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Biomedical subjects

I M van Vliet

Publications and source records attributed to I M van Vliet.

At least 19 recordsLinked to original sources
PubMed2006

[Prediction of effectiveness of electroconvulsive therapy in major depression with routinely collected data].

BACKGROUND: Little is known about the possibility to predict response to electroconvulsive therapy (ECT) in patients with major depression. AIM: To create an indexforthe prediction ofresponse to ECT in an individual patient. METHOD: Fifty-three depressive patients referred for ECT were included. Poor response was defined as a decrease in Hamilton Rating Depression Scale less than 50%. With multivariable analyses a simple index of independent predictors was constructed. RESULTS: Thirty-one patients (58%) showed poor response. The index comprised age < 65 years, psychotic depression, refractory to antidepressant medication, and personality disorder. It discriminated poor response patients reasonably well with an area under the receiver operating characteristic curve of 0.76 (95% confidence interval 0.63-0.89). CONCLUSION: Response to ECT may be predicted using an index with four patient characteristics. Before implementation, however, validation of the index in future patients is mandatory.

Age Factors↗
PubMed2005

[The practice guideline 'Anxiety disorders' (first revision) from the Dutch College of General Practitioners; a response from the perspective of psychiatry].

The revised version of the practice guideline 'Anxiety disorders' from the Dutch College of General Practitioners largely agrees with the Dutch interdisciplinary guidelines. It was agreed that the interdisciplinary guidelines would function as the standard and the professional guidelines would be derived from these. Differences concern the need to distinguish anxiety disorders as distinct conditions, the need to question about psychiatric disorders in the family, the status of tricyclic anti-depressants (TCAs) and selective serontonin re-uptake inhibitors (SSRIs), the medicinal possibilities, and the possibility of an one-offconsultation with a psychologist or psychiatrist.

Antidepressive Agents↗
PubMed2005

[Withdrawal symptoms of antidepressants].

Withdrawal symptoms are encountered with both the classical anti-depressants, i.e. the tricyclic antidepressants and monoamineoxidase inhibitors, the modern antidepressants, i.e. the selective serotonin re-uptake inhibitors, and the new antidepressants such as venlafaxine and mirtazapine. The symptoms that are reported following the withdrawal of these drugs can be classified into 8 groups: influenza-like symptoms, psychic symptoms, gastrointestinal symptoms, sleep disorders, equilibrium disorders, sensory disturbances, extrapyramidal symptoms and other symptoms. It is characteristic of these symptoms that they appear 1-4 days after reduction of the dose or the last administration of the drug. They may also appear in the infants of mothers who used an antidepressant during the last phase of the pregnancy. It is important that the patient be informed accurately and carefully at the start and termination of any treatment with an antidepressant. In order to prevent withdrawal symptoms, it is advisable to reduce the dosage slowly if possible when the treatment is to be terminated.

Antidepressive Agents↗
PubMed2001

Characteristics of patients with social phobia and their treatment in specialized clinics for anxiety disorders in the Netherlands.

BACKGROUND: Social phobia frequently occurs in the general population but is probably underreported due to comorbid disorders which mask the social phobia. Another reason might be that patients do not consult their general pratitioner due to embarrassment or an estimation of their condition. There are several treatments available for social phobia, but not enough is known about the efficacy of the different treatments strategies. METHODS: A retrospective, medical record-based study was carried out in four outpatient clinics specializing in treatment of anxiety disorders to investigate the characteristics of 64 patients with a DSM-IV axis diagnosis of social phobia who seeked help for their problems. Therapies for social phobia within these clinics and differences between these clinics were evaluated. RESULTS: Men with a high educational level tended to seek more help and comorbid disorders tended to cause more impairment in functioning. Further, there is a large delay between onset and therapy attendance (mean 14 years). Finally, there was consistency in the treatment of social phobia in these four clinics which consisted of cognitive behavioral therapy and/or medication. LIMITATIONS: The study is retrospective and based on medical records which means there was no objective measurement of the effectiveness of the therapies. CONCLUSIONS: Seventy-five percent of patients improved after treatment independent of the kind of therapy, the occurrence of comorbid disorders and the type of social phobia.

Adult↗
PubMed2000

Relapse prevention in major depressive disorder after successful ECT: a literature review and a naturalistic case series.

