[Who are the 'no-shows' and why don't they turn up?]. / Wie zijn de no-shows en waarom blijven zij weg?

BACKGROUND: No-show is a problem in mental health care. AIM: To obtain insight into the characteristics of patients who fail to appear at their intake appointments, to find out their reasons for not turning up, and thereby, if possible, to identify aspects of the intake procedures that may require adaptation. METHOD: In a prospective study based on 333 patients, we compared the characteristics of patients who failed to show up for the intake procedure with those of patients who did show up. Via a telephone interview we asked the 'no-shows' why they had not come. RESULTS: The number of 'no-shows' was lower than expected and we found only two very small differences: patients with a non-western background were less likely to turn up, as were patients whose appointments were later in the day, mainly around lunchtime. Via the telephone interview we found that most of the 'no-shows' still had felt unwell and blamed themselves for not turning up. They still wanted to be given professional help. CONCLUSION: No-show at intake appears to be less of a problem than expected. It seems a good idea to approach patients after they have missed appointments, because 'no-shows' still have serious symptoms and are still eager to receive professional help. It will probably be worthwhile conducting a similar investigation among 'no-shows' once they have begun to receive treatment.

Effect of physical activity after a cardiac event on smoking habits and/or Quetelet index.

OBJECTIVES: To further elucidate earlier findings, the present study investigated whether physical activity could serve as a positive stimulus to modify other changeable cardiac risk factors. METHODS: Participants were 140 patients who had completed a cardiac rehabilitation programme focused on physical activity. Their present level of physical activity, smoking habits and Quetelet index were investigated as well as that before the cardiac event, in retrospect. Current feelings of anxiety and depression were also assessed. Participants were divided into two categories according to their present level of physical activity after finishing the rehabilitation programme, compared with that before the cardiac event. RESULTS: It appeared that the more physically active category contained more smokers. Although many of them had quitted smoking, significantly more persisted in their smoking habits compared with the patients who did not increase their physical activity. Significantly less depression was found in the more active patients. CONCLUSIONS: Although it could not be confirmed that physical activity stimulated a positive change in smoking and Quetelet index, the more active patients appeared to be less depressed.

A 3.5-year naturalistic follow-up study of depressed out-patients.

Outcome studies of patients suffering from depression indicate high relapse rates and a tendency towards chronicity. The present study describes the long-term outcome of 95 depressed outpatients in a third-level referral centre. and examines the relationship between baseline-variables (age, sex, level of psychopathology, age at onset of first psychiatric disorder, duration of illness at baseline, diagnosis) and outcome variables. After 3.5 years, 34 patients (36%) had a chronic course, 24 patients (25%) had at least one recurrence and 37 patients (39%) had a non-recurrent course. Chronicity was significantly correlated with an early age of onset of the first psychiatric disorder, a high level of psychopathology and a high level of depressive symptoms at baseline. The duration of depression at index did not differentiate chronic course from recurrent or non-recurrent course. After 1 year of follow-up, patients with recurrence were significantly more likely to stop antidepressant treatment. The results confirm the great chance for chronicity and recurrence in depression and the need to develop long-term treatment programs to prevent relapse.

Lithium augmentation of venlafaxine: an open-label trial.

The authors conducted an open-label study of the efficacy and tolerability of venlafaxine and of lithium augmentation in outpatients with depression who were not responding to venlafaxine. Outpatients aged 18 to 70 years were eligible if they had a minimum baseline score of 16 on the 17-item Hamilton Rating Scale for Depression (HAM-D). Patients were started on venlafaxine 37.5 mg twice daily for 1 week. For weeks 2 through 4, the dose of venlafaxine was increased to 75 mg twice daily, and for weeks 5 through 7, the dose was further increased to 75 mg three times daily. At the end of the 7-week treatment period, patients with a <50% decrease in their HAM-D scores from baseline were given lithium carbonate 600 mg once daily. The dose of lithium carbonate was adjusted to maintain plasma levels in the range of 0.6 to 1.0 mmol/mL. Efficacy was assessed with the 17-item HAM-D, Montgomery-Asberg Depression Rating Scale, and the Clinical Global Impressions Scale. Data were analyzed on an intent-to-treat basis. At the end of the 7-week treatment period, 35% of patients showed a > or = 50% decrease in their HAM-D scores from baseline. Lithium augmentation was initiated in 23 patients. The results showed that the addition of lithium was well-tolerated and led to a further decrease in the HAM-D scores, with eight patients responding and two of them presenting a remission. The addition of lithium to venlafaxine was found to be a well-tolerated strategy in treatment-resistant patients.

