Psymate en psychose: onderzoek en innovatie Prof. Inez Myin-Germeys
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1 Psymate en psychose: onderzoek en innovatie Prof. Inez Myin-Germeys Prof. of Ecological Psychiatry School for Mental Health & Neuroscience
2 De context van ervaringen MHENS School for Mental Health and Neuroscience Faculty of Health, Medicine, and and Life Life Sciences Sciences
3 MHENS School for Mental Health and Neuroscience IS ZELF-RAPPORTAGE IN HET DAGELIJKS LEVEN MOGELIJK BIJ MENSEN MET PSYCHOTISCHE KLACHTEN? Faculty of Health, Medicine, and and Life Life Sciences Sciences
4 De Experience Sampling Methode Beep 1 Beep 2 DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 (day 4 in detail) Beep 3 Beep 4 Beep 5 Beep 6 Beep 7 10 keer per dag 6 opeenvolgende dagen op willekeurige tijdstippen Beep 8 Beep 9 Beep 10 Myin-Germeys et al, 2009; Wichers et al., 2009; Delespaul, 1995
5 Hallucinaties participant 1 hallucinatory intensity time auditory hallucination hallucinatory intensity Participant 1 visual hallucination participant 2 Participant time auditory hallucination visual hallucination
6 Hallucinaties Auditory hallucinations auditory hallucinations Visual hallucinations auditory hallucinations 4 3,5 3 2,5 2 1,5 4 3,5 3 2,5 2 1, ,5 0,5 0-0,5 last before episode first during episode during episode last during episode first after episode 0 last before episode first during episode during episode last during episode first after episode AH intensity VH intensity AH intensity VH intensity mean duration 2.6 beeps (3.9 hr) mean duration: 2.1 beeps (3.1 hr) Oorschot et al, Schiz Res 2012
7 Relatie emoties Auditieve Hallucinaties 0,800 auditory hallucinations auditory hallucination Before episode: - more delusions 0,600 0,400 0,200 0,000-0,200-0,400 last before episode first during episode during episode last during episode pa na delusional intensity first after episode During episode: - higher NA - lower PA - more delusions End of episode: x After episode: x Oorschot et al, Schiz Res 2012
8 ESM paranoia Achterdocht Time Episode = reeks van 1 of meer opeenvolgende momenten met een score van paranoia >=3
9 Interne predictoren: begin van episode *** *** Thewissen et al., Br. J. Clin Psychology, 2011
10 Tijdens een paranoide episode *** *** *** *** Thewissen et al., Br. J. Clin Psychology, 2011
11 Psychosis intensity Interne predictoren: subjectieve stress Daily stress Psychosis Increase in subjective stress Patients, =0.45 Relatives, =0.16 Controls, =0.02 Myin-Germeys et al., Psych Med 2005
12 paranoia Paranoia wordt voorafgegaan door Daling in SE Stijging in angst Stijging in subjectieve stress Tijd
13 2) Negatieve symptomen Emotionele variabiliteit In 150 patients patients high neg. symptoms negative affect patients low neg. symptoms controls time Oorschot et al., schiz Bull 2013
14 Anhedonie Healthy controls Patients with few negative symptoms Patients with a lot of negative symptoms Positive Affect Pleasant event Oorschot et al., schiz bull 2013
15 Wat betekent dit voor de kliniek?
16 1) DIAGNOSTIEK MHENS School for Mental Health and Neuroscience GROEPSBEVINDINGEN ZIJN GOED TE VERTALEN NAAR DE INDIVIDUELE PATIENT Faculty of Health, Medicine, and and Life Life Sciences Sciences
17 intensity Individuele variabiliteit <-> groep female,aged 57 paranoia anxiety Self-esteem monday wednesda y friday paranoia anxiety Self-esteem female, aged 44 tuesday wednesda y thursday Oorschot, et al. Schiz Bull, 2011
18 expressie van symptomen in real life Paranoid patient Non-paranoid patient Oorschot, Lataster et al., Schiz Bull, 2012
19 Individuele variabiliteit <-> groep Anxiety Paranoia 3 3 Paranoia Anxiety -30% ass -30% no ass Paranoia 2 Anxiety -30% no var Oorschot, et al. Schiz Bull, 2011
20 Individuele variabiliteit <-> groep Relaxed Relaxed Paranoia Paranoia Paranoia Paranoia Relaxed Relaxed -50% ass -50% no ass or no var Oorschot, et al. Schiz Bull, 2011
21 MHENS School for Mental Health and Neuroscience 2) EFFECTEN VAN BEHANDELING IN KAART BRENGEN EFFECTEN VAN BEHANDELING MOETEN OBJECTIEF VASTGESTELD WORDEN DOOR EEN CLINICUS Faculty of Health, Medicine, and and Life Life Sciences Sciences
22 Remissie MHENS School for Mental Health and Neuroscience 107 non-remitted, 70 remitted, 148 controls Non-remitted Remitted Control 10 0 % alone % nothing % goal-directed Faculty of Health, Medicine, and and Life Life Sciences Sciences Oorschot, Lataster et al., Schiz Bull, 2012
23 Evaluatie van psychologische behandeling Sample: 130 participants with residual symptoms of depression, not currently depressed 6 days Experience Sampling Questionnaires Mindfulness Training (8 weeks) + TAU TAU 6 days Experience Sampling Questionnaires FU 6 months FU 12 months Geschwind N, et al. J Consult Clin Psychol. 2011
24 Pre post PRE veranderingen POST MBCT CANGES Geschwind N, et al. J Consult Clin Psychol. 2011
25 Pre post veranderingen in het dagelijks leven Collip et al., Plos One 2013
26 Medicatie effecten dosage dosage Lataster J. et al., J. Clin Psychiatry, 2010