OBJECTIVE: Medication-resistance in major depressive disorder (MDD) may be related to high relapse rates after successful ECT when continued medication (C-MED) is used to prevent relapse. An alternative could be to continue ECT (C-ECT). METHOD: Patients with medication-resistant MDD responding to ECT were offered C-ECT without medication. Follow-up was 6 months. Publications from a literature search were screened against prespecified criteria. RESULTS: With C-ECT the 6-month relapse-rate was 50% (6/12, 95% CI:21-79) in our medication-resistant group. In the review we found with C-ECT 29% (7/24,CI:13-51) in 'unknown' medication resistance and no data about medication-resistant depression. With C-MED at 6 months: no data were found concerning medication-resistant depression, 28% (35/124,CI:20-36) in 'unknown' resistance and 13% (2/15,CI:2-41) in non-resistance. With C-MED at 12 months, 73% (16/22,CI:50-90), 50% (16/32,CI:32-68) and 27% (8/30,CI:12-46) were found, respectively. CONCLUSION: The efficacy of C-MED is related negatively to medication resistance before ECT. This may also be the case for C-ECT. Further studies with C-ECT are urgently needed.

Adult↗
PubMed1999

[Behcet disease].

Explore the source record for details and available documents.

Acne Vulgaris↗
PubMed1999

[A hidden compulsion].

Obsessive-compulsive disorder (OCD) is a frequent psychiatric disorder. Patients do not always present with obsessions or compulsions and this may complicate the process of diagnosing and starting adequate treatment. In this article three patients suffering from OCD but not presenting with obsessions or compulsions are discussed. In the first case, in a 42-year-old woman, the presenting symptom is a therapy-resistant dermatitis, due to excessive washing. The second patient, a 27-year-old man, presented with a depression, a frequent comorbid condition. In the third case, a 34-year-old man, the effects on and the suffering of the partner and family of a patient with OCD (they were asked to co-operate in his compulsive behaviour) were the reason for his wife to consult the general practitioner. OCD has a lifetime prevalence rate of 2.5% and is somewhat more frequent in females than in males. The most characteristic symptoms are obsessions and/or compulsions. They cause marked distress, are time consuming (take more than 1 hour a day), and interfere significantly with the person's functioning (occupational, social activities, relationships). Neurobiological studies suggest genetic influences and dysfunctional neuronal circuits in the brain. The treatment of OCD consists of pharmacotherapy and behavioural therapy, but it is a lifelong condition.

Adult↗
PubMed1997

Clinical effects of buspirone in social phobia: a double-blind placebo-controlled study.

BACKGROUND: The results of open pilot studies suggest that the serotonin-1A (5-HT1A) receptor agonist buspirone might be effective in social phobia. METHOD: In the present study, the efficacy of buspirone was investigated in patients with social phobia using a 12-week double-blind placebo-controlled design. Thirty social phobic patients (DSM-IV) were treated with either buspirone 30 mg daily or placebo. Efficacy of treatment was measured using the Social Phobia Scale (subscores anxiety and avoidance) and the Hamilton Rating Scale for Anxiety. RESULTS: Taking a reduction of 50% or more on the Social Phobia Scale as a criterion for clinically relevant improvement, only 1 patient on buspirone and 1 on placebo were classified as responder to treatment. A subjective and clinically relevant improvement was reported by 4 patients (27%) on buspirone and 2 patients (13%) on placebo. There were no statistically significant differences between buspirone and placebo on any of the outcome measures. Generally speaking, buspirone was well tolerated. CONCLUSION: The results of the study do not support the results of open studies, in which a reduction of social anxiety and social avoidance was reported in patients with social phobia treated with buspirone.

Buspirone↗
PubMed1996

Responders and non-responders to drug treatment in social phobia: differences at baseline and prediction of response.

Differences between responders and non-responders to drug therapy were investigated in social phobia. Two previously published studies were pooled to obtain data of 30 patients who were treated for 12 weeks with brofaromine or fluvoxamine. Four criterion variables were used to divide patients in responders and non-responders. Depending on the criterion variable up to 72% of the patients were regarded as responders. Non-responders differed from responders in that they had a higher heart rate and a higher blood pressure. They were also characterized by higher scores on several psychometric scales, indicative of illness severity.

Adult↗
PubMed1996

Effects of the 5-HT1A receptor agonist flesinoxan in panic disorder.

