Kees Van Heeringen - Academia.edu (original) (raw)

Papers by Kees Van Heeringen

Neuron, 2017

In het kader van het Vlaams Actieplan Suïcidepreventie lanceerde het Vlaams Expertisecentrum Suïc... more In het kader van het Vlaams Actieplan Suïcidepreventie lanceerde het Vlaams Expertisecentrum Suïcidepreventie recent een richtlijn en een e-learningwebsite voor hulpverleners. De richtlijn heeft als doel de kennis en vaardigheden van hulpverleners inzake suïcidepreventie te versterken en zo de zorg voor suïcidale personen te verbeteren. Ze biedt concrete aanbevelingen en praktische tools om hulpverleners te ondersteunen en ervoor te zorgen dat suïcidale gedachten en gedrag sneller gedetecteerd, effectiever behandeld en beter opgevolgd kunnen worden.

European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 2017

Journal of Psychiatric Research, 2017

Suicide plans are a major risk factor for suicide, which is a devastating outcome of depression. ... more Suicide plans are a major risk factor for suicide, which is a devastating outcome of depression. While structural and functional brain changes have been demonstrated in relation to suicidal thoughts and behaviour, brain mechanisms underlying suicide plans have not yet been studied. Here, we studied changes in regional cerebral metabolic activity in association with suicide plans in depressed individuals. Using (18)FDG-PET, a comparative study of regional cerebral glucose metabolism (rCMRglu) was carried out in depressed individuals with suicidal thoughts and suicide plans, depressed individuals with only suicidal thoughts, depressed individuals without suicide thoughts and plans, and healthy controls. When compared to the other groups, depressed individuals with suicide plans showed relative hypometabolism in the right middle frontal gyrus and the right inferior parietal lobe (Brodmann areas 10 and 39). Suicide plans in depressed individuals appear to be associated with reduced activity in brain areas that are involved in decision-making and choice, more particularly in exploratory behaviour.

Frontiers in Human Neuroscience, 2016

Objectives: We aimed to examine the effects and safety of accelerated intermittent Theta Burst St... more Objectives: We aimed to examine the effects and safety of accelerated intermittent Theta Burst Stimulation (iTBS) on suicide risk in a group of treatment-resistant unipolar depressed patients, using an extensive suicide assessment scale. Methods: In 50 therapy-resistant, antidepressant-free depressed patients, an intensive protocol of accelerated iTBS was applied over the left dorsolateral prefrontal cortex (DLPFC) in a randomized, sham-controlled crossover design. Patients received 20 iTBS sessions over 4 days. Suicide risk was assessed using the Beck Scale of Suicide ideation (BSI). Results: The iTBS protocol was safe and well tolerated. We observed a significant decrease of the BSI score over time, unrelated to active or sham stimulation and unrelated to depression-response. No worsening of suicidal ideation was observed. The effects of accelerated iTBS on mood and depression severity are reported in Duprat et al. (2016). The decrease in suicide risk lasted up to 1 month after baseline, even in depression non-responders. Conclusions: This accelerated iTBS protocol was safe. The observed significant decrease in suicide risk was unrelated to active or sham stimulation and unrelated to depression response. Further sham-controlled research in suicidal depressed patients is necessary. (Clinicaltrials.gov identifier: NCT01832805).

