PubMed Health⌕ Search

Biomedical subjects

W van den Brink

Publications and source records attributed to W van den Brink.

At least 19 recordsLinked to original sources
PubMed2006

The ability of YSR scales to predict DSM/DISC-C psychiatric disorders among incarcerated male adolescents.

OBJECTIVE: To investigate whether the empirical or DSM-oriented scales of the Youth Self-Report (YSR) can be used to screen for DSM psychiatric disorders among incarcerated boys. DSM-oriented scales have recently been developed by Achenbach to enhance comparability of YSR results with DSM diagnostic categories. METHOD: A representative sample (N = 196) of incarcerated boys aged 12-18 was assessed with the child version of the Diagnostic Interview Schedule for Children (DISC-C) to diagnose DSM psychiatric disorders, and with the Youth Self-Report (YSR). RESULTS: Only 22% had YSR total problem scores in the clinical range, whereas 90 % met criteria of at least one DSM/DISC-C psychiatric disorder. Weak associations between both empirical and DSM-oriented YSR scale scores and DSM/DISC-C diagnoses were found. CONCLUSIONS: Neither the empirical nor the DSM-oriented YSR scales adequately screen for DSM/DISC-C psychiatric disorders among incarcerated boys. The use of the YSR and the DISC-C to assess DSM constructs results in, at least partially, different diagnostic information.

Adolescent↗
PubMed2006

Contact allergy and respiratory/mucosal complaints from heroin (diacetylmorphine).

After the start of heroin (diacetylmorphine)-assisted treatment to a selected group of chronic treatment-resistant heroin-dependent patients in the Netherlands, we reported about work-related eczema and positive patch tests to heroin in some nurses and nasal and respiratory complaints. To investigate the prevalence of heroin contact allergy, we started a questionnaire-based study with follow-up by allergological examinations. Of 120 questionnaires sent, 101 (84%) was returned: 67 from nurses and 34 from other employees. Of 101 workers, 38 (38%) had reported work-related complaints: 33 of 67 (49%) nurses and 5 of 34 (15%) other employees. Patch tests to heroin were performed in 24 nurses and were positive in 8 (33%). All the 8 had eyelid or facial eczema and, in 6, accompanied by mucosal or respiratory complaints. The prevalence of heroin contact allergy in this study was 8% (8/101) among all employees and 12% (8/67) among nurses. Respiratory and mucosal complaints could not be ascribed to a contact allergy, and in these cases, serum was analysed for specific immunoglobulin E to heroin. A type 1 allergy to heroin could not be shown. These complaints are possibly due to the histamine-liberating effect of heroin, to atopic constitution, to a combination of these factors or - less likely - to other non-allergic factors.

Allergens↗
PubMed2005

Adolescence, schizophrenia and drug abuse: a window of vulnerability.

OBJECTIVE: To discuss the neurobiological and psychosocial developmental factors in adolescence contributing to simultaneous onset and co-occurrence of psychosis and substance use disorders. METHOD: A review of the literature. RESULTS: Adolescence is a period with specific psychosocial challenges and specific changes in the brain that increase the probability of the onset of both psychosis and substance abuse, in predisposed people. In vulnerable adolescents it is proposed that an excessive pruning of dopaminergic neurones leads to mesocortical hypofrontality causing anhedonia and dysphoria. At the same time, anhedonia and dysphoria are important risk factors for the development of substance abuse. In turn, hypofrontality leads to a reduction in mesocortical feedback inhibition of the mesolimbic system resulting in aberrant salience and positive symptoms. Finally, the development of aberrant salience plays a role in both psychoses and craving. CONCLUSION: Attention should be paid to the interaction of drug abuse and schizophrenia and an integrated treatment is needed. Dysphoria and anhedonia in schizophrenic adolescents are important factors in treatment with antipsychotic medication, both in terms of patient satisfaction and in the prevention of substance abuse.

Adolescent↗
PubMed2005

Substance use disorders and the orbitofrontal cortex: systematic review of behavioural decision-making and neuroimaging studies.

