Comparing psychotherapy and pharmacotherapy.
Explore the source record for details and available documents.
Antidepressive Agents↗
Biomedical subjects
R Van Dyck
Publications and source records attributed to R Van Dyck.
On becoming depressed or anxious in late life: similar vulnerability factors but different effects of stressful life events.
BACKGROUND: Little research has been done on the uniqueness of risk profiles for depression and anxiety in late life. AIMS: Delineating risk factors for the decline of mental health in older persons, comparing risk profiles for developing symptoms of pure depression, pure anxiety and both anxiety and depression in a prospective design. METHOD: Self-report data on depression and anxiety were collected from community-dwelling older respondents (> or = 55 years) on two occasions, 3 years apart. Data from emotionally healthy respondents (n=1810) were used to investigate the effects of long-standing vulnerability factors and stressful life events. RESULTS: After 3 years 9% of the subjects had scored beyond the thresholds for symptoms. Vulnerability for depression and anxiety was quite similar, but life events differed: onset of depression was predicted by death of a partner or other relatives; onset of anxiety was best predicted by having a partner who developed a major illness. No support for moderator effects between vulnerability factors and stress was found; the effects were purely additive. CONCLUSIONS: Depression and anxiety have many risk factors in common, but specific risk factors also were found, especially in subjects developing both depression and anxiety.
Aged↗
Predictors of change in anxiety symptoms of older persons: results from the Longitudinal Aging Study Amsterdam.
BACKGROUND: Data on the course of anxiety in late life are scarce. The present study sets out to investigate the course of anxiety, as measured by the HADS-A (Zigmond & Snaith, 1983) in community dwelling older persons, and to evaluate predictive factors for change over 3 years in anxiety symptoms following the vulnerability/stress model. METHOD: Based on the first anxiety assessment, two cohorts were formed: subjects with and subjects without anxiety symptoms. In the non-anxious cohort (N = 1602) we studied risk factors for the development of anxiety symptoms; in the anxious cohort (N = 563) the same factors were evaluated on their predictive value for restitution of symptoms. Risk factors included vulnerability factors (demographics, health status, personality characteristics and social resources) and stressors (life events occurring in between both anxiety assessments). Logistic regression models estimated the effects of vulnerability factors, stress and their interaction on the likelihood of becoming anxious and chronicity of anxiety symptoms. RESULTS: It was indicated that the best predictors for becoming anxious were being female, high neuroticism, hearing/eyesight problems and life-events. Female sex and neuroticism also increased the likelihood of chronicity of anxiety symptoms in older adults, but life events were not related to chronicity. The main stressful event in late life associated with anxiety was death of one's partner. Vulnerability factors and stress added on to each other rather than their interaction being associated with development or chronicity of anxiety. CONCLUSION: The vulnerability/stress model offers a useful framework for organizing risk factors for development and chronicity of anxiety symptoms in older persons, but no support was attained for the hypothesis that vulnerability and stress amplify each others effects. Finally, the results indicate to whom preventive efforts should be directed: persons high in neuroticism, women, and those who experience distressing life events.
Aged↗
Long-term outcome of pharmacological and psychological treatment for panic disorder with agoraphobia: a 2-year naturalistic follow-up.
Two years after completion of a controlled outcome study of treatments for panic disorder with agoraphobia, patients were revisited and interviewed about their complaints. In the initial study, four treatments had been compared: (i) fluvoxamine combined with exposure; (ii) placebo medication plus exposure; (iii) psychological panic management plus exposure; and (iv) exposure alone. Comparison of the results at post-test had revealed superior efficacy of fluvoxamine combined with exposure over the other three treatments in reducing agoraphobic avoidance. The current naturalistic follow-up study investigated the long-term efficacy of the treatments with regard to abatement of complaints and reduced demand for further treatment. In addition, we examined whether patients were able to taper off the study medication without a recurrence of complaints. In total, 71 of the 76 patients of the original trial (93%) were interviewed. Comparison of the mean level of psychopathology at follow-up revealed no difference between the original treatment groups. The effect in the fluvoxamine plus exposure group was maintained, but was no longer superior, due to further improvements in the other treatment groups. Most patients received additional treatment during the follow-up period, usually because the 12 treatment sessions in the controlled study had yielded insufficient improvement. There was a trend for patients who received the fluvoxamine plus exposure treatment to require less aftercare than those who received the other treatments. Finally, almost 50% of the patients who had received medication in the original trial were able to taper off the use of fluvoxamine without a recurrence of complaints.
