Biomedical subjects

C van Heeringen

Publications and source records attributed to C van Heeringen.

13 recordsLinked to original sources

PubMed2006

Functional imaging, serotonin and the suicidal brain.

The involvement of the serotonergic system in the pathophysiology of suicidal behaviour has been established through indirect and direct research on serotonin and its metabolites and on serotonin transporters and receptors. Indirect research results include a reduced 5-HIAA in cerebrospinal fluid in violent suicide attempters and a blunted increase in prolactin after a fenfluramine challenge. Direct post-mortem research demonstrated an increase in 5-HT2A receptors. Direct in vivo functional imaging with PET or SPECT demonstrated a reduction in 5-HT2A binding index in suicide attempts in anxious and depressed suicide attempters and an increase in 5-HT2A binding in impulsive suicide attempters. These results are in keeping with 5-HT2A binding studies in depressed patients and impulsive animal research. Interestingly, both an increase and a decrease in 5-HT2A binding index seem to normalize with SSRI treatment.

Brain↗

PubMed2005

The effect of citalopram hydrobromide on 5-HT2A receptors in the impulsive-aggressive dog, as measured with 123I-5-I-R91150 SPECT.

PURPOSE: Involvement of the serotonergic system in impulsive aggression has been demonstrated in both human and animal studies. The purpose of the present study was to investigate the effect of citalopram hydrobromide (a selective serotonin re-uptake inhibitor) on the 5-HT(2A) receptor and brain perfusion in impulsive-aggressive dogs by means of single-photon emission computed tomography. METHODS: The binding index of the radioligand (123)I-5-I-R91150 was measured before and after treatment with citalopram hydrobromide in nine impulsive-aggressive dogs. Regional perfusion was measured with (99m)Tc-ethyl cysteinate dimer (ECD). Behaviour was assessed before treatment and again after 6 weeks of treatment. RESULTS: A correlation was found between decreased binding and behavioural improvement in eight out of nine dogs. The 5-HT(2A) receptor binding index was significantly reduced after citalopram hydrobromide treatment in all cortical regions but not in the subcortical area. None of the dogs displayed alterations in perfusion on the post-treatment scans. CONCLUSION: This study supports previous findings regarding the involvement of the serotonergic system in impulsive aggression in dogs in general. More specifically, the effect of treatment on the 5-HT(2A) receptor binding index could be demonstrated and the decreased binding index correlated with behavioural improvement.

Aggression↗

PubMed2005

Olanzapine in Gilles de la Tourette syndrome: beyond tics.

UNLABELLED: Although there only have been a limited number of double-blind, placebo controlled trials, antipsychotics are considered to be effective drugs for the treatment of tics in Gilles de la Tourette syndrome (GTS). Evidence concerning the efficacy of olanzapine and other atypical antipsychotics in the treatment of tics in GTS is growing, but still limited. Little is known about the use of olanzapine in adult GTS patients and about its effect on comorbid behavioural problems. We report on the use of olanzapine in a 25-year old male GTS patient with comorbid obsessive-compulsive behaviours, who was treated with olanzapine. Tic severity was rated using the Yale Global Tic Severity Scale (Y-GTSS). Comorbid obsessive-compulsive symptoms were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Both scales were performed at admission and after 4 weeks of treatment with olanzapine. Treatment with olanzapine (20 mg) resulted not only in a fast reduction of tic severity and frequency, but also in a reduction of obsessive-compulsive behaviours. CONCLUSIONS: This case report further supports the available literature on the use of olanzapine as a therapeutic strategy for tics in GTS and draws attention to its possible use for comorbid behavioural disorders. Further research of antipsychotics in GTS should include measurements of comorbid behavioural symptom clusters.

Adult↗

PubMed2003

Prefrontal 5-HT2a receptor binding index, hopelessness and personality characteristics in attempted suicide.

