50 statements which could be grouped into the following 8 clusters: active attitude towards depression and the assistance offered, regimen, explanation of the disease to acquaintances, social contacts, undertaking activities, structured attention for yourself, contact with fellow sufferers, and others. The common factor in statements that patients found the most important was that the focus for recovery should be on oneself.
From the patients' perspective several methods were mentioned by which patients can contribute to their own recovery from depression. Practitioners could use these in their contact with the patient during treatment. This study also provides the basis for developing a self-management module for recovery from depression.
Nederlands tijdschrift voor geneeskunde 01/2012; 156(19):A4337.
[show abstract][hide abstract] ABSTRACT: This study aims to investigate the most important factors facilitating a return to work after sick leave due to depression from the perspectives of patients, supervisors and occupational physicians.
Concept mapping was used to develop a conceptual framework. Using purposive sampling, 32 participants representing Employees, supervisors and occupational physicians, were asked to formulate statements on what enables patients with sick leave due to depression to return to work. A total of 41 participants rated and grouped the statements. Data were analyzed using the statistical program Ariadne.
The concept mapping yielded 60 statements that consisted of promoting factors for return to work. Based on these statements, three meta-clusters and eight clusters were identified. The three meta-clusters consisted of work-related, person-related and healthcare- related clusters. The work-related meta-cluster comprised of "Adaptation of work", "Understanding and support in the workplace" and "Positive work experiences". The person- related meta-cluster encompassed "Positive and valid self-perception", "Competence in self management", "Positive level of energy", and "Balanced home/work environment". The healthcare-related meta-cluster was composed of "Supportive healthcare". Stakeholder groups differ in opinion, in what they see as most important for return to work.
The low number of participants and the high educational level of participants are a limitation for generalization of the findings.
The study generated different statements that stakeholders consider important for return to work after sick leave due to depression. These findings can be used as a checklist for coordination of the return to work process. Differences in opinion regarding what stakeholders see as most important for return to work should receive special consideration during the re-integration process.
Journal of affective disorders 07/2011; 136(3):1017-26. · 3.76 Impact Factor
[show abstract][hide abstract] ABSTRACT: To study the validity of detecting panic disorder (PD) using the Patient Health Questionnaire (PHQ) in a high-risk population in primary care and to test whether modified evaluation algorithms improve the operating characteristics of this questionnaire. Furthermore, the influence of psychiatric comorbidity on the test characteristics of the panic module was studied.
The PHQ was administered in a primary care sample with patients at high-risk for psychiatric disorders. The total sample of 479 high-risk patients comprised 311 frequent attenders (FA), 39 patients with unexplained somatic complaints (USC) and 191 patients with mental health problems (MHP). The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID- I) was the reference standard for the presence of PD. Sensitivity, specificity, and predictive values were calculated. The conditional test characteristics were calculated based on the observed prevalence of PD in the three high-risk groups.
PD was diagnosed in 4.8% of the FAs, in 9.8% of the USCs and in 7.6% of the MHPs. The PHQ achieved moderate operating characteristics. Modified evaluation algorithms of the questionnaire led to an improvement of test characteristics, especially the screening question: sensitivity .71 and specificity .83. Psychiatric comorbidity increased sensitivity while decreasing specificity.
The original and modified algorithms of the PHQ-PD performed moderately in screening for panic disorder. Using only the first question of the PHQ-PD showed the best psychometric properties (sensitivity). For screening purposes requiring high sensitivity we endorse to use the screening question instead of the original algorithm.
Journal of affective disorders 11/2010; 130(1-2):260-7. · 3.76 Impact Factor
[show abstract][hide abstract] ABSTRACT: This article focuses on the role of the quality of life concept in forensic psychiatry and the aim is to find out whether quality of life is regarded as an important outcome measure in this subspecialty of psychiatry. To this end, a brief description is given of how the quality of life-concept is dealt with in general psychiatry and what the status of the 'quality of life' concept is in the forensic psychiatric field. One of the major conclusions is that the operationalization and measurement of quality of life in forensic psychiatry is still in its infancy: there are only a couple of publications pertaining to theoretical and/or empirical issues of quality of life for mentally disordered offenders. Therefore, much can be gained from the experience and knowledge in general psychiatry and medicine.
