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Biomedical subjects

F G Zitman

Publications and source records attributed to F G Zitman.

At least 37 records · Page 2Linked to original sources
PubMed2001

Towards a more rational use of psychoactive substances in clinical practice.

Complex knowledge and data intensive nature of the psychoactive drug selection and prescription process often makes for irrational and inconsistent use of psychoactive drugs in clinical practice. After describing the state of the art with respect to psychoactive drug prescription practices and selection processes, our aim is to analyze the advantages of computer support systems in assisting the clinician in his clinical decisions. Finally, we will review the neuropsychiatric expert systems developed for the neuropsychiatric domain. Suboptimal psychoactive drug therapy is common practice, which leads to hospital admissions, extended length of hospital stay, ineffective therapy and increased costs. Furthermore, the psychoactive drug selection process is a complex decision process, using up-to-date integrative knowledge of drugs from basic sciences to the clinical level. Due to the information load, the lack of appropriate up-to-date information at the point of clinical care and the problem of integrating and weighing all information relatively equally, it is questionable whether any clinician can manage such a complex situation with optimal effectiveness. As has been shown in a number of experiments, clinicians can benefit from computer-based systems that provide access to accurate, up-to-date information. We maintain that more rational use of psychoactive drugs in clinical practice is needed, and conclude that rational psychoactive drug prescription is a knowledge and data-intensive task requiring true expertise derived from clinical, pathophysiological and pharmacotherapeutic knowledge. We will be developing a Multidisciplinary Psychoactive Drug Selection advisor system, M-PADS, to support the integration of various types of biomedical information and deliver that integrated information supportive to evidence-based rational drug prescription in the practice of medicine for the drug treatment of individual patients.

Decision Making, Computer-Assisted↗
PubMed2001

Assessment of benzodiazepine dependence in alcohol and drug dependent outpatients: a research report.

In this study on 99 outpatients who were being treated for alcohol and/or drug dependence and also using benzodiazepines (BZDs), prevalence rates of DSM-III-R and ICD-10 substance dependence diagnoses were ascertained and scalability, reliability and validity of the scales of the Benzodiaepine Dependence Self-Report Questionnaire (Bendep-SRQ) were assessed. The latter properties were investigated by Rasch analyses, discriminability coefficients, test-retest coefficients and factor analyses. BZD dependence was found to be a prevalent additional diagnosis. The psychometric findings appear to support the use of the Bendep-SRQ at outpatient addiction centers, which could contribute to a more differentiated treatment for poly-substance dependence.

Adolescent↗
PubMed2001

The role of medial prefrontal cortical dopamine in spontaneous flexibility in the rat.

In rat studies, both lesions in the medial prefrontal cortex (mPFC) and alterations of the level of mPFC dopamine (DA) have been found to induce disturbances in behavioural flexibility, as measured with switching tasks. It is not clear whether mPFC DA is also involved in spontaneous flexibility. Therefore, the aim of the present study was to investigate the role of mPFC DA in spontaneous flexibility. As a measure for spontaneous flexibility, the diversity in spatial distribution of exploration on a large open field was used. The rats received local injections into the mPFC with a D1 or D2 antagonist, or the dopamimetic, amphetamine. The results showed that both DA antagonists reduced spontaneous flexibility, due to increased stimulus-bound behaviour. Amphetamine had a similar effect to the DA antagonists. It is suggested that this is most likely due to an amphetamine-induced increase in extracellular DA, leading to a suboptimal level of mPFC DA.

Amphetamine↗
PubMed2001

Chronic benzodiazepine use in general practice patients with depression: an evaluation of controlled treatment and taper-off: report on behalf of the Dutch Chronic Benzodiazepine Working Group.

