Autonomic and emotion regulation in bereavement and depression

OBJECTIVES: Prior research suggests important differences between depression and the depressed feelings experienced in the context of bereavement, despite some overlap. Differences include an increase in restlessness, suggesting underlying physiological differences between the groups. METHOD: This study examined the level of depressive symptoms, heart rate (HR), and heart rate variability (HRV), and coping style of 10 bereaved, 10 depressed, and 10 control participants. RESULTS: Bereaved participants showed significantly higher HR than either depressed or control participants, while there were no such differences in HRV. Level of depression in the bereaved group correlated negatively with HRV. Additional analyses showed that the use of passive coping had a marginally significant negative correlation with HRV in bereaved subjects. CONCLUSION: The present data suggest that differences in HR and HRV could be associated with increased cardiovascular fatalities in bereaved individuals, known as the "broken heart phenomenon." These physiological differences have potential implications for both the mental and physical health of the bereaved.     

Caregiver expressed emotion and depression in Alzheimer's disease

Expressed Emotion (EE) has been a useful construct for understanding the relationship between family interactions and depression in patients with psychiatric disorders. It has not, however, been well studied in patients with Alzheimer's disease (AD) and their caregivers despite its potential utility in clarifying patient-caregiver interactions and how such interactions may affect patient function, and caregiver burden, mood and quality of care. This study investigated the rate of EE in caregivers of patients with AD and depression. It also investigated the relationship of caregiver EE to patient status and caregiver burden and depression. Fifty-seven AD patient-caregiver dyads were studied in a cross-sectional design. Caregiver measures included the EE Speech Sample, Burden Inventory, and Center for Epidemiological Studies-Depression Scale. Patient measures included the Hamilton Depression Rating Scale, Record of Independent Living, and Revised Memory and Behavior Problem Checklist. Twenty-three (40%) caregivers were high in EE, 34 (60%) were low. This percentage is higher than reported in normal older adults but is consistent with other psychiatric populations. High EE caregivers were significantly more likely to be clinically depressed and have higher levels of burden. They also endorsed fewer positive aspects of caregiving. No relationship was found between caregiver EE status and patient variables. Caregiver EE offers a novel approach to understanding important aspects of caregiver-patient interactions which may impact long term patient functioning and caregivers' ability to provide effective care.     

Crossmodal emotional integration in major depression

Major depression goes along with affective and social-cognitive deficits. Most research on affective deficits in depression has, however, only focused on unimodal emotion processing, whereas in daily life, emotional perception is often highly dependent on the evaluation of multimodal inputs. We thus investigated emotional audiovisual integration in patients with depression and healthy subjects. Subjects rated the expression of happy, neutral and fearful faces while concurrently being exposed to emotional or neutral sounds. Results demonstrated group differences in left inferior frontal gyrus and inferior parietal cortex when comparing incongruent to congruent happy facial conditions, mainly due to a failure of patients to deactivate these regions in response to congruent stimulus pairs. Moreover, healthy subjects decreased activation in right posterior superior temporal gyrus/sulcus and midcingulate cortex when an emotional stimulus was paired with a neutral rather than another emotional one. In contrast, patients did not show such deactivation when neutral stimuli were integrated. These results demonstrate aberrant neural response in audiovisual processing in depression, indicated by failure to deactivate regions involved in inhibition and salience processing when congruent and neutral audiovisual stimuli pairs are integrated, providing a possible mechanism of constant arousal and readiness to act in this patient group.     

理解域下抑郁(英文)

The concept of subsyndromal, subthreshold or subcase depression has received considerable attention in recent decades. Judd and colleagues[1]- who reported that patients with depression are symptomatic more than 60% of the time and that most of that time is spent in subthreshold states - proposed the following operational definition of subsyndromal depression: ‘two or more simultaneous symptoms of depression,     

Face emotion perception and executive functioning deficits in depression

Frontal, limbic and temporal regions of the brain important in emotion perception and executive functioning also have been implicated in the etiology and maintenance of depression; yet, the relationships among these topics remain poorly understood. The present study evaluated emotion perception and executive functioning among 21 depressed women and 20 nondepressed women controls. Depressed women performed significantly worse than controls in emotion perception accuracy and in inhibitory control, an aspect of executive functioning, whereas the groups did not differ in other cognitive tests assessing memory, visual-spatial, motor, and attention skills. The findings suggest that emotion perception and executive functioning are disproportionately negatively affected relative to other cognitive functions, even in a high-functioning group of mildly depressed women. Measures of emotion perception and executive functioning may be of assistance in objectively measuring functional capability of the ventral and dorsal neural systems, respectively, as well as in the diagnosis of depression.     

Relapse in recurrent unipolar depression

Treatment of the acute phase of recurrent depression has become both routine and successful in the last decade, but the rates of relapse and recurrence remain a problem. In this study a combined psychopharmacologic/psychotherapeutic approach to the acute and continuation treatment of unipolar depressed patients was used. For 59 patients who completed the continuation phase of treatment, the relapse rate after 8 weeks of recovery was 8.5%. Since other recent studies of recurrent depression have reported relapse rates of 15%-22%, these results suggest that there are advantages in combined treatment.     

