Mitral prolapsing volume is associated with increased cardiac dimensions in patients with mitral annular disjunction.

INTRODUCTION: In patients with mitral annular disjunction (MAD), it can be difficult to assess the severity of mitral regurgitation (MR), as they present with a prolapsing volume (i.e. volume resulting from mitral valve prolapse, blood volume shift) rather than a regurgitant jet. The influence of the mitral prolapsing volume (MPV) on cardiac dimensions is unknown. We hypothesised that the severity of MR is underestimated in these patients. Our aim was to measure MPV and to investigate its influence on cardiac dimensions in patients with MAD. METHODS: We retrospectively included 131 consecutive patients with MAD from our institution's echocardiographic database. Transthoracic echocardiography was used to assess MPV. Additionally, we established a control group of 617 consecutive patients with degenerative mitral valve disease and performed propensity score matching. RESULTS: Median MPV in the MAD group was 12 ml. MPV was an independent predictor for left ventricular end-diastolic (LVEDD) and end-systolic diameter (LVESD) and left atrial volume (all p < 0.001). In patients with large prolapsing volumes (> 15 ml), LVEDD (56 ± 6 mm vs 51 ± 6 mm, p < 0.001), LVESD [38 mm (34-41) vs 34 mm (31-39), p < 0.01] and left atrial volume [105 ml (86-159) vs 101 ml (66-123), p = 0.04] were significantly increased compared to matched patients with degenerative mitral valve disease and similarly assessed severity of MR. CONCLUSION: Due to a volume shift based on the MPV rather than an actual regurgitant jet, MR severity cannot be assessed adequately in MAD patients. Increased MPV induces ventricular and atrial enlargement. These findings warrant future studies to focus on MPV as an additional parameter for assessment of the severity of MR in MAD patients.

The link between parental psychological control, depressive symptoms and epigenetic changes in the glucocorticoid receptor gene (NR3C1).

AIMS: This paper examines the relationship between parental Psychological Control (PC) and depressive symptoms in adolescents and assesses whether this relationship was mediated by DNA methylation, focusing on the glucocorticoid receptor gene (NR3C1), which plays a crucial role in HPA-axis functioning and is linked to environmental stress and depression. This is among the very few studies that looked at the relation between DNA methylation, environmental stress and depression in family trios. METHODS: The study cohort consisted of 250 families: father, mother and a biologically related adolescent (adolescents (48.9% boys), mean age: 15.14, SD= 1.9; mean age mothers: 45.83, SD= 4.2; mean age fathers: 47.77, SD= 4.7). Depressive symptoms and PC were measured in adolescents and in both parents. DNA methylation levels in NR3C1 were examined in all participants. RESULTS: Depressive symptoms in adolescents were predicted by PC of both mothers and fathers. Moreover, maternal depressive symptoms were associated with maternal PC, and fathers' depressive symptoms and PC. In fathers, only the level of their self-reported PC was associated with their depressive symptoms. There was no relation between adolescents' DNA methylation and depressive symptoms or the level of parental PC. Yet, there was a significant association between maternal depressive symptoms and maternal epigenetic patterns in NR3C1. CONCLUSIONS: These findings highlight the need for more research in order to better understand the biological and contextual mechanisms through which parenting and parental emotional well-being is related to the development of psychopathology.

Attachment in OCD: A meta-analysis.

INTRODUCTION: It has been proposed to extend the cognitive-behavioural model of obsessive-compulsive disorder (OCD) with attachment theory to shed light on the affective and developmental factors underlying the disease. With a growing number of empirical studies on the subject, this meta-analysis aims to quantify a possible relationship between attachment insecurity and OCD. METHODS: A systematic search was conducted for studies in adult populations of patients with OCD as well as general populations displaying symptoms of OCD. Effect sizes of attachment anxiety and attachment avoidance were calculated separately. Covariates of demographic variables were used in meta-regressions. RESULTS: Sixteen studies were included. Meta-analyses showed an association of medium to large effect size (Hedges' g = 0.69; 95 % CI 0.58 - 0.80; p < 0.001) between OCD and attachment anxiety, and an association of medium effect size (Hedges' g = 0.47; 95 % CI 0.39 - 0.54; p < 0.001) between OCD and attachment avoidance. Effect sizes in OCD population and general population studies did not differ significantly. DISCUSSION: Robust effect sizes of both attachment anxiety and avoidance in relation to OCD symptomatology corroborate an attachment-centred view of OCD. These findings furthermore suggest that integrating cognitive and attachment-based therapeutic approaches to OCD may benefit patients in which developmental or emotional factors hinder successful treatment.