The Lancet Psychiatry, 2016

Self-harm (intentional acts of non-fatal self-poisoning or self-injury) is common, particularly i... more Self-harm (intentional acts of non-fatal self-poisoning or self-injury) is common, particularly in young adults aged 15-35 years, often repeated, and strongly associated with suicide. Effective aftercare of individuals who self-harm is therefore important. We have undertaken a Cochrane systematic review and meta-analysis of the effectiveness of psychosocial interventions for self-harm in adults. We searched five electronic databases (CCDANCTR-Studies and References, CENTRAL, MEDLINE, Embase, and PsycINFO) between Jan 1, 1998, and April 29, 2015, for randomised controlled trials of psychosocial interventions for adults after a recent (within 6 months) episode of self-harm. Most interventions were assessed in single trials. We report results for interventions for which at least three randomised controlled trials comparing interventions with treatment as usual have been published and hence might contribute to clinical guidance. The primary outcome was repetition of self-harm at the conclusion of treatment and at 6, 12, and 24 months' follow-up analysed, when available, with the intention-to-treat method; if this was not possible, we analysed with all available case data. We identified 29 non-overlapping randomised controlled trials with three independent trials of the same intervention. Cognitive-behavioural-based psychotherapy (CBT; comprising cognitive-behavioural and problem-solving therapy) was associated with fewer participants repeating self-harm at 6 months' (odds ratio 0·54, 95% CI 0·34-0·85; 12 trials; n=1317) and at 12 months' follow-up (0·80, 0·65-0·98; ten trials; n=2232). There were also significant improvements in the secondary outcomes of depression, hopelessness, suicidal ideation, and problem solving. Patients receiving dialectical behaviour therapy (in three trials) were not less likely to repeat self-harm compared with those provided with treatment as usual at 6 months (odds ratio [OR] 0·59, 95% CI 0·16-2·15; n=267, three trials) or at 12 months (0·36, 0·05-2·47; n=172, two trials). However, the secondary endpoint of frequency of self-harm was associated with a significant reduction with use of dialectical behaviour therapy (mean difference -18·82, 95% CI -36·68 to -0·95). Four trials each of case management (OR 0·78, 95% CI 0·47-1·30; n=1608) and sending regular postcards (OR 0·87, 95% CI 0·62-1·23; n=3277) did not reduce repetition of self-harm. CBT seems to be effective in patients after self-harm. Dialectical behaviour therapy did not reduce the proportion of patients repeating self-harm but did reduce the frequency of self-harm. However, aside from CBT, there were few trials of other promising interventions, precluding firm conclusions as to their effectiveness. National Institute for Health Research.

Development of effective treatments for patients following deliberate self-harm (self-poisoning o... more Development of effective treatments for patients following deliberate self-harm (self-poisoning or self-injury) is a very important element in suicide prevention. The randomized controlled trial (RCT) is the mainstay of evaluation of treatments. In a systematic review of the literature, the effectiveness of treatments based on RCTs was examined and the quality of the RCTs was assessed. Twenty trials were identified, and where possible, these were grouped on the basis of similarities among the types of treatment. In this paper, we examine the methodological aspects of the trials and consider what may be learned that will assist in the design of future studies in this field. The methodological quality of the trials was reasonable, but most trials included too few participants to detect clinically important differences in rates of repeated self-harm. In planning future trials, the following major issues should be addressed: investigators should perform power calculations to determine the number of subjects necessary to detect clinically important effects, provide information on method of randomization and interventions, use standard measures of outcome, and focus on homogeneous subgroups of patients. Improving the methodology of future studies in this field will be essential if sound evidence is to be obtained which can inform effective service provision for deliberate self-harm patients.

Eur J Emerg Med, 1997

Repetition of psychiatric emergency department use by a relatively small number of patients const... more Repetition of psychiatric emergency department use by a relatively small number of patients constitutes a major problem for clinicians and service providers. This study aimed at the identification of risk factors for repetition by addressing the time interval between the first and second visits to the emergency department. The purpose was to investigate what patient characteristics and referral circumstances determine this interval. Over a two year period, data on all psychiatric emergency referrals to the emergency department of four public hospitals were collected with a standardized form. Data collected during the index referral of all patients were used for estimating the risk for repetition using survival analysis techniques. A large proportion of repeaters revisits the emergency department within a short time interval. Younger, male patients who present themselves spontaneously are more likely to repeat than others. Previous inpatient service use and the presence of a diagnosis of substance abuse disorder or psychotic disorder at the first visit further increases the risk for repetition. Previous service use and, to a lesser degree, demographic and clinical characteristics of psychiatric patients are useful in the prediction of variations in time between first and second referrals to the emergency department.

