Chronic pain is an important symptom of rheumatoid arthritis (RA). Pain is a complex experience a... more Chronic pain is an important symptom of rheumatoid arthritis (RA). Pain is a complex experience and is not easily measured with a single instrument. Recently a Dutch version of the McGill Pain Questionnaire (MPQ) became available. The MPQ is a measure of the quality of pain as opposed to the traditional measures of pain intensity such as the Visual Analog Scale (VAS). In a study of 415 RA patients both measures of pain were administered. Both pain measures were only weakly related to medical variables. The VAS is easily administered and is reliable. The MPQ offers insight in the sensory experience of pain and gives more information about the quality of life of the patient. The conclusion is that the MPQ is a useful instrument to obtain a better picture of the complexity of the pain experience in RA.
De CrisisMonitor is een set samenhangende observatieschalen waarmee risico’s van escalatie bij pa... more De CrisisMonitor is een set samenhangende observatieschalen waarmee risico’s van escalatie bij patiënten op acute psychiatrische opnameafdelingen kunnen worden getaxeerd. Op de acute opnameafdelingen van Bavo Europoort werd in 2007 een clustergerandomiseerd onderzoek uitgevoerd om de effecten van het gebruik van de CrisisMonitor te meten. Het werken met de CrisisMonitor leidde tot een significante daling van het aantal separatie-uren en agressie-incidenten. Het artikel geeft ook een retrospectieve procesimpressie van de invoering van de CrisisMonitor in Bavo Europoort.
achtergrond Klinische besluiten rond separaties worden veelvuldig gebaseerd op professionele erva... more achtergrond Klinische besluiten rond separaties worden veelvuldig gebaseerd op professionele ervaringskennis (Lendemeijer 2000). Er is discussie over de wijze waarop de geïdentificeerde risico's en beschermende factoren bij dit soort ingrijpende beslissingen transparant worden gemaakt. Er zijn instrumenten beschikbaar om de kortetermijnrisico's te taxeren, maar deze worden in Nederland zelden gebruikt (Van de Sande 2007). In een recent literatuuronderzoek van Cadeyren e.a. (2007) komt eveneens naar voren dat effectonderzoeken rond gestructureerde risicotaxatie in acute-opnameafdelingen schaars zijn. Bij Bavo-Europoort wordt sinds 2007 gewerkt met Crisis Monitor Acute Psychiatrie. doel Het betreft hier een set van bestaande samenhangende observatie-instrumenten met predictieve en incident evaluerende mogelijkheden. methoden Om het effect van de nieuwe werkwijze te toetsen werd een clustergerandomiseerde trial uitgevoerd waarbij de verschillen in agressie-incidenten en separat...
Criminal behaviour and mental health : CBMH, Jan 31, 2015
Earlier studies have suggested associations between diet-related blood parameters and both aggres... more Earlier studies have suggested associations between diet-related blood parameters and both aggression and psychopathological symptoms, but little is known about this in forensic psychiatric inpatients. This article aims to explore the levels of diet-related blood parameters and their relationship to aggressive behaviour and/or psychopathology among Dutch forensic psychiatric inpatients. Minerals, vitamins, lead and fatty acid levels were measured in blood samples from 51 inpatients, well enough to consent and participate in the study, from a possible total of 99. Levels of aggression and psychopathology were assessed using questionnaires, observation instruments and clinical data. Associations between blood parameters and behavioural measures were calculated. Low average levels of vitamin D3 and omega (ω)-3 fatty acids were found, with nearly two-thirds of the patients having below recommended levels of D3 , while vitamin B6 levels were high. Magnesium, iron, zinc, copper and lead w...
The severity of self-reported withdrawal symptoms varies during detoxification of opioid-dependen... more The severity of self-reported withdrawal symptoms varies during detoxification of opioid-dependent patients. The aim of this study is to identify subgroups of withdrawal symptoms within the detoxification trajectory and to predict the severity of withdrawal symptoms on the basis of drug-related and sociodemographic characteristics. A prospective study carried out in an in-patient setting in four addiction treatment centres in the Netherlands. Two hundred opioid-dependent patients who participated in a randomized controlled trial and completed more than 75 percent of the administrations of the subjective opioid withdrawal scales during rapid detoxification. Main outcome measure was the severity of opioid withdrawal as measured by the subjective opioid withdrawal scale during detoxification (18 measurements). Predictor baseline data were obtained on sociodemographic background, severity of addiction, psychopathology, personality disorder, and craving. Those variables found to be stati...
