PubMed Health⌕ Search

Biomedical subjects

M W Hengeveld

Publications and source records attributed to M W Hengeveld.

At least 19 recordsLinked to original sources
PubMed1997

Physician-assisted death in psychiatric practice in the Netherlands.

BACKGROUND: In 1994 the Dutch Supreme Court ruled that in exceptional instances, physician-assisted suicide might be justifiable for patients with unbearable mental suffering but no physical illness. We studied physician-assisted suicide and euthanasia in psychiatric practice in the Netherlands. METHODS: In 1996, we sent questionnaires to 673 Dutch psychiatrists - about half of all such specialists in the country - and received 552 responses from the 667 who met the study criteria (response rate, 83 percent). We estimated the annual frequencies of requests for physician-assisted suicide by psychiatrists and actual instances of assistance. RESULTS: Of the respondents, 205 (37 percent) had at least once received an explicit, persistent request for physician-assisted suicide and 12 had complied. We estimate there are 320 requests a year in psychiatric practice and 2 to 5 assisted suicides. Excluding those who had ever assisted, 345 of the respondents (64 percent) thought physician-assisted suicide because of a mental disorder could be acceptable, including 241 who said they could conceive of instances in which they themselves would be willing to assist. The most frequent reasons for refusing were the belief that the patient had a treatable mental disorder, opposition to assisted suicide in principle, and doubt that the suffering was unbearable or hopeless. Most, but not all, patients who had been assisted by their psychiatrists in suicide had both a mental disorder and a serious physical illness, often in a terminal phase. Thirty percent of the respondents had been consulted at least once by a physician in another specialty about a patient's request for assisted death. The annual number of such consultations was estimated at 310, about 3 percent of the estimated 9700 requests for euthanasia or physician-assisted suicide in medical practice. CONCLUSIONS: Explicit requests for physician-assisted suicide are not uncommon in psychiatric practice in the Netherlands, but these requests are rarely granted. Psychiatric consultation for medical patients who request physician-assisted death is relatively rare.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Platelet serotonin and [3H]paroxetine binding correlate with recurrence of suicidal behavior.

To distinguish state- from trait-dependent associations between serotonergic function and suicidal behavior, platelet serotonergic measures were repeatedly measured, during a 1-year follow-up, in 106 patients who had recently attempted suicide for at least a second time. A major DSM-III-R axis I diagnosis or use of antidepressants were reasons for exclusion. A higher affinity constant (KD) of platelet [3H]paroxetine binding was related to a higher risk of short-term recurrence of a suicide attempt, suggesting a state relationship. Higher levels of platelet serotonin at baseline were a significant predictor of a recurrent suicide attempt within the year of follow-up, suggesting a trait relationship. These associations held equally within the subgroup of 73 patients with a borderline personality disorder. Neither the maximum number of binding sites (Bmax) of [3H]paroxetine nor platelet monoamine oxidase activity correlated with suicidality. The observed association between indicators of platelet serotonin uptake and suicidal behavior suggests a state- and trait-dependency between suicidality and central serotonergic dysfunction.

Adolescent↗
PubMed1997

Ejaculation-retarding properties of paroxetine in patients with primary premature ejaculation: a double-blind, randomized, dose-response study.

OBJECTIVE: To compare the influence of a daily dose of 20 or 40 mg of the serotonergic antidepressant drug paroxetine in delaying ejaculation in patients with primary premature ejaculation. PATIENTS AND METHODS: Thirty-four patients with primary premature ejaculation were randomly assigned to receive 20 mg or 40 mg daily of paroxetine for 7 weeks in a double-blind fixed-dose trial after an initial dose of 20 mg/day in the first week. Patients and their female partners were interviewed separately. In the group receiving 20 mg, one of two capsules consisted of placebo and in the group receiving 40 mg, both capsules contained active drug. RESULTS: The trial was completed by 27 men; both groups showed a statistically significant difference from the baseline values of ejaculation latency (P < 0.001) and a clinically relevant improvement in ejaculation time. The increase in the intravaginal ejaculation latency time was not statistically significant different between the groups. The patient's assessments were confirmed independently by their partners. CONCLUSIONS: The daily use of 20 mg paroxetine may be considered as an adequate treatment for primary premature ejaculation. Increasing the dose may lead to a further increase in ejaculation latency.

Adolescent↗
PubMed1996

Unexplained physical symptoms: outcome, utilization of medical care and associated factors.

