Gerrit T. Koopmans

Treatment adherence therapy in people with psychotic disorders: randomised controlled trial

BACKGROUND Interventions to improve adherence to treatment in people with psychotic disorders have produced inconclusive results. We developed a new treatment, treatment adherence therapy (TAT), whose intervention modules are tailored to the reasons for an individuals non-adherence. AIMS To examine the effectiveness of TAT with regard to service engagement and medication adherence in out-patients with psychotic disorders who engage poorly. METHOD Randomised controlled study of TAT v. treatment as usual (TAU) in 109 out-patients. Most outcome measurements were performed by masked assessors. We used intention-to-treat multivariate analyses (Dutch Trial Registry: NTR1159). RESULTS Treatment adherence therapy v. TAU significantly benefited service engagement (Cohens d = 0.48) and medication adherence (Cohens d = 0.43). Results remained significant at 6-month follow-up for medication adherence. Near-significant effects were also found regarding involuntary readmissions (1.9% v. 11.8%, P = 0.053). Symptoms and quality of life did not improve. CONCLUSIONS Treatment adherence therapy helps improve engagement and adherence, and may prevent involuntary admission.

Lack of motivation for treatment in emergency psychiatry patients.

A lack of motivation for treatment on the part of patients is a major problem for emergency psychiatric services. Little is known about its determinants. The aim of this study was to investigate determinants of treatment motivation in emergency psychiatric patients. A cross-sectional study of 719 patients was made. Motivation for treatment and other clinical variables were assessed using the Severity of Psychiatric Illness scale and the Brief Psychiatric Rating Scale. In all, 47% of patients were not motivated for treatment and they also had severe clinical problems. Lack of motivation was associated with danger to others [odds ratio (OR) 2.03; confidence interval (CI) 1.21–3.40], substance abuse (OR 1.71; CI 1.09–2.67), suspiciousness (OR 1.4; CI 1.19–1.64), grandiosity (OR 1.19; CI 1.01–1.4), anxiety (OR 0.74; CI 0.64–0.86), and GAF score (OR 0.98; CI 0.96–0.99). Lack of motivation for treatment is a common phenomenon among severely mentally ill patients seen by emergency psychiatric services. Lack of motivation was associated with danger and paranoid symptoms. Motivational techniques as well as involuntary treatment may help to overcome problems due to lack of motivation in these patients.

Chronic conditions, psychological distress and the use of psychoactive medications.

OBJECTIVE The purpose of this study was to examine whether number and type of chronic conditions are related to psychological distress, fatigue, and the use of psychoactive medications. METHODS Data were taken from a community-based sample of adults who had responded to a health survey mailing (N = 9428). Chronic conditions were assessed by self-report. Information on the use of psychoactive medications was extracted from a claims database of prescribed drugs. Chronic conditions were compared controlling for confounding factors. RESULTS Strong associations were found between the number of chronic conditions, on the one hand, and psychological distress and fatigue, on the other. There was a less strong association between these factors and the use of medication for anxiety and stress, the use of sleeping pills or tranquilizers, and the use of antidepressants. There was only a partial association between type of condition, psychological distress, and fatigue. Migraine had the broadest impact, having an effect on psychological distress and fatigue and on the use of anxiolytics, as well as the use of antidepressants. CONCLUSION The association of chronic conditions with psychological distress, fatigue, and the use of psychoactive medications appeared to be related more to the number of conditions than to the type of condition.

The use of outpatient mental health care services of migrants vis-à-vis Dutch natives: equal access?

Background: Although the use of outpatient mental health care services by migrants in the Netherlands has increased in recent years, whether it aligns with the need for care is unclear. Aims: To investigate ethnic-related differences in utilization in outpatient mental health care, taking need into account, and to examine whether socio-economic or cultural barriers explain such differences. Methods: Data for the native population was taken from the second Dutch National Survey of General Practice (N = 7,772). An additional random sample was drawn (N = 1,305) from four migrant groups (Surinamese, Dutch Antilleans, Moroccans and Turks) living in the Netherlands. Participants were surveyed on mental health care utilization, indicators of need, educational level, proficiency in Dutch and acculturation. Results: Use of outpatient mental health care was about 5% for the indigenous population. Among migrants, percentages of use ranged from 6.5% (Moroccans) to 9.0% (Turks). Corrected for need, however, all non-Dutch groups had a lower chance of service utilization than the native group. Acculturation predicted utilization but did not explain all ethnic-related differences; proficiency in Dutch and health beliefs were not explanatory factors. Conclusions: In non-Dutch-speaking migrant groups, utilization is about half the level of the native Dutch, suggesting that a substantial gap exists. Our study found that acculturation only partially explains the differences.

Differences in Overweight and Obesity among Children from Migrant and Native Origin: The Role of Physical Activity, Dietary Intake, and Sleep Duration

A cross-sectional survey was performed to examine to what degree differences in overweight and obesity between native Dutch and migrant primary school children could be explained by differences in physical activity, dietary intake, and sleep duration among these children. Subjects (n=1943) were primary school children around the age of 8–9 years old and their primary caregivers: native Dutch children (n=1546), Turkish children (n=93), Moroccan children (n=66), other non-western children (n=105), and other western children (n=133). Multivariate regressions and logistic regressions were used to examine the relationship between migrant status, child’s behavior, and BMI or prevalence of overweight, including obesity (logistic). Main explanatory variables were physical activity, dietary intake, and sleep duration. We controlled for age, sex, parental educational level, and parental BMI. Although sleep duration, dietary intake of fruit, and dietary intake of energy-dense snacks were associated with BMI, ethnic differences in sleep duration and dietary intake did not have a large impact on ethnic differences in overweight and obesity among children from migrant and native origin. It is suggested that future preventive strategies to reduce overweight and obesity, in general, consider the role of sleep duration. Also, cross-cultural variation in preparation of food among specific migrant groups, focusing on fat, sugar, and salt, deserves more attention. In order to examine which other variables may clarify ethnic differences in overweight and obesity, future research is needed.