A Delphi-technique was used as part of the development of a screening instrument to diagnose pers... more A Delphi-technique was used as part of the development of a screening instrument to diagnose personality disorders in the elderly. Several statements regarding this subject were tested. Fifty-three Delphi-members, with expertise in the field of mental health services for the elderly and knowledge about the concept 'personality disorder', gave their opinion on the statements. In three successive rounds we aimed to get consensus as well as agreement on the contents of the statements. In the first round the Delphi-panel confirmed the importance of diagnosing personality disorders, with regard to individual therapy in older adults and psycho-educational activities. The DSM-IV Axis II criteria and related assessment-instruments do not take into account the emotional and social context of the elderly people. In the second round the Delphi-panel endorsed the importance of several information sources namely biographical information, informant information, behavioural observations an...
Little is known about diagnosing personality disorders in elderly persons. The current Axis II no... more Little is known about diagnosing personality disorders in elderly persons. The current Axis II nosology is not age related and the majority of psychological tests are unreliable. Three cases dealing with personality disorders are presented. In these cases loss of health, relationships and autonomy are pointed out as the age specific stressors. We studied the relation between psychological symptoms, personality, coping style and age specific stressor. It appeared that elderly persons with personality disorders often have difficulties coping with these stressors. Inadequate coping styles may luxate or exaggerate axis I disorders. Therefore we recommend to pay more attention to the axis II classification during the diagnostical process.
A microscopic analysis of doctor-patient communication in the general practitioner's surgery ... more A microscopic analysis of doctor-patient communication in the general practitioner's surgery is presented. Verbatim transcripts of 85 medical interviews, audiotaped in a natural situation were analysed. The effects of type of complaint, patient gender and physician gender on the process of verbal communication were assessed. This study focused upon the relational aspects of communication, using Stiles' Verbal Response Mode coding system (VRM), and, to a limited extent, upon the content of patient's complaints--whether they were primarily somatic or of a psychosocial nature. The hypothesis of an asymmetrical relation between physician and patient was confirmed. Results partially confirmed the hypothesis that interviews of psychosocial patients take more time than those of somatic patients. There was also some evidence that psychosocial patients try to exert more control over the conversation as compared to somatic patients. Male and female patients differed in the way the...
Memories of parental rearing were investigated in 48 polydrug addicts and 91 alcohol addicts with... more Memories of parental rearing were investigated in 48 polydrug addicts and 91 alcohol addicts with the EMBU, an instrument for assessing parental rearing styles. Drug addicts remember their fathers and mothers as more rejecting and overprotecting and their mothers as more favoring than do alcoholics. When the age and the sex of addicts are taken into account, the kind of addiction and the sex of the addicts can explain a part of the variance of the overprotection dimension by fathers and mothers. The age of the addicts can explain a part of the variance of the rejection dimension by fathers and mothers. Finally, the variance in the favoring dimension by mothers can be explained by the kind of addiction.
A wide variety in outcome criteria hinders comparison of results between smoking cessation studie... more A wide variety in outcome criteria hinders comparison of results between smoking cessation studies. Three important methodological issues are discussed: analysis of data of participants who drop out of therapy, treatment of missing data, and repeated use of significance tests. These issues determine to a great extent the results of evaluation studies. In general, they are of interest to all researchers of addiction who study the effects of interventions. Several ways to decide on these issues and the consequences of these decisions are considered. Little consensus exists about the criterion for dropout. It is concluded that a dropout criterion is a burden rather than a help. A better criterion would be the number of sessions present. Few satisfying techniques exist to handle the problem of missing data. Evaluation studies need to set a priori standards to counter the increased risk of a Type I error, caused by the repeated use of significance tests. Reviewers need to be aware of the variety in data treatment before comparing results.
Results with Coping with Rheumatic Stressors (CORS) are reported. The CORS measures eight coping ... more Results with Coping with Rheumatic Stressors (CORS) are reported. The CORS measures eight coping styles directed at the most important chronic stressors of RA i.e. pain, limitations, and dependence. The relation between coping and well-being was analysed while controlling for relevant disease status variables. Comforting cognitions, decreasing activity and diverting attention were styles of coping with pain that were related to well-being, when level of pain was controlled. Optimism, pacing, and seeking creative solutions were styles of coping with limitations. Both optimism and pacing were related to well-being, when functional capacity was being controlled. Acceptance and showing consideration were styles of coping with dependence. Consideration was the only coping style related to well-being, when functional capacity and social network were being controlled.
