Biomedical subjects

Willem van Tilburg

Publications and source records attributed to Willem van Tilburg.

16 recordsLinked to original sources

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

Prevention of late-life depression in primary care: do we know where to begin?

OBJECTIVE: This study attempted to compare two models for selective (people at elevated risk) and indicated (those with subsyndromal depressive symptoms) prevention and to determine the optimal strategy for prevention of late-life depression. METHOD: Onset was assessed at 3 years with the Geriatric Mental State AGECAT in a randomly selected cohort of 1,940 nondepressed and nondemented older people in Amsterdam. Risk factors that can easily be identified in primary care were used. RESULTS: The association of risk factors with depression incidence was expressed in absolute and relative risk estimates, number needed to treat, and population-attributable fractions. Prevention models were identified with classification and regression tree analyses. In the indicated prevention model, subsyndromal symptoms of depression were associated with a risk of almost 40% of developing depression and a number needed to treat of 5.8, accounting for 24.6% of new cases. Adding more risk factors raised the absolute risk to 49.3%, with a lower number needed to treat but also lower attributable fraction values. In the selective prevention model, spousal death showed the highest risk, becoming even higher if the subjects also had a chronic illness. Overall, the attributable fraction values in the indicated model were higher, identifying more people at risk. CONCLUSIONS: Consideration of the costs and benefits of both models in the context of the availability of evidence-based preventative interventions indicated that prevention aimed at elderly people with depressive symptoms is preferred. The focus on treatment should be readdressed; a new approach is needed, with a stronger emphasis on prevention.

Age Factors↗

PubMed2005

The effect of integrated emotion-oriented care versus usual care on elderly persons with dementia in the nursing home and on nursing assistants: a randomized clinical trial.

OBJECTIVES: To examine the effect of integrated emotion-oriented care on nursing home residents with dementia and nursing assistants. DESIGN: A multi-site randomized clinical trial with matched groups, and measurements at baseline and after seven months. SETTING: Sixteen psychogeriatric wards in fourteen nursing homes in the Netherlands. PARTICIPANTS: One hundred and forty-six elderly residents with the diagnosis dementia of the Alzheimer (DAT) type, mixed DAT and vascular dementia, and dementia syndrome (NAO) and 99 nursing assistants. INTERVENTIONS: Integrated emotion-oriented care and usual care. MESUREMENTS: Demented elderly: Behaviour and mood related to adaptation to the illness and the institutionalization. Nursing assistants: General health as measured by feelings of stress, stress reactions, feeling of competence and illness. RESULTS: Positive effects in favour of the integrated emotion-oriented care were found in mild to moderately demented residents on two adaptive tasks: maintaining an emotional balance (less anxiety) and preserving a positive self-image (less dissatisfaction). In the trained group of nursing assistants fewer stress reactions were found only in those who perceived improvement in their emotion-oriented care skills after training. CONCLUSION: Emotion-oriented care is more effective with regard to the emotional adaptation in nursing homes of persons with a mild to moderate dementia. For the severely demented elderly we did not find this surplus value. This outcome is of clinical importance for elderly persons with dementia who are cared for in nursing homes. With respect to the nursing assistants it is concluded that emotion-oriented care has a positive influence on stress reactions in some of them.

Absenteeism↗

PubMed2005

The effects of teaching medical professionalism by means of vignettes: an exploratory study.

The purpose of this study is (1) to evaluate whether an educational program for preclinical students has an effect on the knowledge of professional behaviour for clerks and (2) to study how preclinical students compare with advanced clinical students concerning this knowledge. The authors used an observer-rated test consisting of vignettes describing a dilemma concerning professional behaviour. Students' description of proposed behaviour was scored in one of three categories: unacceptable, acceptable or excellent. Preclinical students were compared with clinical students and the effect of an educational session on student scores on this test was assessed. The educational programme had a positive effect on student scores. However, the knowledge of professional behaviour did not generalize to situations that had not been the explicit topic of the session. A difference was found between preclinical and clinical students in two of the four vignettes: in one vignette clinical students had better scores, in another vignette they had worse scores. It is concluded that the educational programme had a positive effect on student knowledge of professional behaviour but there was no generalization. For more generic rules to sink in, probably many cases need to be discussed, with explicit attention paid to the rationales of these rules. Students who were advanced in their clerkships held different views on professional behaviour compared with preclinical students, possibly due to a socialization process.

Anecdotes as Topic↗

PubMed2004

Effect of combined support for people with dementia and carers versus regular day care on behaviour and mood of persons with dementia: results from a multi-centre implementation study.

