[A multi-centre ROM study of the Guideline-Informed Treatment for Personality Disorders]. / Een ROM-studie van de Guideline-Informed Treatment for Personality Disorders in vier behandelcentra.

BACKGROUND: The Guideline-Informed Treatment for Personality Disorders (GIT-PD) is widely used in the Netherlands and Belgium in the care of people with personality disorders. To date, no evidence existed for the possible efficacy of this treatment framework.  METHOD: In an observational cohort study in four institutions, based on Routine Outcome Monitoring-data, improvements in symptom burden (BSI/OQ-45) and personality functioning (SIPP-SF) in 470 patients were examined.  RESULTS: Significant improvements were observed in each of the settings for both symptom burden and personality functioning. Effect sizes for improvement in overall symptom burden ranged from d = 0.55 to 1.05.  CONCLUSION: Treatment outcomes for GIT-PD are in line with treatment outcomes also seen for specialized treatments for personality disorders in similar practice studies. Possible differences between settings could be related to the intensity, structure and coherence of the GIT-PD program in question. .

[How evidence-based is the guideline-informed treatment for personality disorders (GIT-PD)?] / Hoe bewezen effectief is de guideline-informed treatment for personality disorders (GIT-PD)?

BACKGROUND: The guideline-informed treatment for personality disorders (GIT-PD) was developed as an alternative to the specific treatments for personality disorders. Even though this form of treatment is widely used in health care and has been included in the Health Care Standard for Personality Disorders, its scientific evidence remains unclear. AIM: To review the indirect evidence for GIT-PD and compare it with the evidence for specific treatments. METHOD: Literature review including reviews and meta-analyses in the field of personality disorders. RESULTS: Although there is increasing evidence for specific treatments, the amount of studies remains limited and the quality of the evidence is rather low. There are indications that specific treatments are poorly implemented in clinical practice, which may detract from their efficacy. There is no clear evidence that specific treatments are on average no more effective than well-designed generic treatments that are similar to GIT-PD. There is considerable evidence for the role of the common factors on which GIT-PD is based. CONCLUSION: There is indirect evidence for the efficacy of GIT-PD. Good care on a broad scale needs both specific and generic forms of treatment, whereby the most relevant question becomes how clients can be optimally allocated to both forms of treatment.

[Time for cluster C personality disorders: state of the art]. / Tijd voor cluster C-persoonlijkheids-stoornissen: state of the art.

BACKGROUND: Compared to cluster B personality disorders, the assessment and treatment of people with obsessive-compulsive, dependent, and avoidant personality disorders (cluster C) is given little attention in the field of research and clinical practice. AIM: Presenting the current state of affairs in regard to cluster C personality disorders. METHOD: A systematic literature search was conducted using the main data bases. RESULTS: Cluster C personality disorders are present in approximately 3-9% of the general population. In about half of the cases of mood, anxiety, and eating disorders, there is co-morbid cluster C pathology. This has a major influence on the progression of symptoms, treatment effectiveness and potential relapse. There are barely any well conducted randomized studies on the treatment of cluster-C in existence. Open cohort studies, however, show strong, lasting treatment effects. CONCLUSION: Given the frequent occurrence of cluster C personality disorders, the burden of disease, associated societal costs and the prognostic implications in case of a co-morbid cluster C personality disorder, early detection and treatment of these disorders is warranted.

[Clinical staging and early intervention for borderline personality disorder]. / Klinische stadiëring en vroege interventie bij borderline-persoonlijkheidsstoornissen.

BACKGROUND: Within the accumulating evidence for a life span perspective on borderline personality disorder (BPD), the key factor is a developmental perspective.
AIM: To demonstrate that the lessons learnt from early intervention in somatic medicine and psychosis should be used to improve the diagnosis and treatment of BPD.
METHOD: We describe the rationale for early detection and intervention and present a staging model which can serve as a guideline for the development and selection of interventions for BPD.
RESULTS: There is increasing evidence that BPD first manifests itself in adolescence and that BPD symptoms can already be distinguished from normative adolescent development. BPD tends to develop gradually and to have a progressive, social and professional impact. Inadequate treatment can lead to iatrogenic damage, whereas adequate treatment shows promising results in adolescents with emerging BPD. These findings may underpin an early intervention paradigm for BPD.
CONCLUSION: Early intervention and clinical staging can improve the assessment and treatment of severe forms of psychopathology, such as BPD. This has implications for research, mental health care policy and society.

[The prevalence, burden, structure and treatment of personality disorders in adolescents]. / De prevalentie, ziektelast, structuur en behandeling van persoonlijkheidsstoornissen bij adolescenten.

BACKGROUND: Clinicians seem hesitant about diagnosing personality disorders in adolescents. Furthermore, little is known about the assessment and treatment of adolescents with personality disorders. AIM: To investigate the prevalence, burden, structure, and treatability of personality disorders in adolescents. method 257 adolescents, referred to De Viersprong (the Dutch national centre for personality disorders), were tested on different variables. 133 of them were admitted to the inpatient psychotherapy unit for adolescents and were followed for a period of one year after treatment. RESULTS: Personality disorders were frequently present in the referred adolescents. The burden of disease was high. The structure of the core components underlying personality pathology in adolescents was similar to the structure found in adults. Adolescents with a cluster C personality disorder profited most from the inpatient treatment. CONCLUSION: There appear to be more similarities than differences between personality disorders in adolescents and adults. It seems important to assess personality pathology in referred adolescents so that the most suitable treatment can be provided.

