Over Dirk Geurts
My mission is to offer depressed patients a better prognosis. As a consultant psychiatrist, co-head educator, cognitive neuroscientist and philosopher, I offer high quality, personalized pharmacological and psychotherapeutic treatments, train residents in psychiatry to become well equipped specialists and translate basic neuroscientific endeavors for the benefit of psychiatric patients to clinical practice.
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 deem it of utmost importance to realize that clinical practice is about improving prognosis for human beings. A sensible diagnosis, then, is an understanding of the mechanisms at play for a particular person that predicts differential outcomes given possible therapies influencing these mechanisms. 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 substantially 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 ‘home-designed’ behavioural task batteries allowed me to show for the first time that, in humans, fronto-striatal connectivity was related to individual differences in punishment-motivated, behavioural inhibition. Moreover, I revealed 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, within an international collaborative effort, 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). We showed that incarcerated psychopathic criminals can be dissociated from non-criminal individuals with comparable personality tendencies, based on how reward-related brain regions interact with brain regions controlling behaviour (Koningsheide award, best Dutch translational research in forensic psychiatry). From my translational point of view, I showed in a pilot study that PIT-related amygdala signaling was predictive of clinical recovery after 1 year of treatment for borderline personality disorder (poster-award, national congress Dutch society of Psychiatry).
Regarding (ii) and (iii), I obtained an academic position at the Radboud Psychiatry department, center of mindfulness, to optimize my experience in clinical research (involvement in 3 ongoing controlled trials) with the aim to develop myself as a bridge builder with both knowledge in neuropsychopharmacological science and clinical research. Amongst other projects we carried out a large (n=998) ROM project on effectiveness of MBCT challenging guideline recommendations to restrict MBCT to remitted, recurrent depression. A second goal here was to advance my data-science skills, aimed at deriving value from data for clinical practice. I therefore completed the excellent AI4health course offered by the Radboudumc, which has enabled me to use machine learning to improve predictions based on clinical data (ongoing work).
Recently (2022), I was awarded a ZonMW Clinical Fellowship grant to enable me for the coming 6 years to assess whether we can uncover (neurocognitive) predictors of treatment effects for s-ketamine treatment for patients suffering from hard to treat depression and device a website that helps patients together with health care providers to make well-informed, personal choices in their treatment regimen.