Agoraphobia↗
The inpatient treatment of patients suffering from (motor) conversion symptoms: a description of eight cases.
This article presents a preliminary study that used two controlled randomized trials to study the effect of hypnosis in the treatment of eight patients with (motor) conversion symptoms. Controlled research into the treatment of conversion symptoms is scarce and can often be criticized on methodological grounds. It would appear, however, that both the use of suggestive and behavioral therapeutic techniques and eclectic treatment programs yield good results in the treatment of conversion symptoms. The results of the study suggest that comprehensive clinical treatment including hypnosis has enough promise to be studied in clinical trials. In the interpretation of the results, special attention is given to primary diagnosis, duration of complaints, traumatic experiences in childhood, dissociative capacity, and hypnotizability.
Adult↗
Accurate heartbeat perception in panic disorder: fact and artefact.
The hypothesis was investigated that more accurate perception of heartbeats by patients with panic disorder is an artefact of arousal. Twenty-three patients with panic disorder, 16 patients with a mood disorder and 21 normal controls were tested. There were more panic patients who accurately perceived their heart rates (N = 7) than depressed patients (N = 0) or normals (N = 2). The nine accurate perceivers had higher scores on questionnaires measuring the cognitions associated with panic. For non-accurate perceivers, perceived heart rates were unrelated to actual heart rates, unrelated to cognitive factors, but significantly related to arousal. It is concluded that the accurate perception of heartbeats by patients with panic disorder is both fact and artefact: some patients are accurate perceivers, but the majority are not.
Adult↗
The diagnosis of psychogenic non-epileptic seizures: a review.
Diagnosing psychogenic non-epileptic seizures (PNES) is a clinical challenge. There is neither a standard in diagnosing PNES nor a comprehensive theoretical framework for this type of seizure. The diagnosis of PNES must be made by excluding epilepsy. However, epilepsy cannot always be determined and PNES and epileptic seizures may coexist. In this study, the characteristics of PNES and patients are discussed. The diagnosis of PNES and epileptic seizures was facilitated by the simultaneous recording of seizures on video tape and EEG. Seizure provoking techniques, hormonal indices, and psychological methods were also used. The benefits and limitations of these techniques are discussed and proposals are made for clinical guidelines.
Diagnosis, Differential↗
Depersonalization and derealization during panic and hypnosis in low and highly hypnotizable agoraphobics.
The primary aim of the present study was to investigate the association between spontaneous experiences of depersonalization or derealization (D-D) during panic states and hypnosis in low and highly hypnotizable phobic individuals. Secondarily, the association among level of hypnotizability, capacity for imaginative involvement, and severity of phobic complaints was also assessed. Sixty-four patients with panic disorder with agoraphobia according to the DSM-III-R (American Psychiatric Association, 1987) criteria participated in the study. Proneness to experience D-D during hypnosis was positively related to hypnotizability, but only for agoraphobic patients who had already experienced these perceptual distortions during panic episodes. Correlations of level of hypnotizability and capacity for imaginative involvement with severity of agoraphobic complaints were not significant. These findings suggest that hypnotizability may be a mediating variable between two different, although phenotypically similar, perceptual distortions experienced during panic states and hypnosis. Implications for both theory and clinical practice are discussed.
Adolescent↗
Prediction of outcome and early vs. late improvement in OCD patients treated with cognitive behaviour therapy and pharmacotherapy.