反复发作抑郁症患者甲状腺素水平观察

目的：了解反复发作抑郁症患者的甲状腺激素水平。方法：按性别,年龄１：１匹配选取序贯就诊的患者和健康者各２８例,采用放射免疫法测定患者组治疗前,后和对照组血清Ｔ３、Ｔ４、Ｔ３和ＴＳＨ浓度。     

Understanding the relationship between pain and emotion in idiopathic headaches

The aim of this paper is to review hypotheses regarding pain mechanisms in headache and relationships between headache pain and the brain’s emotional network. There is evidence that chronic pain in idiopathic headaches is, in part, an emotional response induced by alterations in the homeostasis of the interoceptive system—a system that integrates nociceptive information with the emotional network (mediating emotional awareness). These findings suggest that idiopathic headaches are probably due to both an altered pain matrix on the one hand, and an altered affective-cognitive state on the other.     

The neural correlates of sex differences in emotional reactivity and emotion regulation

Sex differences in emotional responding have been repeatedly postulated but less consistently shown in empirical studies. Because emotional reactions are modulated by cognitive appraisal, sex differences in emotional responding might depend on differences in emotion regulation. In this study, we investigated sex differences in emotional reactivity and emotion regulation using a delayed cognitive reappraisal paradigm and measured whole‐brain BOLD signal in 17 men and 16 women. During fMRI, participants were instructed to increase, decrease, or maintain their emotional reactions evoked by negative pictures in terms of cognitive reappraisal. We analyzed BOLD responses to aversive compared to neutral pictures in the initial viewing phase and the effect of cognitive reappraisal in the subsequent regulation phase. Women showed enhanced amygdala responding to aversive stimuli in the initial viewing phase, together with increased activity in small clusters within the prefrontal cortex and the temporal cortex. During cognitively decreasing emotional reactions, women recruited parts of the orbitofrontal cortex, the anterior cingulate, and the dorsolateral prefrontal cortex to a lesser extent than men, while there was no sex effect on amygdala activity. In contrast, compared to women, men showed an increased recruitment of regulatory cortical areas during cognitively increasing initial emotional reactions, which was associated with an increase in amygdala activity. Clinical implications of these findings are discussed. Hum Brain Mapp, 2010. © 2009 Wiley‐Liss, Inc.     

Treatment of recurrent depression

Approximately eight out of ten people experiencing a major depressive episode will have one or more further episodes during their lifetime: a recurrent major depressive disorder. Prolongation or lifelong pharmacotherapy has emerged as the main therapeutic tool for preventing relapse in depression. However, outcome after discontinuation of antidepressants does not seem to be affected by the duration of their administration. Loss of clinical effects, despite adequate compliance, has also emerged as a vexing clinical problem. Use of intermittent pharmacotherapy with follow-up visits is another therapeutic option that would leave patients with periods free of drugs and side effects, in consideration of the fact that a high proportion of patients would discontinue the antidepressant anyway. However, the problems of resistance (the fact that a drug treatment may be associated with a diminished chance of response in those patients who successfully responded to it, but discontinued it) and of discontinuation syndromes are a substantial disadvantage of this therapeutic option. In recent years, several controlled trials have suggested that a sequential use of pharmacotherapy in the treatment of the acute episode and psychotherapy in its residual phase may improve long-term outcome. However, patients should be motivated for psychotherapy and skilled therapists should be available. It is important to discuss with the patient the various therapeutic options and to adapt strategies to the specific needs of patients.     

Neural signatures of cognitive and emotional biases in depression

Functional brain imaging studies suggest that depression is a system-level disorder affecting discrete but functionally linked cortical and limbic structures, with abnormalities in the anterior cingulate, lateral, ami medial prefrontal cortex, amygdala, ami hippocampus. Within this circuitry, abnormal corticolimbic interactions underlie cognitive deficits ami emotional impairment in depression. Depression involves biases toward processing negative emotional information and abnormal self-focus in response to emotional stimuli. These biases in depression could reflect excessive analytical self-focus in depression, as well as impaired cognitive control of emotional response to negative stimuli. By combining structural and functional investigations, brain imaging studies mav help to generate novel antidepressant treatments that regulate structural and factional plasticity within the neural network regulating mood and affective behavior.Functional and structural neuroimaging studies have assumed a unique position in defining the neuroanatomy of depression. Studies of cerebral blood flow and glucose metabolism with positron emission tomography (PET) scans in primary depression and depression associated with brain lesions have consistently revealed that major depressive disorder is a system-level disorder.^1,2     

Music in depression: Neural correlates of emotional experience in remitted depression

