Biomedical subjects

Koen Demyttenaere

Publications and source records attributed to Koen Demyttenaere.

30 records · Page 2Linked to original sources

PubMed2004

Central nervous system involvement in functional gastrointestinal disorders.

Although functional gastrointestinal disorders (FGID) are common, their pathophysiology remains incompletely understood. It is generally accepted that dysfunction of the bidirectional pathways between the gastrointestinal tract and the central nervous system (the 'brain-gut axis') at any level can cause FGID symptoms. In this review article, we focus on the role of the central nervous system in the brain-gut axis. First, we describe the functional anatomy of the brain-gut axis. Second, we focus on the results from brain-imaging studies both in healthy volunteers and in FGID patients. These new investigational techniques made identification of brain regions critically involved in processing of visceral afferent information possible. Differences in central nervous system response to visceral stimuli between controls and FGID patients will be highlighted. Third, we will address the issue of high comorbidity with psychiatric disorders. Some hypotheses about common pathophysiological substrates will be discussed.

Brain↗

PubMed2004

Rapid tranquilization: new approaches in the emergency treatment of behavioral disturbances.

Psychiatric emergencies are often accompanied by behavioral disturbances that interfere with normal assessment and call for immediate intervention. Different pharmacological treatment regimens have been used for this purpose. Most of these regimens are based upon common clinical practice and have limited evidence base. Recently, a major publication by experts in the field of emergency psychiatry has covered this topic and the therapeutic armamentarium has been extended with the atypical antipsychotics. However, research is still hampered by different methodological limitations: unclear definition of the agitated state and therapeutic goal, idiosyncratic measurement, small sample sizes. The perspective of the patient and the interaction between the emergency care setting and treatment regimen also need further attention. All these important, but often neglected issues are covered in a selective review of the literature.

Antipsychotic Agents↗

PubMed2004

Effects of patient and health-system characteristics on community tenure of discharged psychiatric inpatients.

OBJECTIVE: The purpose of this study was to identify the differential effect of patient and health-system characteristics on length of stay in the community among recidivist psychiatric patients. METHODS: Data on demographic and clinical characteristics and mental health service utilization were collected for patients with at least one previous psychiatric hospitalization (N=1,972) who visited a psychiatric emergency department at a university hospital in Leuven, Belgium, between March 2000 and March 2002. Logistic regression analysis was used to compare the characteristics of patients with a short (less than two months), intermediate (two to 12 months), or long (12 months or longer) stay in the community between their last hospital discharge and referral to the psychiatric emergency department. RESULTS: One in three patients visited the psychiatric emergency department within 30 days of discharge from a psychiatric hospitalization, and 43 percent of the patients visited within 60 days of discharge. Patients with a short community stay were more likely to be unemployed and to have had a discharge against medical advice, a short previous hospitalization, no aftercare plan, and a history of two or more previous hospitalizations. Longer community stays were predicted by the presence of a personality disorder. CONCLUSIONS: For patients with a history of psychiatric hospitalization, early psychiatric recidivism may be more highly influenced by health-system characteristics than by the presence of severe mental illness.

Adult↗

PubMed2003

Risk factors and predictors of compliance in depression.

Naturalistic studies show that the average length of antidepressant treatment is less than 6 months and that discontinuations are high, especially in primary care depressed patients. Factors leading to treatment discontinuation are multiple and poorly understood. Discontinuations are most frequent during the first month of therapy, and the prevalent reasons vary during the course of therapy. Approximately 25% of patients do not inform their physician about stopping their antidepressant medication. Recent research provides new information that may serve as a guideline for improving compliance. The physician-patient relationship, including the amount of time the physician takes to explain the expected duration of treatment and possible adverse effects, is a key factor. The physician's attitude about the medication is also important. Strategies should be adapted to the stage of treatment, as common reasons for discontinuation change as treatment progresses.

Age Factors↗

PubMed2003

Psychological distress in the 5-year period after predictive testing for Huntington's disease.

The paper reports on a 5-year longitudinal study on psychological distress after predictive testing for Huntington's disease (HD) and on correlates of post-test distress. Psychometric tests and questionnaires were used. The tested persons were invited to participate in the follow-up study; the uptake rate was 75% (24 carriers, 33 non-carriers). Three time points were included: baseline, 1 year and 5 years post-test. Five years after the test, mean distress scores of both carriers and non-carriers were within the normal range. Carriers did not differ from non-carriers with regard to mean general distress. Compared to non-carriers, however, carriers had significantly less positive feelings (P<0.001) and were more consciously avoiding HD-related situations and thoughts (P<0.01). These findings reflect the carriers' conscious and unconscious attempt to escape from pessimism and to minimise negative consequences of the test result. Psychological distress 5 years post-test was significantly associated with ego-strength (P<0.05 to P<0.001). Except for intrusion and avoidance, distress was also associated with test motivation (P<0.05 to P<0.01). Compared with baseline level, mean depression, general and specific anxiety had significantly decreased 1 year and 5 years post-test (P<0.05 to 0.01). This evolution was independent of the test result. However, based on test motivation, a subgroup of tested persons having long lasting psychological distress could be identified, also irrespective of test result. Persons who asked the test to get rid of the uncertainty, without being able to specify implications for substantial life areas, had more psychological distress before and after the test than those who wanted the test for specific reasons (P<0.001 to P<0.0001). Moreover, the pattern of post-test anxiety differed over time, depending on the test motivation (P<0.05). The findings suggest that pre- and post-test counselling should pay special attention to persons with lower ego-strength and with an unspecified test motivation, because they are at higher risk for long-term psychological distress, independently of the test result.