BACKGROUND: Orbitofrontal cortex dysfunctions have been frequently documented in people with substance use disorders. The exact role of this cortical region, however, remains unspecified. AIMS: To assess the functionality of the orbitofrontal cortex in people with substance use disorders. METHOD: Reports of studies using behavioural decision-making tasks and/or neuroimaging techniques to investigate orbitofrontal cortex functioning in cases of substance misuse were reviewed. Studies focusing exclusively on tobacco-smoking and gambling were excluded. RESULTS: Fifty-two research articles were evaluated. Most studies showed significant deficits in decision-making in people with substance use disorders. A consistent finding in the neuroimaging studies was hypoactivity of the orbitofrontal cortex after detoxification. The association between hyperactivity of this region and craving or cue reactivity was not consistent across studies. CONCLUSIONS: The orbitofrontal cortex has an important role in addictive behaviours. Further studies are needed to elucidate the underlying neuronal substrates of cue reactivity, craving and decision-making, and the implications for treatment and relapse prevention.

Brain Mapping↗
PubMed2004

Natural course and placebo response in short-term, placebo-controlled studies in major depression: a meta-analysis of published and non-published studies.

BACKGROUND: This study was conducted to investigate the role of natural course of a major depressive episode in short-term, placebo-controlled studies. METHODS: We analyzed for sustained response all placebo arms and tricyclic arms from all randomized three-arm studies that were conducted in patients with a major depressive episode and were submitted to the Medicine Evaluation Board (1979-1991). The Medicine Evaluation Board is the regulatory authority of the Netherlands. A responder was defined as a patient with at least 50% improvement on the Hamilton Depression Rating Scale as compared to baseline score. A study responder was defined as a patient meeting response criteria at endpoint (Last Observation Carried Forward). A sustained responder was defined as a patient who, after becoming responder, remained a responder until the end of the study. RESULTS: The ITT population incorporated 1989 patients in the tricyclic arm and 2042 patients in the placebo arm. There was a statistically significant difference for study responders: 39.3% in the tricyclic treatment group and 27.9% in the placebo group (difference 11.4; CI (95%): 8.5% 14.3%). However, no significant differences in sustained response patterns were found, with the exception of a significantly higher sustained response rate for initial responders at week 4. CONCLUSIONS: While efficacy of tricyclic antidepressants was confirmed in this meta-analysis, the sustained response patterns of active treatment and placebo did not differ substantially, suggesting that many of the patients included in the studies were close to, or at the end of, their episode.

Antidepressive Agents, Tricyclic↗
PubMed2004

Development and manufacture of diacetylmorphine/caffeine sachets for inhalation via 'chasing the dragon' by heroin addicts.

In 1998, two clinical trials were started in The Netherlands to evaluate the effect of coprescription of heroin and methadone on the mental and physical health and social functioning of chronic, treatment-resistant, heroin-dependent patients. Since 75-85% of the heroin addicts in The Netherlands use their heroin by "chasing the dragon," one of the two study arms concerned the coprescription of inhalable heroin. A pharmaceutical dosage form for inhalable heroin was developed for this trial, consisting of a 3:1 powder mixture of diacetylmorphine base and caffeine anhydrate. We describe the manufacturing process that was developed for filling sachets with this mixture in four dosages using a micro dose auger filler. In order to control product quality, in-process controls were developed to monitor the filling process and quality control tests were performed on the finished product. In-process control results have shown the filling process to be accurate and precise. The diacetylmorphine/caffeine sachets were shown to comply with the specifications for content and uniformity of mass. The finished product was found to be stable for 2 years when stored at 25 degrees C, 60% relative humidity and for 6 months when stored at 40 degrees C, 75% relative humidity.

Administration, Inhalation↗
PubMed2003

['Pharmacologic interventions in drug addiction': an advisory report from the Health Council of the Netherlands].