Is psychotherapy effective? A re-analysis of treatments for depression.

AimsThe aim of this study was to reanalyse the data from Cuijpers et al.'s (2018) meta-analysis, to examine Eysenck's claim that psychotherapy is not effective. Cuijpers et al., after correcting for bias, concluded that the effect of psychotherapy for depression was small (standardised mean difference, SMD, between 0.20 and 0.30), providing evidence that psychotherapy is not as effective as generally accepted. METHODS: The data for this study were the effect sizes included in Cuijpers et al. (2018). We removed outliers from the data set of effects, corrected for publication bias and segregated psychotherapy from other interventions. In our study, we considered wait-list (WL) controls as the most appropriate estimate of the natural history of depression without intervention. RESULTS: The SMD for all interventions and for psychotherapy compared to WL controls was approximately 0.70, a value consistent with past estimates of the effectiveness of psychotherapy. Psychotherapy was also more effective than care-as-usual (SMD = 0.31) and other control groups (SMD = 0.43). CONCLUSIONS: The re-analysis reveals that psychotherapy for adult patients diagnosed with depression is effective.

Prevalence and impact of childhood adversities and post-traumatic stress disorder in women with fibromyalgia and chronic widespread pain.

OBJECTIVE: This study investigates the prevalence of different types of childhood adversities (CA) and posttraumatic stress disorder (PTSD) in female patients with Fibromyalgia or Chronic Widespread Pain (FM/CWP) compared to patients with Functional Dyspepsia (FD) and achalasia. In FM/CWP, we also investigated the association between CA and PTSD on the one hand and pain severity on the other. METHODS: Patient samples consisted of 154 female FM/CWP, 83 female FD and 53 female achalasia patients consecutively recruited from a tertiary care hospital. Well-validated self-report questionnaires were used to investigate CA and PTSD. RESULTS: Forty-nine per cent of FM/CWP patients reported at least 1 type of CA, compared to 39.7% of FD patients and 23.4% of achalasia patients (p < 0.01). The prevalence of CA did not differ significantly between FM/CWP and FD, but both groups had a higher prevalence of CA compared to both achalasia and healthy controls (p < 0.01). FM/CWP patients were six times more likely to report PTSD than both FD (p < 0.001) and achalasia (p < 0.001) patients. CONCLUSION: In FM/CWP, PTSD comorbidity, but not CA, was associated with self-reported pain severity and PTSD severity mediated the relationship between CA and pain severity. In summary, the prevalence of CA is higher in FM/CWP compared to achalasia, but similar to FD. However, PTSD is more prevalent in FM/CWP compared to FD and associated with higher pain intensity in FM/CWP. SIGNIFICANCE: As expected and has been shown in other functional disorders, we found elevated levels of childhood adversity in FM/CWP patients. Results of this study however suggest that the impact of childhood adversity (i.e. whether such events have led to the development of PTSD symptoms), rather than the mere presence of such adversity, is of crucial importance in FM/CWP patients. Screening for PTSD symptoms should be an essential part of the assessment process in patients suffering from FM/CWP, and both prevention and intervention efforts should take into account PTSD symptoms and their impact on pain severity and general functioning.

Biases in research: risk factors for non-replicability in psychotherapy and pharmacotherapy research.

Replicability of findings is an essential prerequisite of research. For both basic and clinical research, however, low replicability of findings has recently been reported. Replicability may be affected by research biases not sufficiently controlled for by the existing research standards. Several biases such as researcher allegiance or selective reporting are well-known for affecting results. For psychotherapy and pharmacotherapy research, specific additional biases may affect outcome (e.g. therapist allegiance, therapist effects or impairments in treatment implementation). For meta-analyses further specific biases are relevant. In psychotherapy and pharmacotherapy research these biases have not yet been systematically discussed in the context of replicability. Using a list of 13 biases as a starting point, we discuss each bias's impact on replicability. We illustrate each bias by selective findings of recent research, showing that (1) several biases are not yet sufficiently controlled for by the presently applied research standards, (2) these biases have a pernicious effect on replicability of findings. For the sake of research credibility, it is critical to avoid these biases in future research. To control for biases and to improve replicability, we propose to systematically implement several measures in psychotherapy and pharmacotherapy research, such as adversarial collaboration (inviting academic rivals to collaborate), reviewing study design prior to knowing the results, triple-blind data analysis (including subjects, investigators and data managers/statisticians), data analysis by other research teams (crowdsourcing), and, last not least, updating reporting standards such as CONSORT or the Template for Intervention Description and Replication (TIDieR).

