P300 decrements in teenagers with conduct problems: implications for substance abuse risk and brain development.

BACKGROUND: The purpose of this study was to evaluate the effects of conduct disorder problems, family history, gender, and age on P300 electroencephalographic potentials in teenagers. METHODS: The 257 subjects, aged 15 to 20 years, were assigned to one of twelve groups defined by the crossing of three between-subjects factors: 1) gender; 2) ranking below vs above the median number of conduct disorder problems for their gender; and 3) no family history of alcohol or drug dependence vs familial alcohol dependence vs familial heroin or cocaine dependence. RESULTS: P300 amplitude was smaller among subjects reporting a greater number of conduct problems prior to age 15 vs those reporting fewer problems of this type. No family history effects were detected. Another set of analyses examined the effects of age on conduct problem-related decrements in P300. Smaller P300 amplitudes within the posterior scalp region were associated with a greater number of conduct problems among subjects younger than 16.5 years. Among subjects greater than this median age, the effects of these behaviors were only apparent over the frontal scalp. CONCLUSIONS: It is concluded that P300 decrements previously attributed to familial alcohol/substance dependence might be the result of a coincident increase in the prevalence of conduct disorder problems. The analysis of age interactions suggests that P300 amplitude decrements observed at posterior scalp sites among subjects with more conduct problems disappear at approximately 16 to 17 years of age. After that age, decrements in frontal brain function may begin to emerge in the subset of conduct problem subjects who are at risk for developing adult antisocial personality disorder.     

P300 evidence of cognitive inflexibility in female adolescents at risk for recurrent depression

Studies utilizing the P300 event-related potential (ERP) to document potential neurophysiological deficits related to depression have produced variable findings. The present investigation examined the effects of two tasks to determine whether one task would be more sensitive to a history of depression. We examined 124 female subjects, aged 14-20 years. Each subject was assigned to either a history of depression (DEP-Hx) or control group based on the presence versus absence of a DSM-III-R Major Depressive Episode. ERPs were recorded during two auditory oddball tasks. The first task was a simple two-pitch auditory discrimination and the second task was a three-stimulus auditory discrimination. In both tasks, subjects responded to the same rare target tone. Analysis of P300 amplitudes indicated a significant group by task interaction. Simple effects indicated that control subjects exhibited smaller target P300 amplitudes during the three-stimulus task as compared to the two-stimulus task. In contrast, subjects with a history of depression did not show a significant difference in P300 target amplitude between the two tasks. These results suggest that depression history as well as task difficulty/modality may influence the utility of the P300 in documenting the neurophysiological aspects of depression.     

CNS recovery from cocaine, cocaine and alcohol, or opioid dependence: a P300 study.

OBJECTIVES: The goal of the present study was to evaluate the relative effects of cocaine, cocaine and alcohol, or opioid dependence on P300 event-related potentials (ERPs). In addition, the effects of selected premorbid and comorbid factors were examined. METHODS: P300 ERPs were recorded from 72 residential treatment program patients, characterized by a history of either cocaine (n=25), or cocaine and alcohol (n=18), or opioid (n=29) dependence, and 14 non-drug-dependent community volunteers. The 86 subjects completed a visual continuous performance test formed by a series of 150 presentations of individual consonant letters. They were asked to press a key whenever a letter was presented twice in succession. RESULTS: Analyses of P300 ERPs obtained on target trials revealed a similar amplitude decrement in all the patient groups. Further analyses of P300 activity in the 3 drug-dependent patient groups revealed a negative correlation between P300 amplitude and the number of DSM-IIIR childhood conduct disorder criterion behaviors as well as a positive correlation between P300 amplitude and the duration of drug abstinence. CONCLUSIONS: P300 amplitude in drug-dependent patients is influenced by a complex interaction between CNS pathology that predates, and probably promotes, the onset of drug dependence and CNS pathology that resolves during the process of recovery from drug dependence.     