Addiction is a relapsing brain disease with a tendency towards chronicity. Biological, psychological and socio-cultural factors play a role in the onset and course of this disease. The Health Council of the Netherlands has issued a report on pharmacotherapeutic interventions. The treatment of addiction should be regarded as a medical intervention. A growing number of effective pharmacotherapies are becoming available for the treatment of heroin addiction, although not all of those are available in the Netherlands. Currently, no effective pharmacotherapies are available for the treatment of cocaine addiction. In polydrug addicts, pharmacotherapeutic interventions should be directed at the various separate addictions. In the majority of cases pharmacotherapy is part of an integrated treatment approach in which supportive psychosocial interventions are also important. The long-term continuation of treatment is usually indicated. The Health Council recommends that addiction physicians be put in charge of the multidisciplinary treatment. Medical schools should pay attention to the practical aspects of the treatment and management of addicts. The organisation and workforce of addiction treatment services should comply with the demands that are placed upon healthcare services. Public information campaigns about addiction and the treatment options for addicts can contribute to the destigmatisation of this patient category.

Cocaine↗
PubMed2003

Perception of risk and subjective health among victims of the Chernobyl disaster.

Several studies have demonstrated that the nuclear power plant accident at Chernobyl in 1986 had a strong impact on the subjective health of the inhabitants in the surrounding regions and that the majority of these health complaints appear to be stress-related. An epidemiological survey among the adult population of the Gomel region in Belarus near Chernobyl showed higher rates of self-reported health problems, psychological distress and medical service use in this region than in a comparable unexposed region. This paper presents an analysis of data on cognitive factors that were collected in this study. The findings support the hypothesis that cognitive variables such as risk perception and sense of control play an important role as mediating factors in the explanation of the observed health differences between the exposed and non-exposed regions. A tentative model is presented to further clarify the role of risk perception in the occurrence of non-specific health complaints after such ecological disasters.

Adult↗
PubMed2003

Experiences with an outpatient relapse program (community reinforcement approach) combined with naltrexone in the treatment of opioid-dependence: effect on addictive behaviors and the predictive value of psychiatric comorbidity.

BACKGROUND: There is increasing interest in naltrexone, an opiate antagonist, in the treatment of opiate addicts. The effects of naltrexone are often compromised by a lack of compliance and drop-out. The effects of this compound are probably more favorable when combined with a psychosocial intervention such as the Community Reinforcement Approach (CRA). AIM: To explore the effects of a combination therapy (naltrexone plus CRA treatment) and the predictive value of sociodemographic and psychopathologic characteristics. METHOD: Using a before-and-after design, heroine addicts (n = 24) receiving a combined naltrexone plus CRA treatment are compared with a group (n = 20) on methadone maintenance therapy (reference group). RESULTS: Over a period of 6 months, 58% (14/24) did not relapse, after 1 year at least 55% (12/22) still met the initial goal of continuous abstinence. At baseline, the treatment group and the reference group were similar on nearly all variables except for the number of times clients were arrested. Within the treatment group, a comparison was made between the continuous abstinent and those who relapsed into frequent opioid use. Differences were significant in the cluster-B personality disorders and in polydrug users. CONCLUSION: The combination of naltrexone plus intensive CRA in an outpatient setting appears to be promising. A high score on cluster-B and polydrug use is associated with relapse.

Adult↗
PubMed2003

The discriminant validity of alcohol use disorder in well-functioning men with hazardous alcohol use.

The purpose of this study was to establish the discriminant validity of alcohol use disorder (AUD) diagnoses within a population of well-functioning male heavy drinkers. A group of 57 subjects with a consumption of at least 28 alcoholic units (AU)/week was recruited from wine-tasting clubs. Within this group, a comparison was made between those individuals who met the criteria of AUD and those who did not. We compared the subjective and objective health status and drinking habits of both groups. No significant differences were found between the individuals with AUD and those without AUD, or between individuals with alcohol dependence and those without AUD, except for their drinking pattern. These findings raise doubt of the discriminant validity of AUD diagnoses in well-educated heavy wine drinkers.

Adult↗
PubMed2001

Effects of dose, sex, and long-term abstention from use on toxic effects of MDMA (ecstasy) on brain serotonin neurons.

