[The revised version of the Y-BOCS: responsivity and other psychometric properties]. / De herziene versie van de Y-BOCS: responsiviteit en andere psychometrische eigenschappen.

BACKGROUND: The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is a widely used semi structured clinician-rated interview to assess the presence and severity of obsessive-compulsive disorder (OCD). The scale is revised (Y-BOCS-II) to overcome several psychometric limitations, for example by extending the scoring for better discrimination within higher severity levels. AIM: To examine the responsiveness and other psychometric properties of the Y-BOCS-II in a Dutch clinical sample. METHOD: The Y-BOCS-II was translated into Dutch (Y-BOCS-II) and administered to 110 patients seeking therapy for OCD. This was done twice, before and after treatment. The original Y-BOCS was simultaneously rated. Self-report measures regarding depression, symptom severity and OCD symptoms were assessed. RESULTS: The Y-BOCS-II had a good internal consistency (Cronbach’s α = 0.84), test-retest (ICC = 0.81) and inter-rater reliability (ICC = 0.94). The construct validity proved to be modest to good. The responsiveness over time was in favour of the Y-BOCS-II, compared with the YBOCS-I, particularly in the severely affected OCD patients. CONCLUSION: The Y-BOCS-II severity scale is a reliable and valid instrument for accurately assessing the severity of OCD symptoms and for measuring treatment-induced change. This second version also has clinical and psychometric advantages over the YBOCS-I. When these findings are sufficiently replicated, use of the YBOCS-II as the new common standard seems recommendable.

An evaluation of irreversible psychosurgical treatment of patients with obsessive-compulsive disorder in the Netherlands, 2001-2008.

Admissions for irreversible psychosurgical treatment of obsessive-compulsive disorder (OCD) by the Working Group for Indication Psychosurgery in the Netherlands were analyzed, and the postsurgical effects on symptom severity and quality of life were evaluated. The data were extracted from patient records in the period 2001-2008, and there was a postoperative assessment with a semistructured interview. Fourteen patients applied, having severe OCD with mostly one or more comorbid disorders. The mean Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was 32 points. Four of seven patients in whom psychosurgery was deemed useful were operated on. The decrease of the Y-BOCS score from registration to after surgery was 9 points (range, 3-17 points). An improvement in social function was present in three of four patients. In conclusion, psychosurgery can be a valuable treatment option for patients with severe OCD in whom other treatments fail.

[The characterisation of anxiety disorders: staging and profiling based on common sense]. / De karakterisering van angststoornissen: stageren en profileren met gezond verstand.

BACKGROUND: Clinicians need to be well informed about staging and profiling so that they can divide patients with anxiety disorders into groups according to the phase and severity of their illness. The group to which the patient is assigned determines the types of treatment he or she receives. AIM: To investigate ways in which clinicians can be helped to apply staging and profiling procedures to patients with anxiety disorders. METHOD: We searched the literature for articles about the staging and profiling of anxiety disorders. RESULTS: There seems to be practically no literature relating to the staging and profiling of anxiety disorders. However, in daily practice clinicians do attempt to classify their patients and use forms of staging when deciding on special types of treatment for their patients and when assessing the length of treatment required. The revised Dutch guidelines on anxiety disorders include a generalised form of staging, called 'stepped care’. These revisions have been made on the basis of consensus decisions reached by the guideline committee. CONCLUSION: The revised guidelines on anxiety disorders assist clinicians with the application of staging in their daily practice. However, because of the lack of scientific data, our article closes with the presentation of a research agenda.

[The course of borderline personality disorder within adults. A literature review]. / Beloop van de borderlinepersoonlijkheidsstoornis bij volwassenen; een literatuuronderzoek.

BACKGROUND: Borderline personality disorder (BPD) is a frequent and often severely debilitating disorder. According to the definition, a personality disorder is stable and of long duration. In the last few years, however, more and more research results have demonstrated improvements in patients with bpd and even remission. AIM: To investigate to what extent the diagnosis of bpd is stable over time. METHOD: The literature was reviewed systematically with the help of Medline, PsycINFO, EMBASE and the Cochrane Library. RESULTS: After 10 years 88% of adults originally diagnosed as having BPD failed to meet the DSM-IV criteria. Of the various symptoms the affective ones seemed to be the most stable and the impulsive ones the least stable. All symptoms were significantly less severe. With regard to psychosocial functioning, improvements occurred more slowly. Dysfunctioning in relationships was the most stable. It is not clear whether impairments in functioning will persist. CONCLUSION: In recent years there has been a considerable amount of prospective research into the stability of the diagnosis of BPD. Results show that the prognosis relating to symptom reduction and psychosocial functioning is much more favourable than previously assumed.

[Is the MiniScan a useful psychiatric intervention? A pilot study of the incremental validity of a computerised classification system]. / De MiniScan als psychiatrische interventie; pilotonderzoek naar de toegevoegde waarde van een gecomputeriseerd classificatiesysteem.

BACKGROUND: Psychiatric classification based on clinical judgement is not very reliable. Reliability can be increased by the use of standardised interviews. Maximum standardisation of the classification process can both improve reliability and affect treatment. AIM: To determine the effect that the use of a highly standardised and automated classification procedure (MiniScan) can have on the length of stay in hospital and on the course of symptoms. METHODS: Participants were allocated to a test group and a control group. The test group was classified via the MiniScan, the control group on the basis of clinical judgement. Length of hospital stay and symptom course were determined. RESULTS: The use of the MiniScan had no effect on the length of hospital stay, but seemed to play a role in symptom reduction. CONCLUSION: There are indications that the use of the MiniScan contributes to symptom reduction.

[Diagnosis of epilepsy complicated by panic disorder and a non-specific reaction to a SSRI]. / Diagnose epilepsie bemoeilijkt door paniekstoornis met aspecifieke reactie op SSRI.