Modification in Quetelet index five months after myocardial infarction: relevance of biographic and personality characteristics.

BACKGROUND: Obesity can be considered as a risk factor for (re-)occurrence of coronary heart disease. METHODS: The relationship between modification in quetelet index and personality characteristics was assessed in 166 survivors of a first myocardial infarction (MI). Quetelet index (weight/(height)2) was calculated a few days after first MI and again 5 months later. A multiple regression analysis was executed, with the quetelet index after 5 months as dependent variable and adjustment for gender, age, and quetelet index at baseline. RESULTS: It was found that strong feelings of vital exhaustion and lack of tension significantly contributed to the prediction of increased quetelet index 5 months after a first MI. CONCLUSIONS: It is recommended that individually tailored interventions be used based on these personality characteristics to accomplish body weight reduction in MI patients.

A comparison of the 'Hamilton Rating Scale for Depression' and the 'Montgomery-Asberg Depression rating Scale'.

Although the Hamilton Rating Scale for Depression (HRSD) is the most frequently used rating scale for quantifying depressive states, it has been criticized for its reliability and its usability in clinical practice. This criticism is less applying to the Montgomery-Asberg Depression Rating Scale (MADRS). Goal of the present study is to investigate the reliability and validity, and clinical relationship between the HRSD and the MADRS. For 60 out-patients with diagnosed depression (DSM IV296.2x, 296.3x, 300.40 and 311.00), the HRSD and MADRS were scored at baseline and 6 weeks later by an independent rater according to a structured interview. Also the Clinical Global Impression (CGI) was assessed by a psychiatrist. Satisfying agreement was found between the totalscores (r= .75, p>.000 en r=.92, p>.000 respectively, at baseline and 6 weeks later). Furthermore agreement was found between the items of both scales, and these agree with the clinical impression. The reliability of the MADRS is more stable than the reliability of the HRSD (α = .6367 and α =.8900 vs α = .2193 and α = .8362 at baseline and at endpoint respectively). Considering the ease of scoring both scales in one interview and the widely international use of the HRSD, scoring both the HRSD and the MADRS to measure the severity of a depression seems to be an acceptabel covenant.

Modification of physical activity 5 months after myocardial infarction: relevance of biographic and personality characteristics.

The relation between modification of physical activity, a risk factor for coronary heart disease, and personality characteristics was assessed in 166 survivors of a first myocardial infarction (MI). Physical activity was assessed before MI in retrospect and again 5 months after MI. Patients were divided into 3 categories according to their current daily-life physical activities: less active than before MI (n=24), equally active as before MI (n=82), or more active than before MI (n=60). A significant differentiation was found between patients who became less physically active than before MI and the other 2 categories. This less active category was characterized by feelings of disability, a low level of vigor, and feelings of anxiety. In addition, this patient group was on average older and more often female. The results were adjusted for participation in a cardiac rehabilitation program. Finally, the discussion recommends involving psychological intervention in the exercise program for the less active category of patients to diminish feelings of anxiety and disability and to improve vigor.

Modification of smoking habits five months after myocardial infarction: relationship with personality characteristics.

The relationship between personality characteristics and spontaneous modification of smoking habits was assessed in 164 patients after their first myocardial infarction (MI). Smoking habits before the MI were investigated in retrospect and 5 months later. Smoking appeared to have decreased significantly. Persistent smokers could be differentiated from nonsmokers and exsmokers by a significantly high level of state-anxiety and depression. Young persistent smokers had a high level of depression; elderly persistent smokers were highly anxious and had a low level of somatization. The relationship between smoking behaviour modification and personality characteristics is discussed in association with intervention programmes.