Biomedical subjects

Philip Spinhoven

Publications and source records attributed to Philip Spinhoven.

At least 19 recordsLinked to original sources

PubMed2007

Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial.

OBJECTIVE: This study, to the authors' knowledge, is the first randomized controlled trial comparing the efficacy of cognitive behavior therapy (CBT), paroxetine, and a placebo (administered in a double blind fashion) in the treatment of hypochondriasis. METHOD: The authors randomly assigned 112 subjects with hypochondriasis according to DSM-IV criteria to 16 weeks of outpatient treatment with CBT, paroxetine, or a placebo. The main outcome measure was the Whiteley Index. The authors made pretest and posttest assessments and analyzed all outcome measures using a General Linear Model 3x2 repeated measures analysis of variance with Helmert contrasts. The authors considered subjects who scored at least one standard deviation below the mean pretest score on the Whiteley Index as responders. All analyses were conducted on intent-to-treat and completer bases. RESULTS: On the Whiteley Index, Helmert contrasts on the intent-to-treat and completer cohorts revealed that pooled CBT and paroxetine were significantly superior to placebo, but did not differ significantly from each other. The responder analysis on the intent-to-treat cohort and completer cohort, respectively, revealed the following percentages of responders per group: CBT group, 45% and 54%; paroxetine group, 30% and 38%; and placebo group, 14% and 12%. In the intent-to-treat analysis, only CBT differed significantly from the placebo. In the completer analysis, both paroxetine and CBT differed significantly from the placebo. CONCLUSIONS: CBT or paroxetine are effective short-term treatment options for subjects with hypochondriasis.

Adult↗

PubMed2006

Course and predictors of mental health of unaccompanied refugee minors in the Netherlands: one year follow-up.

This epidemiological investigation addresses the prevalence, course, and predictors of the psychological distress and behavioral problems of unaccompanied refugee minors living in the Netherlands. The legal guardians, teachers and minors themselves all reported on the mental health of the refugee minors (n=582) at baseline and follow-up approximately 12 months later. The self-reported psychological distress of refugee minors was found to be severe (50%) and of a chronic nature (stable for one year) which was confirmed by reports from the guardians (33%) and teachers (36%). The number of self-reported experienced adverse life events were strongly related to the severity of psychological distress. Baseline psychopathology was the largest predictor of psychological distress at follow-up reported by all informants accounting for 22-51% of the variance. The present study, which used a population-based sample, further enlarges the knowledge of mental health among refugee adolescents. The investigation is unique because of the large sample size, the longitudinal nature of the study, the use of multiple informants, and the culturally diverse sample.

Adolescent↗

PubMed2006

Behavioral and cognitive group treatment for fear of flying: a randomized controlled trial.

In a long-standing fear-of-flying program, persons with fear of flying (N=150) were after a diagnostic assessment and individual preparation phase randomly assigned to either a 1-day behavioral group treatment (BGT) program, a 2-day cognitive-behavioral group treatment (CBGT) program or a waiting list (WL) control group. A post-treatment flight on a commercial airline measured participants' ability to fly. Different self-report flight anxiety questionnaires were completed before, during and after treatment at 3-, 6- and 12-month follow-up. Results indicated that both treatments were superior to the WL, and equally effective on the flying test and later independent flying, but also that the 2-day CBGT program was significantly more effective than the 1-day BGT program on subjective measures of fear and self-efficacy.

Adult↗

PubMed2006

Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy.