Journal of Affective Disorders, 2016

Although accelerated repetitive Transcranial Magnetic Stimulation (rTMS) paradigms and intermitte... more Although accelerated repetitive Transcranial Magnetic Stimulation (rTMS) paradigms and intermittent Theta-burst Stimulation (iTBS) may have the potency to result in superior clinical outcomes in Treatment Resistant Depression (TRD), accelerated iTBS treatment has not yet been studied. In this registered randomized double-blind sham-controlled crossover study, spread over four successive days, 50 TRD patients received 20 iTBS sessions applied to the left dorsolateral prefrontal cortex (DLPFC). The accelerated iTBS treatment procedure was found to be safe and resulted in immediate statistically significant decreases in depressive symptoms regardless of order/type of stimulation (real/sham). While only 28% of the patients showed a 50% reduction of their initial Hamilton Depression Rating Scale score at the end of the two-week procedure, this response rate increased to 38% when assessed two weeks after the end of the sham-controlled iTBS protocol, indicating delayed clinical effects. Importantly, 30% of the responders were considered in clinical remission. We found no demographic predictors for response. Our findings indicate that only four days of accelerated iTBS treatment applied to the left DLPFC in TRD may lead to meaningful clinical responses within two weeks post stimulation.

The Lancet Psychiatry, 2016

Many countries are developing suicide prevention strategies for which up-to-date, high-quality ev... more Many countries are developing suicide prevention strategies for which up-to-date, high-quality evidence is required. We present updated evidence for the effectiveness of suicide prevention interventions since 2005. We searched PubMed and the Cochrane Library using multiple terms related to suicide prevention for studies published between Jan 1, 2005, and Dec 31, 2014. We assessed seven interventions: public and physician education, media strategies, screening, restricting access to suicide means, treatments, and internet or hotline support. Data were extracted on primary outcomes of interest, namely suicidal behaviour (suicide, attempt, or ideation), and intermediate or secondary outcomes (treatment-seeking, identification of at-risk individuals, antidepressant prescription or use rates, or referrals). 18 suicide prevention experts from 13 European countries reviewed all articles and rated the strength of evidence using the Oxford criteria. Because the heterogeneity of populations and methodology did not permit formal meta-analysis, we present a narrative analysis. We identified 1797 studies, including 23 systematic reviews, 12 meta-analyses, 40 randomised controlled trials (RCTs), 67 cohort trials, and 22 ecological or population-based investigations. Evidence for restricting access to lethal means in prevention of suicide has strengthened since 2005, especially with regard to control of analgesics (overall decrease of 43% since 2005) and hot-spots for suicide by jumping (reduction of 86% since 2005, 79% to 91%). School-based awareness programmes have been shown to reduce suicide attempts (odds ratio [OR] 0·45, 95% CI 0·24-0·85; p=0·014) and suicidal ideation (0·5, 0·27-0·92; p=0·025). The anti-suicidal effects of clozapine and lithium have been substantiated, but might be less specific than previously thought. Effective pharmacological and psychological treatments of depression are important in prevention. Insufficient evidence exists to assess the possible benefits for suicide prevention of screening in primary care, in general public education and media guidelines. Other approaches that need further investigation include gatekeeper training, education of physicians, and internet and helpline support. The paucity of RCTs is a major limitation in the evaluation of preventive interventions. In the quest for effective suicide prevention initiatives, no single strategy clearly stands above the others. Combinations of evidence-based strategies at the individual level and the population level should be assessed with robust research designs. The Expert Platform on Mental Health, Focus on Depression, and the European College of Neuropsychopharmacology.

Tijdschrift voor Geneeskunde, 2003

Psychiatria Danubina, Nov 1, 2014

Background: Suicide is a major health concern. Effective acute interventions are lacking. Recent ... more Background: Suicide is a major health concern. Effective acute interventions are lacking. Recent studies have suggested an acute decrease of suicidal ideations following repetitive Transcranial Magnetic Stimulation (rTMS). However, placebo effects could not be excluded. We aimed to evaluate the acute effect of accelerated intermittent theta burst stimulation (TBS) on suicide risk in depression.

Tijdschrift voor Geneeskunde, 2001

Crisis, 2000

... The international handbook of suicide and attempted suicide. Stephen Rosenman. Article first ... more ... The international handbook of suicide and attempted suicide. Stephen Rosenman. Article first published online: 28 JUN 2008. DOI: 10.1046/j.1440-1614.2001.0949k.x. Issue. ... More content like this. Find more content: like this article. Find more content written by: Stephen Rosenman ...

