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Biomedical subjects

J Peuskens

Publications and source records attributed to J Peuskens.

At least 19 recordsLinked to original sources
PubMed2006

Predictors of risk for relapse in patients with schizophrenia or schizoaffective disorder during olanzapine drug therapy.

PURPOSE: To evaluate the relationship of dose decrease, symptom worsening, and baseline covariates on subsequent relapse during olanzapine treatment in patients with schizophrenia or schizoaffective disorder. METHODS: In two 28-week, randomized, double-blind clinical trials, a Cox proportional hazards model was used to determine potential correlates of relapse (defined as > or =20% worsening on PANSS total and CGI-Severity 3) among patients (N=271) who responded to 8 weeks of olanzapine treatment (10-20mg/day). Variables examined included: demographics, illness characteristics, baseline symptoms, symptom change, dose, adverse events, and functioning. RESULTS: Patients with a lower last dose relative to the preceding visit interval were 4 times more likely to relapse during that visit interval than other patients (p<.001). A similar finding was observed for a decrease in interval modal dose, although this variable was more predictive of relapse in the visit interval immediately following dose decrease (p=.027). In a subgroup analysis by gender, there was a significantly greater incidence of relapse in men with a dose decrease, whereas a dose decrease in women did not correlate with relapse. Relapse was also correlated with the emergence or worsening of a psychiatric adverse event during the same (p<.001) and preceding (p=.007) visit intervals, and with increased rating scale measures of psychopathology. The occurrence of a non-psychiatric adverse event was not associated with relapse. CONCLUSION: Dose decrease is a significant predictor of relapse in male but not female patients. Psychiatric adverse events also predicted relapse. Patients should be periodically reassessed to determine the need for maintenance treatment with appropriate dose.

Adult↗
PubMed2006

Prevalence of diabetes, metabolic syndrome and metabolic abnormalities in schizophrenia over the course of the illness: a cross-sectional study.

BACKGROUND: Patients with schizophrenia are at high risk of developing metabolic abnormalities. METHOD: A prospective study focusing on metabolic disturbances in patients with schizophrenia, including an oral glucose tolerance test, is currently ongoing at our University Hospital and affiliate services. The prevalence of metabolic abnormalities at baseline was assessed in a cohort of 415 patients with schizophrenia. The sample was divided into 4 groups according to duration of illness: first-episode patients (<1.5 years), recent-onset patients (between 1.5 and 10 years), subchronic patients (between 10 and 20 years) and chronic patients (>20 years). RESULTS: Metabolic abnormalities were already present in first-episode patients, and considerably increased with increasing duration of illness. When compared to the general population matched for age and gender, much higher rates of the metabolic syndrome (MetS) and diabetes were observed for patients with schizophrenia. For MetS, the increase over time was similar to that of the general population. In contrast, the difference in the prevalence of diabetes in patients with schizophrenia and the general population dramatically and linearly increased from 1.6% in the 15-25 age-band to 19.2% in the 55-65 age-band. CONCLUSION: Thus, the current data suggest that on the one hand metabolic abnormalities are an inherent part of schizophrenic illness, as they are already present in first-episode patients. On the other hand, however, our results suggest a direct effect of the illness and/or antipsychotic medication on their occurrence. The data underscore the need for screening for metabolic abnormalities in patients diagnosed with schizophrenia, already starting from the onset of the illness.

Journal Article↗
PubMed2006

Pharmacological treatment of ambulatory schizophrenic patients in Belgium.

BACKGROUND: the objective of this study was twofold:1) Describe the use of antipsychotic treatments in ambulatory patients suffering from schizophrenia in Belgium.2) Evaluate to which extend antipsychotic treatment prescribing patterns are in accordance with published treatment guidelines. METHOD: A cross-sectional survey was carried out in 16 Belgian hospitals selected from a sample of 67 hospitals. The hospitals were equally distributed between the north and south part of the country and were representative of Belgian practice. During 2 months, participating psychiatrists were asked to record the medication use as well as demographic parameters of all consecutive ambulatory patients seen at their consultation or attending a day-hospital. Data concerning 1000 ambulatory patients with schizophrenia or schizoaffective disorder were collected. RESULTS: In Belgium, the use of atypical antipsychotics is frequent (69%) in ambulatory patients with schizophrenia. In the overall sample, 73% receive only one antipsychotic drug. The majority of patients are treated with drugs of only one antipsychotic drug group, either first- typical (29.8%) or second-generation, atypical antipsychotics (53.2%). 15.8% of patients combine different types of antipsychotics. Antipsychotic dosing is adequate for the majority of patients but about one fifth receives a higher than recommended dose as per package inserts. Polypharmacy remains within reasonable limits. The use of concomitant medication varies according the antipsychotic treatment: patients who take second-generation antipsychotics only, receive the least additional drugs. CONCLUSION: Atypical antipsychotics appear to be the first line treatment for schizophrenic psychosis. Psychiatrists working with ambulatory patients are well aware of treatment guidelines and follow them quite adequately.

