Impact of epilepsy in adolescence: a UK controlled study

PURPOSE: The goals of the work described here were to investigate the psychological and social impact of epilepsy on adolescents and to identify to what degree clinical and demographic variables and knowledge of epilepsy could influence psychosocial functioning. METHODS: Seventy adolescents with epilepsy were compared with healthy controls (matched for age, sex, and reading ability) on measures of self-esteem, social adjustment, depression, and obsession. Within the epilepsy group, the impact of seizure frequency, seizure severity, and knowledge of epilepsy on the above measures was also determined. RESULTS: Adolescents with epilepsy showed significantly higher levels of depression, anhedonia, and social anxiety and significantly higher numbers of obsessive symptoms than the adolescents without epilepsy. Among the adolescents with epilepsy, high seizure frequency was significantly associated with low self-esteem, and tonic-clonic seizures were specifically associated with higher levels of depression. Finally, low levels of epilepsy knowledge were significantly associated with higher levels of depression, lower levels of self-esteem, and higher levels of social anxiety. CONCLUSIONS: Epilepsy has a significant psychosocial impact on adolescents at this difficult time of life. Social support and access to appropriate information about epilepsy could be of help.     

Self-esteem and depression

Summary This is the last of a series of three papers dealing with the role of self-esteem in the onset of clinical depression. On the basis of a longitudinal population enquiry a comprehensive psychosocial model of depression is developend. It is concluded that self-esteem (primarily in terms of a negative measure) does play a significant role. However, this can be only properly interpreted in the light of the full model. This highlights: 1. the importance of the occurrence of both a negative enviromental factor (negative interaction with children or husband for married or negative interaction with children or lack of a very close tie for single mothers)and a negative psychological factor (low self-esteem or chronic subclinical condition); and 2. how a relatively small group of high risk women in these terms (23% of total at risk based on measures collected well of onset of depression occurring over a 12 month period.     

Activation in dorsolateral prefrontal cortex in response to maternal criticism and praise in recovered depressed and healthy control participants.

BACKGROUND: High family levels of expressed emotion reliably predict relapse in patients with schizophrenia and mood disorders; however, the neural mechanisms linking expressed emotion and relapse are unexplored. Dysfunctional activity in the dorsolateral prefrontal cortex (DLPFC) has been implicated in the pathophysiology of depression. Functional magnetic resonance imaging (fMRI) was used to assess focal activation changes in DLPFC in response to a novel psychosocial challenge stimulus developed from the expressed emotion construct. METHODS: Healthy control subjects and fully remitted unipolar depressed participants completed blood oxygen level-dependent fMRI while they heard their own mothers making critical and praising comments about them. RESULTS: Relative to control subjects, participants with a history of depression failed to activate DLPFC when they heard critical remarks. There were no differences between the two groups in their DLPFC responses to maternal praise. CONCLUSIONS: Even if fully well at the time of testing, participants with a known vulnerability to depression respond differently to the psychosocial challenge of being criticized. These findings might have implications for our understanding of vulnerability to depression and to depressive relapse.     

Emotional adjustment in amyotrophic lateral sclerosis (ALS)

Despite the devastating motor impairment, a significant number of patients with amyotrophic lateral sclerosis (ALS) maintain a good psychosocial adjustment. Here we investigated whether this is specific for ALS or a more general characteristic of terminal disease. Psychosocial adjustment was investigated in 30 ALS patients, 29 cancer patients in palliative treatment and 29 age-, gender- and level of education-matched healthy controls. Subjective quality of life (sQoL), degree of depressive symptoms and coping were evaluated as measures of psychosocial adjustment. Personality factors were described. ALS and cancer patients showed a good psychosocial adjustment. Subjective QoL and depression did not differ significantly. Both patient groups presented a good sQoL. The level of mild depressive symptoms in both patient groups was similar and none showed clinically relevant depression. ALS patients expressed fewer active coping strategies than cancer patients which were explained by gender differences. Both patient groups showed comparable psychosocial adjustment to their disease. Overall, in terminally ill patients the psychological response to the prognosis is not associated with neurobiological changes (e.g., associated with subclinical deficits in ALS) or with physical decline.     