P300 abnormality in schizophrenic subtypes

P300 and other long latency event-related potentials were recorded in 65 schizophrenic subjects and results were compared to findings in 119 healthy controls. Highly significant differences in P300 latency and amplitude were found between the two groups. Forty six per cent of schizophrenics had P300 latency more than two standard deviations longer than the mean for controls, 35% had a P300 amplitude smaller than the mean for controls by the same amount, and 24% were more than two standard deviations outside the mean for controls on both measures. These differences were independent of chronicity of illness, clinical subtype, family psychiatric history or the effects of neuroleptic medication. They confirm that P300 abnormality is present as a stable trait in a high proportion of schizophrenics. The status of abnormal P300 as a biological vulnerability factor for major mental illness is discussed.     

有无家族史抑郁症的临床特征比较

目的 研究有无家族史抑郁症的差异。方法 收集首次住我院的抑郁症病例，对照CCMD-2-R再诊断及随访，以资料完整的102例按有无家族史分组对照分析。结果 家族史阳性者占30.39%，其中女性比例并不占优势，发病季节性亦不明显，病前生活事件显著少于家族史阴性组，三年随访复发率显著高于家族史阴性组，临床症状与住院疗效两者相仿。结论 阳性家族史是抑郁症易发病的重要因素之一，家族史阴性者应重视生活事件等对疾病的促发作用。尚无充足理由依据家族史对抑郁症分型     

Cross-situational coping with peer and family stressors in adolescent offspring of depressed parents

Offspring of depressed parents are faced with significant interpersonal stress both within their families and in peer relationships. The present study examined parent and self-reports of adolescents' coping in response to family and peer stressors in 73 adolescent children of parents with a history of depression. Correlational analyses indicated that adolescents were moderately consistent in the coping strategies used with peer stress and family stress. Mean levels of coping were similar across situations, as adolescents reported greater use of secondary control coping (i.e., acceptance, distraction) than primary control coping (i.e., problem solving, emotional expression) or disengagement coping (i.e., avoidance) with both types of stress. Regression analyses indicated that fewer symptoms of self-reported anxiety/depression and aggression were related to using secondary control coping strategies in response to family stress and primary control coping in response to peer stress. Implications for understanding the characteristics of effective coping with stress related to living with a depressed parent are highlighted.     

Frontal P300 decrements, alcohol dependence, and antisocial personality disorder.

BACKGROUND: The purpose of this study was to examine the independent and interactive effects of alcohol dependence, antisocial personality disorder (ASPD), and age on brain function. METHODS: P300 event-related potentials (ERPs) were recorded from 393 alcohol-dependent and 170 non-alcohol-dependent adults while they performed a visual oddball task. The two subject groups were further subdivided based upon age and the presence/absence of ASPD. RESULTS: Alcohol dependence was associated with a significant P300 amplitude decrement at anterior electrode sites only. Antisocial personality disorder was also associated with reduced P300 amplitudes at anterior electrode sites; however, the effects were only significant among subjects 30 years of age or younger. To validate this association between ASPD and P300 amplitude a correlational analysis was performed; the correlation between anterior P300 amplitude and the total number of childhood conduct disorder and adult ASPD symptoms was significant. CONCLUSIONS: The P300 amplitude decrement found at anterior electrode sites among subjects with ASPD is consistent with the results of numerous ERP, neuroimaging, or neuropsychologic studies of anterior brain function. Our study is unique in suggesting that the effects of ASPD on anterior brain function are best detected during early adulthood. The study also suggests that the detrimental neurophysiologic effects of alcohol dependence predominantly involve the anterior brain.     

Women, Depression, and Biological Psychiatry: Implications for Psychiatric Nursing

topic . The belif that taking medicine alone will eradicate depression can increase feelings of helplessness and dependence in depressed women, and deprive them of the opportunity to explore interpersonal reasons for the depression.
purpose . To examine the impact on depressed womenof a purely biological approach to depression SOURCE. Clinical work with depressed women and review of related literature
conclusions . In a depressed woman who has a history of passive behavior, a purely biological approach has poor long-term effects.     