Differentiating panic disorder form epilepsy can be a difficult task. In this case study the task was made more complicated because the patient was being treated with the selective serotonin reuptake inhibitor (SSRI) citalopram which evoked a partial response, thereby delaying the diagnosis of epilepsy. Research results demonstrate that ssris can have not only an antidepressive and calming effect, they can also have an anticonvulsant effect. However, there are also signs that, as this case illustrates, in the long term the anticonvulsant effect can actually convert to proconvulsant effect.

[Dopamine dysregulation syndrome in a patient with Parkinson's disease; a case report]. / De man die er geen genoeg van kreeg; dopaminedysregulatiesyndroom bij de ziekte van Parkinson.

Both Parkinson's disease and its treatment can be associated with psychiatric symptoms. We illustrate this link by focusing on a patient suffering from Parkinson's who received not only deep brain stimulation but also excessive amounts of dopaminergic drugs, a combination that resulted in hypomania which is also known as dopamine dysregulation syndrome. We discuss the symptoms, possible aetiological pathways and the implications for clinical practice.

[A new explanatory model for obsessive-compulsive disorder]. / Een nieuw verklaringsmodel voor de obsessieve-compulsieve stoornis.

BACKGROUND: Ever since the first descriptions of obsessive-compulsive disorder (ocd) there have been discussions about how the phenomenology of the disorder should be understood. Over the past 50 years the main emphasis has been on the phobic elements of ocd. A new psychological model, called the Inference Based Approach (iba), focuses on an underexposed aspect of the disorder, namely the strange convictions of the patient. AIM: To compare the new model with the existing cognitive behavioral theories of ocd. METHOD: Literature research was conducted using Medline. RESULTS: According to the iba it is assumed that patients with ocd feel anxious because their testing of reality is imperfect. Patients would not feel any anxiety if they were able to integrate adequately information obtained via their senses. In that case ocd would be a cognitive disorder, not an anxiety disorder. Although the model provides an attractive explanation for the symptoms of ocd and some of the research results seem to support the model, many questions still remain unanswered. CONCLUSION: There are indications that, at least in some ocd patients, anxiety might be only a part of the disorder rather than the core.

[The efficacy of electroconvulsive therapy in adolescents. A restrospective study]. / De effectiviteit van elektroconvulsietherapie bij adolescenten. Een retrospectief vergelijkend onderzoek.

BACKGROUND: Electroconvulsive therapy (ECT) is an effective treatment for depressive disorders in adults and the elderly. For adolescents however, ect is still a controversial treatment because little research has been done into the efficacy and side effects of ECT in adolescents and because psychiatrists working with children and adolescents are relatively unfamiliar with this form of treatment. AIM: To investigate the efficacy of ECT in adolescents who were treated in Meerkanten between 2000 and 2006 for a therapy-resistant depressive episode and/or suicidal behaviour. METHOD: Scores on the Hamilton Depression Rating Scale or the Montgomery-Asberg Depression Rating Scale before and after ECT were compared. The percentage improvement on the depression scales and the percentage of patients who showed an improvement of at least 60% on the scales in the group of adolescents were compared with the percentage improvement in a group of adults treated in Meerkanten. RESULTS: One-third of the adolescent patients showed an improvement of 60% or more on these scales; the average improvement was 46%. ECT was found to be equally effective in adolescents and adults. CONCLUSION: ECT is a successful form of treatment for one-third of adolescents with a severe therapy-resistant depressive episode; this is a clinically relevant result for these patients for whom no alternative treatments are available.

[Electroconvulsive therapy in depressed adolescents]. / Elektroconvulsietherapie bij depressieve adolescenten.

Two patients, young women aged 15 and 17, both suffering from major depression with psychotic features, were resistant to treatment with antidepressive regimen and psychotherapy. Both patients became severely suicidal and were subsequently successfully treated with electroconvulsive therapy (ECT). The second patient needed maintenance ECT once a month in order to stay in remission. Whereas ECT is a well-studied and accepted treatment option in adult psychiatry, in child psychiatry people are reluctant to even consider this option. This resistance is partly based on the possible side effects ofECT i.e. memory problems. As a result, the effect ofECT in adolescents has not yet been well studied. In 2004, the American Academy of Child and Adolescent Psychiatry proposed guidelines for the use of ECT in adolescents. Following these guidelines, the use ofECT in adolescents seems to be a safe treatment option, however further research to the effect of ECT in this age group is warranted.

d-cycloserine addition to exposure sessions in the treatment of patients with obsessive-compulsive disorder.

BACKGROUND: Preliminary studies have shown that the addition of the partial NMDA-agonist d-cycloserine (DCS) might be promising in enhancing the results of exposure therapy in obsessive-compulsive disorder (OCD). We examined the effect of DCS addition to exposure therapy in a somewhat larger sample of OCD patients with special attention to subgroups, because of the heterogeneity of OCD. METHODS: A randomized, double-blind, placebo controlled trial was conducted in 39 patients with OCD. Patients received 6 guided exposure sessions, once a week. One hour before each session 125mg DCS or placebo was administered. RESULTS: Scores on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) declined more in the DCS group than in the placebo group, but the difference did not reach statistical significance (P=0.076, partial η2=0.13). Response percentages also did not differ between the DCS and the placebo group (37% and 15% respectively). In the 'cleaning/contamination' subgroup a significant effect was found in favour of DCS (P=0.033, partial η2=0.297). CONCLUSIONS: The results of this study did not support the application of DCS to exposure therapy in OCD. Some specific aspects need further investigation: efficacy of DCS in a larger 'cleaning/contamination' (sub-)group, DCS addition only after successful sessions, interaction with antidepressants.