Journal Article↗
PubMed2006

Psychomotor performance and sequence planning in anorexia nervosa before and after weight restoration.

BACKGROUND: In the study of psychomotor performance in anorexia nervosa (AN), motor control has not been studied extensively. The present study explores sequence planning in a sample of AN patients. METHOD: A group of 26 female restricting AN inpatients, aged 14 to 25, was compared with 24 healthy women matched for age and educational level. During the performance of a simple copying task, in which movement planning, but not working capacity, was challenged, the ease with which generally favored graphic production rules could be applied was manipulated. Computerized recordings of the drawing movements allowed detailed analyses of reaction and movement times and of drawing sequences. Fifteen patients were retested after weight restoration, as were 15 controls. RESULTS: Copying patterns that normally elicit a conflict between preferred graphic production rules induced significantly less slowing in the reaction times of the anorexia nervosa patients than in the controls, both before and after weight restoration. There were no group differences as regards the consistency with which the implicit production rules were applied. DISCUSSION: AN patients seem to show a fast response style combined with good sequence planning capacity.

Adaptation, Psychological↗
PubMed2006

Standardized remission criteria in schizophrenia.

OBJECTIVE: Recent work has focussed on schizophrenia as a 'deficit' state but little attention has been paid to defining illness plasticity in terms of symptomatic remission. METHOD: A qualitative review of a recently proposed concept of remission [N.C. Andreasen, W.T. Carpenter Jr, J.M. Kane, R.A. Lasser, S.R. Marder, D.R. Weinberger (2005) Am J Psychiatry 162: 441] is presented. RESULTS: The proposed definition of remission is conceptually viable, and can be easily implemented in clinical trials and clinical practice. Its increasing acceptance may reset expectations of treatment to a higher level, improve documentation of clinical status and facilitate dialogue on treatment expectations. The availability of validated outcome measures based on remission will enhance the conduct and reporting of clinical investigations, and could facilitate the design and interpretation of new studies on cognition and functional outcomes. While useful as a concept, it is important to consider that remission is distinct from recovery. CONCLUSION: The introduction of standardized remission criteria may offer significant opportunities for clinical practice, health services research and clinical trials.

Chronic Disease↗
PubMed2006

[Glucose abnormalities in a 14-year old patient treated with a second generation antipsychotic].

The increased risk of diabetes mellitus in adult patients treated with second generation antipsychotics is a topic that has been vigorously debated in recent years. However, a literature search indicates that only very limited information is available about the use and the potential metabolic risks of antipsychotics in children and adolescents. We present and discuss a case study in which severe glucose abnormalities were detected in a 14-year-old, non-psychotic patient who was being treated with risperidone. The glucose abnormalities were found to be reversible when risperidone was discontinued. The case-study highlights the importance of screening for and detection of metabolic abnormalities in children and adolescents who are being treated with second generation antipsychotics. It is particularly important that children with additional risk factors are closely monitored.

Adolescent↗
PubMed2006

[Recent findings regarding the treatment of late-onset depression with vascular brain lesions. A literature review].

BACKGROUND: Late-onset depression with vascular brain lesions is showing increased resistance to antidepressive pharmacotherapy. AIM: To give an overview of alternative treatment options. METHOD: We conducted a literature search via PubMed using the key words: 'late-onset depression', 'white matter lesions', 'cerebrovascular pathology' and 'treatment' and thereby a searchfor all available clinical studies about the treatment described in combination with the key words 'vascular depression', or 'late-onset depression' and 'white matter lesions'. RESULTS: Electroconvulsive therapy, repetitive transcranial magnetic stimulation and nimodipine au,gmentation have beneficial effects on vascular depression. CONCLUSION: The treatment options mentioned are promising, but there is a need for further clinical studies.