CONTEXT: Borderline personality disorder is a severe and chronic psychiatric condition, prevalent throughout health care settings. Only limited effects of current treatments have been documented. OBJECTIVE: To compare the effectiveness of schema-focused therapy (SFT) and psychodynamically based transference-focused psychotherapy (TFP) in patients with borderline personality disorder. DESIGN: A multicenter, randomized, 2-group design. SETTING: Four general community mental health centers. PARTICIPANTS: Eighty-eight patients with a Borderline Personality Disorder Severity Index, fourth version, score greater than a predetermined cutoff score. INTERVENTION: Three years of either SFT or TFP with sessions twice a week. MAIN OUTCOME MEASURES: Borderline Personality Disorder Severity Index, fourth version, score; quality of life; general psychopathologic dysfunction; and measures of SFT/TFP personality concepts. Patient assessments were made before randomization and then every 3 months for 3 years. RESULTS: Data on 44 SFT patients and 42 TFP patients were available. The sociodemographic and clinical characteristics of the groups were similar at baseline. Survival analyses revealed a higher dropout risk for TFP patients than for SFT patients (P = .01). Using an intention-to-treat approach, statistically and clinically significant improvements were found for both treatments on all measures after 1-, 2-, and 3-year treatment periods. After 3 years of treatment, survival analyses demonstrated that significantly more SFT patients recovered (relative risk = 2.18; P = .04) or showed reliable clinical improvement (relative risk = 2.33; P = .009) on the Borderline Personality Disorder Severity Index, fourth version. Robust analysis of covariance (ANCOVA) showed that they also improved more in general psychopathologic dysfunction and measures of SFT/TFP personality concepts (P<.001). Finally, SFT patients showed greater increases in quality of life than TFP patients (robust ANCOVAs, P=.03 and P<.001). CONCLUSIONS: Three years of SFT or TFP proved to be effective in reducing borderline personality disorder-specific and general psychopathologic dysfunction and measures of SFT/TFP concepts and in improving quality of life; SFT is more effective than TFP for all measures.

Ambulatory Care↗

PubMed2006

Validation of the multiple language versions of the Reactions of Adolescents to Traumatic Stress questionnaire.

The objective of this study was to assess the preliminary psychometric properties of the Reaction of Adolescents to Traumatic Stress questionnaire (RATS) for refugee adolescents. Four independent heterogeneous adolescent population samples (N = 3,535) of unaccompanied refugee minors, immigrants, and native Dutch and Belgian adolescents were assessed at school. The confirmatory factor analyses, per language version, support the three-factor structure of intrusion, avoidance/numbing, and hyperarsoual. The total and subscales of the RATS show good internal consistency and good (content, construct, and criterion) validity. The RATS, in this study, was found to be a reliable and valid instrument for assessing posttraumatic stress reactions of culturally diverse adolescents.

Adolescent↗

PubMed2006

Inconsistencies in the self-report of traumatic experiences by unaccompanied refugee minors.

The authors investigated the consistency with which stressful life events are reported by unaccompanied refugee minors during a 12-month follow-up period and analyzed to what extent demographic and psychopathology variables affected memory consistency. From a population-based sample of 920 unaccompanied refugee minors aged 12 to 18 years old, 63% completed the follow-up measurements. Younger participants and those with lower levels of internalizing behavior and posttraumatic stress at follow-up were more prone to memory inconsistencies. Moreover, younger participants and those with fewer inconsistencies were more likely to have obtained a temporary residence permit. Given the difference between accuracy and consistency, it is not warranted to interpret memory inconsistencies as an indication of lack of credibility when assessing traumatic life events in minors applying for asylum.

Adolescent↗

PubMed2006

Factors associated with mental health service need and utilization among unaccompanied refugee adolescents.

This study is the first to address the need for mental health Care (MHC) and the patterns of utilization of MHC services among Unaccompanied Refugee Minors (URM). Information concerning the well being, mental health need, and utilization of services of URM was collected from three informants, the minors themselves (n = 920), their legal guardians (n = 557), and their teachers (n = 496). The well-being, need and utilization of MHC services of URM was compared with those of a representative Dutch adolescent sample (n = 1059). The findings of this study indicated that URM that report a mental health care need (57.8%) also report higher levels of emotional distress than Dutch adolescents who report a similar need for MHC (8.2%). In addition, guardians and teachers detect emotional distress and mental health care needs in only a small percentage (30%) of URM. The referral of URM to mental health care services does not appear to be driven by the reported needs of the URM, but by the need and emotional distress as observed and perceived by guardians. This resulted in the fact that 48.7% of the URM total sample reported that their need for mental health care was unmet.

