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Item does not contain fulltext, In recent years, network approaches to psychopathology have sparked much debate and have had a significant impact on how mental disorders are perceived in the field of clinical psychology. However, there are many important challenges in moving from theory to empirical research and clinical practice and vice versa. Therefore, in this article, we bring together different points of view on psychological networks by methodologists and clinicians to give a critical overview on these challenges, and to present an agenda for addressing these challenges. In contrast to previous reviews, we especially focus on methodological issues related to temporal networks. This includes topics such as selecting and assessing the quality of the nodes in the network, distinguishing between- and within-person effects in networks, relating items that are measured at different time scales, and dealing with changes in network structures. These issues are not only important for researchers using network models on empirical data, but also for clinicians, who are increasingly likely to encounter (person-specific) networks in the consulting room.

Contains fulltext : 249813.pdf (Publisher’s version ) (Open Access), In recent years, network approaches to psychopathology have sparked much debate and have had a significant impact on how mental disorders are perceived in the field of clinical psychology. However, there are many important challenges in moving from theory to empirical research and clinical practice and vice versa. Therefore, in this article, we bring together different points of view on psychological networks by methodologists and clinicians to give a critical overview on these challenges, and to present an agenda for addressing these challenges. In contrast to previous reviews, we especially focus on methodological issues related to temporal networks. This includes topics such as selecting and assessing the quality of the nodes in the network, distinguishing between- and within-person effects in networks, relating items that are measured at different time scales, and dealing with changes in network structures. These issues are not only important for researchers using network models on empirical data, but also for clinicians, who are increasingly likely to encounter (person-specific) networks in the consulting room.

Contains fulltext : 249813.pdf (Publisher’s version ) (Open Access), In recent years, network approaches to psychopathology have sparked much debate and have had a significant impact on how mental disorders are perceived in the field of clinical psychology. However, there are many important challenges in moving from theory to empirical research and clinical practice and vice versa. Therefore, in this article, we bring together different points of view on psychological networks by methodologists and clinicians to give a critical overview on these challenges, and to present an agenda for addressing these challenges. In contrast to previous reviews, we especially focus on methodological issues related to temporal networks. This includes topics such as selecting and assessing the quality of the nodes in the network, distinguishing between- and within-person effects in networks, relating items that are measured at different time scales, and dealing with changes in network structures. These issues are not only important for researchers using network models on empirical data, but also for clinicians, who are increasingly likely to encounter (person-specific) networks in the consulting room.

Leading biological hypotheses propose that biological changes may underlie major depressive disorder onset and relapse/recurrence. Here, we investigate if there is prospective evidence for biomarkers derived from leading theories. We focus on neuroimaging, gastrointestinal factors, immunology, neurotrophic factors, neurotransmitters, hormones, and oxidative stress. Searches were performed in Pubmed, Embase and PsychInfo for articles published up to 06/2019. References and citations of included articles were screened to identify additional articles. Inclusion criteria were having an MDD diagnosis as outcome, a biomarker as predictor, and prospective design search terms were formulated accordingly. PRISMA guidelines were applied. Meta-analyses were performed using a random effect model when three or more comparable studies were identified, using a random effect model. Our search resulted in 67,464 articles, of which 75 prospective articles were identified on: Neuroimaging (N = 24), Gastrointestinal factors (N = 1), Immunology (N = 8), Neurotrophic (N = 2), Neurotransmitters (N = 1), Hormones (N = 39), Oxidative stress (N = 1). Meta-analyses on brain volumes and immunology markers were not significant. Only cortisol (N = 19, OR = 1.294, p = 0.024) showed a predictive effect on onset/relapse/recurrence of MDD, but not on time until MDD onset/relapse/recurrence. However, this effect disappeared when studies including participants with a baseline clinical diagnosis were removed from the analyses. Other studies were too heterogeneous to compare. Thus, there is a lack of evidence for leading biological theories for onset and maintenance of depression. Only cortisol was identified as potential predictor for MDD, but results are influenced by the disease state. High-quality (prospective) studies on MDD are needed to disentangle the etiology and maintenance of MDD.