Psychosocial impact of involvement in the Special Olympics

Existing evidence suggests that people with intellectual disabilities are vulnerable to low self-esteem leading to additional psychosocial issues such as social exclusion and stress. Previous research into the involvement of Special Olympics (SO) of people with intellectual disabilities has indicted positive psychosocial outcomes. Involvement in sport is known generally to have psychological and social benefits. This study aimed to compare the psychosocial impact of involvement in sport through the SO to no or limited sports involvement, for a sample of people with intellectual disabilities. A cross sectional design was employed comparing three groups, SO, Mencap Sports, and Mencap No Sports on the variables: Self-esteem, quality of life, stress levels and social networks. One hundred and one participants were recruited either through the SO or Mencap. Data were collected through the completion of validated questionnaires by one to one interviews with the participants. Analysis revealed that self-esteem, quality of life, and stress were all significantly associated with SO involvement. Logistic regression analysis was used to explore whether scores on these variables were able to predict group membership. Self-esteem was found to be a significant predictor of group membership, those in the SO having the highest self-esteem. The findings provide further evidence of a positive association between sport involvement and increased psychological wellbeing, especially for those involved in the SO. The implications of these findings for practice and future research into the relationship between sport and psychological wellbeing within the learning disabled population are considered.     

Bulimia nervosa: Prevalence and psychological correlates in a college community

A questionnaire survey was distributed to 273 female, undergraduate students at a private, liberal arts college (94.1% response rate) to determine the prevalence of bulimia nervosa, as defined by DSM-III-R criteria. In addition, several psychological traits of participants meeting the criteria were compared with a control group and a group of bingers and vomiters of subclinical severity. Results of the study indicated that 11.3% (n = 28) of the student population surveyed met the DSM-III-R criteria for bulimia nervosa. Individuals with bulimia nervosa reported significantly more depression, loneliness, and anxiety, and lower self-esteem, as well as significantly greater concerns about body-shape and size compared to both other groups. A discriminant function analysis isolated three variables (concerns about body shape, self-esteem, and loneliness) that were highly successful (91.2% correctly classified) in predicting group membership. The results emphasize the importance of overconcern with body shape and weight in the syndrome of bulimia nervosa.     

Linear association between social anxiety symptoms and neural activations to angry faces: from subclinical to clinical levels

Social anxiety disorder (SAD), which is characterized by the fear of being rejected and negatively evaluated, involves altered brain activation during the processing of negative emotions in a social context. Although associated temperament traits, such as shyness or behavioral inhibition, have been studied, there is still insufficient knowledge to support the dimensional approach, which assumes a continuum from subclinical to clinical levels of social anxiety symptoms. This study used functional magnetic resonance imaging (fMRI) to examine the neural bases of individual differences in social anxiety. Our sample included participants with both healthy/subclinical as well as clinical levels of social anxiety. Forty-six participants with a wide range of social anxiety levels performed a gender decision task with emotional facial expressions during fMRI scanning. Activation in the left anterior insula and right lateral prefrontal cortex in response to angry faces was positively correlated with the level of social anxiety in a regression analysis. The results substantiate, with a dimensional approach, those obtained in previous studies that involved SAD patients or healthy and subclinical participants. It may help to refine further therapeutic strategies based on markers of social anxiety.     

The role of subclinical paranoia on social perception and behavior

The purpose of this study was to investigate the effects of subclinical paranoia on social perception and behavior. Two groups of participants, those high and low in subclinical paranoia, were identified based on extreme scores on the Paranoia Scale (PS). As expected, persons high in subclinical paranoia had greater depression, social anxiety, self-consciousness, and lower self-esteem compared to persons low in subclinical paranoia. In addition, persons high in subclinical paranoia performed worse than persons low in subclinical paranoia on laboratory measures of emotion perception and on an in vivo social perception task. Finally, behavioral differences between these two groups were revealed: Persons high in subclinical paranoia sat further away from the examiner and took longer to read the consent form than low-paranoia persons. These behavioral differences were not due to the group differences in clinical functioning, indicating that level of paranoia generally accounted for these findings.     

The incidence of anxiety and depression among employees—the role of psychosocial work characteristics

Background: Anxiety and depression are prevalent among employees and are associated with functional disability and work impairment. To date, little is known about the incidence and possible risk factors for developing anxiety and depression in the working population. Study aims were to (a) determine the incidence of subclinical anxiety and depression in a general working population and (b) identify the psychosocial work characteristics associated with the onset of subclinical anxiety and depression. Methods: This prospective study is based on 3,707 employees participating in the Maastricht Cohort Study on Fatigue at Work. Psychosocial work characteristics were measured in May 2000; anxiety and depression were measured with the Hospital Anxiety and Depression Scale in April 2002. Results: The cumulative 23‐month incidence for subclinical anxiety and depression was 4.6 and 3.3%, respectively. High psychological job demands increased the risk for both subsequent anxiety and depression. Moreover, low social support was predictive for the onset of anxiety, whereas job insecurity increased the risk for the onset of depression. These prospective associations were independent of potential confounding variables and the other psychosocial work characteristics. Conclusions: Adverse psychosocial work characteristics are significant predictors for the onset of subclinical anxiety and depression in the general working population. These findings encourage intervention studies testing whether modifying the psychosocial work environment reduces both anxiety and depressive symptoms among employees. Depression and Anxiety 26:1040–1048, 2009. © 2009 Wiley‐Liss, Inc.     

