Course of auditory vocal hallucinations in childhood: 11-year follow-up study.

OBJECTIVE: Childhood auditory vocal hallucinations (AVH) are mostly transient but may predict clinical outcomes. Little is known about their course over time and associations with risk factors, and how this may inform early intervention. Our objective was to assess the 11-year course of AVH, associated psychopathology and risk factors. METHOD: A 5-year (T1) and 11-year (T2) follow-up of a baseline case-control sample (n = 694, of whom 347 with AVH). At T2, online assessment of AVH, other psychotic experiences, psychopathology, trauma and cannabis use was completed by 293 adolescents aged 18-19 years. RESULTS: The AVH 6-year (T1-T2) persistence rate was 18.2%, and the AVH 11-year (T0-T2) persistence rate was 6.2%. AVH at T2 were associated with higher levels of T2 other psychotic experiences, T2 psychopathology and T2 traumatic events, but not with T2 stress or T2 cannabis use. Persistence of AVH (i.e. AVH reported two or three times from T0) was associated with T2 traumatic events and higher risk for post-traumatic stress disorder. CONCLUSION: Auditory vocal hallucinations in early childhood are mostly transitory. AVH in adolescence, especially when persistent, are associated with affective symptoms and environmental risk, particularly traumatic events.

Auditory hallucinations in childhood: associations with adversity and delusional ideation.

BACKGROUND: Previous work suggests that exposure to childhood adversity is associated with the combination of delusions and hallucinations. In the present study, associations between (severity of) auditory vocal hallucinations (AVH) and (i) social adversity [traumatic experiences (TE) and stressful events (SE)] and (ii) delusional ideation were examined. METHOD: A baseline case-control sample of children with and without AVH were re-assessed on AVH after 5 years and interviewed about the experience of social adversity and delusions. RESULTS: A total of 337 children (mean age 13.1 years, S.D.=0.5) were assessed: 40 children continued to hear voices that were present at baseline (24%, persistent group), 15 heard voices only at follow-up (9%, incident group), 130 children no longer reported AVH that were present at baseline (remitted group) and 152 never heard voices (referent group). Both TE and SE were associated with both incident and persistent AVH, as well as with greater AVH severity and delusional ideation at follow-up. In addition, the combination of AVH and delusions displayed a stronger association with TE and SE compared with either AVH or delusions alone. CONCLUSIONS: Early childhood AVH are mostly benign and transitory. However, experience of social adversity is associated with persistence, severity and onset of new AVH closer to puberty, and with delusional ideation.

Positive and useful auditory vocal hallucinations: prevalence, characteristics, attributions, and implications for treatment.

OBJECTIVE: Auditory hallucinations that are viewed by patients as positive and useful may be barriers to treatment-seeking. The aim was to assess prevalence, impact, and course of, and attributions to, these voices in psychotic and non-psychotic patients. METHOD: One hundred thirty-one patients of a Voices Clinic and 65 members of the Dutch Resonance Foundation were assessed with the Positive and Useful Voices Inquiry. Data were analyzed using Pearson's chi-square, one-way anova, and Crohnbach's alpha statistics. RESULTS: First voices are most often reported as negative. Positive voices occur more among non-psychotic subjects, but the specific characteristics and diagnosis are not significantly associated. Lifetime prevalence of positive and useful voices ranged between 40% and 60%, with varied prevalence rates over time. Positive voices are experienced by subjects as direct addresses in the third person. Perceived control of voices is significantly associated with the wish to preserve them. Attribution of protective power to positive voices has the strongest association with positive experience. CONCLUSION: Many patients express a desire to preserve these voices. Voice characteristics do not allow for validly discriminating psychotic from non-psychotic disorders.

[Positive and negative auditory vocal hallucinations]. / Positieve en nuttige auditieve vocale hallucinaties.

BACKGROUND: Modern psychiatry emphasises the negative aspects of hearing voices. However, experience shows that some patients find these voices positive or useful. AIM: To describe the life-time prevalence of hearing voices in a group of patients and the course of this phenomenon and to find out whether these patients find the hearing of voices positive and/or useful. METHOD: The study population consisted of patients and former patients of the Voices Outpatient Department of the Groningen University Medical Centre. For this study the Positive and Useful Voices Inquiry, a self-report questionnaire was developed. RESULTS: The life-time prevalence of positive voices was 52%, whereas the life-time prevalence of useful voices was 40%. In the majority of patients the number of positive voices decreased and the number of useful remained the same. Positive voices provided protection, reassurance or companionship. Useful voices gave advice, assist with daily activities or decision-making. Thirty two percent of the patients wished to continue hearing positive voices, 40% wished to continue hearing useful voices. These wishes were correlated to patients feeling that they have control over these voices. CONCLUSION: The prevalence of positive and useful voices is quite considerable and is therefore therapeutically relevant. A substantial proportion of the patients wishes to continue hearing these types of voices.