Importance: Cognitive behavioral therapy is recommended for anxiety-related disorders, but evidence for its long-term outcome is limited. Objective: This systematic review and meta-analysis aimed to assess the long-term outcomes after cognitive behavioral therapy (compared with care as usual, relaxation, psychoeducation, pill placebo, supportive therapy, or waiting list) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). Data Sources: English-language publications were identified from PubMed, PsycINFO, Embase, Cochrane, OpenGrey (1980 to January 2019), and recent reviews. The search strategy included a combination of terms associated with anxiety disorders (eg, panic or phobi*) and study design (eg, clinical trial or randomized controlled trial). Study Selection: Randomized clinical trials on posttreatment and at least 1-month follow-up effects of cognitive behavioral therapy compared with control conditions among adults with generalized anxiety disorder, panic disorder with or without agoraphobia, social anxiety disorder, specific phobia, PTSD, or OCD. Data Extraction and Synthesis: Researchers independently screened records, extracted statistics, and assessed study quality. Data were pooled using a random-effects model. Main Outcomes and Measures: Hedges g was calculated for anxiety symptoms immediately after treatment and at 1 to 6 months, 6 to 12 months, and more than 12 months after treatment completion. Results: Of 69 randomized clinical trials (4118 outpatients) that were mainly of low quality, cognitive behavioral therapy compared with control conditions was associated with improved outcomes after treatment completion and at 1 to 6 months and at 6 to 12 months of follow-up for a generalized anxiety disorder (Hedges g, 0.07-0.40), panic disorder with or without agoraphobia (Hedges g, 0.22-0.35), social anxiety disorder (Hedges g, 0.34-0.60), specific phobia (Hedges g, 0.49-0.72), PTSD (Hedges g, 0.59-0.72)

Item does not contain fulltext, Achtergrond: Voorschrijven van antidepressiva (ad) is sinds 1980 sterk toegenomen, vooral selectieve serotonineheropnameremmers (ssri's), en voor steeds langere tijd. Toch worden, vooral buiten de beroepsgroep, ad nog steeds bekritiseerd en betwijfelt men hun nut. Doel: Verklaren van toename en bieden van een perspectief op oorzaken en oplossingen van de controverse, aanzet tot debat. Methode: Essay met genuanceerde en kritische presentatie van feiten en argumenten van voor- en tegenstanders. Resultaten: Toename is het gevolg van 1. toegenomen veiligheid en gebruiksgemak, 2. toegenomen hulpvraag voor en herkenning van depressie in de huisartspraktijk, 3. uitbreiding indicatiecriteria, 4. effectieve marketingstrategieën, en 5. effectiviteit van ad in de acute fase en bij preventie van terugval/recidief in continuerings- en onderhoudsfasen. Critici wijzen op: 1. beperkte meerwaarde van ad in acute fase t.o.v. placebo, 2. veel uitvallers en mensen zonder respons, 3. terugval/recidiefpreventie met ad in continuerings- en onderhoudsfasen werkt alleen bij patiënten met goede respons op ad in acute fase, 4. terugval/recidief na discontinuering ad vaak onthoudingsverschijnselen, en 5. publicatiebias, selectieve rapportage, selectieve patiëntselectie en suboptimale blindering, leidend tot overschatting voordelen en onderschatting nadelen. Factoren die controverse onderhouden, zijn: 1. critici wijzen op de netto-effectiviteit en voorstanders op de bruto-effectiviteit (dus inclusief spontaan herstel en placebo-effect); 2. hardnekkigheid van beschadigd vertrouwen in industriegefinancierde rct's; 3. gebrek aan rct’s met relevante langetermijnuitkomstmetingen; 4. ideologische posities, versterkt door belangenconflicten en selectieve citaties; 5. maatschappelijk klimaat. Conclusie: Hoewel het lastig zal zijn om deels ideologisch ingegeven posities tot elkaar te brengen, zien wij mogelijkheden. Drie factoren zijn daarbij van groot belang: polderen (welke data overtuigen de tegenpar