[Measuring alexithymia in fibromyalgia: the need for a multimodal measurement method to replace the TAS-20]. / Alexithymie bij fibromyalgie: meetinstrumenten; argumenten voor een multimodale benadering.

BACKGROUND: In an earlier publication that investigated alexithymia in fibromyalgia, we showed the Toronto Alexithymia Scale was the only instrument being used to measure alexithymia. AIM: To find out which instruments are currently available for measuring alexithymia, to compare the psychometric properties of these instruments and to decide whether some of the test methods involved should be used to give extra value to alexithymia research. METHOD: We conducted a systematic review of the literature in Medline/PubMed with a number of search terms. We selected articles relating to psychometric properties of the tests performed and decided whether they could be influenced by negative affect. RESULTS: We found that 14 different instruments were used to measure alexithymia. From our evaluation we excluded tests which had weak psychometric properties or had been inadequately assessed. There remained three observation scales and two self-report questionnaires, which had been adequately validated and whose relative strengths and weaknesses were compared. CONCLUSION: In view of these findings, we recommend that in studies of alexithymia in fibromyalgia a multimodal measurement method should be used rather than only the tas-20.

[Psychometric properties of the Hospital Ethical Climate Survey: a cross-sectional study among Belgian psychiatric nurses]. / Psychometrische kwaliteiten van de Hospital Ethical Climate Survey: een cross-sectionele studie bij Belgische psychiatrische verpleegkundigen.

BACKGROUND: The task of caring for psychiatric patients is so complex that it often leads to ethical dilemmas. The ethical climate on a ward is a crucial factor. This is the first study about the ethical climate in mental healthcare. AIM: To investigate whether the only instrument currently available for measuring the ethical climate in general hospitals, namely the 'Hospital Ethical Climate Survey' (HECS), is a reliable and valid instrument for use on psychiatric wards. METHOD: A cross-sectional study was performed in a psychiatric hospital in Belgium. All 320 nurses were invited to participate (response rate = 265). The factor structure of the HECS was examined by means of explorative principal component analysis (PCA) and confirmatory factor analysis (CFA). The reliability of the constructed scale and subscales was investigated. RESULTS: Five factors were identified. The structure of these factors in the translated list was almost identical to the structure obtained with the original instrument and its underlying theoretical basis. Items relating to several other allied healthcare professions were added. This addition widened the subscale 'relationship with physician' so that it included 'relationship with other disciplines' (medical and allied healthcare workers). CONCLUSION: The reliability of the instrument appeared to be good and yielded scores comparable to those obtained as a result of earlier research performed in general hospitals. The setting for our investigation produced a significantly higher main score for the ethical climate than did previous studies.

Biker's Nodule : A Case Report and Review of the Literature.

We describe a 17-year-old cyclist who presented with a biker's nodule which is a painful perineal mass resulting from chronic perineal compression and friction during extensive cycling. The treatment of choice is surgical excision. A review of the literature was made concerning this condition. Health care workers who are involved with sportsmen, especially in countries like Belgium where professional and recreational cycling is increasingly popular, should be aware of the diagnostic and therapeutic features of this condition.

[The impact of attachment on behavioral and psychological symptoms in dementia]. / Gehechtheid als beïnvloedende factor van gedrags- en psychologische symptomen bij dementie.

Contemporary research has increasingly acknowledged the importance of attachment on stress-related processes in ageing. Congruent with this, there has been much research on attachment in older adults over the past three decades. In this article, the main findings of this research are summarized, with a focus on attachment and dementia. Results show that, in general, the number of attachment figures decreases in old age. Moreover, their identity changes as adult children, deceased loved ones and God become more prominent. With relation to the quality of attachment, anxiety in close relations appears to diminish as people age, while attachment avoidance remains relatively stable. Individuals with high levels of attachment security also report greater well-being and a more positive attitude towards ageing compared to persons with low levels of attachment security. Furthermore, individuals characterized by insecure attachment show more behavioral and psychological problems in dementia. Also, caregiver burden, depression, as well as the quality of care giving and future caregiver commitment differ depending on the quality of attachment of the caregiver. There is preliminary evidence for the efficacy of attachment-based interventions in dementia. Finally, there is a need for greater methodological uniformity and the use of measures that are validated for an older population.

[The relationship between DSM-IV axis II and the anaclitic and introjective personality dimensions]. / Het verband tussen DSM-IV-as II en de anaclitische en introjectieve persoonlijkheidsdimensies.

