Smart symptom control for psychological problems

Case

Smart symptom control for psychological problems

‘For more than one hundred years, we have been searching for the causes of psychological disorders. However, there is not a gene for depression or a neurological defect that causes an eating disorder. To find starting points for more effective treatments, we will shift our focus to symptoms and their mutual interaction’, is how Anita Jansen from Maastricht University summarises the Gravitation programme “New Science of Mental Disorders”.

Anita JansenAnita Jansen

At least one-quarter of all adults worldwide suffer at some time in their lives from a psychological disorder, such as an anxiety disorder, depression, personality disorder or an addiction. Unfortunately, the best treatments only work in forty to sixty percent of all patients. Researchers from Maastricht University, Leiden University and the University of Amsterdam will spend the next ten years looking at the symptoms that somebody experiences rather than the disorder that a person is diagnosed with.

Did you know? There are actually no major distinctions between various disorders such as depression and anorexia. The different symptoms influence each other.

Network model

‘Within our programme, we will use a network model that has recently been developed by mathematical psychologists. That model reveals how an individual patient’s symptoms are correlated with each other in a network’, says main applicant Jansen. Take, for example, the symptoms that occur in depression, such as lack of sleep, concentration problems, a negative mood, anxieties and tiredness. These symptoms are not independent of each other: if you sleep badly, you are tired. As a result of that, you cannot concentrate properly, and you make mistakes. You feel bad about those. Perhaps you start worrying about the consequences of those mistakes as a result of which you once again cannot sleep…

Jansen: ‘There are considerable differences between individuals who suffer from the same disorder according to the standard diagnosis. In addition, more than seventy percent of the patients experience several disorders at once: therefore, the comorbidity for psychological disorders is high. At present, we generally treat the most clearly occurring disorder. But if you examine the network and systems, then actually there are no major distinctions between various disorders such as depression and anorexia. The different symptoms influence each other. There is not one single cause, but key symptoms that maintain the entire network in a person can certainly be indicated per individual. That is what we will look for so that we can determine which symptoms you can best combat in that patient to treat him or her successfully.’

Right symptom

The aim of this study is definitely not to get rid of existing therapies’, Jansen quickly adds. ‘On the contrary, some excellent, effective treatments exist. We only want to ensure that those treatments are focused on the right symptom in the hope that they will then eventually make the patient better.’

The researchers will not focus on groups with specific disorders, but will ask all patients who register at one of the affiliated health institutions in a certain period whether they are willing to register to participate in the research. Ultimately, they hope to be able to describe the symptom networks of one thousand people in detail. ‘Initially, we will follow these people for a period of two weeks before the treatment starts. Via their mobile phone, they will receive a signal about ten times per day after which they will need to answer several questions. What do you feel? Where are you? What are you thinking? We will combine these data with physical measurements, for example, via pulse monitors and activity trackers. We will analyse all of these data to describe the networks. Which symptoms are connected to which other symptoms and how? How do these influence each other? How strong is that connection? How does such a network relate to the diagnosis established? How stable is the network without treatment? Which symptom occupies a key position? Are there signals that predict a relapse? However, we will also do experimental research into causal relationships between symptoms: how does symptom A lead to symptom B? How can you inhibit those interactions?’ For this, the researchers will mainly focus on symptom mechanisms that occur in several disorders, and that could explain these.

Woman in therapy with a psychologist

Dismantling the network

Finally, the researchers will do a treatment study. They will divide the patients into three groups: one of the groups will receive a traditional treatment, a second group medicines, and the last group therapy specifically aimed at each patient’s network. After the treatment, the researchers will describe the network again. ‘We will measure how people feel and whether they still satisfy the criteria for the disorder diagnosed. We will also examine whether the network has been dismantled as a consequence of the treatment, and if that is the case, whether that improves the success of the treatment in the longer term, which is what we currently expect.’

A better understanding of your own illness is always beneficial
- Anita Jansen

Even if the success of the treatment does not improve in the long term, then this research will definitely still be useful, emphasises Jansen. ‘If you move towards a more individual diagnosis/treatment trajectory, then that always yields useful information. With this network approach, we will offer patients and their therapists more insight into how the patient functions. Therapists can discuss the network with their client, and together they can search for ways of breaking through the frequently occurring vicious circles that a person experiences. Furthermore, a better understanding of your own illness is always beneficial.’

Perspective for psychological suffering

The clinical psychologist is particularly delighted about the Gravitation award: ‘This is a unique opportunity. In this project, we have formed six multidisciplinary research teams in which scientists from different universities work together. That will give an enormous boost to our discipline. Unfortunately, psychological disorders do not receive the same level of funding as research into physical diseases. I hope that with this programme, we can for once provide a better perspective to patients who suffer psychologically.

New Science of Mental Disorders

Applicants: Prof. A.T.M. Jansen (Maastricht University), Prof. M. Kindt (University of Amsterdam), Prof. R.W.H.J. Wiers (University of Amsterdam), Prof. B.M. Elzinga (Leiden University), Prof.A.J. Roefs (Maastricht University), Prof. A. Evers (Leiden University)

Size: 19.3 million euros, 19 researchers from 7 universities

 

Text: Sonja Knols
Photo of Anita Jansen: Thom Frijns
Other images: Shutterstock