Contains fulltext : 217004.pdf (Publisher’s version ) (Closed access), Achtergrond: Voorschrijven van antidepressiva (ad) is sinds 1980 sterk toegenomen, vooral selectieve serotonineheropnameremmers (ssri's), en voor steeds langere tijd. Toch worden, vooral buiten de beroepsgroep, ad nog steeds bekritiseerd en betwijfelt men hun nut. Doel: Verklaren van toename en bieden van een perspectief op oorzaken en oplossingen van de controverse, aanzet tot debat. Methode: Essay met genuanceerde en kritische presentatie van feiten en argumenten van voor- en tegenstanders. Resultaten: Toename is het gevolg van 1. toegenomen veiligheid en gebruiksgemak, 2. toegenomen hulpvraag voor en herkenning van depressie in de huisartspraktijk, 3. uitbreiding indicatiecriteria, 4. effectieve marketingstrategieën, en 5. effectiviteit van ad in de acute fase en bij preventie van terugval/recidief in continuerings- en onderhoudsfasen. Critici wijzen op: 1. beperkte meerwaarde van ad in acute fase t.o.v. placebo, 2. veel uitvallers en mensen zonder respons, 3. terugval/recidiefpreventie met ad in continuerings- en onderhoudsfasen werkt alleen bij patiënten met goede respons op ad in acute fase, 4. terugval/recidief na discontinuering ad vaak onthoudingsverschijnselen, en 5. publicatiebias, selectieve rapportage, selectieve patiëntselectie en suboptimale blindering, leidend tot overschatting voordelen en onderschatting nadelen. Factoren die controverse onderhouden, zijn: 1. critici wijzen op de netto-effectiviteit en voorstanders op de bruto-effectiviteit (dus inclusief spontaan herstel en placebo-effect); 2. hardnekkigheid van beschadigd vertrouwen in industriegefinancierde rct's; 3. gebrek aan rct’s met relevante langetermijnuitkomstmetingen; 4. ideologische posities, versterkt door belangenconflicten en selectieve citaties; 5. maatschappelijk klimaat. Conclusie: Hoewel het lastig zal zijn om deels ideologisch ingegeven posities tot elkaar te brengen, zien wij mogelijkheden. Drie factoren zijn daarbij van groot belang: polderen (welke data overtuigen de tegenpar

Psychological factors hypothesized to account for relapse of major depressive disorder (MDD) roughly originate from five main theories: Cognitive, diathesis-stress, behavioural, psychodynamic, and personality-based. In a meta-analysis we investigated prospective, longitudinal evidence for these leading psychological theories and their factors in relation to depressive relapse. Included studies needed to establish history of MDD and prospective depressive relapse through a clinical interview, have a longitudinal and prospective design, and measure at least one theory-derived factor before relapse. We identified 66 eligible articles out of 43,586 records published up to November 2018. Pooled odds ratios (OR) indicated a significant relationship between the cognitive, behavioural, and personality-based theories and depressive relapse (cognitive: k = 17, OR = 1.24, 95% CI = 1.10–1.40; behavioural, k = 8, OR = 1.15, 95% CI = 1.05–1.25; personality: k = 12, OR = 1.26, 95% CI = 1.02–1.54), but not for the psychodynamic theories (k = 4, OR = 1.29, 95% CI = 0.83–1.99). Pooled hazard ratios of the theories were not significant. There were no articles identified for the diathesis-stress theories. To conclude, there is a restricted number of prospective studies, and some evidence that the cognitive, behavioural, and personality-based theories indeed partially account for depressive relapse.

ObjectiveEight women (9.4%) experienced a recurrence of depression; two during pregnancy and six in the first 12 weeks postpartum. All women with recurrence of depression had first onset of depression during childhood or

Background: According to previous research, dysfunctional attitudes and/or scoring extreme on the end-point anchors of questionnaires of dysfunctional thinking predict depressive relapse/recurrence. Evidence that these two methods represent a risk for depressive relapse/recurrence is however mixed, due to differential or poorly defined concepts. The current study aimed to test the two methods. Methods: Remitted recurrently depressed patients with low residual depressive symptoms (N = 264) were recruited as part of a randomized controlled trial of the effectiveness of mobile Cognitive Therapy for recurrent depression versus treatment as usual. In the current secondary analysis, Cox regression models were conducted to test dysfunctional attitudes and extreme responding variables (assessed on the Dysfunctional Attitudes Scale [DAS]) as predictors of depressive relapse/recurrence within two years after randomization. Results: Data from 255 participants were analyzed. Results showed that DAS total scores at baseline significantly predicted depressive relapse/recurrence (Hazard Ratio [HR] = 1.01, p =.042). An index that reflects endorsement of habitual relative to functional responses was a significant predictor of depressive relapse/recurrence (HR = 2.11, p =.029). Limitations: The current study employed a single measure to identify extreme responses and dysfunctional attitudes. Secondly, various statistical analyses were performed without correcting for multiple testing, which in turn increased the likelihood to finding significant results. Conclusions: Current study confirmed both methods: People who scored higher on the DAS or had relatively more habitual than functional responses on the extreme positive ends of the DAS had a decreased time to depressive relapse/recurrence.

