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Biomedical subjects

D Wiersma

Publications and source records attributed to D Wiersma.

At least 37 records · Page 2Linked to original sources
PubMed2000

Increasing use of Dutch mental health care: an investigation.

BACKGROUND: In the Netherlands, a previous study has shown an increase in the 1-year prevalence of patients in mental health care during the 1990s. Though the number of inpatients decreased, this decrease was far outweighed by a large increase of patients in community care, causing an increase in total year prevalence. The current study aimed at an explanation. METHODS: The Groningen psychiatric case register was used to determine treated incidence and prevalence over a 9-year period for different age groups. RESULTS: Incidence rates proved fairly stable. The increased prevalence was primarily caused by the growing number of existing cases. People had their first encounter with mental health care at an earlier age and remained in care for a larger part of their life. CONCLUSIONS: Results indicate that the accessibility of Dutch mental health care was increased by the implementation of community care. In contrast to other countries, Dutch community care lowered the threshold for mental health care utilization without broadening the target group of mental health services.

Adolescent↗
PubMed2000

Social disability in schizophrenia: its development and prediction over 15 years in incidence cohorts in six European centres.

BACKGROUND: This paper focuses on the long-term course of social disability in schizophrenia assessed at first onset, and after 1, 2 and 15 years in incidence cohorts in six European centres in Bulgaria, Germany, Ireland, The Netherlands, the Czech Republic and the United Kingdom. The study population comprises 349 patients comprising 75% of the original cohorts. METHODS: Social disability was assessed in a standardized way with the WHO Disability Assessment Schedule. RESULTS: Social disability in schizophrenia appears to be a persistent phenomenon. Its severity decreased overall in the period of follow-up, but this was not so in a small group traced to hospital or sheltered accommodation. Only 17% of subjects had no disability and 24% still suffered from severe disability. The great majority lived with their family, a partner, or alone. A deteriorating course was more frequent than late improvement. Gender, age, onset, duration of untreated psychosis or type of remission during the first 2 years did not predict the long-term outcome of disability. Severity of disability at the first three assessments of the illness contributed significantly to the explanation of its variance at 15 years. CONCLUSION: Disability generally ameliorates, but less than expected or hoped. It needs continuing attention and care in this era of de-institutionalization.

Adolescent↗
PubMed2000

Influence of timing and dose of thyroid hormone replacement on development in infants with congenital hypothyroidism.

OBJECTIVES: To test whether early treatment with a high initial dose of levothyroxine can prevent suboptimal mental development in all neonates with congenital hypothyroidism (CH). STUDY DESIGN: Sixty-one patients, 27 with severe CH and 34 with mild CH, were treated either early (<13 days) or late (> or =13 days) with either a high initial dose of levothyroxine (> or =9.5 microg/kg/d) or a low initial dose (<9.5 microg/kg/d). With these criteria, 4 treatment groups were formed. The results of the Bayley test, performed at the age of 10 to 30 months and expressed as mental developmental index (MDI) and psychomotor developmental index (PDI), were related to socioeconomic status, treatment group, initial free thyroxine (FT(4)) concentration, and mean FT(4) concentration during the first 3 months of treatment (FT(4)-A) and the ensuing 9 months (FT(4)-B). RESULTS: Mean (+/- SD) MDI was 113 +/- 14, and mean PDI was 114 +/- 12. In the severe CH group, only the patients treated early with a high initial dose had normal MDI scores (124 +/- 16), whereas the scores of the other groups ranged from 97 to 103. In contrast, all patients in the mild CH group had normal scores (range, 122-125), except those in the group treated late with a low initial dose, whose score was 110 +/- 10. Forty-three percent of the variance in MDI and PDI scores was explained by treatment factors, such as the treatment group, initial FT(4) concentration, FT(4)-A, and FT(4)-B. CONCLUSIONS: Our data suggest that optimal treatment includes achievement of euthyroidism before the third week of life by initiation of therapy before 13 days with a levothyroxine dose above 9.5 microg/kg/d and maintenance of FT(4) concentrations in the upper normal range during the first year. Thus treated, patients with CH can achieve normal psychomotor development at 10 to 30 months, irrespective of the severity of the disease.

Child Development↗
PubMed2000

Distress attributed to negative symptoms in schizophrenia.