Persecutory delusions and the self: An investigation of implicit and explicit self-esteem

Persecutory delusions are proposed to be a defence against low self-esteem reaching conscious awareness (Bentall, Corcoran, Howard, Blackwood, & Kinderman, 2001). Key predictions of this proposal are that individuals with persecutory delusions will have lower implicit self-esteem and equivalent levels of explicit self-esteem compared to healthy controls. This study aims to test the predictions regarding implicit and explicit self-esteem in people with persecutory delusions. Of 22 people screened for persecutory delusions, 16 were recruited to the study. 20 healthy control participants were recruited. The Implicit Association Test was used to measure implicit self-esteem and the Rosenberg self-esteem scale was used to assess explicit self-esteem. Positive and negative self and other schemas were also assessed using the Brief Core Schema Scales. People with persecutory delusions had positive implicit self-esteem, comparable to that of the control group. Explicit self-esteem was lower for the persecutory delusion group, but was associated with increased depression and anxiety. Negative self and other schemas were higher in the clinical group. The results do not support the contention that persecutory delusions defend against negative self-representations and low self-esteem reaching conscious awareness. Non-defensive cognitive models are discussed as an alternative way of understanding persecutory delusions.     

Subclinical depression severity is associated with distinct patterns of functional connectivity for subregions of anterior cingulate cortex

Depression is a prevalent psychiatric condition characterized by sad mood and anhedonia. Neuroscientific research has consistently identified abnormalities in a network of brain regions in major depression, including subregions of the anterior cingulate cortex (ACC). However, few studies have investigated whether the same neural correlates of depression symptom severity are apparent in subclinical or healthy subjects. In the current study, we used resting-state fMRI to examine functional connectivity for subregions of the ACC in N = 28 participants with subclinical levels of depression. In regression analyses, we examined relationships between depression severity and functional connectivity for pregenual ACC (pgACC), anterior subgenual ACC (sgACC), and posterior sgACC seed regions. Additionally, we examined relationships between ACC subregion connectivity and trait levels of positive and negative affect. We found distinct associations between depression severity and functional connectivity of ACC subregions. Higher depression severity was associated with reduced pgACC-striatum connectivity and reduced anterior sgACC-anterior insula connectivity. Consistent with resting-state findings in major depression, higher depression severity was also related to greater anterior sgACC-posterior cingulate connectivity and greater posterior sgACC-dorsolateral prefrontal connectivity. Lastly, there were distinct correlations between connectivity for anterior versus posterior ACC subregions and positive and negative affective traits. These findings provide novel support linking subclinical depression to the same neural substrates associated with major depression. More broadly, these results contribute to an emerging literature on dimensional approaches to psychiatric illness.     

Distracted and down: neural mechanisms of affective interference in subclinical depression

Previous studies have shown that depressed individuals have difficulty directing attention away from negative distractors, a phenomenon known as affective interference. However, findings are mixed regarding the neural mechanisms and network dynamics of affective interference. The present study addressed these issues by comparing neural activation during emotion-word and color-word Stroop tasks in participants with varying levels of (primarily subclinical) depression. Depressive symptoms predicted increased activation to negative distractors in areas of dorsal anterior cingulate cortex (dACC) and posterior cingulate cortex (PCC), regions implicated in cognitive control and internally directed attention, respectively. Increased dACC activity was also observed in the group-average response to incongruent distractors, suggesting that dACC activity during affective interference is related to overtaxed cognitive control. In contrast, regions of PCC were deactivated across the group in response to incongruent distractors, suggesting that PCC activity during affective interference represents task-independent processing. A psychophysiological interaction emerged in which higher depression predicted more positively correlated activity between dACC and PCC during affective interference, i.e. greater connectivity between cognitive control and internal-attention systems. These findings suggest that, when individuals high in depression are confronted by negative material, increased attention to internal thoughts and difficulty shifting resources to the external world interfere with goal-directed behavior.     