Adaptation, Psychological↗

PubMed2003

Improving the chance of recovery from the short- and long-term consequences of depression.

Major depressive disorder (MDD) is a common, chronic disorder that requires long-term management. Although effective treatments are available, MDD frequently remains undiagnosed. Furthermore, once recognized, treatment duration and dosage are often inadequate and adherence to medication is often poor. However, adequate acute phase treatment of MDD is essential to reduce symptomatology, and improve quality of life and the clinical course. After remission, treatment should be continued for 4-9 months to consolidate the remission and prevent relapse. For patients who do not respond adequately to their initial antidepressant therapy, switching or augmentation of therapy may be necessary. Many patients suffer residual symptomatology, even when classified as being in remission. In addition to the suffering and impairment that this causes, residual symptomatology is associated with a high rate of relapse. Clinicians should strive to achieve asymptomatic recovery both in terms of core symptomatology and psychosocial disability. This requires appropriate treatment at therapeutic doses for a sufficient duration; education and support to promote patient compliance with treatment; and regular monitoring and prompt intervention for patients with symptoms that persist even at subsyndromal levels. In conclusion, there remains considerable scope for improving the identification, treatment and management of patients with MDD.

Antidepressive Agents↗

PubMed2003

Prevalence and predictors of sexual dysfunction in patients with type 1 diabetes.

OBJECTIVE: This study aimed to 1) measure the prevalence of sexual dysfunction in patients with diabetes; 2) describe how descriptive variables, psychological variables, diabetic complications, and sexual dysfunction relate in patients with diabetes; and 3) describe the predictors of sexual dysfunction in patients with diabetes. RESEARCH DESIGN AND METHODS: A total of 240 adult type 1 diabetic patients visiting the outpatient diabetes clinic of a university hospital completed questionnaires evaluating psychological adjustment to diabetes and sexual functioning. Medical records were used to obtain HbA(1c) values as well as information on microvascular diabetic complications. RESULTS: Sexual dysfunction was reported by 27% of women and 22% of men. No differences were found between sexes in type of reported sexual dysfunction. In men, but not in women, sexual dysfunction was related to age, BMI, duration of diabetes, and diabetic complications. No correlation with HbA(1c) was found in either sex. In women, but not in men, sexual dysfunction was related to depression and the quality of the partner relationship. Binary logistic regression demonstrated that, in men, the significant predictors of sexual dysfunction were higher age and presence of complications, whereas, in women, sexual dysfunction was related to depression. CONCLUSIONS: Both women and men with diabetes are at increased risk for sexual dysfunction. This study suggests that in men with diabetes, sexual dysfunction is related to somatic and psychological factors, whereas in women with diabetes, psychological factors are more predominant.

Adult↗

PubMed2002

Painful ejaculation and urinary hesitancy in association with antidepressant therapy: relief with tamsulosin.

Painful ejaculation has been reported in association with a variety of antidepressants such as the tricyclic antidepressants (TCAs, e.g. clomipramine, imipramine, desipramine, protriptyline, amoxapine), the selective serotonin reuptake inhibitors (SSRIs, e.g. fluoxetine), venlafaxine and the MAOIs. Apart from lowering the dose and changing the antidepressant, no strategies are available to treat this side effect. In this paper, painful ejaculation following the administration of reboxetine is described in two patients. Both patients were treated concomitantly with the selective alpha(1A)-adrenoceptor antagonist, tamsulosin. A re-challenge was performed in one patient. The Hamilton Depression Rating Scale (HAM-D), the American Urological Association symptom index, a (dis)satisfaction item score and the Udvalg for Kliniske Undersoegelser (UKU-side effect rating scale) were used to assess the treatment. Tamsulosin rapidly and completely resolved the painful ejaculation and urinary hesitancy in both patients. A re-challenge in one patient resulted in a prompt reappearance of both side effects. Tamsulosin resolved the problem of painful ejaculation in these patients; however, larger studies are needed to confirm these results.

Adrenergic alpha-Antagonists↗

PubMed2002

Sexual dysfunction in women with type 1 diabetes: a controlled study.

