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Biomedical subjects

H G Rooijmans

Publications and source records attributed to H G Rooijmans.

At least 19 recordsLinked to original sources
PubMed1995

Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial.

OBJECTIVE: To examine the additional effect of cognitive behavioural therapy for patients with medically unexplained physical symptoms in comparison with optimised medical care. DESIGN: Randomised controlled trial with follow up assessments six and 12 months after the baseline evaluation. SETTING: General medical outpatient clinic in a university hospital. SUBJECTS: An intervention group of 39 patients and a control group of 40 patients. INTERVENTIONS: The intervention group received between six and 16 sessions of cognitive behavioural therapy. Therapeutic techniques used included identification and modification of dysfunctional automatic thoughts and behavioural experiments aimed at breaking the vicious cycles of the symptoms and their consequences. The control group received optimised medical care. MAIN OUTCOME MEASURES: The degree of change, frequency and intensity of the presenting symptoms, psychological distress, functional impairment, hypochondriacal beliefs and attitudes, and (at 12 months of follow up) number of visits to the general practitioner. RESULTS: At six months of follow up the intervention group reported a higher recovery rate (odds ratio 0.40; 95% confidence interval 0.16 to 1.00), a lower mean intensity of the physical symptoms (difference -1.2; -2.0 to -0.3), and less impairment of sleep (odds ratio 0.38; 0.15 to 0.94) than the controls. After adjustment for coincidental baseline differences the intervention and control groups also differed with regard to frequency of the symptoms (0.32; 0.13 to 0.77), limitations in social (0.35; 0.14 to 0.85) and leisure (0.36; 0.14 to 0.93) activities, and illness behaviour (difference -2.5; -4.6 to -0.5). At 12 months of follow up the differences between the groups were largely maintained. CONCLUSION: Cognitive behavioural therapy seems to be a feasible and effective treatment in general medical patients with unexplained physical symptoms.

Adolescent↗
PubMed1995

The prevalence of depression in elderly medical inpatients.

To estimate the point-prevalence of major depression in elderly medical inpatients according to a computerized diagnostic system, a two-phase design was carried out. A consecutive series of 198 elderly medical inpatients completed two self-rating scales for depression (Beck Depression Inventory, Geriatric Depression Scale) and the Mini-Mental State Examination. According to these screening instruments, 69 'probable cases' were identified and were referred for psychiatric evaluation using the Geriatric Mental State Schedule. Only 10 patients were identified as diagnostic cases of depression according to the GMS-AGECAT package. The estimated prevalence rate for depression according to AGECAT in this population was 5.9% (95% confidence limits 2.3-9.3%). This is lower than has been found in previous studies in elderly medical inpatients. Possible reasons for this finding are discussed.

Aged↗
PubMed1995

Outcome in conversion disorder: a follow up study.

Fifty six patients who had been admitted with a conversion disorder other than pseudoseizures were interviewed; mostly by telephone. The median interval was 4.5 years. If a patient had improved during a stay in hospital the eventual outcome was good in 96%, against only 30% in the others (risk ratio 3.2 (95% CI 1.8-5.6)). Rapid improvement was, in turn, related to recent onset of the symptoms. Two patients (4%) subsequently developed an organic deficit that, in retrospect, might be related to the initial episode.

Adolescent↗
PubMed1992

DNA-testing for Huntington's disease in The Netherlands: a retrospective study on psychosocial effects.

Presymptomatic DNA-testing for Huntington's disease has made it possible to predict whether or not at-risk individuals are gene-carriers with a reliability of about 98%. In our retrospective study of 18 tested individuals, most of the newly identified carriers function apparently well. They use avoidance and repression of affect as psychological defense strategies. However, 8 out of 9 non-carriers do not experience the expected relief about their test results. They experience survivor guilt and emotional numbness and find it difficult to cope with the effects of the test results on the family system. The partners of gene-carriers are at risk of becoming emotionally isolated by putting aside their own feelings for fear of seeming self-centered. Appreciation of these effects on tested individuals is important and professional support is needed to prevent post-traumatic stress disorders. Whatever the test result may be, the working through process may take years rather than months. These findings have important implications for patient care and necessitate an extended period of observation after presymptomatic testing.