The effects of flesinoxan, a potent and selective 5-HT1A agonist, were studied in two pilot studies in panic disorder patients to explore the role of 5-HT1A receptors in the mechanism of action of antipanic agents. This paper reports on the results of these two studies with flesinoxan. In study I, using a single-blind crossover design, five patients were treated for 1 week with placebo, 4 weeks with flesinoxan (up to 2.4 mg per day), and 2 weeks with placebo. In study II, 15 patients were enrolled in a double-blind, three-armed study with placebo and two dosages of flesinoxan. After a single-blind placebo run-in phase of 1 week, patients were treated for 8 weeks with placebo, 0.6 or 1.2 mg/day flesinoxan. In pilot study I patients' condition worsened during the 4-week flesinoxan treatment period. Anxiety was frequently reported as an adverse event. Symptoms returned to the pre-treatment level during the 2-week placebo washout period. In pilot study II, no treatment effects in either group were observed. Anxiety as an adverse event was less prominent than in the first pilot study. A lowering of mood was seen in some patients. The sample sizes of these two pilot studies are too small to draw firm conclusions on the efficacy of flesinoxan in panic disorder, but the present data are not encouraging in this respect. The worsening of symptoms seen with the highest dose of flesinoxan is intriguing and might give a clue to the understanding of the mechanism underlying similar effects seen with antidepressants in panic disorder patients.

Adult↗
PubMed1996

MHPG and heart rate as correlates of nonresponse to drug therapy in panic disorder patients. A preliminary report.

Little is known about biological predictors of treatment response in panic disorder (PD). In the present study heart rate, blood pressure, plasma cortisol and plasma MHPG were investigated at baseline in a sample of 44 PD patients as possible predictors for nonresponse to treatment. We used a strict definition of nonresponse to find patients who did not respond at all after 12 weeks of treatment with brofaromine or fluvoxamine. Patients were considered nonresponders when they fulfilled two criteria: they did not show a 50% reduction of agoraphobic avoidance and they still experienced panic attacks at endpoint. The variables that differed significantly between the groups were used to predict nonresponse to drug therapy. Using this strict definition of nonresponse, 15 patients (32.6%) were considered nonresponders. These patients were characterised by a higher plasma MHPG concentration and a higher heart rate at baseline. These variables were subsequently used to predict nonresponse.

Adult↗
PubMed1996

Behavioral, neuroendocrine and biochemical effects of different doses of 5-HTP in panic disorder.

To investigate the role of serotonin (5-HT) in the pathophysiology of panic disorder (PD) a challenge test with L-5-hydroxytryptophan (5-HTP) was conducted. Seven patients suffering from PD and seven healthy controls received an i.v. challenge with 10 mg, 20 mg and 40 mg 5-HTP and placebo in random order on four different occasions. Before, during and until 2 h after 5-HTP administration anxious and depressive symptomatology was assessed. In addition, plasma levels of 5-HTP, cortisol, and 5-HIAA were measured at several timepoints. During and after infusion of placebo or any of the different dosages of 5-HTP, none of the patients or controls experienced a panic attack or showed an increase in anxiety or depressive symptoms. There was a dose-related increase in side effects, like nausea, dizziness and fatigue. Only infusion with 40 mg 5-HTP led to an increase in plasma cortisol in both patients and controls. The observed increase in plasma cortisol level was higher for patients compared to controls only at 30 min after infusion. In conclusion, stimulation of the serotonergic neuronal system by three different dosages of 5-HTP did not induce panic or anxiety in PD patients and healthy controls. The 5-HT hypersensitivity hypothesis of PD could not be confirmed in the present study.

5-Hydroxytryptophan↗
PubMed1996

A double-blind comparative study of brofaromine and fluvoxamine in outpatients with panic disorder.

Previous studies have shown that both selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are effective in the treatment of panic disorders (PD). In this study, the SSRI fluvoxamine (Fluv) was compared with the MAO-A-I brofaromine (Brof). Thirty patients with the diagnosis of PD with or without agoraphobia were treated with either Fluv or Brof (150 mg daily) in a double-blind design. After 12 weeks of treatment, 93% of the Brof group and 87% of the Fluv group considered themselves much or very much improved. Taking a reduction in the Hamilton Rating Scale for Anxiety score of 50% or more, 33% of the Fluv patients and 47% of the Brof patients were responders to treatment. After an increase in anxiety in the 1st week, which was more severe in Fluv-treated patients than for Brof, a clinically relevant decrease in anxiety symptoms and reduction in panic attacks and avoidance behavior was observed. There was no significant difference between the treatment groups. The most prominent side effects were middle-sleep disturbance (Brof), tiredness (Fluv), and nausea after taking the medication (Brof and Fluv). During a double-blind follow-up period of another 12 weeks, a further improvement was found in both treatment groups without significant differences between the two groups. The selective and reversible MAO-A-I brofaromine and the SSRI fluvoxamine are equally effective in the treatment of PD. Both compounds lead to a reduction in the number of panic attacks and a subsequent reduction in agoraphobic avoidance.