AIM: To investigate neural and behavioral correlates of emotional experiences as potential vulnerability markers in remitted depression.METHODS: Fourteen remitted participants with a history of major depression and fourteen closely matched healthy control participants took part in the study. We used two psychiatric interviews (Hamilton Depression Rating Scale, Montgomery-Asberg Depression Rating Scale) and one self-report scale (Beck Depression Inventory) to assess remission. Healthy control participants were interviewed by an experienced psychiatrist to exclude those who showed any current or lifetime psychiatric or neurological disorders. To explore psychosocial and cognitive-interpersonal underpinnings of potential vulnerability markers of depression, early life stress, coping styles and alexithymia were also assessed. We induced pleasant and unpleasant emotional states using congruent combinations of music and human emotional faces to investigate neural and behavioral correlates of emotional experiences; neutral stimuli were used as a control condition. Brain responses were recorded using functional magnetic resonance imaging. Behavioral responses of pleasantness, arousal, joy and fear were measured via button-press inside the resonance imaging scanner.RESULTS: The mean age of the sample was 54.9 (± 11.3) years. There were no differences between remitted depressed (RD) (n = 14; 9 females and 5 males) and healthy participants (n = 14; 8 females and 6 males) regarding age, current degree of depression, early life stress, coping styles and alexithymia. On a neural level, RD participants showed reduced activations in the pregenual anterior cingulate cortex (pgACC) in response to pleasant [parameter estimates: -0.78 vs 0.32; t(26) = -3.41, P < 0.05] and unpleasant [parameter estimates: -0.88 vs 0.56; t(26)= -4.02, P < 0.05] emotional stimuli. Linear regression analysis revealed that pgACC activity was modulated by early life stress [β = -0.48; R² = 0.23, F(1,27) = 7.83, P < 0.01] and task-oriented coping style [β = 0.63; R² = 0.37, F(1,27) = 16.91, P < 0.001]. Trait anxiety modulated hippocampal responses to unpleasant stimuli [β = 0.62; R² = 0.38, F(1,27) = 15.95, P < 0.001]. Interestingly, in their reported experiences of pleasantness, arousal, happiness and fear in response to pleasant, unpleasant and neutral stimuli, RD participants did not differ significantly from healthy control participants. Adding trait anxiety or alexithymia as a covariate did not change the results.CONCLUSION: The present study indicates that, in euthymic individuals, depression history alters neural correlates, but not the subjective dimension of pleasant and unpleasant emotional experiences.     

EEG sleep profiles and recurrent depression

Earlier investigations have suggested that electroencephalographic (EEG) sleep may be altered as a function of the duration of an episode of depression. We compared the EEG sleep profiles in a group of recurrent depressives who had been depressed for less than 6 weeks with their sleep profiles as measured during their previous episode of depression. Findings in this sample of 32 patients point to the presence of specific rapid eye movement (REM) sleep abnormalities as being more pronounced earlier in the course of a depressive episode. Changes in REM latency and REM activity were also reflected in reductions in EEG spectral power in almost all bandwidths during the first REM period of the recurrent episode. These results are not easily explainable on the basis of traditional measures of clinical severity or the number of episodes.     

The effect of emotional context on facial emotion ratings in schizophrenia

Individuals with schizophrenia show deficits both in facial emotion recognition and context processing (Kohler, C.G., Walker, J.B., Martin, E.A., Healey, K.M., Moberg, P.J., 2010. Facial emotion perception in schizophrenia: a meta-analytic review. Schizophr. Bull. 36, 1009-1019). Recent evidence suggests context information can affect facial emotion recognition (Aviezer, H., Bentin, S., Hassin, R.R., Meschino, W.S., Kennedy, J., Grewal, S., Esmail, S., Cohen, S., Moscovitch, M., 2009. Not on the face alone: perception of contextualized face expressions in Huntington's disease. Brain 132, 1633-1644). Thus, individuals with schizophrenia may have deficits in facial emotion processing, at least in part, due to impairments in processing context information (Green, M.J., Waldron, J.H., Coltheart, M., 2007. Emotional context processing is impaired in schizophrenia. Cogn. Neuropsychiatry 12, 259-280.). We used a novel experimental task, the Emotion Context Processing Task (ECPT) to examine the influences of emotional context (IAPS pictures) on the processing of subtle surprised faces in schizophrenia. One of the task conditions included a manipulation designed to determine whether enhancing attention to the context (by requiring a categorization judgment on the context pictures) would facilitate the influence of context on facial emotion processing in schizophrenia. In addition, we tested whether deficits on a non-social context processing would predict deficits in the influence of context on facial emotion processing in schizophrenia. We administered the Dot Probe Expectancy Task (a non-social context processing task) and the ECPT to individuals with schizophrenia (n=35) and healthy controls (n=32). Individuals with schizophrenia showed an intact influence of context information on facial emotion recognition. The manipulation designed to enhance attention to emotional context reduced the effect of context for both groups. In schizophrenia, better processing of non-social context was associated with a stronger influence of context on valence ratings of facial expressions in the negative context condition. These results suggest in schizophrenia, similar mechanisms may influence the processing of context for both social and non-social information.