Exposure-based treatment for anxiety disorders is effective for many patients, but relapse is not uncommon. One predictor of the return of fear is the negative valence of fear-relevant stimuli. The aim of the current experiments was to examine whether counterconditioning with positive film clips reduces this negative stimulus valence as well as the return of fear, compared to standard extinction training and to an extinction training with non-contingent exposure to the positive film clips. Participants were 87 students in Experiment 1 (three-day paradigm), and 90 students in Experiment 2 (one-day paradigm). They first underwent a differential acquisition phase, in which one of three pictures was paired with an electric shock. They were then randomly allocated to one of the three intervention groups. Afterwards, they underwent a test phase in which pictures were presented without shock (to measure spontaneous recovery of fear), which was followed by unsignaled shocks to induce reinstatement of extinguished fear. Outcome variables were self-reported stimulus valence, shock expectancy, skin conductance, and fear-potentiated startle. In both experiments, counterconditioning decreased negative stimulus valence, relative to the other interventions, but it did not reduce spontaneous fear recovery or fear reinstatement. Overall, our findings do not support the notion that counterconditioning reduces return of fear.

Contains fulltext : 195171.pdf (publisher's version ) (Closed access), Background: Evidence-based clinical guidelines for major depressive disorder (MDD) recommend stepped-care strategies for sequencing evidence-based treatments conditional on treatment outcomes. This study aims to evaluate the cost-effectiveness of stepped care as recommended by the multidisciplinary clinical guideline vis-à-vis usual care in the Netherlands. Methods: Guideline-congruent care as described in stepped-care algorithms for either mild MDD or moderate and severe MDD was compared with usual care in a health-economic state-transition simulation model. Incremental costs per QALY gained were estimated over five years from a healthcare perspective. Results: For mild MDD, the cost-utility analysis showed a 67% likelihood of better health outcomes against lower costs, and 33% likelihood of better outcomes against higher costs, implying dominance of guideline-congruent stepped care. For moderate and severe MDD, the cost-utility analysis indicated a 67% likelihood of health gains at higher costs following the stepped-care approach and 33% likelihood of health gains at lower costs, with a mean ICER of about €3,200 per QALY gained. At a willingness to pay threshold of €20,000 per QALY, the stepped-care algorithms for both mild MDD and moderate or severe MDD is deemed cost-effective compared to usual care with a greater than 95% probability. Limitations: The findings of our decision-analytic modelling are limited by the accuracy and availability of the underlying evidence. This hampers taking into account all individual differences relevant to optimise treatment to individual needs. Conclusions: It is highly likely that guideline-congruent stepped care for MDD is cost-effective compared to usual care. Our findings support current guideline recommendations.

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Item does not contain fulltext, Achtergrond: De zorgstandaard Depressieve stoornissen beschrijft het gehele zorgtraject voor patiënten vanaf de leeftijd van 8 jaar met depressieve klachten en stoornissen. Doel: Beschrijven van de belangrijkste aanbevelingen opgenomen in de zorgstandaard Depressieve stoornissen. Methode: De zorgstandaard is een vertaalslag van bestaande richtlijnen voor depressie aangevuld met praktijkkennis van de professional en ervaringskennis van patiënten. Resultaten: Kernelementen in de zorg voor depressie zijn het aanbieden van gepaste zorg en aandacht voor terugvalpreventie. Bij de persisterende depressie is een combinatie van psychotherapie en farmacotherapie geïndiceerd waarbij meer sessies psychotherapie nodig kunnen zijn. Repeterende transcraniële magnetische stimulatie heeft een plaats bij de therapieresistente depressie. Conclusies: De zorgstandaard is een belangrijk instrument om de bestaande zorg voor depressie in een instelling of regio te verbeteren.