BACKGROUND: 3,4-methylenedioxymethamphetamine (MDMA or ecstasy) is a popular recreational drug that has been shown to damage brain serotonin neurons in high doses. However, effects of moderate MDMA use on serotonin neurons have not been studied, and sex differences and the long-term effects of MDMA use on serotonin neurons have not been identified. We investigated the effects of moderate and heavy MDMA use, sex differences, and long-term effects of MDMA use on serotonin neurons in different brain regions. METHODS: By means of flyers posted in "rave" venues in Amsterdam, the Netherlands, we recruited 15 moderate MDMA users, 23 heavy MDMA users, 16 ex-MDMA users who had stopped using MDMA for more than 1 year, and 15 controls who claimed never to have used MDMA. We studied the effects of MDMA on brain serotonin neurons using 123iodine-2beta-carbomethoxy-3beta-(4-iodophenyl) tropane ([123I]beta-CIT)-a radioligand that binds with high affinity to serotonin transporters. Density of binding (expressed as a ratio of region-of-interest binding over binding in the cerebellum) was calculated by single-photon-emission computed tomography (SPECT). FINDINGS: We saw significant effects of group and group by sex (p=0.041 and p=0.022, respectively) on overall [123I]beta-CIT binding ratios. In heavy MDMA users, significant decreases in overall binding ratios were seen in women (p<0.01) but not men (p=0.587). In female ex-MDMA users, overall densities of serotonin transporters were significantly higher than in heavy MDMA users (p=0.004), but not higher than in controls (p=0.524). INTERPRETATION: Our results indicate that heavy use of MDMA is associated with neurotoxic effects on serotonin neurons, that women might be more susceptible than men, and that MDMA-induced neurotoxic changes in several brain regions of female ex-MDMA users are reversible.

Adult↗
PubMed2001

Prefrontal N-acetylaspartate is strongly associated with memory performance in (abstinent) ecstasy users: preliminary report.

BACKGROUND: 3,4-methylenedioxymethamphetamine (MDMA or "Ecstasy") is known to damage brain serotonin neurons in animals and possibly humans. Because serotonergic damage may adversely affect memory, we compared verbal memory function between MDMA users and MDMA-naïve control subjects and evaluated the relationship between verbal memory function and neuronal dysfunction in the MDMA users. METHODS: An auditory verbal memory task (Rey Auditory Verbal Learning Test) was used to study eight abstinent MDMA users and seven control subjects. In addition 1H-MRS was used in different brain regions of all MDMA users to measure N-acetylaspartate/creatine (NAA/Cr) ratios, a marker for neuronal viability. RESULTS: The MDMA users recalled significantly fewer words than control subjects on delayed (p =.03) but not immediate recall (p =.08). In MDMA users, delayed memory function was strongly associated with NAA/Cr only in the prefrontal cortex (R(2) =.76, p =.01). CONCLUSIONS: Greater decrements in memory function predicted lower NAA/Cr levels-and by inference greater neuronal dysfunction-in the prefrontal cortex of MDMA users.

Adult↗
PubMed2001

[Roaming through methodology. XXXI. Estimating partially hidden populations: heroin addicts in Amsterdan].

To estimate the size of a partly hidden population the capture-recapture method can be used. The estimation is based on analysis of the overlap between several samples of the population of interest. The quality of this capture-recapture estimation highly depends on whether the assumptions of the method are or are not met: samples should be independent, the population should be closed, the overlap should be recognised, and samples should contain only individuals originating from the population of interest. Violation of these assumptions may lead to a serious underestimation or (more often) overestimation. The number of problematic heroin addicted people in Amsterdam was estimated on the basis of registered numbers in the easily accessible methadone programme of the municipal health organisation, in the police station methadone treatment programme, and in the hospital registration in the first quarter of 1997: 4130 (95% confidence interval: 3750-4570).

Data Interpretation, Statistical↗
PubMed2001

Cortical serotonin transporter density and verbal memory in individuals who stopped using 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy"): preliminary findings.