[Interacting with patients with a personality disorder: 10 tips]. / Bejegening van patiënten met een persoonlijkheidsstoornis: 10 tips.

Personality disorders have a high prevalence. The behaviour of patients with a personality disorder may make it difficult for doctors to maintain a professional attitude, which may lead to a breakdown in the therapeutic relationship. In order to prevent an imbalance in the therapeutic relationship, we describe in this paper 10 tips for interacting appropriately with patients with a personality disorder in general medical practice. We divide these into three domains. In the first domain we deal with the organisation of care, which should ideally be safe and predictable because unpredictability and unreliability can easily upset these patients. In the second domain recommendations on the attitude of the doctor are given: it should ideally be investigative and inviting but also involve boundaries. In the third domain we advise doctors to monitor the quality of the therapeutic relationship and to restore it if necessary.

Repeatability of lung density measurements with low-dose computed tomography in subjects with alpha-1-antitrypsin deficiency-associated emphysema.

RATIONALE AND OBJECTIVES: Multislice computed tomography (MSCT) of the lungs provides a new opportunity for longitudinal assessment of lung densities because of shorter scan duration. The aim of the present study was to assess the intraindividual variation of lung densities measured by MSCT of patients with emphysema. METHODS: Ten patients with emphysema participated in a study in which MSCT was obtained on two occasions, approximately 2 weeks apart. Scanning parameters were 140 kV, 20 mAs, 4 x 2.5-mm collimation, and effective slice thickness of 2.5 mm. Lung density was measured as the 15th percentile point and the relative area below -910 Hounsfield units (HU) by using Pulmo-LKEB software. RESULTS: The mean difference of the 15th percentile point was -1.29 +/- 3.2 HU, and that for the relative area below the -910-HU parameter was -1.02% +/- 3.09%. Intraclass coefficients of variation were 0.96 (0.86-0.99) and 0.94 (0.8-0.98), respectively (95% confidence interval). CONCLUSIONS: Lung density parameters of emphysema derived by MSCT provide an opportunity for analysis of the treatment effects of new drugs on the progression of emphysema.

[Moulds asthma]. / Asthme bronchique d'origine fongique.

Mould allergy revealed by skin prick tests or by measuring specific IgE (RAST), is frequently diagnosed throughout the world. It is associated to clinical asthma, sometimes severe. Thanks to the know how of teams of specialists, surveys are carried out in home-, work- and school environments, and calendars of moulds found in our country are regularly updated. This allows practitioners to determine specific sensitisation tests (selection of skin prick tests, and RAS tests), and helps them play a role in the diagnosis strategy and the recommendations for necessary eviction and building sanitation measures. These measures are all the more important as until now standardised extracts for specific hyposensitisation to moulds are not yet available.

[Detection of early stage bronchopulmonary cancer: contribution of bronchoscopy]. / Détection du cancer bronchopulmonaire au stade précoce: apport de la bronchoscopie.

Efficient methods for lung cancer screening is today an important challenge in research. Into this article, we review the available techniques for the detection of hilar located lung cancers, mainly squamous cell carcinoma. Fluorescence bronchoscopy is the latest major advance for lung cancer diagnosis.

Endobronchial ultrasound and positron emission tomography positive mediastinal lymph nodes.

Positron emission tomography with 18F-fluoro-2-deoxy-d-glucose (FDG-PET) is more accurate than computed tomography for staging of mediastinal (hilar) lymph nodes. In the case of positive findings, tissue sampling of lymph nodes is required. The diagnostic/staging yield of transbronchial needle aspiration (TBNA) following endobronchial ultrasound (EBUS) localisation was assessed in this particular clinical setting. The number of avoided surgical procedures was evaluated. All consecutive patients referred for staging and/or diagnosis of mediastinal FDG-PET positive lesions were included. Data were prospectively collected. TBNA sampling of lymph nodes was performed after EBUS localisation. If no diagnosis was reached, further surgical sampling or adequate follow-up was performed. From January 2003 to June 2004, 33 patients were included. The average number of TBNA samples per patient was 4.2+/-1.5. Cytological or histological diagnoses were obtained in 27 (82%) of the patients, of which 78% were obtained after previous EBUS localisation. In 25 (76%) of the 33 patients, surgical staging procedures were suppressed. In conclusion, transbronchial needle aspiration after endobronchial ultrasound localisation should be considered as a primary method of evaluation of lymph nodes positive by positron emission tomography with 18F-fluoro-2-deoxy-d-glucose, and may replace the majority of surgical mediastinal staging/diagnostic procedures.

Hemodynamic characteristics in chronic obstructive lung disease as related to cardiac size.

The hemodynamic adaptation during exercise was evaluated in 19 patients suffering from chronic obstructive lung disease. They were divided into two groups according to cardiac size on the X-ray (group 1, small; group 2, normal). A small cardio-thoracic ratio could be correlated with 'emphysema' assessed on the basis of hyperinflation and a low transfer test for CO. No clear-cut difference could be found between the two groups concerning the hemodynamic data at rest or during exercise. However, for all subjects, the cardiac output was found to be slightly related to the cardiac size (smaller cardiac output for smaller cardiac size). During exercise, a low cardiac output was characterized by a low oxygen transport and a high level of lactate. From this, it is suggested that a small cardiac size, a classical feature of hyperinflation and emphysema, may lead to a low cardiac output. The explanation for these results is speculative, but variable hemodynamic profiles in chronic obstructive lung disease with or without hyperinflation may be related to the morphology of the cardiac chambers and to variable intrathoracic pressure regimes during respiration.