27 3) BEHANDELING MHENS School for Mental Health and Neuroscience HET IS NOODZAKELIJK OM DE THERAPIE UIT HET DOKTERSKABINET TE HALEN Faculty of Health, Medicine, and and Life Life Sciences Sciences
28 Behavioral activation in real life MHENS School for Mental Health and Neuroscience ESM feedback TAU + ESM + feedback Baseline ESM HDRS IDS Pseudo-interventie TAU + ESM Post ESM HDRS IDS Depressive symptoms FU 1,2,3 & 6 months Controle TAU Faculty of Health, Medicine, and and Life Life Sciences Sciences Kramer I, World Psychiatry 2014
29 MHENS School for Mental Health and Neuroscience Behavioural activation in real life In depressie Positive emotions per activity Type Activiteiten active relaxation activity passive relaxation activity doing nothing or resting talking self care eating/drinking on the way household activities not at all much Positive emotions active relaxation talking eating/drinking household activities passive relaxation self care on the way doing nothing/resting Faculty of Health, Medicine, and and Life Life Sciences Sciences Kramer I, World Psychiatry 2014
30 MHENS School for Mental Health and Neuroscience Behavioural activation in real life Feedback op gezelschap & PA Type of company Positive affect per type of company People I live with Alone Other people Alone Other people/people I don't know People I live with Not at all Much Positive Affect Faculty of Health, Medicine, and and Life Life Sciences Sciences Kramer I, World Psychiatry 2014
31 IDS-SR Sumscore Behavioural activation -> results MHENS School for Mental Health and Neuroscience Self-report depression (IDS-SR) * Controle Pseudo-interventie Interventie * ** *** 10 Faculty of Health, Medicine, and and Life Life Sciences Sciences Kramer I, World Psychiatry 2014
32 HDRS Sumscore MHENS School for Mental Health and Neuroscience Behavioural activation -> results Rated depression (HAMILTON) Controle Pseudo-interventie 14 Interventie * * * * ** 6 Faculty of Health, Medicine, and and Life Life Sciences Sciences Kramer I, World Psychiatry 2014
33 MHENS School for Mental Health and Neuroscience CBT in real life Heb je last gehad van stemmen? Een beetje Gemiddeld Extreem Denk je dat de stemmen Oncontroleerb aar zijn? Alweten d zijn? Machtig zijn? Anders Je hebt eerder gezegd dat muziek luisteren helpt. Probeer een liedje te neurieen als ze praten. Misschien hebben stemmen het ook wel eens mis. Vraag een vriend of hij info heeft die de stemmen tegenspreekt. Faculty of Health, Medicine, and and Life Life Sciences Sciences Misschien kunnen ze toch niet echt doen wat ze zeggen. Probeer te doen wat je van plan was, ondanks de stemmen. Ze zullen je misschien niet elke minuut van de dag lastig vallen. Probeer eens op te merken wanneer je ze niet hoort. Granholm et al, Schiz Bull 2012
34 MHENS School for Mental Health and Neuroscience CBT in real life Heb je last gehad van stemmen? Nee Goed! Wat helpt? Medicatie Bezig blijven Minder stress Gezon d denken Goede keuze! Die methode zou best wel eens kunnen werken. Faculty of Health, Medicine, and and Life Life Sciences Sciences Granholm et al, Schiz Bull 2012 Probeer deze methode ook eens de komende dagen!
35 MHENS School for Mental Health and Neuroscience CBT in real life Heb je last gehad van stemmen? Nee Goed! Wat helpt? Medicatie Bezig blijven Minder stress Gezon d denken Goede keuze! Die methode zou best wel eens kunnen werken. Faculty of Health, Medicine, and and Life Life Sciences Sciences Granholm et al, Schiz Bull 2012 Probeer deze methode ook eens de komende dagen!
36 MHENS School for Mental Health and Neuroscience CBT in real life Heb je last gehad van stemmen? PILOT (N= 42) Nee 1). << ernst auditieve Goed! hallucinaties Wat helpt? 2). << gedachten dat stemmen Gezon oncontroleerbaar Bezig Minder d Medicatie zijn blijven stress denken 3). << gedachten dat stemmen alwetend zijn Goede keuze! Die methode zou best wel eens kunnen werken. Faculty of Health, Medicine, and and Life Life Sciences Sciences Granholm et al, Schiz Bull 2012 Probeer deze methode ook eens de komende dagen!
37 ACT in daily life Regular ACT-training Briefing 4-week additional ACT in Daily Life Training Debriefing Week 1: 3-day training Evaluation Week 2: 3-day training Evaluation Week 3: 3-day training Evaluation Week 4: 3-day training Evaluation
38 ACT in daily life -> training day Short-questionnairre (3 minutes) ACT-Metaphor / Awareness exercise Morningexercise: Values T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 ESM-I: 10 times a day. Eveningexercise: Commitment Morning ACTexercise Afternoon ACT-exercise Evening ACTexercise Standard-exercise ACTion-exercise
39 ACT in daily life -> PsyMate PsyMate Menu Morning (values) ACTstandard ACTionexercise ACT- Metaphor Evening (commitment) Accept Defusion Mindfulness Accept Defusion 1. Struggle 2. Invite pain 3. Obstakles 4. Dark-side 1. Observe 2. Clouds 3. Zoom out 4. Mind-control 1. Senses 2. Breathing 3. Bodyscan 4. Grounding 1. Compassion 2. Explore 3. Fight or Flight 1. Repeat 2. Step-back 3. Appreciate
40 Faculty of Health, Medicine, and and Life Life Sciences Sciences
41 Thanks to: Funding: ERC, NWO, NARSAD, Health Foundation Limburg
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