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Biomedical subjects

R van Dyck

Publications and source records attributed to R van Dyck.

At least 37 records · Page 2Linked to original sources
PubMed1999

Paroxetine, clomipramine, and cognitive therapy in the treatment of panic disorder.

BACKGROUND: This 12-week, placebo-controlled study was carried out to compare the relative efficacy of paroxetine, clomipramine, and cognitive therapy in the treatment of DSM-III-R-defined panic disorder with or without agoraphobia. METHOD: After a 3-week single-blind, placebo run-in period, 131 patients were randomly assigned to receive double-blind medication or 12 sessions of cognitive therapy based on the model of Clark. Efficacy assessments included the daily panic attack diary, the Clinical Global Impression scale, the Patient Global Evaluation, the Hamilton Rating Scale for Anxiety, the Marks-Sheehan Phobia Scale, the Montgomery-Asberg Depression Rating Scale, and the Sheehan Disability Scale. RESULTS: Comparisons with placebo revealed significant superiority of paroxetine (20-60 mg/day) and clomipramine (50-150 mg/day) on nearly all outcome measures. On most measures, paroxetine also showed higher efficacy than cognitive therapy. With few exceptions, cognitive therapy did not differ significantly from placebo. The number of subjects becoming panic-free (66%) was higher and the onset of action was faster in the paroxetine-treated group. Treatment with cognitive therapy yielded the highest drop-out rate (26%). CONCLUSION: In this short-term study assessing treatment of panic disorder and agoraphobia, paroxetine and clomipramine were consistently superior to pill placebo, whereas cognitive therapy was superior on only a few measures.

Adolescent↗
PubMed1998

Predictability, controllability, and fear of symptoms of anxiety in epinephrine-induced panic.

BACKGROUND: Psychological manipulations (supplied information, safety cues) may influence panic rates during pharmacologic challenge tests in subjects with panic disorder (PD). Psychological panic models assume that fear of stress-related bodily sensations is central to the etiology of PD. METHODS: Prior to infusion of epinephrine, 50 subjects with PD were randomly assigned to one out of four experimental conditions: with or without extensive information and with or without external control, according to a 2 x 2 design. The panic rate was hypothesized to be lower in subgroups possessing extensive information and/or control. Fear of bodily sensations was used as a predictor. RESULTS: Thirty-four out of 50 patients (68%) panicked during the infusion. Subjects who received extensive information were marginally less likely to panic, but manipulation of control did not influence panic rates. Panickers did not differ from nonpanickers in measures of fear of fear. Anxiety sensitivity best predicted baseline anxiety and cognitive symptom scores, but was not associated with other outcome measures in panickers. Only baseline partial pressure of CO2 discriminated between panickers and nonpanickers. CONCLUSIONS: Manipulating external safety cues appears to be of limited value in modulating responses to epinephrine challenge. Together with our finding that fear of anxiety symptoms does not predict panic rates, these data argue against "fear of fear" as a key mechanism in epinephrine-induced panic.

Adult↗
PubMed1998

[Hypochondriasis].

In a female patient aged 33 years and suffering from excessive concern with her physical health, hypochondriasis was diagnosed. By cognitive behavioural therapy the obsessive thoughts, controlling behaviour and avoidance behaviour were alleviated. After treatment the patient needed fewer consultations. In general practice hypochondriasis is a common problem. Patients will ask for a lot of diagnostic tests. Nothing will give them enough reassurance and there can be irritation. The general practitioner must confront them with the fact that their main problem is hypochondriasis and search for solutions. Cognitive and behavioural therapy as well as treatment with antidepressive drugs may be helpful. The earlier the diagnosis and the start of treatment, the better the prognosis.

Adult↗
PubMed1998

[Combination of anxiety disorder and alcohol dependence].

Three patients, two men aged 47 and 37 and a woman aged 32, are described. All three suffered from a combination of alcohol addiction and anxiety disorder. None of them had previously received adequate treatment because on the one hand they had been refused by psychiatric institutes because of their alcohol addiction, and on the other the institutes for the care of addicted had not diagnosed the anxiety disorder. About 150,000 people are estimated to have both an alcohol addiction and an anxiety disorder in the Netherlands. The importance of making a correct diagnosis and providing proper treatment for both disorders is emphasized.