[show abstract][hide abstract] ABSTRACT: In general practice, depression is often not recognized. As treatment of depression is effective, screening has been proposed as one solution to combat this 'hidden morbidity'. The results of screening programmes for depression, however, are inconsistent and most studies do not show a positive effect on patient outcomes. Patients do not always accept this diagnosis and hence do not receive proper treatment. Nothing is known about the tendency of those patients who screen positive for depression to accept treatment for their 'disclosed' disorder.
In this study, we aimed to better understand the views of patients who screened positive in a screening programme for depression.
We performed a qualitative study with semi-structured in-depth interviews with 17 patients. These adult patients (nine females), all suffering from major depressive disorder, were disclosed by a screening programme for depression performed within 11 Dutch general practices. The transcripts were independently analysed by two researchers using MAXqda2.
All patients appreciated the active way in which they were approached for screening. Fifteen of the 17 patients recognized the depressive symptoms but nine of them did not accept the diagnosis. The first explanation for resistance to the diagnosis of depression is fear of stigmatization and scepticism about the usefulness of labelling. Secondly, patients experienced their depressive symptoms as a normal and transitory reaction to adversity. Thirdly, patients had doubts about the necessity and effectiveness of treatment. Depressive symptoms, such as feelings of guilt, self-depreciation and fatigue, hamper help-seeking behaviour.
We conclude that some patients with undisclosed depression, who took the trouble of going through a complete screening programme, felt aversion to being diagnosed as having depression. In the context of screening for depression, we recommend that the patients' view on depression be elicited before diagnosing and offering treatment.
Family Practice 11/2008; 25(6):438-44. · 1.83 Impact Factor
[show abstract][hide abstract] ABSTRACT: Selective serotonin reuptake inhibitors (SSRIs) have been associated with an increased bleeding tendency.
To prospectively quantify the dose-response effects of paroxetine and the influence of the serotonin transporter gene (SLC6A4) promoter polymorphism (5-HTTLPR) on platelet function.
Nineteen drug-free psychiatric outpatients (44.5 +/- 10.8 years) were tested before and after 6 weeks of paroxetine treatment (20 mg day(-1)). Based on clinical symptoms, paroxetine dosages were increased (40-50 mg day(-1)) for 6 more weeks in 11 patients. Parameters related to platelet function were assessed by bleeding time, platelet function analyzer (PFA), platelet serotonin, platelet factor 4 (PF4), beta-thromboglobulin (beta-TG), and aggregation tests.
Paroxetine 20 mg day(-1) increased mean bleeding time by 1.2 min (95% confidence interval (95% CI) -0.2-2.7) and reduced median platelet serotonin level (463 ng 10(-9) platelets; inter quartile range (IQR) 361-666), and platelet ss-TG concentration (3.1 IU 10(-6) platelets; IQR 0.3-6.0). Other platelet parameters did not change significantly. Serial platelet aggregation tests did not become abnormal. Paroxetine dose-escalation did not further influence platelet function. However, 5-HTTLPR polymorphisms modified these effects: in L(A)/L(A)-carriers, bleeding times did not change (-0.2 min; 95% CI -0.6 to 0.9), while bleeding times significantly increased in <2L(A)-allele carriers (2.3 min; 95% CI 0.5 to 4.07; P = 0.032). Platelet serotonin decreases were larger in patients without L(A)-alleles (868 ng 10(-9) platelets; IQR 585 to 1213) than in > or =1 L(A)-allele carriers (457 ng 10(-9) platelets; IQR 392 to 598; P = 0.035). PFA closure time and PF4 increased significantly in patients without L(A)-alleles.
Paroxetine 20 mg day(-1) does not increase overall bleeding time, but impairs platelet function by decreasing the levels of platelet serotonin and platelet ss-TG. These paroxetine effects appear to be mediated by 5-HTTLPR, with most pronounced effects in patients without L(A)-alleles.
Journal of Thrombosis and Haemostasis 11/2008; 6(12):2168-74. · 6.08 Impact Factor