BACKGROUND: A previous study in Amsterdam showed that combined family support in the Meeting Centres Support Programme, in which dementia patients and their carers are both supported by one professional staff member, is more effective in influencing behaviour problems and mood of dementia patients living in the community than non-integrated support, such as day care only. OBJECTIVE: A multi-centre implementation study tests if similar effects are achieved in other regions of The Netherlands. METHODS: A pretest-posttest control group design was applied. 112 dementia patients who visited psychogeriatric day care in eight community centres across the country and in three nursing homes, and their carers participated in the study. The patients in the experimental group (n = 89) received support from the Meeting Centres Support Programme together with their carers, while the control group (n = 23) received day care only. Behaviour problems (agressive behaviour, inactivity, non-social behaviour) and mood (dissatisfaction, depressive behaviour) were assessed using standardized observation scales. Quality of life was assessed by interviewing the patients. RESULTS: After 7 months the Meeting Centres Support Programme, compared to regular day care, showed a moderately positive effect on the degree of total behaviour problems (effect size = 0.52), especially on inactivity (effect size = 0.37) and non-social behaviour (effect size = 0.60), a large effect on depressive behaviour (effect size = 0.92) and a moderate effect on self-esteem (effect size = 0.43). CONCLUSIONS: The Meeting Centres Support Programme proves to be more effective than regular day care in influencing behaviour problems, especially inactivity and non-social behaviour, and depressed mood. Participation in the programme also seems to have a positive effect on self-esteem, an important aspect of quality of life. These findings surpass the results of the Amsterdam study and confirm the surplus value of the combined family support in the Meeting Centres Support Programme as compared to regular day care for people with mild to severe dementia.

Affect↗

PubMed2004

Do severity and duration of depressive symptoms predict cognitive decline in older persons? Results of the Longitudinal Aging Study Amsterdam.

BACKGROUND AND AIMS: Some prospective studies show that depression is a risk factor for cognitive decline. So far, the explanation for the background of this association has remained unclear. The present study investigated 1) whether depression is etiologically linked to cognitive decline; 2) whether depression and cognitive decline may be the consequence of the same underlying subcortical pathology, or 3) whether depression is a reaction to global cognitive deterioration. METHODS: A cohort of 133 depressed and 144 non-depressed older persons was followed at eight successive observations over 3 years. All subjects were participants in the Longitudinal Aging Study Amsterdam (LASA). Depression symptoms were measured by means of the CES-D at eight successive waves. Cognitive function (memory function, information processing speed, global cognitive functioning) was assessed at baseline and at the last CES-D measurement. RESULTS: The severity and duration of depressive symptoms were not associated with subsequent decline in memory functioning or global cognitive decline. There was an association between both chronic mild depression and chronic depression, and decline in speed of information processing. CONCLUSIONS: These results support the hypothesis that, in older persons, chronic depression as well as cognitive decline may be the consequence of the same underlying subcortical pathology.

Aged↗

PubMed2004

Depression in older persons with versus without vascular disease in the open population: similar depressive symptom patterns, more disability.

BACKGROUND: Clinical studies suggest that vascular depression presents with typical symptom patterns. The aim of the present study is to examine whether depressed older persons in the open population with and without vascular disease show different symptom patterns. METHODS: In the Longitudinal Aging Study Amsterdam (LASA), a depressed cohort with (n=114) and without (n=292) vascular disease was identified. Depression was measured using self-reports (CES-D). Vascular disease was confirmed or ruled out using a combination of self-reported data, medication use and reports from general practitioners. RESULTS: No significant differences were found in depressive symptom patterns, in symptom clusters nor individual items of the CES-D. Depressed subjects with vascular disease showed much more disability than those without vascular disease. Age of onset of depression did not show statistically significant difference. CONCLUSIONS: From our study in the open population, there is no evidence to support the hypothesis that depressed older persons with vascular disease have a distinct depressive symptom profile, but they do show more disability.

Activities of Daily Living↗

PubMed2004

The longitudinal relation between chronic diseases and depression in older persons in the community: the Longitudinal Aging Study Amsterdam.

OBJECTIVE: The purposes of this study were to examine the differences in influence of various chronic diseases on depressive symptomatology over time and to determine whether there were differences in such influence depending on physical limitations and time of onset of disease. STUDY DESIGN AND SETTING: Data for this study were obtained from the Longitudinal Aging Study Amsterdam. Two thousand two hundred eighty-eight respondents (age 55-85) were included and followed for a maximum of 6 years. Depressive symptoms (using the CES-D scale), the presence of seven frequently occurring chronic diseases, physical limitations, and sociodemographic variables were assessed by structured interviews. Generalized estimating equation models were estimated for each disease and compared with each other. RESULTS: Lung disease, arthritis, cardiac disease, and cancer were all positively associated with increased depressive symptoms over time. Stroke was associated with depressive symptoms, but these associations were not found when adjusted for physical limitations. For atherosclerosis and diabetes mellitus only weak or no associations with depressive symptoms were found. Recent onset of disease resulted in less strong associations for in cancer, lung disease, and arthritis. CONCLUSION: The results demonstrate that the level of depressive symptoms varies across type of chronic disease. In cardiac disease, arthritis, cancer, and lung disease increased depressive symptoms could not be attributed to physical limitations, but in stroke the association found with depressive symptoms was to a large extent attributable to physical limitations.

