Theo Broekman - Academia.edu (original) (raw)

Papers by Theo Broekman

Nordic Journal of Psychiatry, 2015

Low vitamin D levels are associated with schizophrenia, but the possible association between vita... more Low vitamin D levels are associated with schizophrenia, but the possible association between vitamin D levels and illness severity or duration of exposure to daylight has barely been investigated. To compare vitamin D levels in therapy-refractory severely ill schizophrenia patients and members of staff. To investigate the influence of daylight exposure on vitamin D levels in patients. Vitamin D was measured in patients with therapy-resistant schizophrenia in April, after the winter, and in patients and staff members in June, after an exceptionally sunny spring. Vitamin D levels in April and June were compared in patients, and levels in June were compared in patients and staff. The influence of daylight was taken into account by comparing the time patients spent outdoors during the day with the recommended minimum time for adequate vitamin D synthesis, and by comparing time spent outdoors in patients and staff. Patients had high rates of vitamin D deficiency (79-90%) and lower levels of vitamin D than staff members (p < 0.001), independent of skin pigmentation. In patients, vitamin D levels did not normalize, despite the considerably longer than recommended exposure of the skin to daylight (p < 0.001) and the longer exposure in patients than in staff members (p = 0.003). The vitamin D deficiency of therapy-resistant schizophrenia patients is pronounced and cannot be explained by differences in skin pigmentation or by an inactive, indoor lifestyle on the ward. Even theoretically sufficient exposure of the patients to daylight did not ameliorate the low vitamin D levels. While vitamin D deficiency probably plays a role in somatic health problems, it may also play a role in schizophrenia. Interestingly, exposure to daylight during an unusually sunny spring was not sufficient to correct the vitamin D deficiency seen in the patients. This emphasizes the need to measure and correct vitamin D levels in these patients.

Journal of Clinical Psychiatry, 2003

Alternatives to lithium for prophylactic treatment of patients with bipolar affective disorders a... more Alternatives to lithium for prophylactic treatment of patients with bipolar affective disorders are increasingly being advocated. However, trials comparing lithium with alternatives are scarce and often biased. We studied 94 patients with at least 2 episodes of bipolar disorder (DSM-III-R) during the previous 3 years who were in remission at entry into the study. Treatment with lithium or carbamazepine had not exceeded a total of 6 months during their lifetime. Patients were randomly assigned to carbamazepine or lithium at entry into the 2-year double-blind study or during the acute index episode previous to entry into the study. No concurrent antipsychotics or antidepressants were allowed. On lithium treatment, 12/44 patients developed an episode, compared with 21/50 on carbamazepine treatment. Episodes on lithium treatment occurred almost exclusively during the first 3 months of the trial. Carbamazepine carried a constant risk of an episode of about 40% per year. Efficacy of lithi...

Drug and Alcohol Dependence

European Journal of Psychotraumatology

SUCHT

. Background and Aims: Profiling according to a staging model could be useful for differentiating... more . Background and Aims: Profiling according to a staging model could be useful for differentiating among the heterogeneous group of treatment-seeking substance use disorder (SUD) patients. The staging model that was evaluated in this study is analogous to the hierarchical Tumor-Nodes-Metastasis (TNM) model in oncology. The proposed model distinguishes profiles derived from the following stages of addiction: (0) addicted, but not severely; (1) severely addicted, but without psychiatric comorbidity or social disintegration; (2) severely addicted with psychiatric comorbidity, but with no social disintegration; and (3) severely addicted in combination with psychiatric comorbidity and social disintegration. Methods: We tested whether subgroups suggested by the staging model for SUDs could be identified among Dutch treatment-seeking SUD patients (N = 6,602). Results: The profile of 5,153 patients (80.9 %) fitted the staging model, and the model was invariant for age, sex, and primary substance of abuse. The majority of the patients not fitting the model (N = 906 of 1,202; 75.4 %) were not severely addicted but were in treatment or had recently been treated for a comorbid psychiatric disorder. When psychiatric treatment was removed as an indicator for the presence of psychiatric comorbidity, the fit increased to 87.1 %. Conclusions: These results support the validity of the hierarchical staging model, which may be used to match patients to specific treatment regimens. Keywords: staging, profiling, disease progression, addiction severity, treatment-seeking patients, substance-use disorders

European journal of psychotraumatology, 2018

European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, Jan 16, 2018

Long-stay patients with severe schizophrenia are frequently treated with high doses of first-gene... more Long-stay patients with severe schizophrenia are frequently treated with high doses of first-generation antipsychotics (FGA). Dose reduction or switching to ziprasidone may reduce the severity of negative symptoms and side effects. We investigated in a randomized double-blind trial whether a dose-reduction strategy to achieve an adequate dose of a FGA (5 mg/day haloperidol equivalents, n = 24) or switching to ziprasidone (160 mg/day, n = 24) in treatment resistant patients would decrease negative symptoms after 1 year of treatment. We found that negative symptoms did not change significantly in either condition. Positive symptoms, excited symptoms, and emotional distress worsened over time with ziprasidone, resulting in a significant difference between conditions in favour of FGA dose reduction. Relapse and treatment failure, defined as a prolonged or repeated relapse, occurred more often with ziprasidone than with FGA (45.8% versus 20.8%, and 25.0% versus 16.7%, respectively). Trea...

Journal of Anxiety Disorders, 2017

Exposure therapy has proven efficacy in the treatment of posttraumatic stress disorder (PTSD). Em... more Exposure therapy has proven efficacy in the treatment of posttraumatic stress disorder (PTSD). Emotional processing theory proposes that fear habituation is a central mechanism in symptom reduction, but the empirical evidence supporting this is mixed. Recently it has been proposed that violation of harm expectancies is a crucial mechanism of action in exposure therapy. But to date, changes in harm expectancies have not been examined during exposure therapy in PTSD. The goal of the current study was to examine harm expectancy violation as mechanism of change in exposure therapy for posttraumatic stress disorder (PTSD). Patients (N=50, 44 female) with a primary diagnosis of chronic PTSD received intensive exposure therapy. Harm expectancies, harm experiences and subjective units of distress (SUDs) were assessed at each imaginal exposure session, and PTSD symptoms were assessed pre- and posttreatment with the Clinician Administered PTSD Scale (CAPS). Results showed that harm expectancies were violated within and strongly declined in-between exposure therapy sessions. However, expectancy violation was not related to PTSD symptom change. Fear habituation measures were moderately related to PTSD symptom reductions. In line with theory, exposure therapy promotes expectancy violation in PTSD patients, but this is not related to exposure therapy outcome. More work is warranted to investigate mechanisms of change during exposure therapy in PTSD.

SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice, 2009

Page 1. 209 THEMENSCHWERPUNKT ▶ Gerard M. Schippers1, Theo G. Broekman2, Angela Buchholz3 & R... more Page 1. 209 THEMENSCHWERPUNKT ▶ Gerard M. Schippers1, Theo G. Broekman2, Angela Buchholz3 & Ruud Rutten4 Introducing a new assessment instrument: The Measurements in the Addictions for Triage and Evalution (MATE) ...

Key words ● ▶ treatment allocation ● ▶ allocation guideline ● ▶ alcohol ● ▶ MATE ● ▶ health servi... more Key words ● ▶ treatment allocation ● ▶ allocation guideline ● ▶ alcohol ● ▶ MATE ● ▶ health services research