Adult↗
PubMed1995

Phobic symptoms as predictors of nonresponse to drug therapy in panic disorder patients (a preliminary report).

Factors that predict nonresponse to drug therapy (brofaromine or fluvoxamine) were investigated in a sample of 44 panic disorder patients. We used a strict definition of nonresponse to find patients who did not respond at all after 12 weeks of treatment. Using this definition, 15 patients (32.6%) were considered nonresponders. Nonresponders had a higher score on the Blood-Injury subscore of the Fear Questionnaire (FQ) and more often had high scores on several FQ subscores, indicative of comorbid phobic symptoms. These variables were subsequently used to predict nonresponse.

Adult↗
PubMed1995

Recent developments in the psychopharmacology of social phobia.

The past 2 decades have witnessed an upsurge in the interest in anxiety disorders. Much research effort has been dedicated to panic disorder and obsessive-compulsive disorder. However, it is only very recently that we have begun to understand some of the basic principles about the psychopharmacology of social phobia. Drug classes thus far studied include beta-blockers, nonselective and irreversible monoamine oxidase inhibitors (MAOIs), and benzodiazepines. Beta blockers appear to be of use in specific social phobias, such as public speaking, whereas they are of little use in generalized social phobia. There is considerable evidence suggesting that MAOIs are effective in reducing both social anxiety as well as social avoidance in generalized social phobia. A disadvantage of the conventional irreversible MAOIs is their risk for hypertensive crises when combined with dietary tyramine. Thus far only a small number of studies with selective MAO-A inhibitors, such as moclobemide and brofaromine, have been conducted in social phobia, and the results indicate that both compounds are effective. Drugs exerting selective and specific actions on certain components of, for example, the serotonergic system, can now be studied, and it is hoped that the role of 5-hydroxytryptamine) and other neuronal systems in social phobia can be elucidated. In order to gain more information about selective serotonergic drugs, the first double-blind placebo-controlled study with fluvoxamine was recently published. Preliminary results indicate a reduction in social anxiety after a prolonged treatment period. Finally, the role of peptides in the treatment of social phobia is critically reviewed. The MSH/ACTH analog Org 2766 was investigated in patients suffering from social phobia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1995

Biological dissection of anxiety disorders: the clinical role of selective serotonin reuptake inhibitors with particular reference to fluvoxamine.

The selective serotonin reuptake inhibitor (SSRI) fluvoxamine has been used in an attempt to understand whether there is a biological distinction among anxiety disorders. A comparison of fluvoxamine with the specific noradrenaline reuptake inhibitor maprotiline in patients with panic disorder showed fluvoxamine to be a potent anti-panic agent, whereas maprotiline had no effect on the frequency of panic attacks. This result supported the hypothesis of serotonergic involvement in the pathogenesis of panic disorder. In a second study, unlike fluvoxamine, the 5-HT2A/2C antagonist ritanserin had no effect on the number of panic attacks, or phobic avoidance. This suggested that the efficacy of antidepressants in panic disorder was not a result of down-regulation of postsynaptic 5-HT2 receptors. Most studies suggest that the efficacy of antidepressants in obsessive-compulsive disorder (OCD) is not related to their antidepressant or mood-enhancing effects. Fluvoxamine has also been shown to reduce general and phobic anxiety in social phobia patients. In conclusion, serotonergic systems are implicated in the pathophysiology of global anxiety irrespective of the nosological background, and SSRIs, exemplified by fluvoxamine, appear to be effective in panic disorder, OCD and probably also social phobia.

Anxiety Disorders↗
PubMed1994

Psychopharmacological treatment of social phobia; a double blind placebo controlled study with fluvoxamine.

Previous studies have shown selective and nonselective monoamine oxidase inhibitors (MAOIs) to be effective in the treatment of social phobia. In this study we investigated the efficacy of selective serotonin reuptake inhibitors (SSRIs) in social phobia. Thirty patients with social phobia (DSM-IIIR) were treated with the SS-RI fluvoxamine (150 mg daily) using a 12-week double-blind placebo controlled design. A substantial improvement was observed in seven (46%) patients on fluvoxamine and in one (7%) on placebo. Statistically significant effects were seen on measures of social anxiety and general (or anticipatory) anxiety in patients treated with fluvoxamine compared with placebo. The level of phobic avoidance decreased also but the difference at endpoint between fluvoxamine and placebo failed to reach statistical significance. It is concluded that treatment with the SSRI fluvoxamine has beneficial effects in patients suffering from social phobia, suggesting that serotonergic mechanisms might be implicated in social anxiety.

Adult↗