Age Factors↗

PubMed2004

Instruments to assess decision-making capacity: an overview.

OBJECTIVE: The main objective of this article is to evaluate and describe instruments for assessing decision-making capacity in psychiatry and psychogeriatrics, and to evaluate them for use in daily practice. METHODS: The instruments were selected in Medline articles. We focus on the relationship between these instruments and the concept of competence, represented in the following elements: context in which an instrument is developed, disclosure of information, standards to assess decision-making capacity, the scale or threshold model, and validity and reliability. RESULTS: The developmental context influences how information is provided and standards defined. Although it is not clear how decision-making capacity relates to competency judgments, most instruments provide good reliability. CONCLUSIONS: Comparison of the different instruments opens directions for future research. Although instruments can never replace a physician's judgment, they may provide a clear starting point for a discussion on competence. In daily practice assessments, attention should be given to information disclosure, the influence of our own normative values in evaluating standards of decision-making capacity, and the relation between decision-making capacity and competence.

Aged↗

PubMed2004

Anxiety and the risk of death in older men and women.

BACKGROUND: There are inconsistent reports as to whether people with anxiety disorders have a higher mortality risk. AIMS: To determine whether anxiety disorders predict mortality in older men and women in the community. METHOD: Longitudinal data were used from a large, community-based random sample (n=3107) of older men and women (55-85 years) in The Netherlands, with a follow-up period of 7.5 years. Anxiety disorders were assessed according to DSM-III criteria in a two-stage screening design. RESULTS: In men, the adjusted mortality risk was 1.78 (95% CI 1.01-3.13) in cases with diagnosed anxiety disorders at baseline. In women, no significant association was found with mortality. CONCLUSIONS: The study revealed a gender difference in the association between anxiety and mortality. For men, but not for women, an increased mortality risk was found for anxiety disorders.

Age Factors↗

PubMed2004

Effectiveness of disease management programmes for recognition, diagnosis and treatment of depression in primary care.

OBJECTIVES: Screening is advocated to improve the recognition of patients with major depression in primary care. Furthermore, disease management programmes are advocated to improve the quality of care and outcome for these patients. But is screening and the subsequent implementation of a disease management programme more effective than usual care? METHODS: Review of the literature on the effects of disease management programmes that include screening for major depression in general practice. RESULTS: Six randomised controlled trials were identified in which the effectiveness of disease management programmes were studied in patients with major depression in primary care and compared with usual care. The majority of these, and especially the largest, showed positive effects on the recognition, diagnosis, treatment and outcome of patients. Populations in the US seem to benefit most. CONCLUSION: The results of disease management programmes for major depression in primary care that include screening are positive and are more effective than usual care. Therefore, if proceeded by screening, attention to the whole process of care for patients with major depression instead of paying attention to isolated elements of the process is justified.

Adolescent↗

PubMed2002

The natural history of late-life depression: a 6-year prospective study in the community.

BACKGROUND: Accurate assessment of the natural history of late-life depression requires frequent observation over time. In later life, depressive disorders fulfilling rigorous diagnostic criteria are relatively rare, while subthreshold disorders are common. The primary aim was to study the natural history of late-life depression, systematically comparing those who did with those who did not fulfill rigorous diagnostic criteria. METHODS: Within the Longitudinal Aging Study Amsterdam, a large cohort of depressed elderly persons (n = 277) was identified and followed up for 6 years, using 14 observations. Depression was measured using self-reports (the Center for Epidemiological Studies Depression Scale) and diagnostic interviews (the Diagnostic Interview Schedule). The natural history was assessed for symptom severity (Center for Epidemiological Studies Depression Scale score), symptom duration, clinical course type, and stability of diagnoses. RESULTS: The average symptom severity remained above the 85th percentile of the population average for 6 years. Symptoms were short-lived in only 14%. There were remissions in 23%, an unfavorable but fluctuating course in 44%, and a severe chronic course in 32% (percentages do not total 100 because of rounding). Comparing the outcome, there was a clear gradient in which those with subthreshold disorders had the best outcome, followed by those with major depressive disorder, dysthymic disorder, and double depression. However, the prognosis of subthreshold disorders was unfavorable in most cases, while this group was at high risk of developing DSM affective disorders. CONCLUSIONS: The natural history of late-life depression in the community is poor. DSM affective disorders are relatively rare among elderly persons, but do identify those with the worst prognosis. However, subthreshold depression is serious and chronic in many cases.

