[Experiential acceptance in the treatment of complex somatic symptom disorder]. / Ervaringsgerichte acceptatie bij de behandeling van complexe somatisch-symptoomstoornis.

BACKGROUND: Acceptance and Commitment Therapy (ACT) plays an important role in the treatment of patients with refractory Somatic Symptom Disorder and related disorders with complex problems and/or somatic or psychiatric comorbidity (complex SSD). AIM: To gain insight into the possible role of (experiential) acceptance in improved quality of life during and after treatment. METHOD: Observational longitudinal study in 41 patients with complex SSD treated at Altrecht Psychosomatic Medicine Eikenboom. They completed online questionnaires around the start and completion of treatment and after six months of follow-up. Assessed were experiential acceptance (AAQ-II-NL) and three aspects of quality of life (RAND-36: mental health, physical functioning, general health perception). The associations between changes in acceptance and quality of life were determined. RESULTS: Acceptance increased significantly from treatment initiation to follow-up. Mental health increased significantly between start and end of treatment, and general health perception increased significantly in the follow-up period. Physical functioning did not change. During treatment, an increase in acceptance was significantly associated with improvement in mental health and general health perception; during follow-up, an increase in acceptance was associated with an improvement in mental health. CONCLUSION: The current study demonstrates that an increase in experiential acceptance goes hand in hand with an improvement in mental health and general health perception. These results indicate the potential importance of acceptance-based treatment in patients with complex SSD. Experimental research with more frequent measurements is needed to test a temporal relationship between (first) increased acceptance and (then) improved quality of life.

[Hardnekkige aanhoudende lichamelijke klachten in de huisartsenpraktijk]. / Hardnekkige aanhoudende lichamelijke klachten in de huisartsenpraktijk.

BACKGROUND: In the care of patients with persevering (‘treatment-resistant’) persistant physical symptoms (PPS), problems are common. With this study, we want to identify starting points for improvement of care, including suggestions for the role of mental health care. AIM: Using the profile for persevering PPS we will estimate the prevalence, describe characteristics of this patient group and map problems encountered in their care. METHOD: Online survey in general practitioners (GPs). RESULTS: The response rate to the survey was 12.8%. The mean estimated prevalence of persevering PPS in general practice was 0.7% (corresponding to an estimated 122,500 patients throughout the Netherlands). Many patients encountered iatrogenic harm, experience societal problems and limitations in mobility and ADL independence. Although there was a general increased use of health care in these patients, some also avoided care or were under-treated. In the persistence of symptoms, patient-related factors played a role (like insisting on further somatic diagnostic tests, lack of motivation for PPS-specific treatment), but health-care related factors, like rejection for care or a lack of regional treatment options for patients with PPS, also had a causal role. CONCLUSION: Almost every GP experiences problems in the care for patients with persevering PPS. Mental health care professionals can support the GP better, by optimizing options for consultation and referral.

[Body-oriented mentalization based therapy in severe somatic symptom disorder]. / Lichaamsgerichte mentalisatiebevorderende therapie bij patiënten met een somatisch-symptoomstoornis.

BACKGROUND: Body-oriented mentalization based therapy (L-MBT) is used in specialist mental health care for the treatment of patients with somatic symptom disorder or functional neurological disorder. L-MBT focuses on increasing awareness of bodily sensations and integrating them with psychological functions such as thinking, feeling or remembering. The goal of L-MBT is that patients with somatic symptom disorders learn to mentalize their body signals and the associated inner experiences. There are favorable experiences in clinical practice, but to date the mechanism of change and the effectiveness of treatment with L-MBT has not yet been sufficiently scientifically demonstrated. AIM: To investigate whether patients with severe somatic symptom disorders improve their body awareness and mentalizing capacity during an intensive treatment program based on L-MBT. METHOD: Body awareness and mentalizing capacity were assessed in patients following intensive treatment at Altrecht Psychosomatics Eikenboom, a highly specialized treatment center for adults with a severe somatic symptom disorder or functional neurological disorder Patients’ body awareness was assessed with the Multidimensional Assessment of Interoceptive Awareness (MAIA-2), mentalizing capacity with the Mentalization Questionnaire (MZQ). Questionnaires were filled in at the start, halfway and at the end of treatment. RESULTS: Both body awareness and mentalizing ability improved significantly during the intensive L-MBT-based treatment with generally a large effect size. CONCLUSION: During an intensive treatment program based on L-MBT, there is an increase in body awareness and mentalizing capacity in patients diagnosed with a severe somatic symptom disorder.