Participation in a 10-week course of yoga improves behavioural control and decreases psychological distress in a prison population

Background

Yoga and meditation have been shown to be effective in alleviating symptoms of depression and anxiety in healthy volunteers and psychiatric populations. Recent work has also indicated that yoga can improve cognitive-behavioural performance and control. Although there have been no controlled studies of the effects of yoga in a prison population, we reasoned that yoga could have beneficial effects in a setting where psychosocial functioning is often low, and the frequency of impulsive behaviours is high.

Methods

Participants were recruited from 7 British prisons and randomly allocated to either a 10-week yoga programme (yoga group; 1 class per week; N = 45) or a control group (N = 55). Self-report measures of mood, stress, and psychological distress were collected before and after the intervention period. Participants completed a cognitive-behavioural task (Go/No-Go) at the end of the study, which assessed behavioural response inhibition and sustained attention.

Results

Participants in the yoga group showed increased self-reported positive affect, and reduced stress and psychological distress, compared to participants in the control group. Participants who completed the yoga course also showed better performance in the cognitive-behavioural task, making significantly fewer errors of omission in Go trials and fewer errors of commission on No-Go trials, compared to control participants.

Conclusions

Yoga may be effective in improving subjective wellbeing, mental health, and executive functioning within prison populations. This is an important consideration given the consistently high rates of psychological morbidity in this group and the need for effective and economical intervention programmes.     

Clustering of psychosocial symptoms in overweight children

OBJECTIVE: The aims of the present study were to (i) examine the relationship between children's degree of adiposity and psychosocial functioning; and (ii) compare patterns of clustering of psychosocial measures between healthy weight and overweight/obese children. METHOD: Cross-sectional data from a population-based cohort of 158 healthy weight, 77 overweight, and 27 obese children aged 8-13 years were analysed. Height, weight depression, quality of life, self-esteem, body dissatisfaction, eating disorder symptoms, peer relationships and behavioural and emotional problems were measured. RESULTS: Multi-level analysis showed significant linear associations between child body mass index z-scores and the psychosocial variables, with increasing adiposity associated with increasing levels of psychosocial distress. Principal components analyses indicated subtle differences between the healthy weight and overweight/obese groups with regards to the clustering of psychosocial measures. In particular, in overweight/obese, but not in healthy weight children, global self-worth clustered with body image and eating disorder symptoms. CONCLUSIONS: The psychosocial burden of excess weight is significant and broad reaching, with overweight/obese children showing multiple significant psychosocial problems.     

Positive ego and coping functions in chronic pain and depressed patients

Three groups of elderly subjects (chronic pain patients, patients with major depression, and healthy individuals) were administered measures of self-esteem, ego defense mechanisms, and coping style to examine how these personality components are affected by illness. Ego defense mechanisms and self-esteem for all three groups were not found to be different and were positive except for depressed patients, who used greater levels of projection and demonstrated lower levels of self-esteem. Each subject group utilized equally problem-focused and emotion-focused coping styles. These findings from a preliminary study are consistent with previous research demonstrating stability of personality throughout the life span, and suggest that the psychological functioning of older individuals with chronic pain syndromes or depression remains positive and resilient.     

Psychological processes underlying delusional thinking in late-onset psychosis: a preliminary investigation

BACKGROUND AND AIMS: It has been suggested that delusions may serve as a defence against negative self-representations. The present study investigated general psychological well-being and evidence for defensive emotional processes among people with late-onset psychosis. METHOD: The performance and responses of older people with late-onset psychosis (n = 13), older people with depression (n = 15), and age-matched healthy controls (n = 15) were compared in a cross-sectional design. Participants rated their own levels of depression and self-esteem, and completed an emotional Stroop task to establish whether there was evidence of implicit depression in the absence of explicit acknowledgement. Participants rated themselves on a number of personal attributes in relation to two life stages to generate discrepancies in 'actual', 'ideal' and 'other' self-concepts, and completed measures of their perceptions of current and past psychological well-being. RESULTS: People with late-onset psychosis showed no evidence of overt depression or low-self esteem. All three groups showed an attentional bias to depression-related and age-related words, although response times overall were faster for controls. The psychosis group showed no discrepancies between either their past or their current 'actual' and 'other' self-concepts, suggesting that they do not have more negative views about how others see them. CONCLUSIONS: Evidence from this study does not support the application of the 'delusion-as-defence' model to late-onset psychosis, but methodological constraints must be borne in mind when interpreting the findings.     