All deliverables of the project will be available in 5 languages and disseminated at the final Eu... more All deliverables of the project will be available in 5 languages and disseminated at the final Euregenas conference in December 2014 targeting local, regional and national levels. All information and final deliverables will be available on the website:

Crisis, Mar 6, 2015

The study described here is part of an evaluation of a pilot project concerning the implementatio... more The study described here is part of an evaluation of a pilot project concerning the implementation of three psychiatric crisis units in general hospitals in Belgium. The purpose was to evaluate the short-term outcome of a multidisciplinary crisis intervention for psychiatric patients referred to the emergency department. Patients were assessed with the General Health Questionnaire (GHQ-28) at the time of referral to the emergency department and again 1 month later. Patients referred for a psychiatric crisis intervention were compared with patients receiving short-term psychiatric inpatient treatment in another hospital. Patients referred to the emergency department showed a considerable degree of psychiatric disturbance. The General Health Questionnaire appeared to be a good measure for assessment of the "state" aspect of a psychiatric disturbance. The state of distress was significantly reduced one month after referral in both treatment conditions. Nevertheless, an important proportion of patients remained in a state of considerable distress. The results indicate that a short hospital-based crisis intervention approach is comparable with more traditional acute inpatient treatment. However, in the case of more severely distressed patients it may be insufficient. Several limitations of this study are also discussed (risk of overestimation of improvement, influence of time or pre-existing differences).

The Cochrane database of systematic reviews, Jan 12, 2016

Self-harm (SH; intentional self-poisoning or self-injury) is common, often repeated, and associat... more Self-harm (SH; intentional self-poisoning or self-injury) is common, often repeated, and associated with suicide. This is an update of a broader Cochrane review first published in 1998, previously updated in 1999, and now split into three separate reviews. This review focuses on psychosocial interventions in adults who engage in self-harm. To assess the effects of specific psychosocial treatments versus treatment as usual, enhanced usual care or other forms of psychological therapy, in adults following SH. The Cochrane Depression, Anxiety and Neurosis Group (CCDAN) trials coordinator searched the CCDAN Clinical Trials Register (to 29 April 2015). This register includes relevant randomised controlled trials (RCTs) from: the Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). We included RCTs comparing psychosocial treatments with treatment as usual (TAU), enhanced usual care (EUC) or alternative treatments in adults with a recent ...

Canadian Journal of Psychiatry Revue Canadienne De Psychiatrie, Jul 1, 2003

To investigate the current state of knowledge regarding the neurobiology of suicide and suicidali... more To investigate the current state of knowledge regarding the neurobiology of suicide and suicidality. The literature on the neurobiology of suicidality and suicide was reviewed. There is clear evidence that the activity of 3 neurobiological systems has a role in the pathophysiology of suicidal behaviour. This includes hyperactivity of the hypothalamo-pituitary-adrenal axis, dysfunction of the serotonergic (5-HTergic) system, and excessive activity of the noradrenergic system. While the first and the last system appear to be involved in the response to stressful events, dysfunction of the serotonergic system is thought to be trait-dependent and associated with disturbances in the regulation of anxiety, impulsivity, and aggression. It can be hypothesized that neurobiological dysfunctions mediate the occurrence of suicidal behaviour through the disturbed modulation of basic neuropsychological functions. Increasing insight into the neurobiological basis of suicidal behaviour suggests that serotonin (5-HT) agonists have an important role in the treatment and prevention of suicidal behaviour. Studies of the efficacy of such drugs have, however, been disappointing. Because suicidal behaviour continues to be a major public health problem, further study is clearly needed, including research on the effect of combined pharmacologic and psychotherapeutic approaches.

