Dirk Geurts | Research Fellow
My mission as a psychiatrist is to offer patients a better prognosis. As a consultant psychiatrist, co-head educator, cognitive neuroscientist with a background in philosophy, I aim to offer high quality, personalized pharmacological and psychotherapeutic treatments, train residents in psychiatry to become well equipped specialists and try to translate basic neuroscientific endeavors to clinical practice for the benefit of psychiatric patients .
For me, as a scientist-practitioner, it has been very motivating and frustrating at the same time to see the tremendous progress in the neurosciences, whereas the benefit for clinical psychiatry is poor. From this perspective, I think it is important to realize that clinical practice is about improvement of prognosis through treatment. A sensible diagnosis, then, is an understanding of the mechanisms at play for a particular person that enables us to predict differential outcomes given possible therapies and select the most optimal course of (combined) action. Therefore, I aim (i) to extend knowledge on neuropsycho-pharmacological mechanisms relevant to psychiatric disorders and their (pharmaco- and/or psychological) treatments and (ii) to assess this presumed relevance in clinical practice to (iii) improve clinical practice accordingly.
With respect to (i) I contributed during my phd in the MCC group of Roshan Cools (2009-2016) to the understanding of the neuropsychopharmacological mechanisms underlying the interplay between affective and behavioural regulation, which is central to a wide range of psychiatric disorders, and especially depression. Combining pharmacological interventions and fMRI with behavioural task batteries allowed us to show fronto-striatal connectivity was related to individual differences in punishment-motivated, behavioural inhibition. Moreover, our findings pointed to a specific role of serotonin in inhibition and motivation, key for understanding contemporary treatments of depression. Moving towards more individualized understanding of the underlying mechanisms, we revealed individualized catecholaminergic (i.e. noradrenergic and dopaminergic) effects on affective biases through intervention with methylphenidate and positron emission tomography. Moreover, my fascination with the complexity and uniqueness of each person has been an ongoing motivation to assess individual differences in personality pathology involving affective dysregulation of behaviour (ZonMW AGIKO grant, 2012). We showed that incarcerated violent offenders could be dissociated from non-criminal individuals with comparable personality tendencies, based on how reward-related brain regions interact with brain regions controlling behaviour. From my translational point of view, we showed in a pilot study that PIT-related amygdala signaling was predictive of clinical recovery after 1 year of treatment for borderline personality disorder.
Regarding (ii) and (iii), I hold an academic position since 2016 at the Radboudumc psychiatry department where I am involved in clinical research and translational research. Amongst other projects we carried out a large (n=998) ROM project on effectiveness of mindfulness-based cognitive therapy (MBCT) challenging guideline recommendations to restrict MBCT to remitted, recurrent depression. In addition, we assess whether mindfulness-skill profiles might be predictive of treatment effectiveness and whether for patients with certain profiles, we should amend the standard MBCT protocol. In another study we assess neurobiological changes in highly stressed students from before to after MBCT. Another RCT we ran during the COVID pandemic showed that two highly scalable online mindfulness-based crisis interventions delivered to frontline healthcare workers were effective in reducing mental health symptoms.
Recently (2022), I was awarded a ZonMW Clinical Fellowship grant (2023) to enable me for the coming 6 years (2023-2029) to assess whether we can uncover (neurocognitive) predictors of treatment effects for esketamine treatment for patients suffering from difficult to treat depression and device a decision-tool that helps patients together with health care providers to make well-informed, personal choices in their treatment regimen.