OBJECTIVE: This study aimed to 1) examine the prevalence of sexual problems in women with type 1 diabetes, 2) compare this prevalence rate with that of an age-matched control group, 3) study the influence of diabetes-related somatic factors on female sexuality, and 4) study the influence of psychological variables on the sexual functioning of both groups. RESEARCH DESIGN AND METHODS: A total of 120 women with diabetes visiting the outpatient diabetes clinic completed questionnaires evaluating psychological adjustment to diabetes, marital satisfaction, depression, and sexual functioning. Medical records were used to obtain data on HbA(1c), use of medication, BMI, and early-onset microvascular complications. An age-matched control group of 180 healthy women attending an outpatient gynecological clinic for preventive routine gynecological assessment also completed the non-diabetes-related questionnaires. RESULTS: More women with diabetes than control subjects reported sexual dysfunction (27 vs. 15%; P = 0.04), but a significant difference was found only for decreased lubrication. No association was found between sexual dysfunction and age, BMI, duration of diabetes, HbA(1c), use of medication, menopausal status, or complications. Women with more complications, however, reported significantly more sexual dysfunctions, and the presence of complications altered treatment satisfaction. Both diabetic and control women with sexual dysfunction mentioned lower overall quality of the marital relation and more depressive symptoms than their respective counterparts without sexual problems. Depression was a significant predictor for sexual dysfunction in both women with diabetes and control subjects. CONCLUSIONS: Sexual problems are frequent in women with diabetes. They affect the overall quality of life and deserve more attention in clinical practice and research.

Adult↗

PubMedDate not supplied

Predicting community tenure in patients with recurrent utilization of a psychiatric emergency service.

OBJECTIVE: Factors determining community tenure (CT) between subsequent referrals to a psychiatric emergency room (PER) are only partly understood. We investigated the differential effect of patient and health system characteristics on the CT of patients with a previous referral to a PER. METHOD: Data were collected for patients with a history of PER referrals (N=531) in a university hospital in Leuven, Belgium, between March 2000 and March 2002. Using logistic regression analysis, we compared patients with a short (<2 months), intermediate (2--12 months) and long (>or=12 months) CT between previous and current referrals. RESULTS: A short CT (53% of the patients) was predicted by not receiving aftercare at the previous PER visit (OR=6.43) or by not complying with recommended aftercare (OR=3.89). An intermediate CT (38% of the patients) was predicted by an adjustment disorder (OR=6.72) or a substance use disorder (OR=3.47) or by the absence of a mental disorder (OR=4.13). Nine percent had a long CT. Protective factors of a long CT were noncompliance with aftercare at the last PER visit (OR=0.09) and currently being in outpatient treatment (OR=0.05). CONCLUSION: For patients with a previous use of a PER, short CT was highly influenced by aftercare arrangements and not by clinical characteristics.

Adolescent↗

PubMedDate not supplied

Gender differences in the psychological adjustment to type 1 diabetes mellitus: an explorative study.

This study examined gender differences in (1) the psychological adjustment to diabetes and (2) the relation between psychological adjustment and metabolic control in patients with type 1 diabetes. The 280 adult patients attending the outpatient diabetes clinic completed psychological self-rating questionnaires evaluating coping, depression, marital satisfaction, cognitive and emotional adjustment to diabetes. Glycaemic control was measured with HbA(1c)-values. This study revealed that men used significantly more active coping, less avoiding, less social support seeking and less depressive coping. Despite these differences, glycaemic control was not significantly better in men than in women. Women reported more depressive symptomatology than men did and more women were depressed. Significant gender differences were also found in psychological adjustment to diabetes. The psychological factors negatively related with the psychological adjustment to diabetes in men and women are depressive coping and depressive symptomatology.

Adaptation, Psychological↗

PubMedDate not supplied

Getting what you ask for: on the selectivity of depression rating scales.

A large number of rating scales has been developed to assess depression severity and change during antidepressant therapy. When reviewing the literature, the choice of the rating scales used in a particular study often seems arbitrary. The most frequently used observer rating scales, the Hamilton Depression Rating Scale (HDRS) and the Montgomery-Asberg Depression Rating Scale (MADRS), and the most frequently used self-rating scale (the Beck Depression Inventory, or BDI) were developed more than 20 years ago. Their historical background is too often forgotten and they are reflections of their origin: the HDRS and the MADRS reflect antidepressant activity while the BDI reflects psychotherapy. Moreover, the HDRS is at risk of putting 'all depressions in one basket', while the MADRS is at risk of putting 'all antidepressants in one basket'. Therefore, the question whether a particular antidepressant could be more effective in a particular subtype of depression cannot be answered. Observer rating scales are more frequently used than self-rating scales, and when scales are used that do exist in an observer rating and a self-rating version, interesting differences are found. The present paper does not suggest that one scale is better than another, but suggests that a better knowledge of their differential background can help the researcher choose the correct scale for his purposes.

Antidepressive Agents↗