Elevated striatal and decreased dorsolateral prefrontal cortical activity in response to emotional stimuli in euthymic bipolar disorder: no associations with psychotropic medication load

Objective: To examine abnormal patterns of frontal cortical‐subcortical activity in response to emotional stimuli in euthymic individuals with bipolar disorder type I in order to identify trait‐like, pathophysiologic mechanisms of the disorder. We examined potential confounding effects of total psychotropic medication load and illness variables upon neural abnormalities. Method: We analyzed neural activity in 19 euthymic bipolar and 24 healthy individuals to mild and intense happy, fearful and neutral faces. Results: Relative to healthy individuals, bipolar subjects had significantly increased left striatal activity in response to mild happy faces (p < 0.05, corrected), decreased right dorsolateral prefrontal cortical (DLPFC) activity in response to neutral, mild and intense happy faces, and decreased left DLPFC activity in response to neutral, mild and intense fearful faces (p < 0.05, corrected). Bipolar and healthy individuals did not differ in amygdala activity in response to either emotion. In bipolar individuals, there was no significant association between medication load and abnormal activity in these regions, but a negative relationship between age of illness onset and amygdala activity in response to mild fearful faces (p = 0.007). Relative to those without comorbidities, bipolar individuals with comorbidities showed a trend increase in left striatal activity in response to mild happy faces. Conclusions: Abnormally increased striatal activity in response to potentially rewarding stimuli and decreased DLPFC activity in response to other emotionally salient stimuli may underlie mood instabilities in euthymic bipolar individuals, and are more apparent in those with comorbid diagnoses. No relationship between medication load and abnormal neural activity in bipolar individuals suggests that our findings may reflect pathophysiologic mechanisms of the illness rather than medication confounds. Future studies should examine whether this pattern of abnormal neural activity could distinguish bipolar from unipolar depression.     

Psychological correlates in patients with different levels of hypertension

The evidence linking essential systemic arterial hypertension (SAH) with psychological characteristics remains equivocal. The aims of this study were to assess clinical and subclinical distress, psychosocial aspects and psychological well-being in treated hypertensive patients and to evaluate the psychosocial variables associated with higher levels of blood pressure according to guidelines for hypertension management. A consecutive series of 125 hypertensive patients were evaluated using both self- and observer-rated reliable measures. Generalized anxiety disorder, minor depression, demoralization and alexithymia were the most frequent diagnoses. Cluster analysis revealed an association of three distinct symptomatological groups such as the Anxiety-Depression, the Alexithymia and the Somatization groups, with different levels of hypertension. In particular, patients with moderate to severe hypertension were more frequently in the Anxiety-Depression and the Alexithymia groups, whereas the Somatization cluster has been shown to be associated with isolated systolic hypertension. The results provide new insight into the psychosocial characteristics among patients with different levels of SAH according to recent guidelines of the management of hypertension. They also outline the need to monitor the clinical course of hypertensive patients characterized by these specific clinical and subclinical psychological conditions.     

Early detection of depression and associated risk factors in adults with mild/moderate intellectual disability

The aim of this study was to determine the presentation and risk factors for depression in adults with mild/moderate intellectual disability (ID). A sample of 151 adults (83 males and 68 females) participated in a semi-structured interview. According to results on the Beck Depression Inventory II, 39.1% of participants evinced symptoms of depression (2 severe, 14 moderate, and 43 mild). Sadness, self-criticism, loss of energy, crying, and tiredness appeared to be the most frequent indicators of depression or risk for depression. A significant difference was found between individuals with and without symptoms of depression on levels of automatic negative thoughts, downward social comparison and self-esteem. Automatic negative thoughts, quality and frequency of social support, self-esteem, and disruptive life events significantly predicted depression scores in people with mild/moderate ID, accounting for 58.1% of the variance.     

Cognitive training changes hippocampal function in mild cognitive impairment: a pilot study

A randomized pilot experiment examined the neural substrates of response to cognitive training in participants with mild cognitive impairment (MCI). Participants performed exercises previously demonstrated to improve verbal memory and an active control group performed other computer activities. An auditory-verbal fMRI task was conducted before and after the two-month training program. Verbal memory scores improved significantly and left hippocampal activation increased significantly in the experimental group (gains in 5 of 6 participants) relative to the control group (reductions in all 6 participants). Results suggest that the hippocampus in MCI may retain sufficient neuroplasticity to benefit from cognitive training.