BACKGROUND: Although the popular drug 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy") has been shown to damage brain serotonin (5-HT) neurons in animals, the fate and functional consequences of 5-HT neurons after MDMA injury are not known in humans. We investigated the long-term effects of MDMA use on cortical 5-HT neurons in humans and memory function, because brain 5-HT has been implicated in memory function. METHODS: Twenty-two recent MDMA users, 16 ex-MDMA users who had stopped using MDMA for more than 1 year, and 13 control subjects. The effects of MDMA use on cortical 5-HT neurons was studied by means of single-photon emission computed tomography with iodine 123-labeled 2beta-carbomethoxy-3beta-(4-iodophenyl) tropane ([(123)I]beta-CIT) by quantification of brain 5-HT transporter densities. Verbal memory performance was assessed with the Rey Auditory Verbal Learning Test. RESULTS: Mean cortical [(123)I]beta-CIT-labeled 5-HT transporter density was significantly lower in recent MDMA users than in controls (1.17 vs. 1.28 [-9%]) but not in ex-MDMA users (1.24 vs. 1.28 [-3%]). Recent and ex-MDMA users recalled significantly fewer words than did controls on the immediate recall (47.0 and 48.0 vs 60.0, respectively; P =.001) as well as the delayed recall (9.8 and 10.1 vs. 13.1, respectively; P =.003). Greater use of MDMA was associated with greater impairment in immediate verbal memory. However, memory performance was not associated with [(123)I]beta-CIT binding to cortical 5-HT transporters or duration of abstinence from MDMA. CONCLUSION: The present study suggests that, while the neurotoxic effects of MDMA on 5-HT neurons in the human cortex may be reversible, the effects of MDMA on memory function may be long-lasting.

Adult↗
PubMed2001

The relationship between socio-economic inequality and criminal victimisation: a prospective study.

BACKGROUND: This study investigates the relationship of socio-economic inequality (SEI) with criminal victimisation. It is hypothesised that disadvantage in terms of SEI is associated with increased risk of being victimised and with increased distress following victimisation. Two concepts of SEI are applied: social class (measured in terms of relation to work) and SES (measured in terms of education). METHOD: A representative sample of the Dutch population, comprising 3446 individuals, was followed up and incident crime victims were identified (n=179). A matched comparison group was recruited from the same sample (n=266). SEI and potential vulnerability measures were taken at baseline. Distress was measured 1 week following victimisation and at 1-month intervals for the following consecutive 3 months. RESULTS: The probability of becoming victimised was significantly higher among the unemployed and (unexpectedly) among persons with higher education. The unemployed also showed an increased vulnerability for distress following victimisation compared to all other class categories. This increased vulnerability could not be explained by differences in style of information processing, locus of control, hardiness, need for affiliation, or social support. CONCLUSION: The limitations of the study are discussed and recommendations with respect to the special attention required for unemployed persons are offered.

Adult↗
PubMed2001

Relapse and recurrence prevention in major depression: a critical review of placebo-controlled efficacy studies with special emphasis on methodological issues.

This article critically reviews the design and methodology of studies aimed at evaluating relapse and recurrence prevention in major depression. A literature search in MEDLINE was performed with the medical subject headings 'depression', 'recurrence', 'relapse', 'prevention' and 'study'. This search covered the period from January 1990 to July 1999. Only long-term placebo-controlled studies that included patients with non-chronic major depression were selected. Two types of design could be distinguished: randomised withdrawal studies in responders/remitters (N = 11) and extension studies in responders without re-randomisation (N = 3). Randomised withdrawal studies are suitable for demonstrating long-term efficacy for the duration of the study period. However, this design does not permit a clear differentiation between relapse or recurrence and, therefore, is not suitable to demonstrate unequivocally relapse prevention or recurrence prevention. Extension studies in short-term responders without randomisation are not even suitable to demonstrate long-term efficacy.A novel design is proposed that overcomes the weaknesses of designs employed thus far. In essence, this design calls for a long-term randomised placebo-controlled study in patients who are free of medication for a substantial period of time and who fulfil the criteria of major depression (recurrent) in sustained remission (e.g., HDRS < 7) as a possible option.

Antidepressive Agents↗