Contains fulltext : 195171.pdf (publisher's version ) (Closed access), Background: Evidence-based clinical guidelines for major depressive disorder (MDD) recommend stepped-care strategies for sequencing evidence-based treatments conditional on treatment outcomes. This study aims to evaluate the cost-effectiveness of stepped care as recommended by the multidisciplinary clinical guideline vis-à-vis usual care in the Netherlands. Methods: Guideline-congruent care as described in stepped-care algorithms for either mild MDD or moderate and severe MDD was compared with usual care in a health-economic state-transition simulation model. Incremental costs per QALY gained were estimated over five years from a healthcare perspective. Results: For mild MDD, the cost-utility analysis showed a 67% likelihood of better health outcomes against lower costs, and 33% likelihood of better outcomes against higher costs, implying dominance of guideline-congruent stepped care. For moderate and severe MDD, the cost-utility analysis indicated a 67% likelihood of health gains at higher costs following the stepped-care approach and 33% likelihood of health gains at lower costs, with a mean ICER of about €3,200 per QALY gained. At a willingness to pay threshold of €20,000 per QALY, the stepped-care algorithms for both mild MDD and moderate or severe MDD is deemed cost-effective compared to usual care with a greater than 95% probability. Limitations: The findings of our decision-analytic modelling are limited by the accuracy and availability of the underlying evidence. This hampers taking into account all individual differences relevant to optimise treatment to individual needs. Conclusions: It is highly likely that guideline-congruent stepped care for MDD is cost-effective compared to usual care. Our findings support current guideline recommendations.

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Item does not contain fulltext, Achtergrond: De zorgstandaard Depressieve stoornissen beschrijft het gehele zorgtraject voor patiënten vanaf de leeftijd van 8 jaar met depressieve klachten en stoornissen. Doel: Beschrijven van de belangrijkste aanbevelingen opgenomen in de zorgstandaard Depressieve stoornissen. Methode: De zorgstandaard is een vertaalslag van bestaande richtlijnen voor depressie aangevuld met praktijkkennis van de professional en ervaringskennis van patiënten. Resultaten: Kernelementen in de zorg voor depressie zijn het aanbieden van gepaste zorg en aandacht voor terugvalpreventie. Bij de persisterende depressie is een combinatie van psychotherapie en farmacotherapie geïndiceerd waarbij meer sessies psychotherapie nodig kunnen zijn. Repeterende transcraniële magnetische stimulatie heeft een plaats bij de therapieresistente depressie. Conclusies: De zorgstandaard is een belangrijk instrument om de bestaande zorg voor depressie in een instelling of regio te verbeteren.

Contains fulltext : 195171.pdf (publisher's version ) (Closed access), Background: Evidence-based clinical guidelines for major depressive disorder (MDD) recommend stepped-care strategies for sequencing evidence-based treatments conditional on treatment outcomes. This study aims to evaluate the cost-effectiveness of stepped care as recommended by the multidisciplinary clinical guideline vis-à-vis usual care in the Netherlands. Methods: Guideline-congruent care as described in stepped-care algorithms for either mild MDD or moderate and severe MDD was compared with usual care in a health-economic state-transition simulation model. Incremental costs per QALY gained were estimated over five years from a healthcare perspective. Results: For mild MDD, the cost-utility analysis showed a 67% likelihood of better health outcomes against lower costs, and 33% likelihood of better outcomes against higher costs, implying dominance of guideline-congruent stepped care. For moderate and severe MDD, the cost-utility analysis indicated a 67% likelihood of health gains at higher costs following the stepped-care approach and 33% likelihood of health gains at lower costs, with a mean ICER of about €3,200 per QALY gained. At a willingness to pay threshold of €20,000 per QALY, the stepped-care algorithms for both mild MDD and moderate or severe MDD is deemed cost-effective compared to usual care with a greater than 95% probability. Limitations: The findings of our decision-analytic modelling are limited by the accuracy and availability of the underlying evidence. This hampers taking into account all individual differences relevant to optimise treatment to individual needs. Conclusions: It is highly likely that guideline-congruent stepped care for MDD is cost-effective compared to usual care. Our findings support current guideline recommendations.