Non-verbal behavioral interactions of depressed patients with partners and strangers: the role of behavioral social support and involvement in depression persistence.

Excessive support seeking and lack of receiving social support have been associated with depression onset and unfavorable course of depression. It has been assumed that social support is effected by observable behaviors that express involvement. Twenty-five patients with major depression were studied during a social interaction with their partner and a similar interaction, with a stranger, matched on the sex and age of the partner. We anticipated that (1) partners would display less involvement behaviors to the depressed patients than would strangers and that (2) lack of involvement would predict an unfavorable course of depression, as assessed for depression remission within 6 months of admission. The social interactions, conducted at admission, were videotaped and the behaviors were assessed by ethological methods. The frequency and duration of behavioral elements were associated on the basis of statistical criteria into behavioral factors. Certain factors were supposed to express (lack of) involvement during an interaction. In the patient-partner interaction it was found that both participants displayed lower levels of involvement as compared to the patient-stranger interaction. The patients' low involvement was reflected by less Speech, less Eagerness (yes-nodding and no-shaking), less Speaking Effort (head movements, looking and gesturing during speech) and more Active Listening (intense touching of one's own body and head movements during listening). The partners' low involvement was also expressed by less Speech and more Active Listening, together with less Encouragement (yes-nodding and 'um-hum'-ing during listening). In addition, the partners displayed less Speech to patients who did not remit within 6 months, whereas patients and strangers behaviors were not related to depression remission. These findings supported our anticipations and the findings are related back to data on social support, involvement and to previous human ethological studies on depression.

Effects on depression pharmacotherapy of a Dutch general practitioner training program.

BACKGROUND: General practitioners' (GPs) ability to recognize, diagnose and treat depression improved significantly after a comprehensive, 20-h training programme. This study aims to evaluate in more detail the effects of the training on GPs' pharmacotherapy of depression and related issues. METHODS: A pretest-posttest design was used. Both in the pre- and post-training phase, a sample was drawn from consecutive patients of the 17 participating GPs. In the pre-training phase we identified a sample of 31 cases with an ICD-10 depression who received an antidepressant from their GP. The sample was followed for 1 year. Outcome measures were: type of antidepressant, dosage, duration and number of target instructions given by the GP. Then we trained the GPs. In the post-training phase, we identified a new sample (n = 47) from their practices and measured the same outcomes. RESULTS: Improvements were seen in choice for modern antidepressant, adequate dosage, adequate duration, and number of target instructions given. LIMITATIONS: Observed changes can be due to a period effect, inherent in a pre-post design. CONCLUSIONS: A post-academic hands-on training of GPs can improve depression pharmacotherapy according to clinical guidelines with respect to choice of a modern antidepressant, adequate dosage, adequate duration and psychoeducation.

Training primary care physicians improves the management of depression.

The purpose of this pretest-posttest study was to evaluate effects of a training program designed to improve primary care physicians' (PCPs) ability to recognize mental health problems (MHP) and to diagnose and manage depression according to clinical guidelines. The primary care settings were in the northern part of The Netherlands. There were eight intensive, hands-on training sessions of 2.5 hours, each of which three were targeting depression (7.5 hours). In the pretraining phase we screened 1778 consecutive patients of 17 PCPs with the 12-item General Health Questionnaire (GHQ-12) and interviewed a stratified sample of 518 patients about presence of current depression with the Primary Health Care version of the Composite International Diagnostic Interview (CIDI-PHC). PCPs registered patient's mental health (status, severity, diagnosis) and treatment prescribed. Then we trained the PCPs. In the posttraining phase, we screened a new group of 1724 consecutive patients of the same PCPs and a new stratified sample of 498 patients went through the same interview and rating procedures as patients in the pretraining phase. Knowledge about depression was assessed pre- and posttraining. PCPs' knowledge of depression improved significantly. Recognition of MHP and accuracy of depression diagnosis improved, but was not statistically significant. The proportion of patients receiving treatment according to the clinical guidelines increased significantly. It was observed that training PCPs improves the management of depression.

Nonverbal interpersonal sensitivity and persistence of depression: perception of emotions in schematic faces.

Deficits in the decoding of facial emotional expressions may play a role in the persistence of depression. In a prospective longitudinal study, 33 depressed outpatients (30 major depression, 2 dysthymia, and 1 cyclothymic disorder) judged schematic faces with respect to the emotions they expressed (fear, happiness, anger, sadness, disgust, surprise, rejection, and invitation) at admission (T0) and again 6 and 30 weeks later. Severity of depression (BDI) was assessed at these three times. Those patients who perceived less sadness, rejection, or anger in faces at T0 were less likely to show a favorable course of depression after 6 weeks (sadness, anger) or after 30 weeks (sadness, rejection, anger). These relationships could not be ascribed to initial levels of depression, age, or gender. The perception of sadness and rejection did not change over time, and therefore may have trait-like qualities. Depression appears to be more persistent in the subgroup that is hyposensitive to (negative) facial signals.

