A J L M van Balkom’s research while affiliated with Amsterdam University Medical Center and other places

Preclinical research suggests that pharmacologically elevating cannabinoid levels may attenuate fear memory expression and enhance fear extinction. We studied the effects of cannabidiol (CBD) on fear memory expression and fear re-extinction in 69 patients with panic disorder with agoraphobia or with social anxiety disorder. Moderation by sex, diagnosis, and serotonergic antidepressant (AD) use was explored. A cued fear conditioning paradigm was applied before the first treatment session with 300 mg CBD/placebo augmented exposure therapy. Study medication was administered orally preceding 8 weekly sessions. Fear acquisition and suboptimal extinction took place prior to the first medication ingestion (T0). After the first medication ingestion (T1), we investigated effects on fear memory expression at retention and fear re-extinction. Subjective fear, shock expectancy, skin conductance, and startle responses to conditioned (CS+) and safety stimulus (CS−) were measured. Across the sample, CBD reduced shock expectancy at retention under low and ambiguous threat of shock, but fear re-extinction at T1 was unaffected by CBD. However, in AD users, re-extinction of subjective fear was impaired in the CBD condition compared to placebo. In female AD users, CBD interfered with safety learning measured with fear-potentiated startle. The current findings provide no evidence for enhanced fear re-extinction by CBD. However, CBD acutely decreased threat expectation at retention, without affecting other indices of fear. More studies are needed to elucidate possible interactions with AD use and sex, as well as potential effects of CBD on threat expectancies.

Objective Clinical characteristics appear limited in their ability to predict course of anxiety disorders, therefore we explored the predictive value of biological parameters on course of anxiety disorders. Methods 907 persons with an anxiety (panic, social phobia, generalised anxiety) disorder with a baseline and two-year follow-up measure were selected from the Netherlands Study of Depression and Anxiety (NESDA). Previously, three course trajectories were distinguished which vary in terms of symptom severity and chronicity. Baseline clinical parameters like anxiety severity, anxiety duration, and disability were limited in their ability to predict the two-year course. This study explored whether metabolic syndrome, hypothalamic-pituitary-adrenal-axis functioning, inflammation markers, and neuroplasticity were indicators of two-year course and whether these parameters improved the model containing the most predictive clinical parameters only. Results Baseline diastolic blood pressure of persons with chronic moderate symptoms was significantly higher than of persons with non-chronic mild symptoms (odds ratio [OR] = 1.18, 95% confidence interval [CI95%] 1.01 to 1.38). Baseline high-density lipid cholesterol of persons with severe chronic symptoms was significantly lower than of persons with non-chronic mild symptoms (OR = 0.77, CI95% 0.62 to 0.96). The predictive ability of both parameters was however low with concordance statistics of 0.55 and 0.57 respectively. Addition of biological parameters did not improve the predictive ability of the model containing the clinical parameters. Conclusions In addition to clinical characteristics, biological parameters did not improve the predictive ability of the model for course trajectory of anxiety disorders. Prediction of course trajectory in anxiety disorders remains difficult and warrants further research.

Angst is een nuttige emotie die ons van oudsher beschermt tegen tal van gevaren. Een angststoornis daarentegen is een chronische psychiatrische aandoening die erg beperkend kan zijn. Ook de obsessief-compulsieve en verwante stoornissen vallen hieronder. In dit hoofdstuk komen ze allemaal aan de orde, voorzien van de bijbehorende DSM-5-criteria en epidemiologie. Angststoornissen, zoals de paniekstoornis, fobieën en de sociale angststoornis, komen relatief veel voor en kennen erg veel verschijningsvormen. Ze hebben vermoedelijk een erfelijke component, maar ook temperament, opvoeding en levensgebeurtenissen lijken een rol te spelen. Angststoornissen zijn in het algemeen redelijk te behandelen. De behandeling begint altijd met psycho-educatie, meestal gevolgd door therapie, eventueel in combinatie met medicatie. Vooral cognitieve gedragstherapie boekt goede resultaten, zij het doorgaans tijdelijk. Daarom is er toenemende aandacht voor herstelondersteunende zorg, meer gericht op de kwaliteit van leven mét een angststoornis dan op het ‘genezen’ ervan. Ook ervaringsdeskundigen (lotgenotencontact) worden steeds vaker ingezet.

The present study investigated the associations between self-construal, acculturation, and autonomy–connectedness, as well as the relations between autonomy–connectedness and psychopathological symptoms, controlling for self-construal and acculturation. Participants were 1,209 Dutch individuals, of whom 693 (57.3%) were immigrants with a non-Western background. Results showed that an independent self-construal was positively associated with self-awareness and capacity for managing new situations, and was negatively associated with sensitivity to others (which are the three components of autonomy–connectedness). Moreover, an interdependent self-construal was negatively associated with self-awareness and capacity for managing new situations, and was positively associated with sensitivity to others. Importantly, the latter associations were similar for both Dutch natives and immigrants, and the associations between acculturation and autonomy–connectedness were small and nonsignificant. Autonomy–connectedness, after controlling for self-construal and acculturation, explained a large amount of additional variance in anxiety (12.7%) and depression (14.1), and a medium amount of additional variance in drive for thinness (3.7%) and bulimia (4.8%). Autonomy–connectedness, thus, seems to be an important construct for people with a Western background, as well as for immigrants with a non-Western background.

1 Background Early identification of the subgroup of patients with major depressive disorder (MDD) in need of highly specialized care could enhance personalized intervention. This, in turn, may reduce the number of treatment steps needed to achieve and sustain an adequate treatment response. The aim of this study was to identify patient‐related indicators that could facilitate the early identification of the subgroup of patients with MDD in need of highly specialized care. 2 Methods Initial patient indicators were derived from a systematic review. Subsequently, a structured conceptualization methodology known as concept mapping was employed to complement the initial list of indicators by clinical expertise and develop a consensus‐based conceptual framework. Subject‐matter experts were invited to participate in the subsequent steps (brainstorming, sorting, and rating) of the concept mapping process. A final concept map solution was generated using nonmetric multidimensional scaling and agglomerative hierarchical cluster analyses. 3 Results In total, 67 subject‐matter experts participated in the concept mapping process. The final concept map revealed the following 10 major clusters of indicators: 1‐depression severity, 2‐onset and (treatment) course, 3‐comorbid personality disorder, 4‐comorbid substance use disorder, 5‐other psychiatric comorbidity, 6‐somatic comorbidity, 7‐maladaptive coping, 8‐childhood trauma, 9‐social factors, and 10‐psychosocial dysfunction. 4 Conclusions The study findings highlight the need for a comprehensive assessment of patient indicators in determining the need for highly specialized care, and suggest that the treatment allocation of patients with MDD to highly specialized mental healthcare settings should be guided by the assessment of clinical and nonclinical patient factors.