M. Verbraak

drijven, en niet top-down vanuit een bepaald theoretisch model zijn geconcipieerd, sluit de afzondering van de distressdimensie uitstekend aan bij bestaande theorieen over stress en coping (Lazarus & Folkman, 1984) en demoralisatie (Frank, 1974). Distress is daarbij de uiting van een stress-copingproces. Om precies te zijn kan distress worden opgevat als een uiting van hoeveel moeite iemand heeft om de stress het hoofd te bieden, oftewel hoe moeilijk iemand het heeft. De Symptom Checklist (scl-90) is een van de bekendste en meest gebruikte zelfbeoordelingsklachtenlijsten in de klinische psychologie (Arrindell & Ettema, 1986; Arrindell & Ettema, 2003). De scl-90 (die we verder zullen aanduiden als ‘scl’) bevat acht schalen waarvan drie qua naamgeving overeenkomen met 4dkl-schalen, te weten depressie, angst en somatisatie/ somatische klachten. Daarnaast gebruikt de scl de totaalscore van alle acht schalen plus negen ongeschaalde items als maat voor het algemene niveau van psychisch di...

In navolging van de somatische zorg is ook binnen de ggz de laatste jaren langzaam maar zeker de goede gewoonte gegroeid om het niet meer uitsluitend aan de behandelaars over te laten hoe zij hun therapieen uitvoeren, maar om die uitvoering te sturen en te reguleren via richtlijnen en protocollen. Deze sturingsmechanismen worden zo veel mogelijk gebaseerd op wetenschappelijke bevindingen. De waarde van die wetenschappelijke onderbouwing wordt daarbij genuanceerd door rekening te houden met de omvang en de kwaliteit van de onderliggende onderzoeken, en met de eenduidigheid van de bevindingen. De actuele toepasbaarheid in de praktijk van de richtlijnen en protocollen voor diverse problemen verschilt daarmee. Zo is, in het algemeen gesproken, de wetenschappelijke onderbouwing voor allerlei handelswijzen binnen de curesector van de ggz sterker dan die binnen de caresector. Dus zijn ook de evidence-based protocollen in de curesector dominanter.

Fatigue is a main feature of the burnout syndrome but also very common in other psychiatric disorders such as major depression and anxiety disorders. This raises the question of whether the level and appraisal of fatigue is experienced differently by individuals suffering from burnout than by those exhibiting anxiety disorders and major depression. If fatigue is experienced differently in burnout compared with other disorders, this may clarify why fatigue is the main feature of the burnout syndrome. This knowledge may lead to the application of specific therapeutic interventions aimed at the experience of fatigue in burnout. In the present study, we investigated whether fatigue is experienced differently in burnout patients than in patients suffering from anxiety disorders or major depression. We presented 73 burnout patients, 67 depressed patients, 57 patients with an anxiety disorder and 127 healthy participants with a rating scale containing statements about the fatigue-performance relationship, and we assessed the level of fatigue, depression and anxiety. The level of fatigue reported by burnout patients was high but did not differ from that of the other patient groups. The appraisal of fatigue also did not differ among the patient groups. The burnout patients did not appraise their fatigue as a result of unrewarding activities nor did they catastrophize fatigue in an exceptional way. Thus, the level of fatigue and the appraisal of fatigue may be less relevant to the understanding of the specific pathological processes associated with burnout than is often presumed. Copyright © 2013 John Wiley & Sons, Ltd. The level of fatigue and the appraisal of fatigue in burnout patients do not differ from those reported in patients with major depression or anxiety disorders ,and may therefore, not be relevant to the understanding of the specific pathological processes associated with burnout. General level of fatigue appeared to predict worrying about fatigue and fear of social rejection, regardless of diagnosis. Fatigue is a feature of several psychiatric disorders. Understanding fatigue may help to gain insight into pathological processes underlying a range of disorders.

ABSTRACT Een set van procesindicatoren wordt gepresenteerd, welke het mogelijk maakt om op een gerichte manier te kunnen werken aan het verbeteren van de zorg voor patiënten met een angststoornis. De ontwikkeling van deze set indicatoren wordt zorgvuldig beschreven en tevens wordt het praktisch gebruik ervan geïllustreerd aan de hand van een praktijkvoorbeeld.

To examine the effect of implementing anxiety disorders guidelines on guideline adherence and patient outcomes in specialized mental health care. A treatment setting in which guidelines were implemented (intervention condition) was compared with one in which guidelines were only disseminated (control condition). Of 61.7% of 81 intervention-condition patients received treatment according to the guidelines vs. 40.6% of 69 control-condition patients (P = 0.01). At 1-year follow-up, intervention-condition patients showed a greater decrease in anxiety symptoms (d = 0.48, P < 0.05); higher percentages of response (52.6% vs. 33.8%; P = 0.025) and remission (33.3% vs.16.9%; P = 0.026); and a greater decrease in the rate of phobic avoidance (d = 0.34, P < 0.05). At 2-year follow-up, control-condition patients had experienced a longer period of treatment, which had eroded most of these differences, except for phobic avoidance. Systematic guideline implementation results in earlier gains...