Age Factors↗
PubMed2006

[Mirtazapine-induced dystonia in a patient with Alzheimer's disease].

A 79-year old female patient with Alzheimer's disease developed acute dystonia twelve hours after taking a single dose of mirtazapine 30 mg. Forty-five hours later the patient's dystonia began to subside and after sixty hours it had disappeared completely. This side-effect of mirtazapine is hardly mentioned in the literature. So far, little is known about the pathophysiology of acute dystonia and the possible role of mirtazapine. Some hypotheses and recommendations are proposed.

Acute Disease↗
PubMed2005

Electroconvulsive therapy in Belgium: a nationwide survey on the practice of electroconvulsive therapy.

OBJECTIVE: To review and describe the practice of electroconvulsive therapy (ECT) in Belgium. METHODS: A 30-item questionnaire on the practice of ECT was sent to all institutions providing ECT. RESULTS: In 2003 ECT was offered in 32 hospitals. Although ECT hospitals are equally spread over three regions, there is a significant difference in the ECT utilization rate. There are no major regional differences in the practice of ECT. Fifty-three percent of the hospitals reported less than 10 treatment sessions per month. The major indication for ECT was depression (89.7%). Propofol was the anesthetic most commonly used (75%). Eleven departments (34.3%) used a sine wave device. Bitemporal electrode placement was the preferred option in 65.6% of all departments, and 37% of these used the combination of bitemporal electrode placement and a fixed high stimulus dose. Continuation ECT and outpatient ECT were rarely used. LIMITATIONS: This questionnaire study relies upon answers given by psychiatrists, and did not audit actual practices. CONCLUSIONS: Although ECT is widely available in Belgium, it remains underused and the practice of ECT is amenable for improvement. Guidelines should be implemented and continuing education is needed.

Belgium↗
PubMed2005

Sensorimotor and cognitive slowing in schizophrenia as measured by the Symbol Digit Substitution Test.

OBJECTIVES: A vast amount of studies demonstrates the presence of psychomotor slowing in schizophrenia. The objective of the present study was to investigate whether this overall psychomotor slowing can be divided into distinct processes that differentially affect cognitive functioning in schizophrenia. METHODS: The pen-tip movements of 30 schizophrenic inpatients and 30 matched controls were digitally recorded during performance of the Symbol Digit Substitution Test (SDST) and analysed to differentiate matching time and writing time, representing the cognitive and sensorimotor component of slowing, respectively. In addition, the results were compared to each other and to the scores of traditional neuropsychological tests that assess domains such as memory and attention. RESULTS: Both matching time and writing time were longer in the schizophrenic patients relative to the controls but did not correlate. Only matching time correlated significantly with the conventional neuropsychological test results. CONCLUSIONS: Although schizophrenic patients display both sensorimotor and cognitive slowing, the two processes are unrelated. Furthermore, only the cognitive component was associated with most of the cognitive deficits as measured by traditional neuropsychological tests.

Adult↗
PubMed2004

A study of the family burden of 150 family members of schizophrenic patients.

PURPOSE: Investigation into the family burden (FB) of schizophrenic patients has recently risen sharply. Nevertheless, to date there has been little consensus as to what factors influence the FB. The purpose of this study is to acquire a greater insight into the variables that influence the FB. SUBJECTS/METHODS: The FB was measured with the interview for the family burden (Kluiter H, Kramer JJAM, Wiersma D, et al. Interview voor de belasting van de familie 1997 [Interview for the burden on the family]. Department Sociale Psychiatrie. Groningen: Rijksuniversiteit). One hundred and fifty family members (parents/partners) of schizophrenic patients participated in the study. RESULTS: The results of our study show (1) that family members experience burden both on a practical and an emotional level, (2) a highly significant correlation between the amount of symptomatic behaviour of the patient and FB, (3) that parents had taken on more tasks, had contributed more financially and had experienced a tenser atmosphere at home than partners did and (4) that family members of patients who have been treated for less than 1 year worry more about the other members of their family than family members of patients who have been receiving treatment for more than 1 year. CONCLUSIONS: Family members of schizophrenic patients experience burden on a practical, financial and emotional level and the extent of the burden is closely linked to the amount of symptomatic behaviour of the patient.