Interactive effects of HIV/AIDS,body mass,and substance abuse on the frontal brain: A P300 study

In view of the rising prevalence of an overweight body mass among patients living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), clinicians must now be mindful of possible adverse outcomes resulting from the co-occurrence. The present study was designed to examine the additive and interactive effects of HIV/AIDS and an excess body mass, as well as the additional contributions of substance abuse or dependence. The dependent variable was brain function estimated by the measurement of P300 electroencephalographic potentials. P300 potentials were recorded during a task designed to elicit subcomponents with frontal (P300a) and both frontal and non-frontal (P300b) generators. Analyses revealed greater frontal P300a latencies among the 102 HIV-1 seropositive versus the 68 seronegative participants. In addition, frontal P300a latency was further increased by a synergistic interaction of HIV-1 serostatus with a body mass index (BMI) ≥ 25 kg/m². A history of substance abuse/dependence did not alter these changes. However, it did combine with HIV/AIDS to produce a smaller P300a amplitude than was seen in participants with neither disorder. The findings suggest that white matter changes accompanying an excess BMI may exacerbate those that attend HIV/AIDS and thereby slow down frontal brain function. Substance abuse, likewise, interacts with HIV/AIDS but may impair frontal brain function via a different mechanism.     

Familial (genetic) subtypes of pure depressive disease.

The author reviewed data from five studies and found that depressed patients with a history of depression in a parent or child have more sibships containing depression than depressed patients without this family history. Thus, there is a clustering of depressions in certain families. Sporadic pure depressive disease (PDD), where no depressive illness exists in a first-degree family member of a depressed proband, is associated with a later age of onset than familial PDD, where depressive illness does exist in a first-degree relationship. The possibility exists that familial PDD and sporadic PDD are autonomous illnesses. The presence of a family history of depression may be predictive to some extent of a good response to adequate tricyclic medication or ECT.     

Lifetime history of sexual abuse, clinical presentation, and outcome in a clinical trial for adolescent depression

OBJECTIVE: To investigate the impact of sexual abuse on clinical presentation and treatment outcome in depressed adolescents. METHOD: 107 adolescent outpatients, 13 to 18 years old, with DSM-III-R major depression were randomly assigned to cognitive-behavioral therapy (CBT), systemic behavioral family therapy (SBFT), or nondirective supportive therapy (NST) from Oct. 1, 1991 through May 31, 1995. Subjects were classified on the basis of the presence or absence of lifetime history of sexual abuse. Since only 1 subject assigned to SBFT had a history of sexual abuse, we restricted our analyses to those 72 subjects assigned to either CBT or NST. The impact of lifetime history of sexual abuse on service use, depression, and treatment outcome was examined. RESULTS: Depressed adolescents with a past history of sexual abuse were more likely, at 2-year follow-up, to have had a psychiatric hospitalization and have a depressive relapse, even controlling for maternal depression, source of referral, race, and treatment assignment. CBT was more efficacious than NST in absence of sexual abuse but was not better than NST in those with a history of sexual abuse. CONCLUSION: Sexual abuse is a negative predictor of long-term outcome in adolescent depression. CBT for depression may not be as efficacious for those depressed adolescents with a history of sexual abuse. These findings suggest that a history of sexual abuse should be assessed not only in clinical practice, but also in research studies of depressive outcome. Further work is indicated to understand the relationship between sexual abuse and poor outcome in order to help restore these high-risk youths to an optimal developmental trajectory.     

Never-depressed females with a family history of depression demonstrate affective bias

According to cognitive theories of depression, individuals susceptible to depression attend selectively to negative information. The purpose of the study was to examine if such an affective processing bias is present in never-depressed individuals with a family history of major depressive disorder (MDD). Formerly depressed female patients having at least one first-degree relative with a history of MDD (n=23), their never-depressed female siblings (n=21) and never-depressed female controls (n=21) performed a conventional and an emotional Stroop task using negative, positive and neutral words. A significant effect was found of group on negative processing bias; post hoc comparisons indicated that never-depressed siblings showed a larger negative processing bias than never-depressed controls. No significant differences were observed in positive bias or conventional interference between the three groups. Our findings suggest that never-depressed females with a family history of depression, like depressed patients, have more difficulties to inhibit negative material and to direct their attention towards task-specific material. This adds to the existing evidence that affective processing bias is a trait characteristic that contributes to the onset of depression and that could be a useful endophenotype for MDD.     

