Psymate en psychose:
onderzoek en innovatie
Prof. Inez Myin-Germeys
Prof. of Ecological Psychiatry
School for Mental Health & Neuroscience
MHENS School for Mental Health and Neuroscience
De context van ervaringen
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IS ZELF-RAPPORTAGE IN HET DAGELIJKS LEVEN
MOGELIJK BIJ MENSEN MET PSYCHOTISCHE KLACHTEN?
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De Experience Sampling
Methode
Beep
1
Beep 2
DAY 1
DAY 2
Beep 3
Beep 4
DAY 3
Beep 5
DAY 4 (day 4 in detail)
Beep 6
DAY 5
Beep 7
DAY 6
 10 keer per dag
 6 opeenvolgende dagen
 op willekeurige tijdstippen
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Beep 8
Beep 9
Beep 10
Myin-Germeys et al, 2009; Wichers et al., 2009; Delespaul, 1995
Hallucinaties
participant 1
Participant 1
7
6
5
4
3
2
1
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
time
participant 2
auditory hallucination
hallucinatory intensity
hallucinatory intensity
8
visual hallucination
Participant 2
7
6
5
4
3
2
1
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
time
auditory hallucination
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visual hallucination
Hallucinaties
Auditory
hallucinations
auditory hallucinations
4
Visual hallucinations
auditory hallucinations
4
3,5
3,5
3
3
2,5
2,5
2
2
1,5
1,5
1
1
0,5
0,5
0
0
-0,5
last before
episode
first during
episode
during episode
AH intensity
last during
episode
first after episode
last before
episode
VH intensity
mean duration 2.6 beeps (3.9 hr)
Faculty of Health, Medicine and Life Sciences
Oorschot et al, Schiz Res 2012
first during
episode
during episode
AH intensity
last during
episode
first after episode
VH intensity
mean duration: 2.1 beeps (3.1 hr)
Relatie emoties – Auditieve Hallucinaties
auditory hallucinations
Before episode:
auditory hallucination
0,800
- more delusions
0,600
During episode:
- higher NA
- lower PA
- more delusions
0,400
0,200
0,000
-0,200
last before
episode
first during
episode
during episode
last during
episode
first after
episode
End of episode:
x
-0,400
pa
na
delusional intensity
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Oorschot et al, Schiz Res 2012
After episode:
x
ESM paranoia
Achterdocht
Time
Episode = reeks van 1 of meer opeenvolgende momenten
met een score van paranoia >=3
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Interne predictoren: begin van episode
***
***
Faculty of Health, Medicine and Life Sciences
Thewissen et al., Br. J. Clin Psychology, 2011
Tijdens een paranoide episode
***
***
***
***
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Thewissen et al., Br. J. Clin Psychology, 2011
Interne predictoren: subjectieve stress
Daily stress
Psychosis
Psychosis intensity
2
0
1
8
1
6
Patients, =0.45
1
4
Relatives, =0.16
Controls, =0.02
1
2
1
0
8
1
2
3
4
5
6
Increase in subjective stress
Faculty of Health, Medicine and Life Sciences
Myin-Germeys et al., Psych Med 2005
7
Paranoia wordt voorafgegaan door …
• Daling in SE
• Stijging in angst
paranoia
• Stijging in subjectieve stress
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Tijd
2) Negatieve symptomen
Emotionele variabiliteit
In 150 patients
patients high neg. symptoms
negative
affect
patients low neg. symptoms
controls
time
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Oorschot et al., schiz Bull 2013
Anhedonie
Healthy controls
Patients with few negative symptoms
Patients with a lot of negative symptoms
Positive Affect
18
16
14
12
10
8
6
4
2
0
Pleasant event
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Oorschot et al., schiz bull 2013
Wat betekent dit voor de kliniek?