The purpose of the study was to examine (1) to which negative symptoms schizophrenia patients attribute distress and (2) whether clinical variables can predict the levels of reported distress. With the help of a research assistant, 86 hospitalized patients completed a self-rating scale for negative symptoms. The 21 items of the self-rating scale were taken from the Scale for the Assessment of Negative Symptoms (SANS). A psychiatrist rated the patients on a number of scales, including the SANS. When patients reported particular symptoms, they were asked whether those symptoms bothered or distressed them. Answers to this question were highly dependent on the type of symptom involved. Distress was most often attributed to symptoms in the subscale avolition-apathy. Patients were also asked how much they were bothered or distressed. Again, high levels of distress were most often attributed to items in the subscale avolition-apathy. A summary score was developed for the level of reported distress: the distress score. Regression analysis showed that distress scores were not associated with the observed severity of negative symptoms or with the level of psychiatric disability. High distress scores were best predicted by the combination of high scores for depression and high scores for insight into positive symptomatology. However, this model explained only a quarter of the variance in distress scores.

Adult↗
PubMed1999

Psychopathology and cognition in schizophrenia spectrum disorders: the role of depressive symptoms.

The cognitive correlates of five symptom dimensions based on PANSS ratings were examined in a group of 50 recent onset psychotic patients, using both objective and subjective cognitive measures. We were particularly interested in the depression dimension, since it has not been studied extensively thus far. The depression dimension showed a high number of correlations with both objective and subjective cognitive measures, such as problems with simple and divided attention, psychomotor slowing and subjectively experienced distractibility, overload and diminished attentional control. The other dimensions, including negative symptoms, have less cognitive correlates. It is possible that previous studies based on a three-dimensional model confounded correlates of negative symptoms with correlates of depressive symptoms. The results of this study suggest the need for more research into the mechanisms underlying the relationship between depressive symptoms and cognitive functioning in schizophrenia, and that patients with depressive symptoms are less efficient in information processing, but can compensate by investing more mental effort. Because subjective cognitive measures were related to mental effort in previous research, they can be a useful tool in future research.

Adult↗
PubMed1998

Stability and change in needs of patients with schizophrenic disorders: a 15- and 17-year follow-up from first onset of psychosis, and a comparison between 'objective' and 'subjective' assessments of needs for care.

Need for care was studied in a Dutch incidence cohort of patients with schizophrenic disorders 15 and 17 years from first onset of psychosis. Long-term course of the disorders varied from complete remission and full community participation to chronic psychosis and long-term hospital stay. Fifty patients were assessed twice with the Needs For Care Assessment Schedule (NFCAS, Brewin and Wing 1989); at the latter follow-up an assessment was also made using the Camberwell Assessment of Need (CAN, Phelan et al. 1995). The NFCAS is an investigator- or professional-based instrument which provides an 'objective' assessment of needs. Need for care was recorded in 22 areas of clinical and social functioning. Comparison of the two assessments over a 2-year period demonstrated a high stability on the individual items (mean 88%, mostly concerning the absence of a problem twice), but did not show the expected stability of need status among this group of patients with chronic disorders. One in five patients (22%) had no needs at all on both occasions and 56% of the patients showed a change in needs. There was more negative than positive change: 28% suffered from new unmet needs at the 17-year follow-up, while only 12% had improved their status to no needs. About one-third (36%) had at least one unmet need, mostly regarding psychotic symptoms, dyskinesia or underactivity. The CAN provides a 'subjective' assessment of needs according to the view of patients themselves. The problems patients reported most commonly were in the areas of day-time activities, social relationships and information on their condition and treatment, for all which they asked for more help than they received. This patient-based instrument produces slightly higher numbers of problems and unmet needs, and a lower ratio between met and unmet needs. There is an overall percentage of 21% of disagreement between patient and investigator view regarding the unmet need status. Agreement between the two instruments on the nature of the problems with unmet needs was lacking altogether.

Adult↗
PubMed1998

Natural course of schizophrenic disorders: a 15-year followup of a Dutch incidence cohort.

Data are presented on the 15-year natural course of schizophrenia and other nonaffective functional psychoses in a cohort of 82 first-contact cases from a circumscribed area in the Netherlands. The subjects were suffering from functional psychosis with International Classification of Diseases-Ninth Revision (ICD-9) diagnoses 295, 297, or 298.3-9 (broad definition of schizophrenia) on entry. Standardized assessments of psychopathology, psychological impairments, negative symptomatology, social disability, and use of mental healthcare were used. The study reveals a pattern of chronicity and relapses with a high risk of suicide: Two-thirds of the subjects had at least one relapse and after each relapse 1 of 6 subjects did not remit from the episode; 1 of 10 committed suicide; and 1 of 7 had at least one episode with affective psychotic symptoms that started on average 6 years after the onset of the schizophrenic disorder. Diagnoses were reclassified in five patients, according to DSM-III-R criteria for a bipolar disorder. The predictive power--in terms of time in psychosis and in partial or full remission--of demographic, illness, and treatment variables at onset of the illness was very limited. Insidious onset and delays in mental health treatment are risk factors that predict a longer duration of first or subsequent episodes. The importance of mental health treatment in regard to outcome is probably subject to change because an early warning and intervention strategy could prevent further damage and deterioration. Our data support the need for an adequate relapse prevention program as a priority for our mental health services.