老年期抑郁症病人听觉事件相关电位P300的比较研究

目的 探讨老年期抑郁症病人的认知功能状况。方法 按CCMD-3中心境障碍抑郁发作诊断标准，收集33例60岁以上首次抑郁发作的病人(抑郁组)，32名健康老年人(对照组)。使用HAMD、HAMA和MMSE量表对所有入组者进行评定，并作P300测定。结果 抑郁组MMSE总分低于对照组。抑郁组N2和P3潜伏期比对照组延长；抑郁组的P300潜伏期N2和P3与HAMD的迟缓因子分呈正相关，与MMSE总分呈负相关。结论 老年期抑郁症病人存在认知功能障碍。     

3H-imipramine binding in depressed elderly: relationship to family history and clinical response

Platelet 3H-imipramine binding (Bmax) was determined in 34 elderly (mean age 64.8) unipolar depressed outpatients who were being treated with either nortriptyline or interpersonal psychotherapy for 10 to 16 weeks, and in nondepressed elderly controls. Bmax values were decreased in the depressed group. In addition, Bmax values were depressed further in subjects with a history of depression in first degree relatives. Good clinical response with either nortriptyline or psychotherapy was associated with lower Bmax compared to those subjects who had a poorer response to treatment. Treatment nonresponders and those with a negative family history of depression had Bmax values that were somewhat decreased but not significantly different from controls. This study extends to the elderly the potential applicability of platelet 3H-imipramine binding as a marker of depressive illness, and proposes a predictor for treatment response in elderly unipolar depressed patients.     

P300 and alcohol consumption in normals and individuals at risk for alcoholism. A preliminary report

Pairs of college student subjects (36 male, 36 female) were matched on age, sex, and personal drinking history. One pair member had a parent who met the DSM III criteria of alcoholism, while the other pair member had no close alcoholic relative. The P300 event-related brain potential (ERP) was obtained from each subject with auditory stimuli in an "oddball" paradigm. Target stimuli occurred randomly on 20% of the trials in a frequency discrimination task, a relatively easy intensity discrimination task, and a more difficult intensity discrimination task. Subjects indicated when the target items occurred by moving their index finger. No significant overall effects were obtained for family history for either P300 latency or amplitude. P300 latency increased and amplitude decreased with increases in the reported amount of alcohol consumption in all subjects only for the difficult intensity task but were statistically significant only for individuals with a negative family history for alcoholism.     

Psychiatric disorders in candidates for surgery for epilepsy.

BACKGROUND--Current evidence indicates that, on their own, neither flash visual evoked responses (FVEPs) nor event related potentials (ERPs) are sufficiently useful to the clinician in the very early stages of memory dysfunction. However, the possibilities for the combined use of these measures has not been fully explored. METHODS--This study examined the clinical utility of combined FVEP and ERP-P300 component latencies as predictive markers in 16 patients with Alzheimer''s disease, 15 patients with depression, and 21 control subjects. RESULTS--There were significant group differences in FVEP P2 latency (P = 0.004) between the controls and both the depressive patients and those with very mild Alzheimer''s disease. There were no statistically significant group differences for the ERP component (N2/P300) amplitudes or latencies. The P300 component latency was positively correlated with both the FVEP N2 and FVEP P2 component latencies in the patients with Alzheimer''s disease but not in the control subjects or the depressed patients. A discriminant function, using two ERP and two FVEP component measures, gave an overall correct classification rate for dementia of 78%. In this study of very mildly impaired patients the FVEP latencies provided a more sensitive marker for the presence of cognitive dysfunction than P300 latency delay. CONCLUSIONS--The findings support the use of multimodal evoked potentials in the differential diagnosis of very mild Alzheimer''s disease and normal aging.     

