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1.
Lupus ; 22(13): 1371-81, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24158973

RESUMO

OBJECTIVE: The objective of this paper is to determine whether patients with systemic lupus erythematosus (SLE) and mixed connective tissue disease (MCTD) possess differential IgM- and IgG-specific reactivity against peptides from the U1 small nuclear ribonucleoprotein particle (U1 snRNP). METHODS: The IgM- and IgG-mediated responses against 15 peptides from subunits of the U1 snRNP were assessed by indirect enzyme linked immunosorbent assays (ELISAs) in sera from patients with SLE and MCTD and healthy individuals (n = 81, 41, and 31, respectively). Additionally, 42 laboratory tests and 40 clinical symptoms were evaluated to uncover potential differences. Binomial logistic regression analyses (BLR) were performed to construct models to support the independent nature of SLE and MCTD. Receiver operating characteristic (ROC) curves corroborated the classification power of the models. RESULTS: We analyzed IgM and IgG anti-U1 snRNP titers to classify SLE and MCTD patients. IgG anti-U1 snRNP reactivity segregates SLE and MCTD from nondisease controls with an accuracy of 94.1% while IgM-specific anti-U1 snRNP responses distinguish SLE from MCTD patients with an accuracy of 71.3%. Comparison of the IgG and IgM anti-U1 snRNP approach with clinical tests used for diagnosing SLE and MCTD revealed that our method is the best classification tool of those analyzed (p ≤ 0.0001). CONCLUSIONS: Our IgM anti-U1 snRNP system along with lab tests and symptoms provide additional molecular and clinical evidence to support the hypothesis that SLE and MCTD may be distinct syndromes.


Assuntos
Autoanticorpos/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Lúpus Eritematoso Sistêmico/imunologia , Doença Mista do Tecido Conjuntivo/imunologia , Ribonucleoproteína Nuclear Pequena U1/imunologia , Área Sob a Curva , Autoanticorpos/classificação , Autoimunidade , Biomarcadores/sangue , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Humanos , Imunoglobulina G/classificação , Imunoglobulina M/classificação , Modelos Logísticos , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/diagnóstico , Doença Mista do Tecido Conjuntivo/sangue , Doença Mista do Tecido Conjuntivo/diagnóstico , Valor Preditivo dos Testes , Curva ROC
2.
Acta Psychiatr Scand ; 122(3): 246-54, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20136801

RESUMO

OBJECTIVE: In a previous paper, we reported about the efficacy of the addition of lamotrigine to lithium in patients with bipolar depression. In the second phase of this study paroxetine was added to ongoing treatment in non-responders. METHOD: Bipolar depressed patients (n = 124) treated with lithium were randomized to addition of lamotrigine or placebo. In non-responders after 8 weeks, paroxetine 20 mg was added for another 8 weeks to ongoing treatment. RESULTS: After 8 weeks the improvement in patients treated with lamotrigine vs. patients treated with placebo was significant. After addition of paroxetine this difference disappeared as a result of greater further improvement in the non-responders to placebo. CONCLUSION: Addition of lamotrigine to lithium was found effective in bipolar depressed patients. Further addition of paroxetine in non-responders to lithium plus lamotrigine did not appear to provide additional benefit, while it appeared to do so in non-responders to lithium plus placebo.


Assuntos
Algoritmos , Anticonvulsivantes/uso terapêutico , Antimaníacos/uso terapêutico , Carbonato de Lítio/uso terapêutico , Paroxetina/uso terapêutico , Triazinas/uso terapêutico , Adulto , Anticonvulsivantes/efeitos adversos , Antidepressivos de Segunda Geração , Antimaníacos/efeitos adversos , Esquema de Medicação , Quimioterapia Combinada , Feminino , Humanos , Lamotrigina , Carbonato de Lítio/efeitos adversos , Masculino , Pessoa de Meia-Idade , Países Baixos , Paroxetina/efeitos adversos , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Psicometria , Triazinas/efeitos adversos
3.
Tijdschr Psychiatr ; 51(10): 727-36, 2009.
Artigo em Holandês | MEDLINE | ID: mdl-19821240