Activities of Daily Living↗
PubMed1998

Effectiveness of cognitive therapy with coping training for persistent auditory hallucinations: a retrospective study of attenders of a psychiatric out-patient department.

Recent studies have suggested positive effects of cognitive therapy on psychotic symptoms. However, the effects of coping training are less clear, and generalization to daily functioning has not been attempted for either intervention. A total of 40 patients with therapy-refractory auditory hallucinations received standard care plus cognitive therapy with coping training. In a retrospective, descriptive study, multiple assessments of outcome were measured. The experimental therapy seems to improve both overall symptomatology and quality of life, and is acceptable to both patients and relatives. Generalization to daily functioning and continuation over time was observed. Improvements with regard to the occurrence of hallucinations, fear, disturbance of thought, social interactions and daily activities were significant. Complete disappearance of hallucinations occurred in 20% of participants, and in 40% of those who were regularly discharged from treatment. The level of satisfaction with therapy was high (78%), and the drop-out rate was low (9%). Improvement was not significantly correlated with psychiatric diagnosis (schizophrenia vs. other diagnoses), and was sustained at follow-up after 1 year.

Adaptation, Psychological↗
PubMed1998

Experience of negative symptoms: comparison of schizophrenic patients to patients with a depressive disorder and to normal subjects.

OBJECTIVE: Three hypotheses were tested: 1) schizophrenic patients would report more impairments on a self-rating scale for negative symptoms than normal subjects and attribute higher levels of distress to these impairments, 2) schizophrenic patients would report fewer impairments than patients with a depressive disorder and attribute lower levels of distress to these impairments, and 3) schizophrenic patients would attribute their impairments less often to mental illness than would patients with a depressive disorder. METHOD: A self-rating scale for negative symptoms was administered to 86 patients with schizophrenia, 20 patients with a depressive disorder, and 33 normal subjects. The scale items were derived from the Scale for the Assessment of Negative Symptoms (SANS). Two psychiatrists also rated all of the patients on the SANS. RESULTS: The hypotheses were supported. The differences between the two groups of patients in the rates of reported impairments and the levels of reported distress remained statistically significant after control for differences in age, sex, length of current admission, length of illness, dose of neuroleptic medication, use of clozapine, and severity of negative symptoms. CONCLUSIONS: The results suggest that a large number of schizophrenic patients are somewhat aware of negative symptoms but that they are less aware of these impairments and less concerned about them than are patients with a depressive disorder.

Adolescent↗
PubMed1997

Prevalence of long-term mental health care utilization in The Netherlands.

The objective of this study is to estimate the proportion of the population in The Netherlands who receive long-term care for chronic psychiatric problems. The care needs of this population are assessed in terms both of diagnosis and of specific impairments and disabilities. Data from three surveys and two psychiatric case registers in five different areas of The Netherlands provide an estimate of about 3.5 long-term users of psychiatric care per 1000 members of the population aged 20 years or over. One-third of them receive a diagnosis of schizophrenia and related psychotic disorders. Patients most frequently suffer from impairments of mood and affect, volition and drives. Nearly all patients are disabled in their occupational role (work), and about half of the population have problems with self-care and household tasks. Long-term care is to a large extent (40%) provided in hospitals and sheltered accommodation, and the role of day services is relatively insignificant.

Adult↗
PubMed1996

Measuring social disabilities in mental health.