[Improved recognition and treatment of depression with occasional faster recovery through postgraduate training of family practitioners]. / Betere herkenning en behandeling van depressie en soms sneller herstel na nascholing van huisartsen.

OBJECTIVE: To examine to what extent postgraduate training of general practitioners (GPs) with the Intervention Study Primary Care (INSTEL) programme improved detection, diagnosis, and treatment of depression, and whether the course of depression was influenced favourably. DESIGN: Prospective, comparative. SETTING: Academic Hospital Groningen, discipline group Psychiatry and General Practice, Groningen, the Netherlands. METHOD: General practitioners active in ten practices in Groningen and surrounds were trained in recognition and treatment of depression. The first group consisted of ten GPs who had not participated in psychiatrically oriented research before, the second group of seven GPs who had participated in such research. Both before and after the training, a group of patients aged 18-65 years visiting these GPs' office hours were examined by the investigators for presence of depression with the aid of questionnaires. The GPs recorded of each patient whether or not they found him/her depressed, and they mentioned the treatment. The researchers assessed the outcomes of depressed patients shortly after the index consultation and at 3 and 12-month follow-up. RESULTS: Before the training a questionnaire was completed by 1778 patients, of whom 179 were depressed; after the training a questionnaire was completed by 1724 patients, of whom 155 were depressed. Detection and diagnosis of depression improved in the first group of GPs, but not in the second group. Treatment improved for patients in both groups. In terms of symptoms, illness duration, daily functioning, and absence from work patients recovered slightly faster from their depression after the training, although the effects were weak, not always statistically significant (p < 0.05), and mostly limited to the subgroup of recognized depressions with a recent onset. At the 12-month follow-up the pre-post differences were not statistically significant. CONCLUSION: The postgraduate training with the INSTEL programme appears to be an effective intervention that improves treatment and somewhat speeds up recovery in recent onset cases.

Comparison of the Q-fever complement fixation test and two commercial enzyme-linked immunosorbent assays for the detection of serum antibodies against Coxiella burnetti (Q-fever) in ruminants : recommendations for use of serological tests on imported animals in New Zealand.

AIM: To make valid recommendations on the use of serological test methods for the detection of serum antibodies in ruminants against Coxiella burnetii (Q-fever), by comparing the performance of the complement fixation test (CFT) and two ELISA, and by identifying reasons for discrepancies between the test methods. METHODS: A total of 73 serum samples from infected cattle, 69 from infected goats, and 100 samples from non-infected cattle and 57 samples from non-infected sheep, as well as 95 samples from infected cattle herds (mix of seropositive and seronegative samples), were tested using the CFT, the IDEXX ELISA (I-ELISA) and the Pourquier ELISA (P-ELISA). A mixed panel of 12 serum samples from sheep from inter-laboratory proficiency testing (proficiency panel) was also tested using the CFT and both ELISA, and further investigated using IgG- and IgM-specific ELISA. RESULTS: Generally, the two commercial ELISA were more sensitive than the CFT for the detection of infected ruminants. Good agreement between ELISA for positive and negative results was found for samples from the infected herd, while results for the positive panels varied between the two ELISA. For the total of the positive serum panels, the I-ELISA detected 95% of samples as positive or suspicious, while the P-ELISA detected only 81%. In the P-ELISA, more samples were considered suspicious (18%) than in the I-ELISA (14%). All sera from non-infected sheep and cattle tested negative in the serological test methods employed, except for one positive sample from a sheep in the P-ELISA. Further investigation revealed that a CFT-positive but ELISA-negative result was due to high IgM and low IgG reactivity. CONCLUSIONS: The two commercial ELISA were more sensitive than the CFT in all panels from infected ruminants. However, they could only detect IgG. The I-ELISA should be the serological test method of choice for cattle, sheep and goats for import testing of animals into New Zealand because it was more sensitive than the P-ELISA and was equally specific to the PELISA and the CFT. For other animal species, such as deer and camelids, the CFT should still be used since none of the ELISA has been evaluated for these species. This study has shown that the two commercial ELISA will detect the majority of infected ruminants but may miss animals that have not developed an IgG response.

Multi-family treatment for patients with persistent auditory hallucinations and their relatives: a pilot study.

OBJECTIVE: To test feasibility and effectiveness of multi-family treatment (MFT) for patients with persistent auditory hallucinations. METHOD: A naturalistic pilot study with 6-month follow-up of 12 patients and 10 relatives. Pre- and post-treatment assessment concerned compliance, satisfaction, subjective burden, and control of voices, psychopathology, quality of life, social functioning and burden on the family. RESULTS: Significant improvements were found in all domains. Compliance and satisfaction with treatment were satisfactory. Self-help contacts outside treatment sessions increased over time. CONCLUSION: MFT may be considered a potentially effective form of additional treatment for refractory voice hearers.