BACKGROUND: Many patients with depression take benzodiazepine drugs long term despite the absence of continuing therapeutic value. AIMS: To evaluate a treatment programme involving gradual discontinuation with or without simultaneous selective serotonin reuptake inhibitor (SSRI) prescribing and to determine the long-term outcome after benzodiazepine withdrawal. METHOD: Patients went through three phases - change to an equivalent dose of diazepam; subsequent randomisation to either 20 mg of paroxetine or placebo; and gradual reduction of diazepam in depression-free patients - with a follow-up after 2 or 3 years. RESULTS: A total of 230 patients were recruited and 75% in the paroxetine group and 61% in the placebo group were successfully treated after 6 weeks (P:=0.067). After 2 or 3 years 13% of patients were still benzodiazepine free: 26% of those who had successfully tapered off benzodiazepine and 6% of the total group. CONCLUSIONS: Transfer to diazepam followed by gradual withdrawal is an effective way of discontinuing chronic benzodiazepine use. The addition of SSRI treatment is of limited value.

Adult↗
PubMed2000

Treatment of depression related to recurrence: 10-year follow-up in general practice.

OBJECTIVES: To study outcomes related to long-term treatment of depression and differences in treatments for first episodes of depression in patients with and without recurrences. METHODS: A historic cohort design study with 222 general practice patients who had been followed up for 10 years after being diagnosed of depression. Prescriptions for antidepressants, psychotropics and referrals over the period of 10 years following the first diagnosis of depression were studied. RESULTS: Over the 10-year period, the length of treatment with antidepressants and the doses prescribed were low compared to what is known to be efficacious in depression. This was also true for treatment during the first episode. Patients with a recurrent type of illness were more often treated with antidepressants and other psychotropics during their first episode than patients with only one episode of depression, but they were not referred any more often. CONCLUSION: Even though treatment was not as recommended for depression, the majority of the patients did not have recurrences. Future prospective research is needed to study causal relationships between treatment of depression and long-term outcome.

Adult↗
PubMed2000

Memory impairment in those who attempted suicide by benzodiazepine overdose.

BACKGROUND: A prospective study was conducted to investigate the presence of anterograde amnesia in those who attempted suicide by benzodiazepine overdose and to study the correlation with sedation. METHOD: In 43 patients who attempted suicide by taking benzodiazepines, memory was tested with a 15-word memory recall task. The immediate and delayed recall on the first day after admission (day 1) and 24 hours later (day 2) were rated. Each patient and the interviewer scored the patient's degree of sedation on a visual analogue scale. Patients also had to try to recognize, from photographs, the psychiatrist with whom they had spoken the day before. RESULTS: The ratings of immediate and delayed recall were significantly lower on day 1 than on day 2. Subjective ratings of sedation of the patients were not significantly higher than the ratings of the observer. Less than half of the patients recognized the psychiatrists and knew that they were the ones they had spoken to the day before. CONCLUSION: Anterograde amnesia is present in suicide attempters who take overdoses of benzodiazepines. The implications of this finding for the assessment of suicide attempters during admission are discussed.

Adult↗
PubMed2000

The validity of the diagnosis of depression in general practice: is using criteria for diagnosis as a routine the answer?

BACKGROUND: In general practice, making a diagnosis does not follow the same lines as in secondary care because every new diagnosis is made against 'foreknowledge' and could be coloured by it. This could explain low accordance and differences in diagnoses between primary and secondary care, in particular when mental illness such as depression is concerned. When criteria are used for diagnosis there should be no differences. AIM: To establish the accordance with the Diagnostic and Statistical Manual of mental disorders, 4th edition (DSM-IV) criteria of major depressive disorder when the diagnosis of depression has been made by general practitioners (GPs) for whom coding and using criteria for diagnosis is a daily routine (ICHPPC-2 criteria). METHOD: Ninety-nine general practice patients from four general practices belonging to the Continuous Morbidity Registry (CMR) of the University of Nijmegen in The Netherlands were interviewed using the Composite International Diagnostic Interview (auto) 12-month version (DSM-IV criteria). Thirty-three patients had a code for depression; 33 patients a code for chronic nervous functional complaints (CNFC); and 33 had no code for mental illness (the depression and CNFC codes were given in the 12 months prior to the interview). Specificity and accordance with the DSM-IV criteria of major depressive disorder (MDD) were calculated with the results from the interviews. RESULTS: Of the 33 general practice depression cases (all matching ICHPPC-2 criteria), 28 matched DSM-IV criteria: 26 for MDD and 2 for dysthymia. No cases of DSM-IV MDD were found in the control group without a code for a mental disorder, and seven out of 33 were found in the control group with the code for CNFC. CONCLUSION: The specificity of diagnosis of depression made by GPs in a continuous morbidity registry and the accordance with DSM-IV criteria are high. Using criteria for diagnosis, which is a trend, could be one of the solutions towards a better diagnosis. As far as the sensitivity is concerned, GPs should not be distracted from using criteria for the diagnosis of depression when a large variety of complaints is presented.