BACKGROUND: Depression, hopelessness, impaired problem solving capacities and deficient serotonergic functions have been identified as major causes of suicidal behaviour. In general, the relation between biological markers of attempted suicide and psychological functions has been investigated using indirect peripheral markers of, e.g. the serotonergic system. Recently, functional neuroimaging techniques with radioligands allow direct in vivo assessment of the neurobiological status of the central nervous system. METHODS: We studied the binding index of serotonin-(2a) (5-HT(2a)) receptors in the frontal cortex of attempted suicide patients (n=9) and normal controls (n=13) using [123I]5-I-R91150, a highly selective 5-HT(2a) receptor ligand. Moreover, we measured personality characteristics (using Cloninger's Temperament and Character Inventory) and levels of hopelessness (using Beck's Hopelessness Scale), and studied the association between 5-HT(2a) receptor binding index, hopelessness and these personality dimensions. RESULTS: When compared to normal controls, attempted suicide patients had a significantly lower binding potential of frontal 5-HT(2a) receptors, a higher level of hopelessness, a higher score on the temperament dimension harm avoidance and lower scores on the character dimensions self-directedness and cooperativeness. A significant correlation was found between harm avoidance, hopelessness and binding index in the population of patients that attempted suicide. LIMITATIONS: The limited number of patients and potential ingestion of psychotropic drugs may influence the results of the study. CONCLUSIONS: Lower central serotonergic function, hopelessness and harm avoidance are interrelated phenomena, which may increase the probability of the occurrence of attempted suicide.

Adult↗

PubMed2003

Depression and anxiety during isolation and radionuclide therapy.

The combination of a diagnosis of malignancy and hospitalization, isolation and radioactivity of a radionuclide therapy may have an important effect on the psychological equilibrium of patients and may hamper compliance and acceptability. We performed a psychiatric evaluation in order to study psycho-pathological manifestations and underlying personality related vulnerabilities. During radioisolation, 48 patients (24 male, 24 female; mean age 57.8 years) with a malignant (n=26) or non-malignant (n=22) pathology who needed isolation for radionuclide therapy, completed a series of questionnaires in order to assess anxiety (Spielberger State and Trait Anxiety Inventory; STAI), depression (Beck Depression Inventory; BDI), hopelessness (Beck Hopelessness Scale; BHS), personality characteristics (Temperament and Character Inventory; TCI) and coping strategies (Utrecht's Coping List; UCL). Compared to patients with low state anxiety, patients who experienced a high level of state anxiety showed higher levels of depression (t=-2.10; P=0.04) and hopelessness (t=-4.20; P=<0.001). Their personality was characterized by significantly higher scores on harm avoidance (t=-2.78; P=0.008) and lower scores on self-directedness (t=3.12; P=0.003). Coping strategies were more passive (t=-2.43; P=0.02), avoiding (t=-2.15; P=0.04) and less well aimed (t=2.64; P=0.01). Surprisingly, the nature of disease (malignant versus non-malignant) did not influence these results, nor was there a difference between males and females, age, years of education, having a relationship or not, or the duration of hospitalization. Thus, contrary to what may be expected in isolation with radionuclide therapy, subgroups such as women, elderly, cancer patients or lower educated people do not, a priori, exhibit a higher state anxiety level. Our study shows these levels to be closely related to individual personality traits and coping strategies that are inadequate for the situation. Screening for trait anxiety before admission can be easily done and may guide interventions aimed at increasing patient comfort and acceptability.

Adaptation, Psychological↗

PubMed2001

Decreased frontal serotonin 5-HT 2a receptor binding index in deliberate self-harm patients.