In the last decades, shared decision-making (SDM) models have been developed to increase patient ... more In the last decades, shared decision-making (SDM) models have been developed to increase patient involvement in treatment decisions. The purpose of this study was to evaluate a SDM intervention (SDMI) for patients dependent on psychoactive substances in addiction health care programs. The intervention consisted of a structured procedure to reach a treatment agreement and comprised 5 sessions. Clinicians in 3 treatment centres in the Netherlands were randomly assigned to the SDMI or a standard procedure to reach a treatment agreement. A total of 220 substance-dependent patients receiving inpatient treatment were randomised either to the intervention (n = 111) or control (n = 109) conditions. Reductions in primary substance use (F((1, 124)) = 248.38, p < 0.01) and addiction severity (F((8)) = 27.76, p < 0.01) were found in the total population. Significant change was found in the total population regarding patients' quality of life measured at baseline, exit and follow-up (F((2, 146)) = 5.66, p < 0.01). On the European Addiction Severity Index, SDMI showed significantly better improvements than standard decision-making regarding drug use (F((1, 164)) = 7.40, p < 0.01) and psychiatric problems (F((1, 164)) = 5.91, p = 0.02) at 3-month follow-up. SDMI showed a significant add-on effect on top of a well-established 3-month inpatient intervention. SDMI offers an effective, structured, frequent and well-balanced intervention to carry out and evaluate a treatment agreement.
The authors investigated cross-cultural replicability of the five-factor model (FFM) of personali... more The authors investigated cross-cultural replicability of the five-factor model (FFM) of personality as represented by the revised NEO Personality Inventory (NEO-PI-R; P. T. Costa & R. R. McCrae, 1992) in a sample of 423 Dutch psychiatric patients. Also, NEO-PI-R domain scales were compared with the Personality Psychopathology Five (PSY-5; A. R. Harkness & J. L. McNulty, 1994) scales of the Minnesota Multiphasic Personality Inventory-2 (J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 2002). Principal-components analysis with procrustean rotation confirmed the hypothesized structural similarity of the present sample with the U.S. normative factor scores. All of the hypothesized relations between NEO-PI-R and PSY-5 scales were confirmed. The results provide evidence for cross-cultural replicability of the FFM and for validity of the NEO-PI-R and PSY-5 constructs in the psychological assessment of psychiatric patients.
Chronic pain is an important symptom of rheumatoid arthritis (RA). Pain is a complex experience a... more Chronic pain is an important symptom of rheumatoid arthritis (RA). Pain is a complex experience and is not easily measured with a single instrument. Recently a Dutch version of the McGill Pain Questionnaire (MPQ) became available. The MPQ is a measure of the quality of pain as opposed to the traditional measures of pain intensity such as the Visual Analog Scale (VAS). In a study of 415 RA patients both measures of pain were administered. Both pain measures were only weakly related to medical variables. The VAS is easily administered and is reliable. The MPQ offers insight in the sensory experience of pain and gives more information about the quality of life of the patient. The conclusion is that the MPQ is a useful instrument to obtain a better picture of the complexity of the pain experience in RA.
De CrisisMonitor is een set samenhangende observatieschalen waarmee risico’s van escalatie bij pa... more De CrisisMonitor is een set samenhangende observatieschalen waarmee risico’s van escalatie bij patiënten op acute psychiatrische opnameafdelingen kunnen worden getaxeerd. Op de acute opnameafdelingen van Bavo Europoort werd in 2007 een clustergerandomiseerd onderzoek uitgevoerd om de effecten van het gebruik van de CrisisMonitor te meten. Het werken met de CrisisMonitor leidde tot een significante daling van het aantal separatie-uren en agressie-incidenten. Het artikel geeft ook een retrospectieve procesimpressie van de invoering van de CrisisMonitor in Bavo Europoort.
achtergrond Klinische besluiten rond separaties worden veelvuldig gebaseerd op professionele erva... more achtergrond Klinische besluiten rond separaties worden veelvuldig gebaseerd op professionele ervaringskennis (Lendemeijer 2000). Er is discussie over de wijze waarop de geïdentificeerde risico's en beschermende factoren bij dit soort ingrijpende beslissingen transparant worden gemaakt. Er zijn instrumenten beschikbaar om de kortetermijnrisico's te taxeren, maar deze worden in Nederland zelden gebruikt (Van de Sande 2007). In een recent literatuuronderzoek van Cadeyren e.a. (2007) komt eveneens naar voren dat effectonderzoeken rond gestructureerde risicotaxatie in acute-opnameafdelingen schaars zijn. Bij Bavo-Europoort wordt sinds 2007 gewerkt met Crisis Monitor Acute Psychiatrie. doel Het betreft hier een set van bestaande samenhangende observatie-instrumenten met predictieve en incident evaluerende mogelijkheden. methoden Om het effect van de nieuwe werkwijze te toetsen werd een clustergerandomiseerde trial uitgevoerd waarbij de verschillen in agressie-incidenten en separat...