Adult↗
PubMed2000

Long-term follow-up of depression among patients in the community and in family practice settings. A systematic review.

BACKGROUND: Current knowledge about the long-term outcome of depression is largely based on the results of studies performed with the small selection of patients who are referred to psychiatric professionals. However, because of the high prevalence of depression in the community and in primary care, information about the longterm outcome in these populations is indispensable if physicians are to offer the best possible care in these settings. METHODS: We performed a literature search to identify relevant papers published between 1970 and 1999 on original long-term follow-up studies of depression in community and primary care populations. The included studies were of adult populations with depression based on diagnostic criteria and a follow-up of at least 5 years. Data about recurrences, relapses, psychopathology, disability, or quality of life at follow-up were examined. RESULTS: We found 8 studies that fulfilled our criteria. The reported rates of recurrence or depression at follow-up were between 30% and 40%. Higher rates were found in the younger and older age groups. Data about other predictors of outcome, health status, and the relation between treatment and outcome did not justify any hard conclusions. CONCLUSIONS: The long-term outcome of depression in the community and in primary care is rarely studied. The results of available studies are difficult to compare because of the large differences in populations and methods. Nevertheless, these studies suggest that the longterm prognosis of depression in the community and in primary care is not as poor as in psychiatry.

Adolescent↗
PubMed1999

The relationship between depression and mortality in elderly subjects with less severe dementia.

BACKGROUND: Little is known about the effects of depression on the mortality rates of elderly subjects with dementia. METHODS: Logistic regression analysis, adjusting for possible confounders, was used to study the associations between GMS-AGECAT derived syndrome and symptom measures and 12-month mortality rates in a cohort of 73 elderly subjects who met the DSM-III-R criteria of dementia with a median MMSE score of 19. RESULTS: Twenty-three subjects (32%) died within the 12 month follow-up period. A baseline diagnosis of syndromal or subsyndromal depression was associated with increased mortality. At the symptom level mortality was predicted by higher scores on the factor 'mood symptoms'. The effects of interactions between depression measures and severity of dementia were not significant. CONCLUSIONS: Short-term mortality in elderly subjects with less severe dementia is predicted by the presence of (sub) syndromal depression and by mood symptoms. The effects of depression and severity of dementia on the mortality rates seem to be largely independent.

Aged↗
PubMed1998

Determinants of psychotropic drug usage in a general intensive care unit.

During a 3-month period, determinants of psychotropic drug utilization (sex, age, length of stay, reason for admission, disease severity) and data on psychotropic consumption (type of medication--antidepressants, benzodiazepines and antipsychotics--dosage and length of treatment) were retrospectively collected in a general intensive care unit of a Dutch university hospital. Daily exposure to psychotropics was standardized in number of Defined Daily Doses (DDD). Benzodiazepines were used by 35.8% of all patients (137) during their stay in the ICU whereas 17.5% of all patients used a neuroleptic agent. Antidepressants were hardly prescribed. High doses of benzodiazepines (9.9 DDDs) and low doses of antipsychotics (0.5 DDDs) were prescribed, which probably reflect the unusual nature of this critically ill group of patients compared with the reference group for DDD's. Clear patterns of determinants of psychotropic drug use in ICU patients were found and both benzodiazepines, antipsychotics and combined use of these agents could be associated with the determinants assessed. The time patterns we found in terms of length of stay give clues for further investigations in order to rationalize psychotropic drug use in the management of severely ill and complex patients.