Adult↗
PubMed1998

Anxiety disorders in later life: a report from the Longitudinal Aging Study Amsterdam.

OBJECTIVE: To study the prevalence and risk factors of anxiety disorders in the older (55-85) population of The Netherlands. METHOD: The Longitudinal Aging Study Amsterdam (LASA) is based on a random sample of 3107 older adults, stratified for age and sex, which was drawn from the community registries of 11 municipalities in three regions in The Netherlands. Anxiety disorders were diagnosed using the Diagnostic Interview Schedule in a two-stage screening design. The risk factors under study comprise vulnerability, stress and network-related variables. Both bivariate and multivariate statistical methods were used to evaluate the risk factors. RESULTS: The overall prevalence of anxiety disorders was estimated at 10.2%. Generalized anxiety disorder was the most common disorder (7.3%), followed by phobic disorders (3.1%). Both panic disorder (1.0%) and obsessive compulsive disorder (0.6%) were rare. These figures are roughly similar to previous findings. Ageing itself did not have any impact on the prevalence in both bivariate and multivariate analyses. The impact of other factors did not change much with age. Vulnerability factors (female sex, lower levels of education, having suffered extreme experiences during World War II and external locus of control) appeared to dominate, while stresses commonly experienced by older people (recent losses in the family and chronic physical illness) also played a part. Of the network-related variables, only a smaller size of the network was associated with anxiety disorders. CONCLUSIONS: Anxiety disorders are common in later life. The risk factors support using a vulnerability-stress model to conceptualize anxiety disorders. Although the prevalence of risk factors changes dramatically with age, their impact is not age-dependent. The risk factors indicate which groups of older people are at a high risk for anxiety disorders and in whom active screening and treatment may be warranted.

Aged↗
PubMed1998

Psychological distress of caregivers: the mediator effect of caregiving appraisal.

This study concerns the role of caregiving appraisal, whether it explains why stressors in the caregiving situation affect caregivers' psychological distress. This putative mediator effect of caregiving appraisal is separately tested for spouse and non-spouse caregivers of demented elderly persons. Caregiving appraisal is operationalized by a measure of pressure from informal care as perceived by the caregiver. For spouse caregivers, perceived pressure explained the association between their caregiving tasks and psychological distress. However, the strong association found between behavioral problems and psychological distress was not explained by perceived pressure in spouse caregivers. Furthermore, results showed clear mediator effects of perceived pressure for associations between stressors (both behavioral problems of the demented elder and caregiving tasks) and non-spouse caregivers' psychological distress. Thus, it is inadequate to focus interventions merely on stressors in the caregiving situation, for non-spouse caregivers in particular. A reduction of perceived pressure from informal care is also needed.

Adaptation, Psychological↗
PubMed1998

Degree of somatoform and psychological dissociation in dissociative disorder is correlated with reported trauma.

In this study, the prevalence and severity of traumatic experiences as reported by patients with dissociative disorders and with other DSM-IV psychiatric diagnoses were compared. Furthermore, the predictive value of emotional, physical, and sexual trauma with respect to somatoform and psychological dissociation was analyzed. In contrast with comparison patients, dissociative disorder patients reported severe and multifaceted traumatization. Physical and sexual trauma predicted somatoform dissociation, sexual trauma predicted psychological dissociation as well. According to the memories of the dissociative disorder patients, this abuse occurred in an emotionally neglectful and abusive social context. Pathological dissociation was best predicted by early onset of reported intense, chronic and multiple traumatization. Methodological limitations restricting causal inferences between reported trauma and dissociation are discussed.

Adolescent↗
PubMed1998

Somatoform dissociative symptoms as related to animal defensive reactions to predatory imminence and injury.