Depression in patients being evaluated for heart transplantation

In the evaluation of 68 consecutive heart transplant candidates, 37 (54%) had one or more depressive syndromes. Premorbid psychiatric risk factors of depression were prevalent throughout the group. Statistically significant associations with depression were found with age, educational and occupational levels, and a history of past depressive episodes, but not with family psychiatric history, parental loss in childhood, history of serious childhood illness, or history of substance abuse. Of the 43 patients transplanted, 16 of 22 who were depressed preoperatively required psychiatric intervention postoperatively compared to 8 of 21 who were not depressed; 75% had a beneficial response to treatment. We recommend that a diagnosis of depression not be considered reason to exclude otherwise suitable candidates for cardiac transplantation.     

Symptom criteria and family history in major depression

The author examined the relationship between symptom criteria for major depression and family history of mood disorders in 82 outpatients with major depression and 27 outpatients with nonaffective disorders. The family members of depressed patients with six or more groups of DSM-III symptoms of major depression exhibited substantially higher rates of mood disorders than the family members of depressed patients with fewer than six groups of symptoms and the family members of patients with nonaffective disorders. These data suggest that stricter symptom criteria for major depression may define a more homogeneous phenotype, at least from the standpoint of familial aggregation.     

Brain maturation and subtypes of conduct disorder: interactive effects on p300 amplitude and topography in male adolescents

OBJECTIVE: Adolescents with conduct disorder problems are, on average, at increased risk for a variety of unfortunate adult outcomes, including substance dependence. This study was designed to identify the neurophysiological correlates of different categories of conduct disorder problems as well as the relationship between these correlates and the maturational status of the brain. METHOD: The subjects were 94 males, aged 14-19 years, recruited from the community. None were recruited from treatment or juvenile justice programs. The subjects varied in the type and number of conduct problem behaviors exhibited prior to age 15. Groups were operationally defined by the relative number (0 versus > or =1) of DSM-IV conduct disorder diagnostic criteria within each of four categories: rules violations, aggression, deceitfulness/theft, and destructiveness. Age was included as an additional grouping factor. P300 electroencephalographic potentials were recorded while subjects performed a task in which rare auditory stimuli were used to signal a change in stimulus-response mapping during a succeeding set of trials. RESULTS: Analyses revealed that boys with a history of rules violations failed to exhibit the normal maturational increase in P300 amplitude found in boys without a history of rules violations. Topographic analyses of current source densities suggest that the source of the maturational deficit involved P300 generators within the frontal brain. Parietal generators of P300 matured normally. CONCLUSIONS: The present results are interpreted as reflecting a decrement in frontal brain maturation among boys potentially at risk for substance dependence, antisocial personality disorder, or other forms of adult psychopathology.     

Emotional information processing in first and recurrent major depressive episodes

Depressive states are classically associated to increased sensitivity to negative events. However this hypersensitivity may not be stable in time, being absent in remission periods or further reinforced with recurrent depressive episodes, or may concern positive stimuli instead, e.g. in young depressive patients. To study the evolution of the processing of emotional information in depression we recorded late components of evoked potentials in first-episode and recurrent depressed patients before and after recovery. We used a visual attentional paradigm manipulating the processing of emotional information. Subjects first counted words with positive valence, and then words with negative valence from lists of usual words. The results showed that recurrent patients had increased P300 amplitudes for negative words selection only in negative words counting situation, while first-episode patients had decreased P300 amplitudes for positive words selection. After clinical improvement, the negative biases in recurrent patients group disappeared but P300 amplitudes of first-episode patients remained significantly low for positive words. First-episode depressed patients show a selective impairment for positive stimuli, with decreased response to pleasant stimuli, while recurrent depressive subjects show signs of hyperesthesia for negative stimuli. These results suggest that responses to emotional stimuli in word processing are related to the duration of the mood disorders.