In this study, follow-up results of cognitive-behaviour therapy and of a combination of cognitive-behaviour therapy with a serotonergic antidepressant were determined. The study also examined factors that can predict this treatment effect, both in the long term and in the short term. In addition, it investigated whether differential prediction is possible for cognitive-behaviour therapy vs. a combination of cognitive-behaviour therapy with a serotonergic antidepressant. A total of 99 patients were included in the study. Treatment lasted 16 weeks, and a naturalistic follow-up measurement was made 6 months later. Of the 70 patients who completed the treatment, follow-up information was available for 61 subjects. Significant time effects were found on all outcome measures at both post-treatment measurement and follow-up. No differences in efficacy were found between the treatment conditions. Effectiveness at post-treatment measurement appears to predict success at follow-up. However, 17 of the 45 non-responders at the post-treatment measurement had become responders by the follow-up. The severity of symptoms, motivation for treatment and the dimensional score on the PDQ-R for cluster A personality disorder appear to predict treatment outcome. No predictors were found that related specifically to cognitive-behaviour therapy or combined treatment. These results indicate that the effectiveness of cognitive-behaviour therapy or a combination of cognitive-behaviour therapy and fluvoxamine at the post-treatment measurement is maintained at follow-up. However, non-response at post-treatment does not always imply non-response at follow-up. Patients with more severe symptoms need a longer period of therapy to become responders. Although predictors for treatment success were found, no evidence was found to determine the choice of one of the treatment modalities.
Adult↗
Does preference for type of treatment matter? A study of exposure in vivo with or without hypnosis in the treatment of panic disorder with agoraphobia.
There is evidence that preference for a given therapy may influence results. Literature also suggests that hypnotizability may be elevated in agoraphobic patients, making hypnosis a potentially powerful method for treatment. Agoraphobic patients (N = 64) were treated with either exposure in vivo or exposure combined with hypnosis in a crossover design. Half of the patients started with the treatment they preferred and the other half received the other treatment first. Although patients' preference clearly shifted in favor of the combined therapy in the course of the study, no effect of preference on outcome was evident. Although hypnotizability clearly correlated to outcome in the combined therapy, no difference in effect between the two therapies was found on behavioral, self-report, and observer measures. No additional effect of hypnosis could be shown and preference was not found to be a powerful mediator of effect.
Adolescent↗
The case for a dissociative interpretation of pseudoepileptic seizures.
A pseudoepileptic seizure (PES) can be considered as a paroxysmal behavior pattern that mimics epilepsy and is initiated by psychological mechanisms. There is no evidence that the symptomatology of PES forms a specific syndrome. This paper presents evidence for the explanatory value of the concept of dissociation in at least a subgroup of PES. Characteristics of patients with PES and possible factors in the etiology of PES are reviewed. Based on the dissociation hypothesis, some suggestions are offered to explain the relatively high comorbidity of PES and epilepsy.
Amnesia↗
The development and psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20).
According to 19th century French psychiatry and contemporary clinical observations, dissociation pertains to both psychological and somatoform components of experience, reactions, and functions. Because such an instrument was lacking, we aimed to develop a self-reporting questionnaire measuring what we propose to call somatoform dissociation. Patients with dissociate disorder and with other DSM-IV psychiatric diagnoses completed a list of 75 items that, according to clinical experience and expert judgment, could reflect instances of somatoform dissociation. Separate logistic analyses and determination of discriminant indices per item revealed 20 items that best discriminated between those with and without dissociative disorders. Mokken analysis showed that these items are strongly scalable on a dimensional latent scale interpreted to measure somatoform dissociation. Reliability of the scale was high. Construct validity was supported by high intercorrelations with the Dissociation Questionnaire, which measures psychological dissociation, and higher scores of patients with dissociative identity disorder compared with patients with dissociative disorders not otherwise specified. In conclusion, the Somatoform Dissociation Questionnaire (SDQ-20) is a scale of good psychometric quality, which measures somatoform dissociation. The symptoms pertain to negative and positive dissociative phenomena, which were well known in 19th century French psychiatry as the mental stigmata and mental accidents of hysteria.