Age Factors↗

PubMed2002

Longitudinal relationship between pain and depression in older adults: sex, age and physical disability.

OBJECTIVE: Better understanding of the relationship between pain and depression in older adults in the community is of particular importance considering the high prevalence of both conditions in these adults. In the present study, the longitudinal relationship between pain and depression in older adults was examined, thereby taking into account the role of physical disability and the possibly modifying effect of sex and age. METHODS: The study is based on a sample which at the outset consisted of 325 non-depressed and 327 depressed persons (55-85) drawn from a larger random community-based sample in the Netherlands. Depression (CES-D) and pain (subscale of the Nottingham Health Profile) were measured at eight successive waves over 3 years. RESULTS: Pain was very persistent over time as was to a lesser extent depression. The prognosis of comorbid pain and depression was poor. In longitudinal analyses (Generalized Estimating Equations), pain and depression were strongly associated. At the symptom level, the pain-depression relationship was found to be stronger in men than in women. There was no effect of age on the pain-depression relationship. No support was found for the hypothesis that the pain-depression relationship is mediated by disability. CONCLUSION: The persistent nature of pain and to a lesser extent depression and the intimate and probably reciprocal association between them stress the need for adequate treatment strategies.

Activities of Daily Living↗

PubMed2002

The impact of depression on the well-being, disability and use of services in older adults: a longitudinal perspective.

OBJECTIVE: To study the impact of depression on the wellbeing, disability and use of health services of older adults. METHOD: Prospective community-based study, using a large (n = 2,200) sample of the elderly (55-85) in the Netherlands. Using a 3-year follow-up, the effect of depressive symptoms (CES-D) on disability, wellbeing and service utilization was assessed, controlling for competing need-for-care (chronic physical illness, functional limitation and cognitive decline), enabling (partner status, size of the social network, social support and locus of control), and predisposing factors (age, sex and level of education). RESULTS: Depressive symptoms have considerable impact on the wellbeing and disability of older people and clear economic consequences caused by inappropriate service utilization. Compared with other need-for-care variables the impact of depression is weaker (service utilization), similar (disability) or stronger (wellbeing). CONCLUSION: The steeply rising prevalence of competing health risks in later life does not influence the significance of depression.

Aged↗

PubMed2002

[The assessment of competence in cognitively impaired elderly persons: a closer look at the vignette method].

This article focuses on the assessment of competence of elderly persons both with and without cognitive impairment. In total 113 patients of a geriatric clinic were interviewed. Competence was assessed by using two clinical vignettes, representing respectively a hypothetical treatment situation with mild consequences (endoscopy) and one with severe consequences (operation for colon cancer). Competence was evaluated using the following standards: the ability to evidence a choice, the ability to understand a situation, the ability to reason about a choice, and the ability to appreciate a situation. In the vignette with mild consequences, elderly persons with cognitive impairment performed significantly worse on understanding, reasoning and appreciation than elderly persons without cognitive impairment. In the vignette with severe consequences, elderly persons with cognitive impairment performed significantly worse only on understanding as compared to elderly persons without cognitive impairment. No differences were found for reasoning and appreciation between the cognitively impaired and non-impaired elderly persons. We conclude that competence is less limited by cognitive impairment when assessed in a treatment situation with severe consequences. Therefore, the use of hypothetical vignettes should be carefully reconsidered.

Aged↗

PubMedDate not supplied

The emotional impact of psychiatric symptoms in dementia on partner caregivers: do caregiver, patient, and situation characteristics make a difference?

This study aims to investigate the emotional impact of psychiatric symptoms of patients with dementia on their caregiving partners, and to explore if caregiver, patient, and situation factors predict this emotional impact on caregivers. A cross-sectional design was used. Partners of patients with slight to moderately severe dementia who live in the community (n = 85) were interviewed. In a subgroup (n = 58) potential predictors of emotional impact of psychiatric symptoms on caregivers were studied. Agitation, irritability, apathy, and disinhibition produced the highest mean emotional impact scores in caregivers. Besides the neuropsychiatric symptoms themselves, the emotional impact of these symptoms on caregivers was predicted by sense of competence, degree of care needed by the patient, and financial expenditure due to the caregiving situation. The emotional impact of psychiatric symptoms on caregivers is predicted by several patient, caregiver, and situation factors. Interventions aimed at decreasing the experienced burden of caregivers should therefore not only focus on the psychiatric symptoms of the patient, but also on the sense of competence of the caregiver and the financial burden due to the caregiving situation.

Adaptation, Psychological↗