The authors hypothesized that there would be a similarity between animal defensive responses to variable predatory imminence and injury and certain somatoform dissociative symptoms of trauma-reporting patients who have dissociative disorder. As a first test of this hypothesis, 12 somatoform symptom clusters consisting of clinically observed somatoform dissociative phenomena were constructed. All clusters discriminated between patients with dissociative disorders (n = 50) and patients with other psychiatric diagnoses (n = 50). Those expressive of the hypothesized similarity--freezing, anesthesia-analgesia, and disturbed eating--belonged to the 5 most characteristic symptoms of dissociative disorder patients. Anesthesia-analgesia, urogenital pain, and freezing symptom clusters independently contributed to predicted presence of dissociative disorder. Using an independent sample, it appeared that anesthesia-analgesia best predicted presence of dissociative disorder after controlling for symptom severity. The results were largely consistent with the hypothesized similarity.

Adult↗
PubMed1998

Follow-up on the treatment of panic disorder with or without agoraphobia: a quantitative review.

We conducted a meta-analysis to update the knowledge of long-term efficacy of different treatments in panic disorder with or without agoraphobia. Included were 68 studies pertaining to 106 treatment conditions and 1346 patients. Effect sizes Cohen's d were calculated within the treatment conditions at posttest and at follow-up for panic and agoraphobia. A comparison was made between six treatments: high-potency benzodiazepines, antidepressants, psychological panic management, exposure in vivo, antidepressants combined with exposure, and psychological panic management combined with exposure in vivo. The mean (+/- SD) duration of the follow-up period was 62 +/- 89 weeks. In the majority of the studies (84%), follow-up had a naturalistic character. The lack of information about treatments received between posttest and follow-up limits the interpretation of the results. For all conditions, the treatment gains at posttest were maintained during the follow-up period. The mean (+/- SD) d for panic was 1.11 +/- 0.70 at posttest and 1.28 +/- 0.61 at follow-up; for agoraphobia, the mean d at posttest was 1.36 +/- 1.10 and at follow-up it was 1.41 +/- 0.82. Significant differences were found in efficacy on agoraphobic measures at follow-up between the combination of antidepressants and exposure in vivo versus psychological panic management, exposure in vivo, and the combination of psychological panic management and exposure. Overall, the data suggest that different treatment options for panic disorder with or without agoraphobia are effective at both posttest and follow-up. Research on long-term treatment, discontinuation of therapies, and interventions between posttest and follow-up need more attention, for pharmacotherapy as well as psychotherapy.

Agoraphobia↗
PubMed1998

Cognitive and behavioral therapies alone versus in combination with fluvoxamine in the treatment of obsessive compulsive disorder.

The purpose of this treatment package design study was to investigate the differential efficacy of cognitive therapy or exposure in vivo with response prevention for obsessive compulsive disorder (OCD) versus the sequential combination with fluvoxamine. Patients with OCD (N = 117) were randomized to one of the following five conditions: a) cognitive therapy for weeks 1 to 16, b) exposure in vivo with response prevention for weeks 1 to 16, c) fluvoxamine for weeks 1 to 16 plus cognitive therapy in weeks 9 to 16, d) fluvoxamine for weeks 1 to 16 plus exposure in vivo with response prevention in weeks 9 to 16, or e) waiting list control condition for weeks 1 to 8 only. Assessments took place before treatment (pretest) and after 8 (midtest), and 16 weeks (posttest). In the first 8 weeks, six treatment sessions were delivered. During weeks 9 to 16, another 10 sessions were given. Thirty-one patients dropped out. Outcome was assessed by patient-, therapist- and assessor-ratings of the Anxiety Discomfort Scale, the Yale-Brown Obsessive Compulsive Scale, and the Padua Inventory-Revised. In contrast with the four treatments, after 8 weeks the waiting list control condition did not result in a significant decrease of symptoms. After 16 weeks of treatment, all four treatment packages were effective on these OCD ratings, but they did not differ among each other in effectiveness. In OCD, the sequential combination of fluvoxamine with cognitive therapy or exposure in vivo with response prevention is not superior to either cognitive therapy or exposure in vivo alone.