Adult↗
PubMed1992

[Prevalence of the dementia syndrome in the oldest residents of a somatic nursing home].

OBJECTIVE: To estimate the prevalence of dementia among subjects of 85 years and over residing in a somatic nursing home. DESIGN: A two-phase design with the mini-mental state examination (MMSE) in the screening phase and the geriatric mental state schedule (GMS) in the diagnostic phase. SETTING: Three somatic nursing homes in Leiden. SUBJECTS: All subjects aged 85 years and over residing in one of the three nursing homes on December 1, 1986. First phase participation rate was 75%; second phase participation rate was 88%. MAIN OUTCOME MEASURE: DSM-III diagnosis of dementia without further specification of the aetiology of the dementia. RESULTS: An overall prevalence of 54% (95% CI: 43-66%) was found. This included 32% mild dementia, 9% moderate and 13% severe dementia. CONCLUSION: Dementia was found to be the most prevalent disorder among somatic nursing home residents aged 85 years and over. The shortage of psychogeriatric nursing home beds may have contributed to this high prevalence of dementia. However, the relatively large number of mild cases, which are usually not listed for admission to a psychogeriatric nursing home, indicates that the combination of a beginning dementia with physical impairment led to admission to a somatic nursing home. Considering the growth of the oldest part of the population it is to be expected that the prevalence of dementia will remain high among the oldest residents of somatic nursing homes.

Aged↗
PubMed1992

Mental play in Gilles de la Tourette's syndrome and obsessive-compulsive disorder.

A new phenomenon, found only in Gilles de la Tourette (GTS) patients, and which we have called 'mental play', is described. It was compared with the phenomenon of counting, which occurred in both GTS and obsessive-compulsive patients. In the GTS patients both mental play and counting were best characterised as playful impulsions. In contrast to the GTS patients, the counting of the obsessive-compulsive patients was in line with their obsessive-compulsive behaviour. These findings suggest that repetitive symptoms in GTS patients, even when they share superficial similarities with obsessive-compulsive symptoms, should not be diagnosed automatically as obsessive-compulsive.

Adolescent↗
PubMed1991

Alcohol abuse among elderly patients in a general hospital as identified by the Munich Alcoholism Test.

The aim of this study was to assess the prevalence of alcohol abuse among elderly patients in a general hospital. Scores on the Dutch version of the Munich Alcoholism Test (MALT) and medical records were obtained from 132 patients aged 65 and over, staying at the University Hospital Leiden. According to the MALT, 9% of the elderly patients (13% of the men and 7% of the women) were classified as alcoholics. In contrast, the discharge diagnosis involved alcohol dependence or abuse for only 0.5% of the patients 65 years and over admitted in 1989. In this study, two thirds of the alcoholic patients were recognized by the attending physician. Vague symptoms as admission diagnosis occurred more frequently in alcoholics than in nonalcoholics. Regarding former medical diagnoses, alcoholics had suffered significantly more often from organic brain diseases. In comparison to nonalcoholics, elderly alcoholics used more psychotropic drugs.

Aged↗
PubMed1988

Psychiatric consultations with depressed medical inpatients: a randomized controlled cost-effectiveness study.

Nonspecific, supportive psychiatric consultations were performed with a random sample of thirty-three general medical inpatients scoring thirteen or more on the Beck Depression Inventory. The control group consisted of thirty-five patients, matched for sex, marital status, somatic history, and seriousness of illness. The number of patients receiving no analgesic and/or psychotropic medication in the consult group (39%) was significantly greater than that in the control group (17%). When compared with their mean BDI score on admission, the BDI score just before discharge had decreased significantly in the consult group (from 20 to 13), but not in the control group (from 19 to 16). Probably because the patient sample was too heterogeneous, with too low a prevalence of mental disorders (45%), a significant reduction in other medical care expenditures and in length of hospital stay could not be demonstrated.

Cost-Benefit Analysis↗