Social functioning is important in relation to mental illness as it can limit the ability to function independently and because it may vary separately from symptoms. This paper summarises and critically reviews the development of the WHO Classification of Impairments, Disabilities and Handicaps. The value of social role theory is described followed by a classification of the relevant assessment scales in this field. Mental disorders are in general strongly associated with social dysfunctioning, particularly in schizophrenia and the major affective disorders. For a long time social dysfunctioning was considered an epiphenomenon and just a part of the disease process. Criteria for the diagnosis of a mental disorder were and still are often derived from the domains of work and social relationships. There are at least two related reasons why social functioning deserves a closer look: 1. There is an increasing trend to treat patients in the community instead of in the hospital: the changing orientation on community care needs careful evaluation with respect to its consequences. To what extent is survival in the community possible and what is the quality of life like there? Are community programs better than hospital treatment, and for whom? Therefore, separate measurement is justified for evaluation of outcome and costs and benefits. 2. There is growing evidence that the courses of symptomatology and social dysfunctioning may vary relatively independently: social disablement of a patient may be characterized much more by social disabilities than by persistent psychiatric symptoms; the former may call for another kind of action than usually available. For example, psychosocial rehabilitation focuses on cognitive and social abilities of the patient which are crucial for a more or less independent life. Therefore, separate measurement is justified for the sake of the right choice of treatment. The usual diagnostic systems such as the ICD and the DSM offer no adequate solution to the problem of classification and assessment of social dysfunctioning as a consequence of mental disorder. We have to look for other classification systems such as the International Classification Impairments, Disabilities and Handicaps (ICIDH) of the WHO (1980, 1993) which offers a conceptual model to study the long-term consequences in terms of functional disabilities and experienced social handicaps, and the effectiveness of health care to handle these kind of problems.

Humans↗
PubMed1996

Assessment of the need for care 15 years after onset of a Dutch cohort of patients with schizophrenia, and an international comparison.

Assessment of needs for care is crucial in the evaluation of ongoing changes from institutional care to various forms of day- and outpatient treatment. Do patients really do better in the community and are they adequately cared for? The 15-year follow-up of a Dutch incidence cohort of patients with schizophrenia and other functional non-affective psychoses showed that 47 (out of 63) patients had positive ratings of symptoms and disabilities. They were assessed by means of the Needs for Care Assessment Schedule, which articulates the problems and corresponding interventions resulting in a judgement of met or unmet need for treatment or assessment. There was a mean of 2.1 clinical problems and 2.1 social problems per patient. Few problems were considered to generate unmet needs: 14% of the clinical problems and only 7% of the social problems. Nevertheless, 32% of the patients had one or more unmet needs. These results were compared with data from six research centres in the United Kingdom (Camberwell, Oxford and South Glamorgan), Canada (Montreal), Italy (Verona) and Finland (Tampere). Despite differences in health care settings in the four countries, the ratio of met to unmet needs (about 4-5 to 1) among chronic, mostly schizophrenic patients is more or less the same with the exception of an apparently underserved hostel population in Oxford and the Finnish patient population probably due to high expectations with respect to independent community living.

Adolescent↗
PubMed1995

Costs and benefits of hospital and day treatment with community care of affective and schizophrenic disorders.

BACKGROUND: A randomised controlled trial of day treatment with community care for patients with schizophrenic and affective disorders, referred for in-patient psychiatric treatment, was conducted to evaluate patterns of treatment and the course of illness with its psychosocial consequences over a period of two years. METHOD: Seventy patients, of whom 34 had affective and 36 had schizophrenic disorder, were assigned to the experimental condition (day treatment with ambulatory and domiciliary care), and 33 patients, of whom 16 had affective and 17 had schizophrenic disorder, were assigned to the control condition of standard clinical care. RESULTS: Day treatment with community care was feasible for 40.6% of the affective patients and 33.3% of the schizophrenic patients. The direct treatment costs of both disorders, based on numbers of in- and day-patient days and out-patient contacts over two years, appeared more or less the same. Patients benefited equally from day treatment as from in-patient treatment, although there were some gains in self-care and in functioning in the household among experimentals. Although schizophrenics were socioeconomically worse off, and also suffered from more (severe) symptoms and social disabilities than the affective patients at entry into the study, they were similar at two years. This finding is unexpected, compared with other follow-up studies. Extra cost for patients and families were not observed. Patients and their families in the experimental condition were significantly more satisfied with the treatment. Experimental patients spent much more time at home during admission, remained much less time in secluded wards, and were more compliant with treatment. CONCLUSIONS: Day treatment could be considered a cost-effective alternative to in-patient treatment.

Activities of Daily Living↗
PubMed1994

Efficacy of psychiatric day treatment. Course and outcome of psychiatric disorders in a randomised trial.