Adult↗
PubMed1998

Psychometric characteristics of the somatoform dissociation questionnaire: a replication study.

BACKGROUND: The present study aimed to replicate the results of previous studies concerning the development of two versions of the Somatoform Dissociation Questionnaire. The SDQ-20 evaluates the severity of somatoform dissociative phenomena, and the SDQ-5 is a dissociative disorders screening instrument. METHODS: Thirty-one patients with dissociative disorders and 45 consecutive psychiatric outpatients with other DSM-IV diagnoses completed the SDQ-20 and SDQ-5 as well as the Dissociation Questionnaire which measures psychological dissociation. RESULTS: Mokken scale analysis showed that the items of the SDQ-20 are strongly scalable on a latent unidimensional scale. Internal consistency was high. The SDQ-20 convergent validity was supported by high intercorrelations with the DIS-Q. Dissociative patients obtained significantly higher scores than comparison patients. Patients with dissociative identity disorder scored significantly higher compared to patients with dissociative disorder nos. Sensitivity (94%) and specificity (98%) of the SDQ-5 were very satisfactory, as were, at an estimated prevalence rate of dissociative disorders of 10% among psychiatric patients, positive predictive value (84%) and negative predictive value (99%). CONCLUSIONS: All results replicated the first findings, and therefore corroborate the conclusion that the SDQ-20 and SDQ-5 are instruments of sound psychometric quality, and that somatoform dissociative phenomena are core symptoms of complex dissociative disorders.

Adolescent↗
PubMed1997

The development of the somatoform dissociation questionnaire (SDQ-5) as a screening instrument for dissociative disorders.

Using cases of dissociative disorder (n=50) and other DSM-IV diagnoses (n=50), a somatoform dissociation self-report questionnaire was developed and its capacity to function as a screening device for dissociative disorders was analysed. A list of 75 items was constructed which, according to clinical experience and expert judgement, could reflect instances of somatoform dissociation. Statistical analyses revealed the 20 best discriminating items. Stepwise forward logistic analysis detected five items which, as a group, provided optimal discrimination between the two groups. At an estimated prevalence rate of dissociative disorders of 10% among psychiatric patients the sensitivity would be 94%, the specificity would be 96%, the positive predictive value would be 72%, and the negative predictive value would be 99%. Cross-validation in an independent sample (n=33/42) largely corroborated the initial findings. The SDQ-5 can be used as a brief screening device for dissociative disorders.

Adolescent↗
PubMed1997

The notion of somatization: an artefact of the conceptualization of body and mind.

BACKGROUND: Somatization is a contemporary notion which derives from the conceptualization of body and mind and the resultant concept of disease. The common element in this thinking is that the presumed separation of the concepts body and mind can be spanned by clinical symptoms. METHODS: This paper examines the history of these concepts and the assumptions underlying them. RESULTS: It is shown that the debate on the pathological regions of the body-mind relation is of early origin. It is reflected in the evolution of concepts of disease and disease entities. The ongoing attempts to form a conceptual synthesis have resulted in a multiplicity of disease entities and in the notion of somatization. However, somatization is shown here to differ conceptually from controversial contemporary disease entities with which it often seems intertwined, such as myalgic encephalomyelitis and the hypersensitivity syndrome. CONCLUSION: This insight may help diminish the ambiguity in this area of research and practice.

Female↗
PubMed1996

Epinephrine infusions in panic disorder: a double-blind placebo-controlled study.

Twenty-four subjects with Panic Disorder were infused with epinephrine in physiological doses or placebo according to a double-blind design. The panic rate in the epinephrine group (67%) was higher than in the placebo group (25%). Placebo panic occurred early during the procedure and was apparently associated with anticipation anxiety and stress-provoking situational factors. Panickers were characterized by a greater increase in heart rate as well as a drop in pCO2. Fear of bodily sensations was only weakly associated with state anxiety levels at point of panic. It is concluded that cognitive factors may not be important in epinephrine-induced panic.

Adult↗