The aim of the study was to investigate the recovery and frequency of physician contact in patients with unexplained physical symptoms and to identify factors associated with persistent disorder. Of 100 consecutive patients who presented with medically unexplained symptoms to a general medical out-patient clinic, 81 participated in a follow-up study. The mean follow-up time was 15.2 months (S.D. 4.0). At follow-up, many of the patients with unexplained physical symptoms reported that they had recovered (30%) or improved (46%) with regard to their presenting symptoms. Female sex and a high number of symptoms predicted a bad outcome in terms of recovery. Persistence of symptoms was not related to the duration of the symptoms, type of presenting complaint or the presence of psychiatric disorder. Forty per cent of patients with unexplained symptoms did not visit their general practitioner on their own initiative in the year following the initial visit to the clinic. Medical care utilization appeared to be associated with female sex, age, number and duration of symptoms, fatigue and psychiatric disorder, especially somatoform disorders. However, the association of a high frequency of physician contact with female sex and psychiatric disorder was not sustained after controlling for possible confounding factors.

Female↗
PubMed1996

Suicidality, circadian activity rhythms and platelet serotonergic measures in patients with recurrent suicidal behaviour.

The circadian activity rhythm was assessed over a one-week period using a wrist-worn activity monitor in 59 patients with a history of recurrent suicide attempts. In 40 of these patients a second recording was made 6 months later. Platelet serotonin (5-HT) and monoamine oxidase-B activity (MAO) were measured. Suicidal ideation, borderline personality disorder and impulsiveness were associated with the absence of a clear 24-hour periodicity in motor activity. Depressive mood and hopelessness were associated with a less regular bed-in time and a lower daytime activity. Platelet 5-HT as well as MAO correlated negatively with the amplitude of the circadian activity rhythm. Our results support the suggested link between suicidality, altered circadian activity and serotonergic function.

Adult↗
PubMed1996

A pilot study of a short cognitive-behavioral group treatment for female recurrent suicide attempters.

OBJECTIVE: To test the feasibility and effectiveness of a high-frequency short-term group cognitive-behavioral therapy (CBT) for recurrent suicide attempters. METHOD: CBT consisting of eight weekly and two "booster" sessions was given to nine female out-patients who had attempted suicide at least twice, seven of whom had a personality disorder. RESULTS: Four patients dropped out during the treatment; either because they were "chronic repeaters" (i.e., had a history of more than 8 suicide attempts), or because the last suicide attempt was too long ago. Although the patients were generally positive about the content of the therapy, no effects on psychiatric symptomatology or repetition of suicidal behavior could be demonstrated. CONCLUSIONS: Based on this experience, and on the two controlled studies of CBT of recurrent suicide attempters published in the literature, it is tentatively concluded that it is difficult to organize a short-term high-frequency group treatment for recurrent suicide attempters with personality disorders, and that CBT may delay repetition of suicidal behavior, but that "major repeaters" (i.e., who made 4 or more suicide attempts) with a borderline personality disorder tend to stay major repeaters.

Adult↗
PubMed1995

Psychosexual functioning of partners of men with presumed non-organic erectile dysfunction: cause or consequence of the disorder?

In the treatment of couples where the male partners have erectile dysfunction (ED) it often becomes apparent that characteristics of the female partners and of the relationship in general have contributed to the problem. However, this has received little research attention. We investigated female partners of men with ED where no organic cause could be found (n = 34) and partners of men with organically based ED (n = 71) to compare their views on their relationships, sexual function, sexual attitudes, and psychological adjustment. Relationship problems and the psychosexual dysfunctions of vaginismus and dyspareunia were more common in the partners of men with nonorganic ED; they also reported higher levels of sexual interest. Female sexual dysfunctions in the nonorganic ED group had usually preceded the onset of the erectile difficulties. While belief in male sexual myths was substantial in both groups of patients, neither the presence of traditional views on sexuality nor psychological complaints distinguished partners of men experiencing nonorganic ED from those with organic ED. Relationship problems, female psychosexual dysfunction, and the possible effect of relatively high levels of female sexual interest may contribute to the onset, exacerbation, and maintenance of ED. These should be addressed during assessment and treatment of couples in which the male partners have erectile difficulties.

Adult↗
PubMed1995

Factors that influence the provision of sexual health care by Dutch cancer nurses.

A descriptive-correlational design was used with a sample of Dutch cancer nurses (n = 104) to describe provision of sexual health care (SHC) and to explore influential factors. This report is limited to the second goal. The Theory of Reasoned Action provided the conceptual framework for investigation of five previously identified factors and one unexplored factor. Knowledge, comfort, attitude (towards sexuality) and subjective norm were significantly related with provision of SHC. Multiple regression analysis demonstrated that knowledge and comfort were significant explanatory variables, accounting for 37% of the variance.

Adult↗
PubMed1995

Medically treated suicide attempts: a four year monitoring study of the epidemiology in The Netherlands.

