Voorbij diagnostische labels:
Een dynamische netwerk benadering van psychopathologie.
Marieke Wichers, Adjunct-hoogleraar
Interdisciplinary Center Psychopathology and Emotion regulation
University Medical Centre Groningen
Naam spreker Prof. Dr. M. C. Wichers
Belangenverstrengeling (potentieel) Geen / Zie hieronder
Voor bijeenkomst mogelijk relevante
relaties met bedrijven -
Sponsoring of onderzoeksgeld
Honorarium of andere (financiële)
vergoeding
Aandeelhouder
Andere relatie, namelijk …
ERC consolidator grant 2015
350 euro vergoeding voor
het geven van deze lezing. Dit
bedrag wordt weer voor ander
onderzoek ingezet.
Disclosure belangen spreker
Wat zijn eigenlijk psychiatrische stoornissen??
Patient 1
Patient 2
DSM structuur
What kind of things are mental disorders?
Frequent prospective measurements
Childhood trauma Stress-sensitivity Depressive
symptoms
Kramer, I et. Al. Schizophr Bull. 2014 Mar;40(2):278-86
Follow-up psychotic symptoms
moment-to-moment interplay between negative affect and
paranoia
Exp1 Exp2 Exp3 Exp4 Exp5
ESM: experiences producing cascades of effects
Low connectivity in the network High connectivity in the network
Wichers, Wigman, Myin-Germeys, Emotion Review, 2015
Cascades and networks
Healthy controls (n=207)
Insecure
Suspicious
1
2
4
3
5
Cheerful
Satisfied
Down
Satisfied
1
2
4
3
5
Cheerful
Insecure
Down Suspicious
Depression (n=129)
Looking through the microscope: real data
Wigman JTW. (…) Wichers M., Psychol Med 2015
Satisfied
1
2
4
3
5
Cheerful
Insecure
Down Suspicious
Depression (n=129)
1
2
4
3
5
Cheerful
Satisfied
Insecure
Down Suspicious
Psychosis (n=263)
Looking through the microscope: real data
Wigman JTW. (…) Wichers M., Psychol Med 2015
Netwerken: andere visie op psychopathologie
Weinig mechanistisch inzicht Statische benadering Geen oplossing voor individuele
verschillen
Traditional approach: Network approach:
Geeft mechanistisch inzicht Neemt dynamiek mee Persoons-specifieke modellen Meer info dan alleen symptomen
Impact van stress
Traditioneel model
Netwerk model
Cramer AOJ. BorsBoom D. (…) Kendler KS 2012. Psychol Medicine
And what about genes?
Wichers, Psychological Medicine 2014
Transdiagnostic approach
Cramer AOJ. (..) Borsboom 2010. Behavioral and Brain Sciences 33, 137-150 Borsboom D. & Cramer AOJ. Annu Rev Clin Psychol. 2013;9:91-121.
Personalized network structures
Towards translation of science to clinical practice
Automatic feedback of project “How nuts are the Dutch”, Peter de Jonge UMCG
Concentration
Cheerfulness
Mental unrest
Self-esteem Worry
My own factor
Stress
Activity
PA low aroual
NA low arousal
PA high arousal
NA high arousal
Stress
Activity
PA low arousal
NA low arousal
PA high arousal
NA high arousal
Personal models
People with same depression score on QIDS and matched on age and seks (in total n=50; HowNutsareDutch data)
Non-anhedonic: PA most strongly influences other network nodes Anhedonic: NA most strongly influences other network nodes
19
2,5
2,0
1,5
1,0
S C L - 9 0 - R
depression scale
0 5 10 15 20 25 30 35
w e e k
Dose reduction week 7-14
Single-case experiment
2,0
1,5
1,0
S C L - 9 0 - R
depression scale
0 5 10 15 20 25 30 35
w e e k
Start of experiment Close to transition
PA= positive affect; SU= suspicious; MU= mental unrest NA= negative affect; WO = worry
Application to eating disorders?
Symptoom dynamiek? Transdiagnostische verbanden? Mechanismen?
stressor
Lage eigenwaarde
somber Sociaal terugtrekken
piekeren
Positief affect
binge moment