Adolescent↗

PubMed2006

Childrearing style of anxiety-disordered parents.

This study investigated whether anxiety-disordered (AD) parents differ in their childrearing style from non-disordered parents. A clinical sample of 36 AD parents with children aged 6-18 was compared with a normal control sample of 36 parents. Childrearing was assessed through parent report and child report. The results demonstrated significant differences in childrearing style between AD parents and non-disordered control parents, both from the perspective of the parent and from that of the child. AD parents reported a less nurturing and more restrictive rearing style than control parents. Their children did not report more rejection or less warmth than children of control parents; they did, however, report significantly more overprotection than children of control parents. The findings, from parental as well as child reports, apply to both AD mothers and AD fathers.

Adolescent↗

PubMed2006

Autobiographical memory in the euthymic phase of recurrent depression.

The authors investigated autobiographical memory specificity in subjects who formerly had depression. In 122 euthymic patients with at least two previous major depressive episodes, memory specificity was significantly impaired compared to matched control participants but not related to residual symptoms and illness characteristics, was not differentially affected by cognitive therapy, and was also not predictive of relapse/recurrence during the 2-year follow-up. However, memory specificity was associated with age, education, and immediate and delayed memory recall. The results suggest that memory specificity may reflect a global cognitive impairment that remains in patients who (formerly) had depression but does not constitute a trait marker for vulnerability for relapse/recurrence.

Adult↗

PubMed2006

Predictors of response to the 'Coping with Depression' course for older adults. A field study.

This field study explored the prognostic factors of the immediate and long-term effects of the Coping with Depression course for older adults (CWD). With the aim of both indicated as well as secondary prevention, the course is provided by the prevention departments of the community mental health care system in the Netherlands. A total of 317 course participants (age 55-85 years; 69% female) took part in this study; 41% had a major depressive disorder (MDD). A variety of demographic, clinical, psychosocial and treatment factors of possible relevance for indicated and secondary prevention were investigated. Random coefficient regression models and logistic regression models were used to examine their contribution to the immediate and maintenance effect. The course was beneficial for all participants, and the level of depression reached at the end of the course was maintained over the next 14-months. Current MDD, high levels of anxiety, less previous depressive episodes and more education predicted a larger benefit. However, the clinical significance of these predictors was too small to justify further triage. Further treatment should be considered for the participants with a post-treatment score >/=16. Group-membership was not a significant predictor of the variation in effect.

Adaptation, Psychological↗

PubMed2006

Interictal depression, anxiety, personality traits, and psychological dissociation in patients with temporal lobe epilepsy (TLE) and extra-TLE.

PURPOSE: This study was performed to investigate the relation between symptoms of interictal depression, anxiety, personality traits, and psychological dissociation with the localization and lateralization of the epileptogenic zone in patients with partial epilepsy. METHODS: All patients were diagnosed according to the localization-related concept of the 1989 International League Against Epilepsy (ILAE) Classification of Epilepsies and Epileptic Syndromes, and the localization and lateralization of the epileptogenic zone was established by using the clinical criteria for noninvasive presurgical evaluation. This resulted in 67 patients with temporal lobe epilepsy (TLE) and 64 patients with extra-TLE. All patients were assessed on the various aspects of psychopathology by using a comprehensive battery of standardized diagnostic instruments. RESULTS: We did not find the hypothesized excess of psychiatric symptoms in patients with (mesial) TLE in comparison with patients with extra-TLE. We also found no differences between patients with the lateralization of epilepsy in the left versus the right hemisphere. CONCLUSIONS: TLE per se cannot be considered a risk factor in developing more or more severe symptoms of psychopathology in patients with partial epilepsy. Concomitant factors, such as the duration of epilepsy, seizure frequency, and frontal lobe dysfunction may play an additional role. Our findings support the hypothesis of a multifactorial explanation for the psychiatric symptoms in patients with epilepsy.