APACHE↗
PubMed1998

An evaluation of DSM-III-R and ICD-10 benzodiazepine dependence criteria using Rasch modelling.

AIMS: To evaluate the homogeneity of the elements of the Substance Dependence Syndrome (SDS) as applied to benzodiazepines (BZDs) by Rasch modelling. MEASUREMENTS: The Rasch scaling model was applied to data obtained by administering the SCAN (Schedules for Clinical Assessments in Neuropsychiatry) substance dependence sections. Subsequently, Rasch-homogeneous sets of DSM-III-R and ICD-10 BZD dependence criteria were assessed for subject and item discriminability. To support their construct validity a theoretical rationale was formulated based on the Rasch scale values. PARTICIPANTS: A heterogeneous sample of 599 outpatient BZD users. FINDINGS: Only particular subsets of the DSM-III-R and ICD-10 BZD dependence criteria met the requirements for Rasch-homogeneity, which appears to be due to medical aspects of BZD use. The subject and item discriminability results were sufficiently good. CONCLUSIONS: The DSM-III-R and ICD-10 BZD dependence constructs may need to be redefined. The use of a BZD dependence severity model based on a Rasch-homogeneous scale appears to have greater clinical value than a dichotomous diagnostic model based on an arbitrary cut-off point. We recommend Rasch modelling to investigate the homogeneity of the elements of the SDS across other psychoactive substances.

Adolescent↗
PubMed1998

Ten year follow-up of depression after diagnosis in general practice.

BACKGROUND: Depression is a serious illness with a high recurrence rate, mortality, and suicide rate, and a substantial loss of quality of life. Long-term course of depression, in particular of patients not referred to specialist care, is not completely clear. We performed a study in which the course of depression in general practice was studied for 10 years after the first diagnosis. AIM: To learn more about long-term course and outcome of patients with depressive illness for a full 10 years after diagnosis. METHOD: A historic cohort study with 386 patients classified as depressive before January 1984, recruited from four general practices belonging to the Continuous Morbidity Registry of the University of Nijmegen in The Netherlands. This cohort was followed up for 10 years. Mortality was compared with a control group matched for age, sex, social class, and practice. Of 222 patients out of this cohort who could be followed up for a full 10 years after diagnosis, the case records were studied in detail. RESULTS: No statistically significant difference was found in mortality between the 386 patients and the control group. Recurrence of depressive episodes did not occur in about 60% of the 222 patients (confidence interval 54% to 67%). Of the depressive patients, 15% were referred to secondary care and 9% were admitted to hospital. CONCLUSION: Mortality, suicide, and recurrence rate were lower than expected, taking into account what is known from depression studies in psychiatry. These results stress the importance of long-term prospective follow-up studies of all patients with depression because of the emphasis on case-finding and treatment without exact knowledge of long-term course and outcome of patients who were not referred.

Adolescent↗
PubMed1997

[Guidelines and their observance in the psychiatric care of failed suicides in general hospitals].

OBJECTIVE: To gain insight into the guidelines established for the care of failed suicides in general hospitals, and into the degree to which these guidelines are observed in practice. DESIGN: Descriptive, retrospective. SETTING: Department of Psychiatry, Rijnstate Hospital, Arnhem, the Netherlands. METHOD: An inventory of guidelines for the care of failed suicides was made by interviewing seven psychiatrists on the staff of general hospitals. The inventory was limited to access (interval between admission and referral/consultation), and the coordination of the care (i.e. adjustment to the patient's condition, transfer of information). Subsequently, the cases of all failed suicides admitted to these hospitals in 1991 were studied to find out how these guidelines were observed in practice; use was made for this purpose of data from a more extensive European study. RESULTS: All seven hospitals proved to have rules for coping with tailed suicides. Guidelines concerning accessibility of care were fairly similar in the various hospitals; regarding the coordination of care, more local variants were found to exist. The accessibility of care was found to be mostly in accordance with the guidelines. There were more deviations from the guidelines where the coordination of care was concerned; in addition, there were substantial differences between the hospitals in the degrees to which deviation from the guidelines occurred. CONCLUSION: Guidelines for the care of failed suicides admitted to general hospitals were not in all respects similar; the observance differed markedly, especially regarding the coordination of care.