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MHENS School for Mental Health and Neuroscience
1) DIAGNOSTIEK
GROEPSBEVINDINGEN ZIJN GOED TE VERTALEN NAAR
DE INDIVIDUELE PATIENT
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Individuele variabiliteit <-> groep
7
female ,aged 57
intensity 
6
5
paranoia
anxiety
Self-esteem
4
3
2
1
monday
wednesda
y
friday
7
6
paranoia
anxiety
Self-esteem
5
4
3
2
1
female, aged 44
tuesday
wednesda
y
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Oorschot, et al. Schiz Bull, 2011
thursday
expressie van symptomen in real life
Paranoid patient
Non-paranoid patient
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Oorschot, Lataster et al., Schiz Bull, 2012
Individuele variabiliteit <-> groep
Anxiety
Paranoia
Paranoia
3
Paranoia
3
Anxiety
2
-30% no ass
-30% no var
Anxiety
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Oorschot, et al. Schiz Bull, 2011
-30% ass
Individuele variabiliteit <-> groep
Relaxed
Relaxed
Paranoia
Paranoia
6
3
Paranoia
Paranoia
3
Relaxed
5
Relaxed
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Oorschot, et al. Schiz Bull, 2011
-50% ass
-50% no ass
or no var
MHENS School for Mental Health and Neuroscience
2) EFFECTEN VAN BEHANDELING IN KAART BRENGEN
EFFECTEN VAN BEHANDELING MOETEN OBJECTIEF
VASTGESTELD WORDEN DOOR EEN CLINICUS
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Remissie
107 non-remitted, 70 remitted, 148 controls
60
50
40
Non-remitted
30
Remitted
Control
20
10
0
% alone
% nothing
% goal-directed
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Oorschot, Lataster et al., Schiz Bull, 2012
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
6 days Experience
Sampling
Questionnaires
TAU
FU 6 months
FU 12 months
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Geschwind N, et al. J Consult Clin Psychol. 2011
– POST MBCT CANGES
Pre – postPRE
veranderingen
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Geschwind N, et al. J Consult Clin Psychol. 2011
Pre – post veranderingen in het dagelijks leven
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Collip et al., Plos One 2013
Medicatie effecten
dosage
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Lataster J. et al., J. Clin Psychiatry, 2010
dosage
MHENS School for Mental Health and Neuroscience
3) BEHANDELING
HET IS NOODZAKELIJK OM DE THERAPIE UIT HET
DOKTERSKABINET TE HALEN
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Behavioral activation in real life
ESM feedback
TAU + ESM + feedback
Baseline
ESM
HDRS
IDS
Pseudo-interventie
TAU + ESM
Controle
TAU
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Kramer I, World Psychiatry 2014
Post
ESM
HDRS
IDS
Depressive
symptoms
FU 1,2,3 &
6 months
MHENS School for Mental Health and Neuroscience
Behavioural activation in real life
In depressie
Type Activiteiten
Positive emotions per activity
active relaxation activity
passive relaxation activity
doing nothing or resting
talking
self care
eating/drinking
on the way
household activities
not at all 1
2
3
4
5
6
7 much
Positive emotions
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Kramer I, World Psychiatry 2014
active relaxation
talking
eating/drinking
household activities
passive relaxation
self care
on the way
doing nothing/resting
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
Not at all 1
Alone
Other people/people I don't know
People I live with
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Kramer I, World Psychiatry 2014
2
3
4
Positive Affect
5
6
7 Much
MHENS School for Mental Health and Neuroscience
Behavioural activation -> results
Self-report depression (IDS-SR)
IDS-SR Sumscore
40
Controle
35
30
25
20
Pseudo-interventie
Interventie
*
*
**
15
10
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Kramer I, World Psychiatry 2014
***
MHENS School for Mental Health and Neuroscience
Behavioural activation -> results
Rated depression (HAMILTON)
HDRS Sumscore
18
Controle
16
Pseudo-interventie
14
Interventie
12
*
10
8
*
*
*
6
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Kramer I, World Psychiatry 2014
**
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?
Je hebt
eerder
gezegd
dat
muziek
luisteren
helpt.
Alweten
d zijn?
Machtig
zijn?
Vraag
Misschien kunnen ze
toch niet echt doen
een
wat ze zeggen.
vriend of
hij info
heeft die
de
stemmen
tegenspreekt.
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Probeer een liedje
te neurieen als ze
praten.
Misschien hebben
stemmen het ook
wel eens mis.
Granholm et al, Schiz Bull 2012
Anders
…
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.
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.
Probeer deze methode ook eens de komende
dagen!
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Granholm et al, Schiz Bull 2012
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.
Probeer deze methode ook eens de komende
dagen!
Faculty of
Medicine,
andand
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Granholm et al, Schiz Bull 2012
MHENS School for Mental Health and Neuroscience
CBT in real life
Heb je last gehad van
stemmen?
Nee
PILOT (N= 42)
1). << ernst auditieve
hallucinaties
Goed!
Wat helpt?
2). << gedachten dat stemmen
“Gezon
Bezig
Minder
d
“oncontroleerbaar”
zijn
Medicatie
denken
blijven
stress
3). << gedachten dat stemmen “alwetend”
”
zijn
Goede keuze! Die methode zou best wel eens
kunnen werken.
Probeer deze methode ook eens de komende
dagen!
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Granholm et al, Schiz Bull 2012
ACT in daily life
Week 4:
3-day
training
Evaluation
Week 3:
3-day
training
Evaluation
Week 2:
3-day
training
Evaluation
Evaluation
Week 1:
3-day
training
4-week additional ACT
in Daily Life Training
Debriefing
Briefing
Regular ACT-training
ACT in daily life -> training day
Short-questionnairre
(3 minutes)
T1
Morningexercise:
Values
T2
T3
T4
T5
ACT-Metaphor /
Awareness exercise
T6
T7
T8
T9
T10
ESM-I: 10 times a day.
Morning ACTexercise
Afternoon
ACT-exercise
Standard-exercise
Evening ACTexercise
ACTion-exercise
Eveningexercise:
Commitment
ACT in daily life -> PsyMate
PsyMate Menu
Morning
(values)
Accept
1. Struggle
2. Invite pain
3. Obstakles
4. Dark-side
ACTstandard
Defusion
Mindfulness
1. Observe
2. Clouds
3. Zoom out
4. Mind-control
1. Senses
2. Breathing
3. Bodyscan
4. Grounding
ACTMetaphor
ACTionexercise
Accept
Defusion
1. Compassion
2. Explore
3. Fight or Flight
1. Repeat
2. Step-back
3. Appreciate
Evening
(commitment)
w.beuken@pn.unimaas.nl
00 31 43 368 53 30
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Thanks to:
Funding: ERC, NWO, NARSAD, Health Foundation Limburg
Faculty of Health, Medicine and Life Sciences