Adult↗

PubMed2006

Differential predictors of response to preventive cognitive therapy in recurrent depression: a 2-year prospective study.

BACKGROUND: Major depressive disorder is a recurrent disease. Brief cognitive therapy (CT), added to either regular care or medication, is helpful in preventing relapse/recurrence. Little is known which type of persons benefit from preventive CT, the so called 'aptitude treatment interaction' effect. METHOD: The present cohort included exclusively patients with at least two previous episodes remitted on various types of treatments (n = 172). They were assessed within a clinical trial comparing treatment as usual (TAU) with preventive CT added to TAU. Differential demographic, illness-related, psychological and biological risk factors in postponing recurrence by preventive CT were examined. RESULTS: Significant aptitude-treatment-interaction effects were found for the number of previous episodes, daily hassles and life events, avoidant coping, gender, and morning cortisol levels. Preventive CT seemed ineffective in patients with life events (as more frequently reported by women in our study) and in patients with high episode number characterized by higher levels of avoidant coping. Generic predictors indicate that in CT, as in TAU, patients with more residual depressive symptomatology and higher levels of dysfunctional attitudes profit less from preventive CT. CONCLUSION: The finding that preventive CT protects against the influence of a consistently found risk factor of relapse/recurrence, i.e. the number of depressive episodes, underlines the potential of psychological preventive interventions. Preventive CT seemed to be especially effective in reducing presumably internally provoked, relapse/recurrence but may be quite ineffective in reducing externally provoked relapse/recurrence. CT possibly prevents either stress generation or disrupts kindling effects. Kindling effects probably cannot be disrupted in patients with higher levels of avoidant coping who experienced a high number of episodes, and patients who experienced life events.

Adult↗

PubMed2006

The boundary between hypochondriasis and obsessive-compulsive disorder: a cross-sectional study from the Netherlands.

OBJECTIVE: To investigate similarities and differences between the symptom profiles of patients with hypochondriasis and those of patients with obsessive-compulsive disorder (OCD) and to compare the contamination/cleaning OCD subtype to other OCD subtypes. METHOD: Between January 1998 and July 2002, 76 patients diagnosed with hypochondriasis (N = 31) or OCD (N = 45) (DSM-IV criteria) and 25 subjects with no formal DSM-IV diagnosis were compared with regard to the extent of diagnosis-specific symptoms, the number and nature of physical symptoms, and whether these symptoms evoked fear. The analyses were repeated after subdividing the OCD patients into the contamination/cleaning and other OCD subgroups. RESULTS: Patients with hypochondriasis and OCD differed significantly from each other on the extent of diagnosis-specific symptoms (all p < .001). Patients with hypochondriasis reported significantly more obsessive-compulsive symptoms and patients with OCD reported significantly more hypochondriacal symptoms than did the healthy control-group members (all p < .05). Neither group differed significantly from the other on the number and nature of feared physical symptoms. The contamination/cleaning OCD subtype did not differ significantly from other OCD subtypes in either the severity of hypochondriacal symptoms or the number of feared physical symptoms. CONCLUSION: Hypochondriasis and OCD can be distinguished on the basis of diagnosis-specific symptoms, although they share a number of similarities. In addition, although patients with the contamination/cleaning OCD subtype tend to be afraid of contracting diseases, the differences between the symptom profiles of these patients and those of patients with hypochondriasis exceed the similarities. Our results confirm that the 2 conditions are separable and valid diagnoses.

Adult↗

PubMed2006

Prediction of recurrence in recurrent depression and the influence of consecutive episodes on vulnerability for depression: a 2-year prospective study.