Adult↗
PubMed2003

Evaluation of cardio-respiratory fitness and perceived exertion for patients with depressive and anxiety disorders: a study on reliability.

PURPOSE: The implementation of a physical reconditioning programme for patients with depressive and/or anxiety disorders requires a thorough evaluation of the physical fitness and the perceived exertion during exercise. This implies the use of reliable and clinically useful instruments. The present study examined the reliability of the Franz ergocycle test, as measure for cardio-respiratory fitness, and the Borg Category Ratio 10 Scale, as measure for subject-perceived exertion. METHOD: Sixty-eight hospitalized patients performed test and re-test of the Franz ergocycle test and the Borg CR 10 Scale with a between interval of 1 week. RESULTS: The Physical Work Capacity 130 and the Physical Work Capacity 150, determined by the Franz ergocycle test, had a proper to good test-re-test reliability (r ranged from 0.74 to 0.90). The Borg Category Ratio 10 Scale had a moderate reliability (r ranged from 0.42 to 0.82). CONCLUSIONS: The Franz ergocycle test seems to be a reasonable reliable instrument for measuring physical work capacity of these patients. Possible explanations for the simply moderate reliability of the Borg Category Ratio 10 Scale could be the low level of physical activity prior to hospitalization, and the depressive and anxiety symptoms that might influence the perceived exertion.

Adult↗
PubMed2003

The effectiveness of two psychomotor therapy programmes on physical fitness and physical self-concept in nonpsychotic psychiatric patients: a randomized controlled trial.

OBJECTIVE: To compare the changes in cardiorespiratory and muscular fitness, and the changes in physical self-concept after participation in one of two psychomotor therapy programmes in a sample group of psychiatric patients. To study the relationship between the changes in physical fitness and the changes in physical self-concept. DESIGN: Randomized controlled parallel-group trial with repeated measures. SETTING: Three treatment units of a university psychiatric hospital in Belgium. SUBJECTS: One hundred and ninety-nine patients with severe symptoms of depression and/or anxiety, and/or personality disorders. INTERVENTIONS: A general programme of psychomotor therapy, consisting of different forms of physical exercises and relaxation training, and a personalized psychomotor fitness programme, consisting of aerobic and resistance training. These programmes were followed three times a week for a period of 16 weeks. OUTCOME MEASURES: The maximum dynamic strength, the strength endurance, physical work capacity at 60% and 80% of the estimated maximal heart rate reserve, and the physical self-concept by means of the Dutch version of the Physical Self-Perception Profile. RESULTS: After eight weeks, both groups exhibited an improvement in muscular fitness (both p-values < 0.0001), but only the psychomotor fitness group had improved in cardiorespiratory fitness (p < 0.01). After 16 weeks, the patients in the general programme of psychomotor therapy had not increased in cardiorespiratory fitness. At the end of the 16-week programmes, both groups showed a more positive physical self-concept (p from 0.01 to < 0.0001). However, these improvements were not related to the progress in physical fitness. CONCLUSIONS: The main difference in the effectiveness of the two programmes was the increase in cardiorespiratory fitness in the psychomotor fitness group. The gains in fitness did not play an essential role in the enhancement of physical self-concept.

Adult↗
PubMed2003

Improvements in physical fitness of non-psychotic psychiatric patients following psychomotor therapy programs.

AIM: To investigate the changes in physical fitness after participation in 1 of 2 psychomotor therapy programs in a sample group of non-psychotic psychiatric patients. METHODS EXPERIMENTAL DESIGN: randomized controlled parallel group trial with follow-up measures after 8 weeks and after 16 weeks. SETTING: 3 treatment units of a university psychiatric hospital in Belgium. PATIENTS: 141 (51 males, 90 females) patients with severe depressive and/or anxious symptoms, and/or personality disorders. INTERVENTIONS: patients followed a personalized psychomotor fitness program (PF), consisting of aerobic and resistance training, or a general program of psychomotor therapy (GPMT), consisting of different forms of physical exercises and relaxation training. MEASURES: the maximum dynamic strength, the strength endurance and physical work capacity at 60% and 80% of the estimated maximal heart rate reserve. RESULTS: After 8 weeks it was observed that the PF group enhanced in all parameters of cardio-respiratory as well as muscular fitness; the GPMT group had improved in 7 out of the 9 muscular fitness measurements. At the end of the 16 weeks, both groups had shown an improvement in all of the muscular fitness parameters, but only the PF group had increased in cardio-respiratory fitness. CONCLUSION: In order to improve both muscular and cardio-respiratory fitness in these patients, a balanced personalized training program, which includes aerobic and resistance training, is necessary during a period of at least 8 weeks. The less specific GPMT, when followed for a period of 16 weeks, is sufficient for improving muscular fitness and for maintaining cardio-respiratory fitness.