BACKGROUND: In his psychodynamic theory of personality development, Blatt distinguishes between an anaclitic and an introjective cluster of psychological disorders. Whereas, in the past, research in this area has focused mainly on depression, nowadays more and more attention is being given to the relevance of this distinction for the theoretical conceptualisation and treatment of personality disorders (PD). AIM: To examine the association between dsm-iv pd characteristics and the anaclitic and introjective personality dimensions. METHOD: We conducted a cross-sectional study (n = 48) embedded in a five-year follow-up study after psychodynamic treatment for PD. We used multiple linear-regression analysis to investigate the relationship between pd characteristics (scid-ii Personality Questionnaire) and the anaclitic and introjective personality dimensions (Depressive Experiences Questionnaire), while controlling for the severity of the depression (Beck Depression Inventory) and for the introjective and anaclitic dimension, respectively. RESULTS: There was evidence for a positive relationship between the anaclitic dimension and dependent and borderline pd characteristics on the one hand and between the introjective dimension and avoidant, obsessive-compulsive, passive-aggressive, depressive, paranoid, schizotypal and narcissistic PD characteristics on the other hand. CONCLUSION: Results are consistent with and provide important empirical support for Blatt's assumptions concerning an anaclitic and an introjective cluster of personality pathology.

Self-critical perfectionism and its relationship to fatigue and pain in the daily flow of life in patients with chronic fatigue syndrome.

BACKGROUND: Research suggests that the personality factor of self-critical or maladaptive perfectionism may be implicated in chronic fatigue syndrome (CFS). However, it is not clear whether self-critical perfectionism (SCP) also predicts daily symptoms in CFS. Method In the present study we investigated whether SCP predicted fatigue and pain over a 14-day period in a sample of 90 CFS patients using a diary method approach. After completing the Depressive Experiences Questionnaire (DEQ) as a measure of SCP, patients were asked each day for 14 days to complete Visual Analogue Scales (VAS) of fatigue, pain and severity of depression. Data were analysed using multilevel analysis. RESULTS: The results from unconditional models revealed considerable fluctuations in fatigue over the 14 days, suggesting strong temporal variability in fatigue. By contrast, pain was relatively stable over time but showed significant inter-individual differences. Congruent with expectations, fixed-effect models showed that SCP was prospectively associated with higher daily fatigue and pain levels over the 14-day period, even after controlling for levels of depression. CONCLUSIONS: This is the first study to show that SCP predicts both fatigue and pain symptoms in CFS in the daily course of life. Hence, therapeutic interventions aimed at targeting SCP should be considered in the treatment of CFS patients with such features.

[Stress research in psychiatry: a complex story]. / Stressonderzoek in de psychiatrie: een complex verhaal.

Research into the role of stress in psychiatric disorders faces major challenges. However, over the last few decades there has been considerable progress in this area as a result of methodological, technological and conceptual developments. The advent of recursive and non-linear models and research into the neurobiology of stress have made important contributions to this progress. Not only have these developments increased our insight into the aetiopathogenesis and classification of psychiatric disorders, they also have important implications for clinical assessment and treatment. In particular, renewed interest in the role of meaning-making has opened up a number of new avenues for clinical practice and research.

[Bodily aspects of mentalization: a therapeutic focus in the treatment of patients with severe medically unexplained symptoms]. / Lichamelijke aspecten van mentalisatie; therapeutische focus bij ernstige onverklaarde lichamelijke klachten.

BACKGROUND: Our knowledge about medically unexplained symptoms (mus) is increasing, but translating this knowledge into more effective treatment, particularly if symptoms are severe, continues to be problematical. AIM: To clarify the physical aspect of mentalisation (body-mentalisation) and to outline a theoretical perspective of body-mentalisation, starting from theories such as the attachment theory and the mentalisation theory, and to describe the diagnostic and therapeutic value of this approach. METHODS: Clinical experience with body-mentalisation led to a systematic literature search (via PsycInfo and Medline). RESULTS: Body-mentalisation is the ability to detect the signals of our own and of other, to respond to them and perceive the links with underlying mental states. Poor body-mentalisation occurs frequently in patients with severe mus and can be treated successfully by means of intensive residential or day-therapy programmes. CONCLUSION: Body-mentalisation may turn out to be a useful concept in connection with the treatment of persons with severe mus. More research is needed to test the diagnostic validity and therapeutic relevance of this concept.

Personality and intrapersonal and interpersonal functioning of women starting their first IVF treatment.

