[Staging, Profiling and Routine Outcome Monitoring].
[Staging, profiling and routine outcome monitoring].
Filed under: Depression Treatment
Tijdschr Psychiatr. 2012; 54(11): 979-84
Zitman FG
Summary background Staging and profiling can make a valuable contribution to more effective and tailor-made treatments. In psychiatry these techniques have so far played only a very limited role. Routine outcome monitoring (rom) may be able to alter the situation. aim To describe the criteria of a rom-system that is ideal for staging and profiling and to find out to what extent some existing rom-systems satisfy these criteria. method The method used was to investigate to what extent the minimal dataset of the Stichting Benchmark ggz and the rom of the Leiden Routine Outcome Monitoring Study meet the criteria formulated in this article for an ideal rom and provide a ‘proof of principle’. results The minimal dataset of the Stichting Benchmark ggz satisfies fewer criteria than the rom of the Leiden Routine Outcome Monitoring Study, but neither fulfils all the criteria. Nevertheless, even without adequate datasets the Leiden Routine Outcome Monitoring Study can make a useful contribution to the staging of depression and mental health in general and to the profiling of depression. conclusion ROM is an important instrument for the development of staging and profiling in psychiatry.
HubMed – depression
[Staging and profiling of unipolar depression].
Filed under: Depression Treatment
Tijdschr Psychiatr. 2012; 54(11): 957-63
Peeters FP, Ruhé HG, Beekman AT, Spijker J, Schoevers R, Zitman F, Schene A
Summary background Not only is the heterogeneous concept of depression too comprehensive, it is also insufficiently differentiated. This serves as a barrier to scientific research and obscures the symptoms that should indicate what treatment is required. aim To describe an accurate model for staging and profiling depression. method We placed depressive disorders in the context of the entire course of the disorder and we regarded the course as a continuum of psychopathology. results First of all we distinguish five stages: (1) the prodromal phase, (2) the first depressive episode, (3) residual symptoms following an episode, (4) the relapse episode and (5) the chronic and/or treatment-resistant depression. The higher the stage, the greater the need for complex and specialised treatment. As characteristics for profiling we distinguish (a) aetiological and pathophysiological variables and (b) clinical factors. The latter are the ones that mainly influence treatment from stage 2 onwards. conclusion In our article we give a tentative overview of possible characteristics for profiling. At the moment the clinical factors are the ones used most for assessment. Current research into the value of aetiological characteristics for profiling will increase the applicability of a staging and profiling model.
HubMed – depression
[Staging and profiling in bipolar disorders].
Filed under: Depression Treatment
Tijdschr Psychiatr. 2012; 54(11): 949-56
Kupka RW, Hillegers MH
summary background Bipolar disorders are expressed in a wide variety of forms and last for different lengths of time. This has a major influence on diagnosis and treatment and on the interpretation of research findings. aim To propose and describe a method for staging and profiling of bipolar disorders. method We searched the literature for evidence of attempts to define stages of illness progression and risk factors that determine the course of illness. results The staging of bipolar disorders evolves from a symptom-free phase with high-risk conditions to a treatment-resistent chronic mood disorder. A family history of recurrent mood disorder, affective symptoms in childhood and depression in adolescence strongly predict future bipolar disorder. The profiling system that we propose incorporates not only clinical phenomenology in accordance with current classification but also clinically relevant predictors for an unfavorable course of illness. These predictors include age at onset, cognitive profiles, comorbidity, traumatic life events, psychosis, suicidality, insight into illness, and respons to treatment. There is some emerging evidence for genetic or other biological markers. conclusion Staging and profiling may contribute to early diagnosis, preventive strategies, and personalised treatment and may provide guidance for further research.
HubMed – depression
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