The European Journal of Public Health, Jun 1, 2003

on behalf of the EUROSAVE Working Group * Background: There are an estimated one million complete... more on behalf of the EUROSAVE Working Group * Background: There are an estimated one million completed suicides per year worldwide. As a response to increasing concern about suicide within Europe, the EUROSAVE (European Review of Suicide and Violence Epidemiology) study was undertaken to examine recent trends in the epidemiology of suicide and self-inflicted injury mortality in the European Union (EU). Methods: Suicide and self-inflicted injury mortality data for the 15 EU countries for the years 1984-1998 were obtained from the World Health Organisation (WHO), the European Statistical Office of the European Commission (EUROSTAT) and national statistical agencies. Data were also obtained for a second group of deaths classified as 'undetermined' or 'other violence'. Age-standardized mortality rates were calculated and examined for trends over time. Results: Finland had the highest suicide rate, while Greece had the lowest for the latest available year (1997). Age-standardized suicide rates tended to be lowest in the Mediterranean countries. Significant downward linear time trends in suicide mortality were observed in most countries, although rates varied markedly between countries. Both Ireland and Spain displayed significant upward linear trends in suicide mortality. Portugal had the highest rate of undetermined deaths both in 1984 and 1998 while Greece had the lowest in both 1984 and 1997. Five countries (including Ireland and Spain) showed significant downward trends in deaths due to undetermined causes whereas Belgium and Germany showed borderline significant upward linear trends in deaths due to undetermined causes. Conclusions: Although suicide rates in most countries seem to be decreasing, the validity of the data is uncertain. Misclassification may contribute to the geographical and temporal variation in suicide rates in some EU countries but it does not explain the phenomenon. More detailed research comparing suicide-recording procedures and practices across the EU is required. In the absence of adequate EU wide data on suicide epidemiology, effective prevention of this distressing phenomenon is likely to remain elusive.

European eating disorders review : the journal of the Eating Disorders Association, Jan 9, 2016

In this study, possible differences in the neural correlates of set-shifting abilities between th... more In this study, possible differences in the neural correlates of set-shifting abilities between the restrictive (AN-R) and bingeing/purging (AN-BP) subtypes of anorexia nervosa have been explored. Three groups of participants performed a set-shifting task during functional magnetic resonance imaging: patients with AN-R (N = 16), AN-BP (N = 13) and healthy control participants (N = 15). As in a typical set-shifting experiment, participants had to switch between two easy tasks (i.e. 'Is the presented number odd/even' or 'Is the presented number smaller/larger than 5'). The trials in which the task was repeated (repeat trials) were compared with trials in which the task was switched (switch trials). With regards to the level of task performance, no significant group differences could be established. However, when comparing switch specific brain activity across study groups, a stronger activation was found in the insula and the precuneus in AN-R when compared to AN-BP and...

Canadian Journal of Psychiatry, 2003

Neuron, 2017

European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 2017

Journal of Psychiatric Research, 2017

Frontiers in Human Neuroscience, 2016

The Lancet Psychiatry, 2016

Eur J Emerg Med, 1997

Journal of Affective Disorders, 2016

The Lancet Psychiatry, 2016

Tijdschrift voor Geneeskunde, 2003

Psychiatria Danubina, Nov 1, 2014

Tijdschrift voor Geneeskunde, 2001

Crisis, 2000

Crisis, Mar 6, 2015

The Cochrane database of systematic reviews, Jan 12, 2016

Canadian Journal of Psychiatry Revue Canadienne De Psychiatrie, Jul 1, 2003

The European Journal of Public Health, Jun 1, 2003

European eating disorders review : the journal of the Eating Disorders Association, Jan 9, 2016

Canadian Journal of Psychiatry, 2003

Vlaamse richtlijn voor de preventie van zelfdoding in de gezondheidszorg. Bevat aanbevelingen voo... more Vlaamse richtlijn voor de preventie van zelfdoding in de gezondheidszorg. Bevat aanbevelingen voor de detectie, behandeling en opvolging van suïcidale personen. Primaire doelgroep: artsen, psychologen, therapeuten en verpleegkundigen. Thema's die aan bod komen:

- Detecteren en bespreken van suïcidaliteit
- Interventies om het suïciderisico te verlagen
- Wat te doen na een suïcidepoging
- Wat te doen na een suïcide
- Hoe een suïcidepreventiebeleid opstellen