RESUMO

BACKGROUND: Chronic depression is a common disorder in secondary care. Treatment results for this group of depressed patients are often disappointing and the existing treatment protocols are insufficiently tailored to chronic MDD. For this reason, an effective psychotherapeutic treatment will constitute a welcome addition to the range of treatments currently available for chronically depressed patients. AIM: To describe 'cognitive behavioral analysis system of psychotherapy' (CBASP), the first form of psychotherapy specifically designed for the treatment of chronic depression. METHOD: This article describes the evidence, rational and the most important techniques of CBASP. RESULTS: In the United States CBASP has proven to be effective in one trial. As a result of these findings, CBASP is recommended in the Dutch treatment guidelines as an evidence-based treatment option for chronic depression. However, the findings have not yet been replicated and little is known about possible ways of implementing CBASP in the Netherlands. For this reason a randomised controlled trial on the effectiveness of CBASP has started in three psychiatric hospitals in the Netherlands. CONCLUSION: CBASP is recommended as a treatment option for chronic depression in the Dutch treatment guidelines, but evidence should be further supported by additional research.


Assuntos
Terapia Cognitivo-Comportamental , Transtorno Depressivo/terapia , Guias de Prática Clínica como Assunto , Doença Crônica , Transtorno Depressivo Maior/terapia , Medicina Baseada em Evidências , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
4.
Tijdschr Psychiatr ; 48(12): 921-5, 2006.
Artigo em Holandês | MEDLINE | ID: mdl-17171604

RESUMO

The multidisciplinary guideline for the treatment of depression has come to be regarded as an important summary of the currently available information about the treatment of depression. We are critical of several of the views expressed in this guideline--first of all, the guideline opts for the selective uptake inhibitors fluvoxamine, paroxetine and sertraline rather than for citalopram, and secondly, the guideline rates antidepressants more highly than psychotherapy or a combination of antidepressants and psychotherapy. There is a lack of cohesion between the various aspects of treatment and little attention is given to the problems of treating depression in everyday practice. In our view this restricts the applicability of the guideline.


Assuntos
Antidepressivos/uso terapêutico , Depressão/tratamento farmacológico , Depressão/terapia , Guias de Prática Clínica como Assunto , Psicoterapia , Terapia Combinada , Humanos , Psicoterapia/métodos
5.
J Affect Disord ; 70(1): 95-9, 2002 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12113925

RESUMO

BACKGROUND: Certain personality characteristics may change during depression, reflecting temporary states, while others remain stable. This study investigates the stability of personality during depression. Identification of depression-sensitive personality traits may help to elucidate the mechanisms that influence course and outcome of depression. METHODS: For 42 ambulatory and 38 day care patients with a depressive disorder, depression severity and personality characteristics were measured repeatedly during a 12 week-period. The total HDRS score was indicative of depression severity, while the NEO-FFI was used for measurement of basic personality traits and the IPS for depression-specific traits. RESULTS: In 12 weeks, depression severity significantly decreased for both patient groups. The Big Five traits Neuroticism and Extraversion and all but one aspect of Interpersonal sensitivity showed depression-related changes towards the normal range. Openness, Altruism and Conscientiousness remained stable. LIMITATIONS: The number of patients excluded from the study due to missing data is substantial. Furthermore, it was not possible to control for treatment influence due to a double-blind design. CONCLUSIONS: Neuroticism, Extraversion and Interpersonal sensitivity scores are likely to reflect state components during a depression, while the stability of Openness, Conscientiousness and Altruism scores indicates pure personality traits.


Assuntos
Transtorno Depressivo/psicologia , Determinação da Personalidade , Adulto , Feminino , Humanos , Masculino , Personalidade
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