Diagnostic accuracy of the Dutch version of the Somatic Symptom Disorder - B Criteria Scale (SSD-12) compared to the Whiteley Index (WI) and PHQ-15 in a clinical population.

OBJECTIVE: Somatic Symptom and Related Disorders(SSRD) are characterised by an intense focus on somatic symptoms that causes significant distress. A self-report scale developed to assess distress as symptom-related thoughts, feelings, and behaviors (SSD-12) has proved to be a reliable, valid and time-efficient measure for Somatic Symptom Disorder(SSD). This cross-sectional study aimed to compare the SSD-12 with psychiatric assessment as gold standard in a Dutch clinical population for SSRD compared to other widely used measures. METHODS: Data were collected from adult patients visiting a specialised mental health outpatient clinic for SSRD in the Netherlands, between 2015 and 2017. Analyses included item evaluation, scale reliability, construct validity, diagnostic utility and cut points. Performance of SSD-12, Whiteley Index(WI) and PHQ-15 were compared in Receiver operating characteristics (ROC) curves. RESULTS: 223 patients with SSD, Functional Neurological Disorder, Illness Anxiety(IA) and no SSRD participated. SSD-12 items were normally distributed; total scores correlated with measures of health anxiety, anxiety and depression. The optimal cut point for the SSD-12 was 22 (sensitivity 75.9%, specificity 63.6%). The ROC area under the curve for SSD-12 was 0.75 compared to 0.68 for the WI and 0.65 for the PHQ-15. Combinations of those questionnaires did not yield better results than for the SSD-12 alone. CONCLUSION: The SSD-12 alone outperformed the WI and PHQ-15 and combined scales in effectively distinguishing SSRDs from other mental disorders. This may suggest that distress is a more accurate indicator of SSRD than earlier diagnostic criteria as operationalised in the WI and PHQ-15.

[Patient-tailored approach in tertiary care expert centres using individual dynamic network analysis]. / Maatwerk in hoogspecialistische ggz met individuele dynamische netwerkanalyse.

BACKGROUND: Patients with mental health disorders often have difficulty perceiving associations between multiple symptoms, such as inter-relations between somatic and psychological symptoms. This difficulty may be particularly challenging in patients with complex disorders. Individual dynamic network analysis may provide novel diagnostic and treatment possibilities because it can create a starting point for a personalized approach in complex cases in tertiary mental health care expert centres, where standard protocolized interventions were insufficiently effective. AIM: To explore the possibilities provided by dynamic network technologies in the care of patients in tertiary care expert centres. METHOD: Overview of these possibilities, with a focus on somatic symptom disorder. RESULTS: Intensive longitudinal data can be obtained using a short and personalized questionnaire that is presented via a patient's smartphone a few times per day during several weeks. These data are then converted to patient-specific dynamic symptom networks using time series analysis. These networks display how variations over time in somatic and mental symptoms and other factors (such as specific situations) mutually influence each other in daily life. They also provide information about cause-effect associations. CONCLUSION: Dynamic symptom networks provide insight into the associations between symptoms and other factors and can be used to personalize treatment goals and interventions in tertiary care expert centres. Furthermore, these networks create opportunities to examine the (patient-tailored) effects of personalized interventions.

An early prediction of delirium in the acute phase after stroke.

BACKGROUND: We developed and validated a risk score to predict delirium after stroke which was derived from our prospective cohort study where several risk factors were identified. METHODS: Using the ß coefficients from the logistic regression model, we allocated a score to values of the risk factors. In the first model, stroke severity, stroke subtype, infection, stroke localisation, pre-existent cognitive decline and age were included. The second model included age, stroke severity, stroke subtype and infection. A third model only included age and stroke severity. The risk score was validated in an independent dataset. RESULTS: The area under the curve (AUC) of the first model was 0.85 (sensitivity 86%, specificity 74%). In the second model, the AUC was 0.84 (sensitivity 80%, specificity 75%). The third model had an AUC of 0.80 (sensitivity 79%, specificity 73%). In the validation set, model 1 had an AUC of 0.83 (sensitivity 78%, specificity 77%). The second had an AUC of 0.83 (sensitivity 76%, specificity 81%). The third model gave an AUC of 0.82 (sensitivity of 73%, specificity 75%). We conclude that model 2 is easy to use in clinical practice and slightly better than model 3 and, therefore, was used to create risk tables to use as a tool in clinical practice. CONCLUSIONS: A model including age, stroke severity, stroke subtype and infection can be used to identify patients who have a high risk to develop delirium in the early phase of stroke.