OBJECTIVE: The incidence of medically treated attempted suicides was investigated in a defined area in the western part of The Netherlands, and demographic groups at risk were identified. DATA AND METHODS: Suicide attempts treated at general hospitals, psychiatric hospitals, and in general practice were monitored between 1 January 1989 and 1 January 1993. Information on demographic characteristics of the subjects who attempted suicide and characteristics of the attempts was registered through a monitoring system and there was maximum coverage. Data on the general population in the catchment area were derived from national, regional, and municipal bureaux of statistics. RESULTS: The mean annual incidences of medically treated suicide attempts (events) were 95/100,000 for males and 155/100,000 for females. At risk groups for attempted suicide were the young (< 40 years); females; people who were divorced, unemployed, or disabled; or those who had low levels of education. CONCLUSIONS: Apart from general hospitals and psychiatric hospitals, 28% of all reported suicide attempts were reported exclusively by general practitioners, which supports the conclusion that they are an important source of information. There were indications that the number of medically treated suicide attempts in this area is stabilising.

Adolescent↗
PubMed1995

A prospective long-term follow-up study of patients evaluated for erectile dysfunction: outcome and associated factors.

The aim of this study was to investigate the long-term outcome of erectile dysfunction (ED) assessed in a routine clinical setting. The original population consisted of 209 patients who were consecutively referred to either the Urology Clinic or the Sexual Dysfunction Clinic of a University Hospital. At follow-up, 22 patients had died and 32 could not be found. Of the remaining 155, 107 (69%) patients participated in the study. The mean follow-up period was 4.1 years. Of these, 21 had had a prosthesis implanted, 34 had received self-injection therapy. 31 had sex therapy and 28 patients had not received any treatment. Overall, the rate of penetration increased, whereas coital frequency did not change. Despite the fact that sexual functioning in terms of penetration rate improved, more than of the patients reported that they were dissatisfied with the overall quality of their sex-lives.

Coitus↗
PubMed1994

Excess mortality in general hospital patients with delirium: a 5-year follow-up of 519 patients seen in psychiatric consultation.

Mortality was determined in 519 patients with delirium who were seen in psychiatric consultation in two general hospitals. Among 419 patients with simple delirium (DSM-III: 293.00) in-hospital mortality was 26%. As compared to average hospital patients the age adjusted in-hospital excess mortality ratio varied from 6.2 for patients with malignancies to 2.1 for patients with motor system disease. After hospital discharge the 5-yr cumulative mortality was 51%. As compared to the general population excess mortality was noted in most, but not in all diagnostic subgroups. The age and sex adjusted excess mortality ratio varied from 14.1 for malignancies to 1.3 for motor system disease. The figures underline a general notion that delirium may be an indicator of disorders of grave prognosis, but mortality appears to depend more on the medical condition than on the presence of delirium.

Adolescent↗
PubMed1994

Paroxetine treatment of premature ejaculation: a double-blind, randomized, placebo-controlled study.

Seventeen male outpatients with premature ejaculation were randomly assigned to treatment with paroxetine (N = 8) or placebo (N = 9). After a first week dose of 20 mg/day, the paroxetine regimen was increased to 40 mg/day for 5 weeks. Patients and their female partners were interviewed separately. Patients treated with paroxetine had significantly greater clinical improvement than the patients given placebo.

Adult↗
PubMed1993

[Sexual possibilities following total penis amputation].

A male aged 45 was subjected to total penis amputation because of a penile carcinoma; a perineal urethral stoma was created. The postoperative course was uneventful. One month after the last operation the patient for the first time felt the need for sexual contact, but his wife hesitated. After medical-sexological counselling, the partners achieved satisfactory sexual functioning with the husband occasionally having an orgasm.

Amputation, Surgical↗
PubMed1993

Discrimination between psychogenic and organic erectile dysfunction.

The aim of this study was to develop a screening test based on the Leiden Impotence Questionnaire (LIQ) in order to assist in the difficult process of differentiating between psychogenic and organic erectile dysfunction (ED). The main sample consisted of 176 patients with ED, which was classified according to the results of the urological and psychiatric assessment as either organic, in 109 (62%) patients, or psychogenic, in 67 (38%) patients. A logistic regression model including six general items from the LIQ correctly identified psychogenic ED in 62% of the cases, and organic ED in 86%, with an overall correct classification rate of 76%. Adding information regarding sexual intercourse and the relationship in patients who had a partner and were having sexual intercourse the correct classification rates were: psychogenic 77%, organic 94%, and overall 87%. Discrimination between psychogenic and organic ED is improved when more information concerning sexual activity can be assessed.

Diagnosis, Differential↗