Studies of serotonin metabolites in body fluids in attempted suicide patients and of post-mortem brain tissue of suicide victims have demonstrated the involvement of the serotonergic neurotransmission system in the pathogenesis of suicidal behaviour. Recently developed neuroimaging techniques offer the unique possibility of investigating in vivo the functional characteristics of this system. In this study the 5-HT2a receptor population of patients who had recently attempted suicide was studied by means of the highly specific radio-iodinated 5-HT2a receptor antagonist 4-amino-N-[1-[3-(4-fluorophenoxy) propyl]-4-methyl-4-piperidinyl]-5-iodo-2-methoxybenzamide or 123I-5-I-R91150. Nine patients who had recently (1-7 days) attempted suicide and 12 age-matched healthy controls received an intravenous injection of 185 MBq 123I-5-I-R91150 and were scanned with high-resolution brain single-photon emission tomography (SPET). Stereotactic realigned images were analysed semi-quantitatively using predefined volumes of interest. Serotonin binding capacity was expressed as the ratio of specific to non-specific activity. The cerebellum was used as a measure of non-specific activity. An age-dependent 5-HT2a binding index was found, in agreement with previous literature. Deliberate self-harm patients had a significantly reduced mean frontal binding index after correction for age (P=0.002) when compared with controls. The reduction was more pronounced among deliberate self-injury patients (DSI) (P<0.001) than among deliberate self-poisoning patients (DSP). Frontal binding index was significantly lower in DSI patients than in DSP suicide attempters (P<0.001). It is concluded that brain SPET of the 5-HT2a serotonin receptor system in attempted suicide patients who are free of drugs influencing the serotonergic system shows in vivo evidence of a decreased frontal binding index of the 5-HT2a receptor, indicating a decrease in the number and/or in the binding affinity of 5-HT2a receptors.

Adolescent↗

PubMed2001

Suicide, serotonin, and the brain.

The involvement of impaired serotonergic functioning in the development of suicidal behavior is one of the best documented findings in biological psychiatry. It is, however, less clear in which way this dysfunction contributes to the occurrence of suicidal behavior. Correlational studies have demonstrated associations between peripheral measures of serotonergic function and characteristics such as impulsivity, disinhibition, anxiety, and/or behavioral inhibition. Postmortem and neuroimaging studies have provided insight in the localization of serotonergic dysfunction in the central nervous system. Nevertheless, results in this area of research have also been contradictory. Following a short overview of recent research findings on serotonin and suicidal behavior, this paper focuses on the involvement of the prefrontal cortex of the brain in the development of suicidal behavior and on the role of serotonin in its executive functions. Based on these considerations, suggestions for future research are discussed.

Brain↗

PubMed2001

Suicide in adolescents.

In many parts of the world rates of suicidal behaviour are increasing among young people. Community surveys of suicidal ideation have demonstrated that up to 24% of adolescents have experienced suicidal thoughts at some point in their lives. Rates of attempted suicide are highest among young people, and increased occurrence is reported, particularly among young males. A similar picture emerges with regard to completed suicide, and in some countries rates of suicide among young males are higher than those for older age groups. Risk factors can be grouped according to their social/familial, individual, or environmental nature. Based on these findings an explanatory model of suicidal behaviour can be developed, in which three criteria can be discerned: i.e. trait-dependent factors, including those related to serotonin, personality and cognitive psychological dysfunctions; state-dependent characteristics, such as depression and hopelessness; and threshold factors, which may have a risk-enhancing or protective effect, such as social support, contagion effects, the availability of means, and the accessibility of mental health care. Preventive actions need to be developed, targeting the general population (through, for example, educational programmes) or populations at particular risk, such as adolescents attempting suicide. Potential treatment approaches include the treatment of individual psychopathological phenomena, whether or not in school-based clinics, but particular attention has to be given to inducting and keeping young people at risk in treatment.

Adolescent↗

PubMed2000

Suicidal acts and ideation in homosexual and bisexual young people: a study of prevalence and risk factors.

BACKGROUND: Suicide attempts are the most robust clinical predictor of suicide, which is now the second cause of death among young people in many countries. Previous research has shown an increased risk of attempted suicide associated with a homosexual orientation. However, the mechanisms underlying this increased risk are not yet clear. This study therefore aimed to determine the risk of attempted suicide and the effect of potential risk factors on the occurrence of suicidal ideation and behaviour among homosexual youngsters. METHODS: The association between suicidal ideation and behaviour and potential risk factors was assessed by means of a questionnaire in a general population sample of homosexual or bisexual young people and a control sample consisting of school pupils. RESULTS: A twofold increased risk of suicidal ideation was found associated with a homosexual or bisexual orientation. A significantly increased risk of attempted suicide associated with homosexuality or bisexuality was found in females. Independent of sexual orientation, depression was identified as a significant risk factor for suicidal ideation, while suicidal behaviour was associated with low self-esteem, higher levels of hopelessness and suicidal behaviour in someone close. Among homosexual or bisexual young people, less satisfying homosexual friendships were an additional risk factor for suicidal behaviour. CONCLUSIONS: The identified increased risk of suicidal ideation among homosexual or bisexual young people is associated with depression and may lead to suicidal behaviour, independent of sexual orientation, especially in the presence of a role model of suicidal behaviour, and among those with unsatisfying friendships.