Adolescent↗
PubMed1997

Drug use and cognitive function in residents of homes for the elderly.

In order the investigate the relationship between cognitive function and daily used drugs in the elderly we performed an observational, cross-sectional study in 5 homes for the elderly in the region of Nijmegen, the Netherlands. Participants were 497 residents of these homes. For all these subjects the daily used drugs, classified according to the Anatomical Therapeutic Classification system were registered and global cognitive function was measured as the total score on the Mini Mental State Examination. Adjusting for age and education, there was a small but significant and positive correlation between the use of metoprolol and the total MMSE score. The use of CNS drugs was not related to the total MMSE score. All eleven most frequently used drugs together explained 2.9% of the variance in the MMSE scores. These results indicate that there is a negligible association between daily drug use and cognitive function in these subjects.

Aged↗
PubMed1997

High prevalence of benzodiazepine dependence in out-patient users, based on the DSM-III-R and ICD-10 criteria.

Despite the fact that there have been many reports on benzodiazepine (BZD) dependence, consensus about its definition has not been reached. Reliable prevalence data to estimate the dependence liability of BZDs are therefore lacking. This study is the first to assess the prevalence of BZD dependence in out-patient BZD users (115-general practice (GP) patients, 124 psychiatric out-patients and 33 self-help patients) on the basis of the DSM-III-R and ICD-10 substance dependence criteria. Past year and lifetime diagnoses of BZD dependence were made by means of the Schedules for Clinical Assessments in Neuropsychiatry (SCAN). High prevalence figures were found, ranging from 40% in the GP patients (DSM-III-R past year) to 97% in the self-help patients (ICD-10 lifetime), indicating that BZD users run a high risk of developing BZD dependence. The clinical management of BZD use could benefit from further development of diagnostic instruments such as a self-report questionnaire which reflects the severity of BZD dependence.

Adolescent↗
PubMed1996

Randomised, double-blind, placebo-controlled study of fluoxetine in chronic fatigue syndrome.

BACKGROUND: No somatic treatment has been found to be effective for chronic fatigue syndrome (CFS). Antidepressant therapy is commonly used. Fluoxetine is recommended in preference to tricyclic agents because it has fewer sedative and autonomic nervous system effects. However, there have been no randomised, placebo-controlled, double-blind studies showing the effectiveness of antidepressant therapy in CFS. We have carried out such a study to assess the effect of fluoxetine in depressed and non-depressed CFS patients. METHODS: In this randomised, double-blind study, we recruited 44 patients to the depressed CFS group, and 52 to the non-depressed CFS group. In each group participants were randomly assigned to receive either fluoxetine (20 mg once daily) or placebo for 8 weeks. The effect of fluoxetine was assessed by questionnaires, self-observation lists, standard neuropsychological tests, and a motion-sensing device (Actometer), which were applied on the day treatment started and on the last day. FINDINGS: The two groups were well matched in terms of age, sex distribution, employment and marital status, and duration of CFS. There were no significant differences between the placebo and fluoxetine-treated groups in the change during the 8-week treatment period for any dimension of CFS. There was no change in subjective assessments of fatigue, severity of depression, functional impairment, sleep disturbances, neuropsychological function, cognitions, or physical activity in the depressed or the non-depressed subgroup. INTERPRETATION: Fluoxetine in a 20 mg daily dose does not have a beneficial effect on any characteristic of CFS. The lack of effect of fluoxetine on depressive symptoms in CFS suggests that processes underlying the presentation of depressive symptoms in CFS may differ from those in patients with major depressive disorder.

Adult↗