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K van der Meer

Publications and source records attributed to K van der Meer.

12 recordsLinked to original sources
PubMed2006

Short-term effects of enhanced treatment for depression in primary care: results from a randomized controlled trial.

BACKGROUND: Depression is a highly prevalent, often recurring or persistent disorder. The majority of patients are initially seen and treated in primary care. Effective treatments are available, but possibilities for providing adequate follow-up care are often limited in this setting. This study assesses the effectiveness of primary-care-based enhanced treatment modalities on short-term patient outcomes. METHOD: In a randomized controlled trial we evaluated a psycho-educational self-management intervention. We included 267 adult patients meeting criteria for a DSM-IV diagnosis of major depressive disorder, assessed by a structured psychiatric interview. Patients were randomly assigned to: the Depression Recurrence Prevention (DRP) program (n=112); a combination of the DRP program with psychiatric consultation (PC+DRP, n=39); a combination with brief cognitive behavior therapy (CBT+DRP, n=44); and care as usual (CAU, n=72). Follow-up assessments were made at 3 months (response 90%) and 6 months (85%). RESULTS: Patient acceptance of enhanced care was good. The mean duration of the index episode was 11 weeks (S.D.=9.78) and similar in CAU and enhanced care. Recovery rate after 6 months was 67% overall; 17% of all participants remained depressed for the entire 6-month period. CONCLUSION: Enhanced care did not result in better short-term outcomes. We found no evidence that the DRP program was more effective than CAU and no indications for added beneficial effects of either the psychiatric evaluation or the CBT treatment to the basic format of the DRP program. Observed depression treatment rates in CAU were high.

Adult↗
PubMed2002

Effects on depression pharmacotherapy of a Dutch general practitioner training program.

BACKGROUND: General practitioners' (GPs) ability to recognize, diagnose and treat depression improved significantly after a comprehensive, 20-h training programme. This study aims to evaluate in more detail the effects of the training on GPs' pharmacotherapy of depression and related issues. METHODS: A pretest-posttest design was used. Both in the pre- and post-training phase, a sample was drawn from consecutive patients of the 17 participating GPs. In the pre-training phase we identified a sample of 31 cases with an ICD-10 depression who received an antidepressant from their GP. The sample was followed for 1 year. Outcome measures were: type of antidepressant, dosage, duration and number of target instructions given by the GP. Then we trained the GPs. In the post-training phase, we identified a new sample (n = 47) from their practices and measured the same outcomes. RESULTS: Improvements were seen in choice for modern antidepressant, adequate dosage, adequate duration, and number of target instructions given. LIMITATIONS: Observed changes can be due to a period effect, inherent in a pre-post design. CONCLUSIONS: A post-academic hands-on training of GPs can improve depression pharmacotherapy according to clinical guidelines with respect to choice of a modern antidepressant, adequate dosage, adequate duration and psychoeducation.

Adolescent↗
PubMed1999

Training primary-care physicians to recognize, diagnose and manage depression: does it improve patient outcomes?

BACKGROUND: We developed a comprehensive, 20-hour training programme for primary-care physicians, that sought to improve their ability to detect, diagnose and manage depression. We evaluated the effects of physician training on patient outcomes, using a pre-post design. METHODS: In the pre-training phase of the study, we sampled 1834 consecutive patients of 17 primary-care physicians and evaluated 518 of these patients for the presence of depression. We measured outcomes of all patients with depression at 3 months and 1 year. The outcome measures were: severity of psychopathology; duration of depressive episode; and level of daily functioning. After the 17 physicians completed the training, we drew a new sample from their practices (498 of 1785 consecutive patients were evaluated for depression) and measured outcomes for the depressed patients. RESULTS: We found an effect of the training on short-term outcome, particularly for patients with a recent-onset depression. At 3-month follow-up depressed patients whose physicians had received training had less severe psychopathology and patients with recent-onset depression also showed higher levels of daily functioning than patients of the same physicians prior to the training. The patients with a recent-onset depression that was recognized by trained physicians had shorter depressive episodes, but this was not statistically significant. At 1-year follow-up, all training effects had faded away. CONCLUSIONS: Training primary-care physicians to recognize, diagnose and manage depression can improve short-term patient outcomes, especially for patients with a recent onset of depression. Patients suffering from a recurrent or chronic depression may need more specific interventions, both for acute treatment and long-term management.

Adult↗
PubMed1998

[Improved recognition and treatment of depression with occasional faster recovery through postgraduate training of family practitioners].