The course of the psychopathology and social functioning in an experimental day-treatment group referred for inpatient psychiatric treatment is compared with that of a control group receiving standard inpatient care. During a follow-up period of 2 years subjects were interviewed three times. The interview comprised information about psychiatric symptoms, psychological functions, psychiatric diagnosis and social-role functioning. Apart from these discrete assessments an effort was made to map episodes of illness throughout the follow-up period. Upon entry the groups did not differ in terms of psychopathology or social functioning. At follow-up both groups had improved significantly with respect to symptomatology, psychological and social functioning. The extent to which the groups improved did not differ significantly regarding pathology, but self-care improved more in the experimental group. The average duration of episodes of illness was similar for the experimental and control group. During the 2-year follow-up patients suffered from a well-defined disorder during an average of 11 months. The fact that approximately 40% of them were still a psychiatric case after 2 years further underscores the severity of their pathology.

Activities of Daily Living↗
PubMed1993

Evaluation of a patient classification system for community health care.

A patient classification system for community health care developed in the Netherlands is described. The system classifies the time nurses devote to the care of patients. Its purpose is to support the nurse in managerial work. The patient care classification system uses three axes to classify the care: the care type, the number of home visits per week and length of service. The patients are scored on these three axes after the first visit to the patient. This system cannot be used to determine staffing needs on a daily basis but is used as an indicator for budgetary and longer term planning purposes. The system was evaluated by 65 nurses on 1000 patients during 3 months. It is concluded that the care type axis provides good information about the activities that have been performed. Another conclusion is that nurses overestimate the number of visits per week to the patients.

Community Health Nursing↗
PubMed1992

Predicting feasibility of day treatment for unselected patients referred for inpatient psychiatric treatment: results of a randomized trial.

OBJECTIVE: Because previous studies of day treatment as an alternative to inpatient treatment had major disadvantages or methodological shortcomings, the authors conducted a randomized controlled trial to estimate and predict the extent to which day treatment is feasible for unselected patients referred for inpatient treatment. METHOD: Of 160 patients, 57 were randomly assigned to the control condition and 103 were assigned to the experimental condition. Control patients received standard clinical care. In the experimental condition, day treatment was attempted as soon as the patient's condition permitted. The average number of nights per week that experimental patients spent away from the hospital was compared to the average number of nights away for patients under standard care. RESULTS: Day treatment was satisfactory for 40% of the experimental patients but was completely infeasible for another 40%. The level of surveillance needed in the first week, physical illness, number of previous admissions, depressive symptoms, and treatment by qualified psychiatrists versus registrars were variables predictive of these differences. CONCLUSIONS: In this unselected group of patients, no absolute contraindications against day treatment were found. This suggests that the selection criteria applied in nearly all other controlled studies on the subject were unwarranted. The approach used in this study facilitated treatment in the least restrictive environment possible.

Adolescent↗
PubMed1991

Pretreatment with drinking water solutions containing trichloroethylene or chloroform enhances the hepatotoxicity of carbon tetrachloride in Fischer 344 rats.

Previous studies have demonstrated that various compounds, including the common groundwater contaminants trichloroethylene (TCE) and chloroform (CHCl3), can produce a synergistic toxic response when coadministered with the model hepatotoxicant carbon tetrachloride (CCl4). This phenomenon has not, however, been demonstrated following administration of these compounds in drinking water. Initial experiments indicated that Fischer 344 (F-344) rats were significantly more sensitive to these effects than the more commonly utilized Sprague-Dawley strain. To establish the suitability of this strain as a model, a variety of indicators of hepatotoxicity was evaluated and compared to histological evidence of injury 24 hr after dosing with CCl4 or a combination of CCl4 + TCE. Plasma alanine aminotransferase (ALT) activity was the most reliable indicator of hepatic injury and was well-correlated with the histologic data. Dose-response studies utilizing simultaneous ip dosing confirm the sensitivity of the F-344 rat, demonstrating synergistic toxicity at doses as low as 0.165 mmol/kg of CCl4 and 0.6 mmol/kg of TCE. Synergism was also detected following simultaneous ip administration of 1 mmol/kg CCl4 and 0.5 mmol/kg of CHCl3. To evaluate the effects of drinking water exposure, rats were pretreated for 3 days with solutions containing TCE (0-40 mM) or CHCl3 (0-8 mM) stabilized with 1% Emulphor (EL-620P) as their only source of fluids. A single, ip dose of CCl4 (1 mmol/kg) was then administered and 24 hr later animals were killed for examination of liver histology and determination of ALT activity. Although none of the pretreatments were detectably hepatoxic, rats which drank 15 and 40 mM TCE or 8 mM CHCl3 exhibited an enhanced response to CCl4.

Alanine Transaminase↗