BACKGROUND: IVF treatment involves a reassessment of issues concerning autonomy and relatedness. This study aims to extend prior studies on the psychological impact of IVF/ICSI by studying the association between the personality dimensions of Self-Criticism and Dependency with the psychological well-being and quality of the couple relationship for women starting their first IVF treatment. METHODS: This is a cross-sectional study of 68 women starting their first IVF treatment at the Leuven University Fertility Centre of the University of Leuven, Belgium. All women were administered validated self-report measures assessing Self-Criticism and Dependency, negative life events, psychological well-being, relationship satisfaction, and relationship and sexual concerns. Pearson's correlation coefficients were calculated between all study variables, followed by four separate hierarchical multiple regression analyses for psychological well-being, relationship satisfaction, and relationship and sexual concerns. RESULTS: High Self-Criticism was negatively associated with psychological well-being (r = -0.63, P < 0.001) and relationship satisfaction (r = -0.29, P < 0.05), and positively associated with relationship (r = 0.39, P < 0.01) and sexual (r = 0.37, P < 0.01) concerns. High Dependency was negatively associated with psychological well-being (r = -0.30, P < 0.05), not significantly associated with relationship satisfaction and relationship concerns, and positively related to sexual concerns (r = 0.31, P < 0.05). CONCLUSIONS: This cross-sectional study suggests that the personality dimensions of Self-Criticism and Dependency may enhance our understanding of the psychological well-being and quality of the couple relationship of women starting their first IVF treatment. However, further prospective research on this topic is needed.

[Fifty years of psychiatry at the interface between psyche and soma: a SWOT analysis]. / Vijftig jaar psychiatrie op de grens tussen psyche en soma: een SWOT-analyse.

During the past 50 years the border area between psychiatry and somatic medicine has undergone remarkable changes. Theories have become better-founded, both psychologically and neurobiologically, research has become more sophisticated, and liaison-psychiatrists and health psychiatrist/behavioural medicine psychologists have played an increasingly active role in this domain. At the beginning of the 21st century modern psychosomatic medicine is facing new challenges; these include how to create a workable diagnostic classification system, how to instruct and educate both health professionals and lay-persons to an adequate level, how to utilize innovative research paradigms without having recourse to reductionism and how to implement in medical practice treatments that are geared to the needs of the individual patient.

Rehabilitation of decreased motor performance in patients with chronic fatigue syndrome: should we treat low effort capacity or reduced effort tolerance?

AIM: The aetiology, pathophysiology, diagnostic delineation and treatment of chronic fatigue syndrome (CFS) remain a matter of debate. Here some aspects of the debate are elucidated, with a particular focus on the patients' decreased motor performance. HYPOTHESIS: The pathophysiological basis of decreased motor performance in CFS may, theoretically, involve three components: (1) a peripheral energetic deficit (impaired oxidative metabolism and/or physical deconditioning); (2) a central perceptual disturbance (higher effort sense or increased 'interoception'); and (3) a fundamental failure of the neurobiological stress system, leading to an abnormal 'sickness response'. It is proposed that the first two components may lead to low effort capacity, while the third component may lead to reduced effort tolerance. Although there is evidence for low effort capacity influencing symptoms and functional limitations in CFS, it is assumed that reduced effort tolerance might be the primary disturbance in CFS. DIAGNOSTIC IMPLICATIONS: Distinguishing low effort capacity and reduced effort tolerance may contribute to a refinement of current diagnostic criteria of CFS and the identification of subgroups. THERAPEUTIC IMPLICATIONS: The above-mentioned distinction may make it possible to formulate a rationale for an effective implementation and adequate outcome evaluation of rehabilitation strategies in CFS. RESEARCH IMPLICATIONS: This new heuristic framework may inform future research aimed at disentangling the complex determination of impaired motor performance in CFS, as well as studies aimed at customizing treatment to different subtypes of patients.

Stress, depression and fibromyalgia.

There is increasing evidence that stress and depression may play a crucial role in the aetiology and pathophysiology of fibromyalgia (FM). We first review recent studies on the possible role of life stress, including childhood trauma, in FM. Subsequently we focus on clinical and aetio-pathogenetic links between stress, depression and pain. We put forward the hypothesis that chronic stress/depression may contribute to a dysregulation of neuro-endocrine, immune and central pain mechanisms in FM. Finally, we discuss some future directions, including the use of new conceptual models, research topics and strategies, as well as potential implications from recent studies in affective disorders for the treatment of FM.

From morphology to function: new neuro applications in functional magnetic resonance.

Functional Imaging of the brain is one of the most exciting recent developments in Magnetic Resonance Imaging (MRI). It refers to techniques which provide functional information about the human brain which goes beyond morphology. Examples are brain activation studies, perfusion and diffusion imaging. For example, the visualization of activated cortical brain regions during external stimulations or while performing specific tasks opens a completely new perspective for the use of MRI.