OBJECTIVE: To examine to what extent postgraduate training of general practitioners (GPs) with the Intervention Study Primary Care (INSTEL) programme improved detection, diagnosis, and treatment of depression, and whether the course of depression was influenced favourably. DESIGN: Prospective, comparative. SETTING: Academic Hospital Groningen, discipline group Psychiatry and General Practice, Groningen, the Netherlands. METHOD: General practitioners active in ten practices in Groningen and surrounds were trained in recognition and treatment of depression. The first group consisted of ten GPs who had not participated in psychiatrically oriented research before, the second group of seven GPs who had participated in such research. Both before and after the training, a group of patients aged 18-65 years visiting these GPs' office hours were examined by the investigators for presence of depression with the aid of questionnaires. The GPs recorded of each patient whether or not they found him/her depressed, and they mentioned the treatment. The researchers assessed the outcomes of depressed patients shortly after the index consultation and at 3 and 12-month follow-up. RESULTS: Before the training a questionnaire was completed by 1778 patients, of whom 179 were depressed; after the training a questionnaire was completed by 1724 patients, of whom 155 were depressed. Detection and diagnosis of depression improved in the first group of GPs, but not in the second group. Treatment improved for patients in both groups. In terms of symptoms, illness duration, daily functioning, and absence from work patients recovered slightly faster from their depression after the training, although the effects were weak, not always statistically significant (p < 0.05), and mostly limited to the subgroup of recognized depressions with a recent onset. At the 12-month follow-up the pre-post differences were not statistically significant. CONCLUSION: The postgraduate training with the INSTEL programme appears to be an effective intervention that improves treatment and somewhat speeds up recovery in recent onset cases.

Adolescent↗
PubMed1996

[Depression in primary health care; international data on prevalence and treatment, among others from The Netherlands].

OBJECTIVE: To establish the prevalence of depression and other psychiatric disorders in the contact population of primary care physicians (PCPs) in several countries. DESIGN: Descriptive. SETTING: World Health Organization (WHO), Geneva, Switzerland. METHOD: The WHO carried out a study in 15 centers in 14 different countries, including the Groningen centre in the Netherlands. This study comprised interviewing 5438 patients with the primary health care version of the 'Composite international diagnostic interview' (CIDI). The PCPs also evaluated their patients' somatic and psychic health. RESULTS: Depression was found to be seen at all centres, according to the CIDI results as well as according to the physicians. Most patients with a depression were treated by the PCPs themselves; only a small proportion were referred. As regards pharmacotherapy, in most centres tranquillizers were prescribed more often than antidepressive agents. Groningen differed from the other centres in that a larger proportion of depressive patients attended the PCPs for a psychological reason for encounter, and in that the patients' somatic health was classified as much better. The Groningen PCPs referred to institutes for mental health care more often than the PCPs in most other centres. CONCLUSION: Depression was diagnosed in all participating countries, both by PCPs and with the aid of the CIDI results.

Antidepressive Agents↗
PubMed1995

[A new development in the treatment of anxiety and trauma: "eye movement desensitization and reprocessing (EMDR)"].

This article presents a new development on the field of psychotherapy: Eye-Movement Desensitization and Reprocessing (EMDR). This recently developed procedure promises rapid and effective treatment of anxiety related complaints, including post-traumatic stress disorders (DSM-III-R). In essence the therapist induces a series of rapid and rhythmic eye-movements. EMDR facilitates cognitive changes and lasting decrease of anxiety. As indicated by research and illustrated by case histories, EMDR can be effective in one session. Until now there is no definitive explanation for the effectiveness of this method.

Adaptation, Psychological↗
PubMed1989

General practitioners' characteristics and the assessment of psychiatric illness.

We put forward the hypothesis that general practitioners (GPs) with a family medicine orientation are more sensitive to the presence of mental health problems than GPs with a clinical orientation. To test it, GPs were divided into three subgroups on the basis of an attitude questionnaire. The General Health Questionnaire (GHQ) and the Present State Examination (PSE) were used as criteria. No differences in sensitivity to psychiatric illness were observed using either scale. Results of factor analysis with the subscales of the GP attitude questionnaire and the indices 'bias' and 'accuracy' were similar to those reported by GOLDBERG and associates. 'New' patients were defined as patients in whom the GP had not identified a mental health problem (MHP) in the past year. 'Old' patients were defined as 'not new'. GPs tended to under-identify MHPs in 'new' and over-identify them in 'old' patients. Recognition of psychiatric illness was better in 'old' than in 'new' patients. In 'new' patients, recognition depended on psychiatric diagnosis. Among 'old' patients, older people and people (especially women) with low education predominated. In their assessments GPs used information not contained in the GHQ.

Adult↗
PubMed1977

Quantum chemical studies on clonidine and related derivatives.

The ground state geometry of the protonated form of clonidine was established by CNDO/2 (complete neglect of differential overlap) calculations. For the interplanar angle of this molecule we found a value of about 40 degrees. The interplanar angles of a number of clonidine related derivatives, both bases and protonated forms, were calculated on the basis of the results obtained for clonidine by taking into account the bond lengths and van der Waals radii of the substituents present at the ortho positions of the phenyl ring. The preferred conformations of the free bases and protonated forms were used as inputs for the semi-empirical PPP-MO (Pariser, Parr and Pople molecular orbital) calculation procedure in order to obtain several quantum chemical parameters. Excellent correlations resulted in relating some of the calculated parameters with the experimentally determined pK'a of the molecules. The results show the ability of MO-calculations to predict the basicity in this series of congeneric molecules and furthermore support the reliability of the calculation procedure in providing the quantum chemical parameters reported in this paper.

Chemical Phenomena↗