Criminal behaviour and mental health : CBMH, Jan 31, 2015
Earlier studies have suggested associations between diet-related blood parameters and both aggres... more Earlier studies have suggested associations between diet-related blood parameters and both aggression and psychopathological symptoms, but little is known about this in forensic psychiatric inpatients. This article aims to explore the levels of diet-related blood parameters and their relationship to aggressive behaviour and/or psychopathology among Dutch forensic psychiatric inpatients. Minerals, vitamins, lead and fatty acid levels were measured in blood samples from 51 inpatients, well enough to consent and participate in the study, from a possible total of 99. Levels of aggression and psychopathology were assessed using questionnaires, observation instruments and clinical data. Associations between blood parameters and behavioural measures were calculated. Low average levels of vitamin D3 and omega (ω)-3 fatty acids were found, with nearly two-thirds of the patients having below recommended levels of D3 , while vitamin B6 levels were high. Magnesium, iron, zinc, copper and lead w...
The severity of self-reported withdrawal symptoms varies during detoxification of opioid-dependen... more The severity of self-reported withdrawal symptoms varies during detoxification of opioid-dependent patients. The aim of this study is to identify subgroups of withdrawal symptoms within the detoxification trajectory and to predict the severity of withdrawal symptoms on the basis of drug-related and sociodemographic characteristics. A prospective study carried out in an in-patient setting in four addiction treatment centres in the Netherlands. Two hundred opioid-dependent patients who participated in a randomized controlled trial and completed more than 75 percent of the administrations of the subjective opioid withdrawal scales during rapid detoxification. Main outcome measure was the severity of opioid withdrawal as measured by the subjective opioid withdrawal scale during detoxification (18 measurements). Predictor baseline data were obtained on sociodemographic background, severity of addiction, psychopathology, personality disorder, and craving. Those variables found to be stati...
A Delphi-technique was used as part of the development of a screening instrument to diagnose pers... more A Delphi-technique was used as part of the development of a screening instrument to diagnose personality disorders in the elderly. Several statements regarding this subject were tested. Fifty-three Delphi-members, with expertise in the field of mental health services for the elderly and knowledge about the concept 'personality disorder', gave their opinion on the statements. In three successive rounds we aimed to get consensus as well as agreement on the contents of the statements. In the first round the Delphi-panel confirmed the importance of diagnosing personality disorders, with regard to individual therapy in older adults and psycho-educational activities. The DSM-IV Axis II criteria and related assessment-instruments do not take into account the emotional and social context of the elderly people. In the second round the Delphi-panel endorsed the importance of several information sources namely biographical information, informant information, behavioural observations an...
Little is known about diagnosing personality disorders in elderly persons. The current Axis II no... more Little is known about diagnosing personality disorders in elderly persons. The current Axis II nosology is not age related and the majority of psychological tests are unreliable. Three cases dealing with personality disorders are presented. In these cases loss of health, relationships and autonomy are pointed out as the age specific stressors. We studied the relation between psychological symptoms, personality, coping style and age specific stressor. It appeared that elderly persons with personality disorders often have difficulties coping with these stressors. Inadequate coping styles may luxate or exaggerate axis I disorders. Therefore we recommend to pay more attention to the axis II classification during the diagnostical process.
A microscopic analysis of doctor-patient communication in the general practitioner's surgery ... more A microscopic analysis of doctor-patient communication in the general practitioner's surgery is presented. Verbatim transcripts of 85 medical interviews, audiotaped in a natural situation were analysed. The effects of type of complaint, patient gender and physician gender on the process of verbal communication were assessed. This study focused upon the relational aspects of communication, using Stiles' Verbal Response Mode coding system (VRM), and, to a limited extent, upon the content of patient's complaints--whether they were primarily somatic or of a psychosocial nature. The hypothesis of an asymmetrical relation between physician and patient was confirmed. Results partially confirmed the hypothesis that interviews of psychosocial patients take more time than those of somatic patients. There was also some evidence that psychosocial patients try to exert more control over the conversation as compared to somatic patients. Male and female patients differed in the way the...