Adolescent↗
Continuous monitoring of panic.
Data on naturally occurring panic attacks were gathered through continuous self-monitoring for 94 patients suffering from panic disorder with agoraphobia. A total of 1276 panic attacks were collected. In this article various aspects of panic attacks, including severity, duration and time of onset and situations in which panic occurs are addressed. In addition, the symptoms of panic were investigated, examining the (in)variability of attacks within each patient and the patterning of symptoms in the entire group of patients. The most important findings were as follows: attacks occurred predominantly in nonphobic situations; nocturnal panic attacks were generally more severe than attacks during the day; symptom patterns across various attacks, stemming from the same patient, were rather variable; and finally, a substantial number of the attacks (40%) did not meet the DSM-III-R criteria for number of symptoms.
Adult↗
Dissociation and traumatic experiences in the general population of The Netherlands.
Explore the source record for details and available documents.
Adolescent↗
Practical zero-shift tuning in geonium.
Compositeness of the electron may show up in a very small deviation of the measured electron g factor from one calculated for a point electron by quantum electrodynamics. The precision of our g measurements is currently limited by an interaction of the cyclotron motion with standing waves in the trap cavity containing the electron. The important element introduced here is the systematic exploration of the trap cavity modes and the electron's coupling to them by measuring the shifted electron g factor gc = gc(omega e) as a function of the cyclotron frequency omega e. By measuring gc values at five different omega e values and modeling the trap cavity by six lumped LC circuits, the L values for the four most important modes may be determined and finally the unshifted g value may be extracted. Auxiliary experiments are relied upon only for the L values of the two least critical cavity modes. By designing the trap as a high-Q microwave cavity, an electron cyclotron and anomaly resonance linewidth one or even two orders of magnitude narrower than in free space may be approached without introducing appreciable frequency shifts.
Journal Article↗
Self-monitoring of panic attacks and retrospective estimates of panic: discordant findings.
An event sampling method was used to study the frequency of panic attacks during treatment of agoraphobics. Results revealed a much lower incidence of panic attacks in agoraphobics according to self-monitoring than was expected on account of their retrospective estimation. When more stringent criteria for panic attacks are applied, retrospective overestimation becomes even more apparent. The implication of this finding for the classification of panic disorder patients is discussed.
Agoraphobia↗
Autogenic training and self-hypnosis in the control of tension headache.
This study compares autogenic training and training in multiple self-hypnosis strategies in a sample of 56 patients diagnosed as having chronic tension headache on the basis of medical evaluation by a neurologist. At posttreatment and follow-up, no differences between the two treatment regimens in the reduction of headache and psychological distress were observed. During treatment, patients reduced their headache activity and level of psychological distress significantly in contrast to the waiting-list period (p < 0.05). Follow-up measurements indicated that therapeutic improvement was maintained (p < 0.05). Short-term and long-term pain reduction was accompanied by an increase in perceived pain control (p < 0.003). Moreover, those patients who attributed the pain reduction obtained during therapy to their own efforts manifested long-term pain reduction (p < 0.003).
Adaptation, Psychological↗
Hypnosis: placebo or nonplacebo?
According to Grünbaum's definition of placebo, a therapeutic procedure can be considered a nonplacebo if it can be demonstrated that its effects are produced according to the theory upon which the therapy is based. If the theory is adopted that hypnotic effects depend upon mobilization of the patient's hypnotizability, which is a measurable characteristic, a testable theory is provided. Experimental literature is reviewed that shows that placebo effects are not related to hypnotizability. Clinical outcome studies make it clear that results of hypnotherapy are related to hypnotizability in some disorders such as pain and anxiety, but not in the treatment of addiction or habit disorders. An example of a procedure is given in which hypnosis is nonetheless usefully applied for its placebo value as a method to generate positive expectancies.
Combined Modality Therapy↗