Adolescent↗

PubMed1993

Recent changes in the age- and gender-specific rates of attempted suicide in Gent.

The gender-specific rate of attempted suicide, calculated from hospital admission data, was significantly lower in 1990 than in 1986 in females and, when age is taken into account, in females younger than 35 and in males younger than 25 years. The incidence of suicide attempts seen by general practitioners also decreased. Indications for rejection of the artefact hypothesis as explanation for this decrease have been investigated. It was shown that the decrease in the prevalence was found at local and national levels and was not the result of a decrease in referrals to general hospitals. Moreover, the decrease in the rate was associated with an increase in the use of outpatient mental health facilities in females and with a trend to increase in the 15-24 age group. The number of suicide attempts referred by Community Mental Health Services to the general hospital and the suicide rate in out-patients remained constant during the study period. The findings do not support the artefact hypothesis but indicate that there was a real decrease in the rate of attempted suicide. Moreover, the findings suggest that out-patient treatment can be efficacious in the primary prevention of suicidal behaviour.

Adolescent↗

PubMed1989

Depression after surgery for breast cancer. Comparison of mastectomy and lumpectomy.

The impact of the loss of the breast in women undergoing surgical treatment for breast cancer is subordinated to the confrontation with the diagnosis of a malignancy in causing depression. The equal distribution of depression in mastectomy and in lumpectomy patients supports the hypothesis that it is the confrontation with the potentially lethal outcome of the diagnosis which is decisive in causing depression. The grief reaction following mastectomy has two components: a depressive reaction to the loss of the breast and an anticipatory grief for anticipation of the potentially lethal outcome. Psychosocial therapeutic support in breast malignancy must give priority to coping with the diagnosis of cancer over the loss of the breast.

Adaptation, Psychological↗

PubMed1988

Sexual function disorders after local radiotherapy for carcinoma of the prostate.

In order to contribute some insight into the extent to which local radiotherapy for carcinoma of the prostate is followed by disorders in sexual functioning, 18 patients whose age ranged from 60 to 82, were interviewed 4 to 45 months after their Radiotherapy (RT). Our results confirmed the fact that RT was followed by impotence as such in only a minority of cases (3 out of 12 or 0.25). However, when other aspects of sexuality were taken into account, a higher proportion appeared to have problems. In a substantial number of patients, psychogenic factors seemed to be (at least partly) responsible. More attention to these facts and, when necessary, psychiatric assistance, may help reduce the incidence of sexual disorders following RT to the prostate.

Aged↗

PubMedDate not supplied

Personality-related characteristics in restricting versus binging and purging eating disordered patients.

The current study sought to examine differences in personality-related characteristics between restricting anorexia nervosa (RAN), binging/purging anorexia (BPAN), and purging bulimia nervosa (BN) patients. Scores on the Temperament and Character Inventory (TCI) and on the Dutch Eating Behaviour Questionnaire (DEBQ) were compared for 166 RAN, 78 BPAN, and 151 BN patients. Bingers/purgers showed a higher score for restrained, external and emotional eating and a lower score for a subscale of "self-directedness" compared to patients who never binge and purge. Personality differences were most marked between RAN and BN patients, while personality characteristics of BPAN patients tended to be similar to those of BN patients. BN patients showed higher scores on "novelty seeking" and the subscales "exploratory excitability," "impulsivity," and "extravagance," and lower scores on "self-directedness," compared to restricting patients. Moreover RAN patients also showed higher scores on subscales of character dimensions, compared to BN patients. The higher the scores on novelty seeking, the lower the scores on several character scales, which has important implications for the reinforcement of behavior and the treatment of eating disorders.

Adolescent↗