OBJECTIVE: Depression is a recurring disease. Identifying risk factors for recurrence is essential. The purpose of this study was to identify factors predictive of recurrence and to examine whether previous depressive episodes influence vulnerability for subsequent depression in a sample of remitted recurrently depressed patients. METHOD: Recurrence was examined prospectively using the Structured Clinical Interview for DSM-IV Axis I Disorders in 172 euthymic patients with recurrent depression (DSM-IV) recruited from February 2000 through September 2000. Illness-related characteristics, coping, and stress (life events and daily hassles) were examined as predictors. RESULTS: Risk factors for recurrence were a high number of previous episodes, more residual depressive symptomatology and psychopathology, and more daily hassles. Factors with both an increasing and decreasing pathogenic effect with increasing episode number were detected. CONCLUSION: We found some support for dynamic vulnerability models that posit a change of vulnerability with consecutive episodes. Preventive interventions should be considered in patients with multiple recurrences, focusing on residual symptomatology and specific coping styles.

Activities of Daily Living↗

PubMed2005

Consistency of memory for emotionally arousing events: a review of prospective and experimental studies.

Although emotionally arousing events are more memorable than ordinary daily life events, the nature of memories for emotionally arousing events is widely debated. On the one hand, researchers consider memories for highly emotional events as malleable and subject to distortion, while on the other hand these memories are perceived as both indelible and consistent over the lifetime. Up till now, a systematic comparison of research findings on consistency of memory for emotional events is lacking. This paper is the first effort to summarize available studies on consistency of memory for emotionally arousing events and to address methodological limitations and suggestions for future research as well. In general, findings show that quality of the selected studies is sufficient to good, with studies with victims of assault and studies on war-exposure reaching higher quality scores than studies on flashbulb memories and experimental memory studies. Victims of assault or war-exposure tend to amplify their memories for the event, while results from flashbulb memory research and experimental research suggest that memory for emotional events is either stable or diminishes over time.

Adolescent↗

PubMed2005

The reporting of specific physical symptoms for mental distress in general practice.

OBJECTIVE: Do patients report specific physical symptoms in the presence of mental distress, taking into account the presence of somatic disease? METHODS: Cross-sectional data were collected from 1458 participants in eight general practices in The Netherlands. Electronic patient records provided information on somatic disease. Questionnaires included the Hospital Anxiety and Depression Scale (HADS) to measure mental distress and the Physical Symptom Checklist (PSC). RESULTS: Patients reporting mental distress reported all types of physical symptoms more often than did patients without mental distress. Multivariate analyses in women, corrected for the presence of somatic disease, did not substantially change the univariate pattern. Odds ratios were particularly high (>6) for feeling tired or having low energy, fatigue without exertion and forgetfulness. CONCLUSION: It is the level of mental distress rather than gender or somatic disease that accounts for the reporting of any physical symptom. Fatigue might be an exception, but here, the classification as "physical" rather then "mental" is somewhat ambiguous.

Adult↗

PubMed2005

Automatic negative evaluation of suffocation sensations in individuals with suffocation fear.

The current study tested whether "suffocation sensations" (respiratory loads) are automatically evaluated in a negative way by people fearing these sensations. It was found that, after having been primed with a slight respiratory load, participants with high suffocation fear (n=15) reacted more quickly to suffocation words and more slowly to positive words than participants with low suffocation fear (n=21). However, the effect was present only in participants who had noticed the primes. The findings are relevant to the cognitive model of panic disorder because automatic negative appraisal of sensations may play a role in initiating a panic attack.

Adolescent↗

PubMed2005

Preventing relapse/recurrence in recurrent depression with cognitive therapy: a randomized controlled trial.

This article reports on the outcome of a randomized controlled trial of cognitive group therapy (CT) to prevent relapse/recurrence in a group of high-risk patients diagnosed with recurrent depression. Recurrently depressed patients (N = 187) currently in remission following various types of treatment were randomized to treatment as usual, including continuation of pharmacotherapy, or to treatment as usual augmented with brief CT. Relapse/recurrence to major depression was assessed over 2 years. Augmenting treatment as usual with CT resulted in a significant protective effect, which intensified with the number of previous depressive episodes experienced. For patients with 5 or more previous episodes (41% of the sample), CT reduced relapse/recurrence from 72% to 46%. Our findings extend the accumulating evidence that cognitive interventions following remission can be useful in preventing relapse/recurrence in patients with recurrent depression.

Cognitive Behavioral Therapy↗