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Background: It is presumed that pharmacological and non-pharmacological treatment of prenatal common mental disorders can mitigate associated adverse effects in offspring, yet strong evidence for the prophylactic benefits of treatment is lacking. We therefore examined the effect of prenatal treatments for common mental disorders on offspring outcomes. Methods: For this meta-analysis, articles published up to August 31, 2017, were obtained from PubMed, PsycInfo, Embase, and Cochrane databases. Included studies needed to be randomized controlled trials (RCTs) on the effect of treatment of prenatal common mental disorders comparing an intervention to a control condition, including offspring outcome(s). Random effects models were used to calculate Hedges' g in the program Comprehensive Meta-Analysis © (version 3.0). Results: Sixteen randomized controlled trials among 2778 pregnant women compared offspring outcomes between prenatal interventions and control groups. There were zero pharmacological, 13 psychological, and three other interventions (homeopathy, relaxation interventions, and short psycho-education). Birth weight (mean difference 42.88 g, g = 0.08, 95% CI -0.06 to 0.22, p = 0.27, n = 11), Apgar scores (g = 0.13, 95% CI -0.28 to 0.54, p = 0.53, n = 4), and gestational age (g = 0.03, 95% CI -0.06 to 0.54, p = 0.49, n = 10) were not significantly affected. Other offspring outcomes could not be meta-analyzed due to the inconsistent reporting of offspring outcomes and an insufficient number of studies. Conclusions: Non-pharmacological interventions had no significant effect on birth outcomes, although this outcome should be considered with caution due to the risk of biases. No randomized controlled trial examined the effects of prenatal pharmacological treatments as compared to treatment as usual for common mental disorders on offspring outcomes. Present clinical guidelines may require more research evidence on offspring outcomes, including child dev

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__Background__ Major depressive disorder (MDD) is highly recurrent and has a significant disease burden. Although the effectiveness of internet-based interventions has been established for the treatment of acute MDD, little is known about their cost effectiveness, especially in recurrent MDD. __Objectives__ Our aim was to evaluate the cost effectiveness and cost utility of an internet-based relapse prevention program (mobile cognitive therapy, M-CT). __Methods__ The economic evaluation was performed alongside a single-blind parallel group randomized controlled trial. Participants were recruited via media, general practitioners, and mental health care institutions. In total, 288 remitted individuals with a history of recurrent depression were eligible, of whom 264 were randomly allocated to M-CT with minimal therapist support added to treatment as usual (TAU) or TAU alone. M-CT comprised 8 online lessons, and participants were advised to complete 1 lesson per week. The economic evaluation was performed from a societal perspective with a 24-month time horizon. The health outcomes were number of depression-free days according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) criteria assessed with the Structured Clinical Interview for DSM-IV axis I disorders by blinded interviewers after 3, 12, and 24 months. Quality-adjusted life years (QALYs) were self-assessed with the three level version of the EuroQol Five Dimensional Questionnaire (EQ-5D-3L). Costs were assessed with the Trimbos and Institute for Medical Technology Assessment Questionnaire on Costs Associated with Psychiatric Illness (TiC-P). Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were displayed to assess the probability that M-CT is cost effective compared to TAU. __Results__ Mean total costs over 24 months were €8298 (US $9415) for M-CT and €7296 (US $8278) for TAU. No statistically signific

Background Psychological treatments occupy an important place in evidence-based mental health treatments. Now is an exciting time to fuel treatment research: a pressing demand for improvements is poised alongside new opportunities from closer links with sister scientific and clinical disciplines. The need to improve mental health treatment is great; even the best treatments do not work for everyone, treatments have not been developed for many mental disorders, and the implementation of treatments needs to address worldwide scalability. Psychological treatments have yet to benefit from numerous innovations that have occurred in science, particularly those that have emerged in the past 20 years, and arguably vice versa. This Commission comprises ten parts that each outline an area in which we see substantial opportunity and scope for advancements that will move psychological treatments research forward.

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