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Contains fulltext : 110312.pdf (Publisher’s version ) (Open Access) BACKGROUND: Not only is the heterogeneous concept of depression too comprehensive, it is also insufficiently differentiated. This serves as a barrier to scientific research and obscures the symptoms that should indicate what treatment is required. AIM: To describe an accurate model for staging and profiling depression. METHOD: We placed depressive disorders in the context of the entire course of the disorder and we regarded the course as a continuum of psychopathology. RESULTS: First of all we distinguish five stages: (1) the prodromal phase, (2) the first depressive episode, (3) residual symptoms following an episode, (4) the relapse episode and (5) the chronic and/or treatment-resistant depression. The higher the stage, the greater the need for complex and specialised treatment. As characteristics for profiling we distinguish (a) aetiological and pathophysiological variables and (b) clinical factors. The latter are the ones that mainly influence treatment from stage 2 onwards. CONCLUSION: In our article we give a tentative overview of possible characteristics for profiling. At the moment the clinical factors are the ones used most for assessment. Current research into the value of aetiological characteristics for profiling will increase the applicability of a staging and profiling model.

BACKGROUND: Research is needed into ways of reducing patients' dependence on benzodiazepine. So far, dose reduction has never been compared with reduction without intervention. Furthermore, the added value of combining treatment with psychotherapy has never been evaluated in a randomised controlled study. AIM: To evaluate the efficacy and feasibility of controlled dose reduction with and without the help of group cognitive behavioural therapy (CBT) in primary care. METHOD: One hundred and eighty chronic users of benzodiazepine unable to stop taking the drug on their own accord participated in a randomised controlled trial. They were assigned to 3 groups: a controlled dose-reduction group; a controlled dose-reduction group receiving group-CBT; and a group receiving usual care. RESULTS: Of the patients subjected to controlled reduction 62% stopped taking benzodiazepine entirely, which significantly differed from the control group (21%). Adding group-CBT did not increase the success rate in the controlled dose-reduction group. The intention to participate in the controlled reduction programme motivated 1 in 5 patients to stop taking benzodiazepine on their own accord. Neither discontinuation nor the type of intervention had any influence on patients' psychological functioning. Both intervention programmes could be performed successfully by family doctors although only 17% of the 1036 eligible benzodiazepine users agreed to participate in this study. CONCLUSION: In primary care controlled dose reduction is an effective way of helping motivated long-term users of benzodiazepine to stop taking the drug. The addition of group-CBT, however, provides no added value. No definitive conclusions can be drawn until long-term follow-up data recording relapse rates become available.

Item does not contain fulltext BACKGROUND: Despite generally accepted advice to keep treatment short, benzodiazepines are often prescibed for more than six months. Prevention of long-term benzodiazepine use could be facilitated by the utilisation of risk indicators for long-term use. However, the characteristics of long-term benzodiazepine users described in the literature are based on studies in which long-term users were compared with non-users. Thus these characteristics may be imprecise. AIM: To study the characteristics of long-term benzodiazepine users by comparing their demographic data and health status (mental and physical) with those of short-term users. DESIGN OF STUDY: Cross-sectional comparison of short-term and long-term benzodiazepine users. SETTING: Patients from 32 GP practices of the Nijmegen Health Area, The Netherlands. METHOD: The characteristics of 164 short-term and 158 long-term benzodiazepine users in general practice were compared, using interview data and morbidity referral and prescription data from GP records. RESULTS: Long-term benzodiazepine users were (a) older, (b) had a more severe history of mental health problems for which they had received more serious treatment, (c) used more psychotropic drugs, (d) had a higher hospital specialist consultation frequency, (e) had more diagnoses of the following: diabetes, asthma, chronic obstructive pulmonary disease, hypertension a serious skin disorder, and (f) reported a lower perceived general health status. There were no sex differences. CONCLUSION: Specific risk characteristics of long-term benzodiazepine users can be used to develop a risk profile for the management of benzodiazepines in general practice. We believe that (somatic) secondary care also contributes to benzodiazepine use. It may be worthwhile to coordinate care for benzodiazepine users between GPs and hospital specialists.