The Yale Brown Obsessive-Compulsive scale (Y-BOCS) is a semi-structured interview considered to be the gold standard in the measurement of obsessive-compulsive disorder (OCD) severity, yet findings about its factorial structure are conflicting. This study aimed at comparing different models, and testing whether factorial structure differs along various sub-groups. Exploratory and confirmatory factor analyses were conducted on Y-BOCS scores of a large OCD patient group (n = 544). A three-factor structure (obsessions, compulsions, and resistance) provided the best fit for the data across different factor analytic procedures. The difference in goodness of fit between the original two factor (obsessions and compulsions) and the three-factor solutions seemed, however, very small. Since the two-factor solution is the original theory-driven structure, and the most widely used, we recommend the use of this factor.

De essentië le kenmerken van de obsessieve-compulsieve stoornis of dwangstoornis zijn de steeds terugkerende dwanggedachten en of dwanghandelingen. Dwanggedachten (obsessies) zijn ideeën, gedachten, beelden of flitsen die steeds terugkeren of aanhouden en die aanzienlijke angst en ongemak oproepen. Ze worden ervaren als onvrijwillig, intrusief, zinloos en verwerpelijk, maar uiteindelijk toch als een product van de eigen persoon. De gedachten vertonen

Burnout is presumed to be the result of chronic stress, and chronic stress is known to affect the HPA-axis. To date, studies on HPA-axis functioning in burnout have showed inconsistent results. In the present study, a large sample (n=74) of clinically diagnosed burnout individuals, mostly on sick-leave, were included and compared with 35 healthy controls. Salivary cortisol was sampled on 2 days to determine the cortisol awakening response (CAR) and the day-curve. In addition, the dexamethasone suppression test (DST) was applied to assess the feedback efficacy of the HPA-axis. There were no differences observed in the CAR, day-curve or CAR after DST in the burnout group as compared to a healthy control group. Burnout shows overlap in symptoms with chronic fatigue syndrome (CFS) and depression. Therefore, differential changes in HPA-axis functioning that resemble the hypo-functioning of the HPA-axis in CFS, or rather the hyper-functioning of the HPA-axis in depression, might have obscured the findings. However, no effect of fatigue or depressive mood on HPA-axis functioning was found in the burnout group. We concluded that HPA-axis functioning in clinically diagnosed burnout participants as tested in the present study, seems to be normal.

ABSTRACT Over the past decade, an increasing body of literature supports the validity and utility of the 2 × 2 achievement goal framework (Elliot & McGregor, 2001). From this foundation, researchers have begun to investigate the complex antecedents and consequences underlying achievement goal pursuit. In the current studies, we investigated the relations between the Big Five personality traits and context-specific achievement goals in two different contexts (school and work). The results across both studies showed three sets of anticipated, consistent, and specific trait-goal relations. First, conscientiousness was strongly and positively related to mastery-approach goals. Second, agreeableness was positively related to mastery-approach goals and negatively related to performance-approach goals. Third, both avoidance goals and both performance goals were positively related to neuroticism.

In this study, 20 schizophrenic patients were subdivided into a schizophrenia group with positive symptoms (N = 11) and a schizophrenia group with negative symptoms (N = 9) by Andreasen's rating scales: the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms. These groups were compared with 17 normal controls and 17 subjects with a closed head injury. Indices of information processing derived from Coglab, a multiparadigmatic cognitive test battery developed by Spaulding et al., were used for comparison. The "negative" schizophrenia subjects were characterized by a more pervasive deficient information-processing capacity than the "positive" schizophrenia subjects. The deficits both groups had in common were, however, not of equal severity. The closed head injury group, who served as an indirect control for the presumed generalized deterioration in the negative schizophrenia group, did not compare very well to this latter group. The results are discussed in relation to the question of whether the information-processing deficiencies stem from a single causal process, or whether these deficiencies are independent and associated with many etiological pathways.

De essentië le kenmerken van de obsessieve-compulsieve stoornis of dwangstoornis zijn de steeds terugkerende dwanggedachten en of dwanghandelingen. Dwanggedachten (obsessies) zijn ideeën, gedachten, beelden of flitsen die steeds terugkeren of aanhouden en die aanzienlijke angst en ongemak oproepen. Ze worden ervaren als onvrijwillig, intrusief, zinloos en verwerpelijk, maar uiteindelijk toch als een product van de eigen persoon. De gedachten vertonen

De essentië le kenmerken van de obsessieve-compulsieve stoornis of dwangstoornis zijn de steeds terugkerende dwanggedachten en of dwanghandelingen. Dwanggedachten (obsessies) zijn ideeën, gedachten, beelden of flitsen die steeds terugkeren of aanhouden en die aanzienlijke angst en ongemak oproepen. Ze worden ervaren als onvrijwillig, intrusief, zinloos en verwerpelijk, maar uiteindelijk toch als een product van de eigen persoon. De gedachten vertonen