Physical activity differences between children from migrant and native origin

BackgroundChildren from migrant origin are at higher risk for overweight and obesity. As limited physical activity is a key factor in this overweight and obesity risk, in general, the aim of this study is to assess to what degree children from migrant and native Dutch origin differ with regard to levels of physical activity and to determine which home environment aspects contribute to these differences.MethodsA cross-sectional survey among primary caregivers of primary school children at the age of 8–9 years old (n = 1943) from 101 primary schools in two urban areas in The Netherlands. We used bivariate correlation and multivariate regression techniques to examine the relationship between physical and social environment aspects and the child’s level of physical activity. All outcomes were reported by primary caregivers. Outcome measure was the physical activity level of the child. Main independent variables were migrant background, based on country of birth of the parents, and variables in the physical and social home environment which may enhance or restrict physical activity: the availability and the accessibility of toys and equipment, as well as sport club membership (physical environment), and both parental role modeling, and supportive parental policies (social environment). We controlled for age and sex of the child, and for socio-economic status, as indicated by educational level of the parents.ResultsIn this sample, physical activity levels were significantly lower in migrant children, as compared to children in the native population. Less physical activity was most often seen in Turkish, Moroccan, and other non-western children (p < .05).ConclusionsAlthough traditional home characteristics in both the physical, and the social environment are often associated with child’s physical activity, these characteristics provided only modest explanation of the differences in physical activity between migrant and non-migrant children in this study. The question arises whether interventions aimed at overweight and obesity should have to focus on home environmental characteristics with regard to physical activity.

Effects of psychiatric consultation on medical consumption in medical outpatients with abdominal pain

A randomized controlled clinical trial was conducted in an outpatient clinic of internal medicine to test the hypothesis that a protocol of cooperation and communication between internist and general practitioner, sustained with psychiatric consultation, would reduce medical consumption in a group of medical outpatients with abdominal pain (N = 106). A reduction in medical consumption could not be demonstrated. However, a great variation in protocol adherence was found, partly related to the severity of the psychological problems. There is some evidence that the protocol, if restricted to cases with more severe psychiatric comorbidity, might reduce medical consumption.

Effects of psychiatric consultation on medical consumption in medical outpatients with low back pain

A randomized, controlled, clinical trial (N = 104) was conducted to test the hypothesis that a protocol of collaboration and communication between neurologist and general practitioner, sustained with psychiatric consultation, would reduce medical consumption (especially of diagnostic procedures and medication) in medical outpatients with low back pain. The intervention was designed at the health care provider level; the psychiatrist did not see or examine the patient. A reduction in medical consumption could not be demonstrated. As there was a great variation in adherence to the protocol in the experimental group, this might explain the lack of hypothesized effects. Full implementation of the protocol seemed to imply a lower number of major surgery operations, but this effect disappeared after excluding cases with a diagnosed hernia. The possibilities for consumption reduction for three post hoc-defined patient categories (cases with hernia and chronic and nonchronic cases) and the consequences for patient selection and treatment intensity are discussed. It is concluded that the target groups should be more narrowly defined, and that a more intensive intervention might prove to be more effective.

Differences in Quality of Antenatal Care Provided by Midwives to Low-Risk Pregnant Dutch Women in Different Ethnic Groups

INTRODUCTION The objective of this study was to evaluate whether differences existed in the adherence to the Dutch national guidelines regarding basic antenatal care by Dutch midwives for low-risk women of different ethnic groups. METHODS This was an observational study using data from electronic antenatal charts of 7 midwife practices (23 midwives), participating in the Generation R Study. The Generation R Study is a multiethnic, population-based, prospective, cohort study that is investigating the growth, development, and health of urban children from fetal life until young adulthood. The study is conducted in Rotterdam, The Netherlands. The antenatal charts of 2093 low-risk pregnant women with an expected birthing date in 2002 through 2004 were used to determine the mean quality of antenatal care scores for 7 ethnic groups. These scores reflected the degree of adherence to the guidelines regarding 10 tests and examinations. RESULTS Few differences between ethnic groups were found in adherence to the guidelines that addressed the obstetric-technical quality of antenatal care. This finding applied more to nulliparous than to multiparous women. Adherence to guidelines was not always better in the antenatal care provided to native Dutch multiparous women when compared to other ethnic groups. Midwives adhered well to the guidelines regarding most tests. For all women, irrespective of ethnic background, hemoglobin was not measured as often as recommended, and this was especially the case for Moroccan, Surinamese-Creole, and Dutch-Antillean multiparous women. DISCUSSION The poorer adherence regarding screening for hemoglobin needs further investigation, as women with African or Mediterranean heritage are more at risk for hemoglobinopathies. However, in general, midwives adhered well to the clinical guidelines regarding most tests irrespective of the ethnic background of the pregnant women. When differences were present, these were not systematically less favorable for non-Dutch pregnant women.