Adult↗
PubMed2002

Expressed emotion in the client-professional caregiver dyad: are symptoms, coping strategies and personality related?

OBJECTIVE: The aim of this study was to investigate whether the characteristics of residents and professional caregivers are associated with the professionals' expressed emotion (EE). METHOD: Fifty-six residents in sheltered living who suffer from schizophrenia or a related psychotic disorder and their professional caregivers were enlisted. Standardised validated instruments were used to measure EE, the residents' social functioning, symptoms and social network size, and the professional caregivers' coping strategies and personality. RESULTS: There was strong evidence that high EE was associated with the residents' age, poorer social functioning and smaller network sizes. There was no significant relationship between EE and the residents' symptoms except for excitement. Concerning the professional caregivers, high EE professionals were less open than their low EE colleagues and had a lower education level. CONCLUSION: The residents' social functioning is an important correlate of the EE index.

Adaptation, Psychological↗
PubMed2002

Amisulpride improves depressive symptoms in acute exacerbations of schizophrenia: comparison with haloperidol and risperidone.

The Brief Psychiatric Rating Scale (BPRS) anxiety/depression subscore has been used to assess affective symptoms in three studies (n = 612) comparing amisulpride (400-800 mg/day, n = 339) with haloperidol (15-20 mg/day, n = 160) and risperidone (8 mg/day, n = 113) in the treatment of acute exacerbations of schizophrenia. At endpoint, the mean improvement in the anxiety/depression subscore showed a significant (P = 0.011) difference in favour of amisulpride (5.6+/-6.1) compared with haloperidol (4.4+/-5.5) and risperidone (3.7+/-4.7). Amisulpride provided a significantly greater improvement compared both to haloperidol and risperidone in more severely depressed patients (BPRS anxiety/depression subscore > or = 16 at baseline, P = 0.001). This significant advantage in favour of amisulpride is seen from the 2nd week of treatment.

Adult↗
PubMed2002

Switching to amisulpride.

The introduction of atypical antipsychotics represents an important advance in the treatment of schizophrenia. As their therapeutic efficacy, tolerability and safety profiles are clearly superior to classical neuroleptics, atypical antipsychotic agents are considered to be the treatment of choice in first episode patients. In addition, an increasing number of patients are being switched from classical to atypical antipsychotic agents. Switching is especially relevant in patients with a poor therapeutic response to classical neuroleptics and persistent symptoms (positive symptoms, negative symptoms, depressive syndromes, cognitive deficit); in patients with a psychotic relapse despite compliance; in patients with important side-effects (not only acute and tardive extrapyramidal symptoms [EPS] and general side-effects, but also dysphoria or neuroleptic-induced deficit syndrome [NIDS]); and in patients who are non-compliant due to side-effects. Switching to atypical antipsychotics should be performed with extreme care in stabilised patients; or in patients who present a danger to themselves or others at relapse; or in patients who are on depot neuroleptics who were non-compliant to previous oral treatment. Switching requires careful planning to reduce the risk of withdrawal effects (neuroleptic withdrawal syndrome, cholinergic rebound, exacerbation of symptoms or relapse, rebound of parkinsonism, dystonia, akathisia, dyskinesia), which may mask the beneficial effects and lead to early discontinuation of the new treatment. Patients, family and carers should be actively involved at all stages, and educated about the possible benefits and problems associated with switching therapy. Cross-tapering old and new treatment is the preferred method for switching and this involves tapering off the previous antipsychotic agent and any adjunctive treatment (sedatives, anticholinergic medication), while gradually titrating the new atypical antipsychotic agent to the established therapeutic dose. Switching patients to amisulpride treatment offers effective antipsychotic therapy, with a positive effect on negative and depressive symptoms. Amisulpride treatment also results in improved quality of life and social functioning in addition to fewer relapses and days of hospitalisation during long-term follow-up.

Amisulpride↗