Memories of parental rearing were investigated in 48 polydrug addicts and 91 alcohol addicts with... more Memories of parental rearing were investigated in 48 polydrug addicts and 91 alcohol addicts with the EMBU, an instrument for assessing parental rearing styles. Drug addicts remember their fathers and mothers as more rejecting and overprotecting and their mothers as more favoring than do alcoholics. When the age and the sex of addicts are taken into account, the kind of addiction and the sex of the addicts can explain a part of the variance of the overprotection dimension by fathers and mothers. The age of the addicts can explain a part of the variance of the rejection dimension by fathers and mothers. Finally, the variance in the favoring dimension by mothers can be explained by the kind of addiction.
A wide variety in outcome criteria hinders comparison of results between smoking cessation studie... more A wide variety in outcome criteria hinders comparison of results between smoking cessation studies. Three important methodological issues are discussed: analysis of data of participants who drop out of therapy, treatment of missing data, and repeated use of significance tests. These issues determine to a great extent the results of evaluation studies. In general, they are of interest to all researchers of addiction who study the effects of interventions. Several ways to decide on these issues and the consequences of these decisions are considered. Little consensus exists about the criterion for dropout. It is concluded that a dropout criterion is a burden rather than a help. A better criterion would be the number of sessions present. Few satisfying techniques exist to handle the problem of missing data. Evaluation studies need to set a priori standards to counter the increased risk of a Type I error, caused by the repeated use of significance tests. Reviewers need to be aware of the variety in data treatment before comparing results.
Results with Coping with Rheumatic Stressors (CORS) are reported. The CORS measures eight coping ... more Results with Coping with Rheumatic Stressors (CORS) are reported. The CORS measures eight coping styles directed at the most important chronic stressors of RA i.e. pain, limitations, and dependence. The relation between coping and well-being was analysed while controlling for relevant disease status variables. Comforting cognitions, decreasing activity and diverting attention were styles of coping with pain that were related to well-being, when level of pain was controlled. Optimism, pacing, and seeking creative solutions were styles of coping with limitations. Both optimism and pacing were related to well-being, when functional capacity was being controlled. Acceptance and showing consideration were styles of coping with dependence. Consideration was the only coping style related to well-being, when functional capacity and social network were being controlled.
In the last decades, shared decision-making (SDM) models have been developed to increase patient ... more In the last decades, shared decision-making (SDM) models have been developed to increase patient involvement in treatment decisions. The purpose of this study was to evaluate a SDM intervention (SDMI) for patients dependent on psychoactive substances in addiction health care programs. The intervention consisted of a structured procedure to reach a treatment agreement and comprised 5 sessions. Clinicians in 3 treatment centres in the Netherlands were randomly assigned to the SDMI or a standard procedure to reach a treatment agreement. A total of 220 substance-dependent patients receiving inpatient treatment were randomised either to the intervention (n = 111) or control (n = 109) conditions. Reductions in primary substance use (F((1, 124)) = 248.38, p < 0.01) and addiction severity (F((8)) = 27.76, p < 0.01) were found in the total population. Significant change was found in the total population regarding patients' quality of life measured at baseline, exit and follow-up (F((2, 146)) = 5.66, p < 0.01). On the European Addiction Severity Index, SDMI showed significantly better improvements than standard decision-making regarding drug use (F((1, 164)) = 7.40, p < 0.01) and psychiatric problems (F((1, 164)) = 5.91, p = 0.02) at 3-month follow-up. SDMI showed a significant add-on effect on top of a well-established 3-month inpatient intervention. SDMI offers an effective, structured, frequent and well-balanced intervention to carry out and evaluate a treatment agreement.
The authors investigated cross-cultural replicability of the five-factor model (FFM) of personali... more The authors investigated cross-cultural replicability of the five-factor model (FFM) of personality as represented by the revised NEO Personality Inventory (NEO-PI-R; P. T. Costa & R. R. McCrae, 1992) in a sample of 423 Dutch psychiatric patients. Also, NEO-PI-R domain scales were compared with the Personality Psychopathology Five (PSY-5; A. R. Harkness & J. L. McNulty, 1994) scales of the Minnesota Multiphasic Personality Inventory-2 (J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 2002). Principal-components analysis with procrustean rotation confirmed the hypothesized structural similarity of the present sample with the U.S. normative factor scores. All of the hypothesized relations between NEO-PI-R and PSY-5 scales were confirmed. The results provide evidence for cross-cultural replicability of the FFM and for validity of the NEO-PI-R and PSY-5 constructs in the psychological assessment of psychiatric patients.
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Papers by Cees Van Der Staak