Learned Helplessness, Attributional Style, and Depression in Epilepsy

Summary: Purpose: We wished to examine the relevance of the theory of learned helplessness in general, and attributional style in particular, to the understanding of depression among patients with epilepsy.
Methods: Patients with lateralized temporal lobe epilepsy (TLE) (right = 73, left = 70) were administered two self-report depression inventories [Beck Depression Inventory (BDI), Center for Epidemiological Studies-Depression scale (CES-D)]. Depression scores were examined in relation to a key component of the revised theory of learned helplessness (attributional style) using the Optimism/Pessimism Scale.
Results: Attributional style was significantly associated with increased self-reported depression and remained significant when the effects of several confounding variables were controlled [age, age at onset, laterality of TLE, sex, and method variance].
Conclusions: The results indicate that the concepts of learned helplessness in general, and attributional style in particular, are related to the genesis of depression in epilepsy. Because they are known to be related to depression in the general population, and because specific techniques for intervention and prevention are available, greater consideration of learned helplessness and attributional style in the genesis of depression in epilepsy may be worthwhile.     

Preparatory brain potentials in major depressive disorder.

1. Psychomotor slowing in depression is frequently reflected by delayed reaction times (RT). 2. The role of central arousal mechanisms in response slowing was examined by comparing scalp-recorded slow negative potentials of depressed patients with normal controls in two separate studies. 3. Varying fore-warned RT conditions elicited contingent negative variation (CNV) waveforms and the resultant mid-point amplitudes of these waveforms together with orienting (O-wave), expectancy (E-wave) and post-imperative negative variation (PINV) component amplitudes and sensory evoked responses (N1, P2) were compared between groups. 4. RTs were significantly slowed in depressed patients and the patient group exhibited consistently larger PINV amplitudes. Depending on the RT condition, patients also exhibited larger mid-point CNV amplitudes and smaller N1 and P2 amplitudes.     

Postimperative negative variation (PINV) in ambulatory schizophrenic patients.

The contingent negative variation (CNV), first described by Walter in 1964,¹ is considered today as a cerebral phenomenon and not as an artifact from some extracerebral source. The CNV is recorded at vertex during the presentation of two successive stimuli, S₁-warning stimulus, S₂-imperative stimulus (classic CNV situation), preceding a motor response. The prolongation of the CNV after the motor response is called a postimperative negative variation (PINV).The PINV would appear more helpful in psychiatry than the CNV.² An abnormal PINV is more frequently observed in schizophrenic patients (75%) than in a normal control group (15%).² The present study was designed to investigate the possible influence of age, sex, and length of illness on the recording of the PINV in schizophrenic patients.     

Slow brain potentials and psychomotor retardation in depression

Event-related cortical potentials were recorded in 11 patients with primary depression and 11 healthy control subjects during a serial choice reaction task. Each new trial was voluntarily initiated when the subject pressed a microswitch; an acoustic go or no-go signal followed after a fixed interval. This elicited a Bereitschaftspotential (BP), a contingent negative variation (CNV), acoustically evoked potentials (N1, P2, P3), and a post-imperative negative variation (PINV) in direct succession. These were evaluated conventionally and by principal component analysis (PCA). Patients exhibited significantly longer reaction times and more negative PINVs. BP and CNV did not differ between groups. In conventional amplitude measurement small P3 amplitudes in depressives may be feigned by markedly negative PINVs.     

Slow EEG potentials (contingent negative variation and post-imperative negative variation) in schizophrenia: their association to the present state and to Parkinsonian medication effects.

Between warning signal (S1) and imperative signal (S2), the EEG shifts negatively (contingent negative variation, CNV) reflecting preparation and expectancy. Reduced CNV and continued negativity after S2 (post-imperative negative variation, PINV) have been repeatedly found in schizophrenic patients and have been interpreted as a deficit in attentional processes (CNV) and as uncertainty about the correctness of one's own response to the S2 (PINV). Recent studies obtained a CNV reduction specifically at central sites but not at frontal ones. The present study investigated whether these alterations of slow negative potentials depend on present state of symptoms, on the particular task used, and on neuroleptic medication. Therefore, out-patients and in-patients were studied, two different S1-S2 tasks were used, and the control groups were healthy subjects and patients with Parkinson's disease. The central CNV reduction was stable across tasks and across in-patients and outpatients. Frontal CNV was reduced in in-patients but in only one of the two tasks in outpatients. The schizophrenic patients' enhanced PINV was larger contralaterally than ipsilaterally to the responding hand, correlated with medication, and occurred in similar way in patients with Parkinson's disease. Thus, the PINV increase might reflect the Parkinsonian side effects of the anti-psychotic medication. In contrast, the central CNV reduction appears as a stable marker of schizophrenia, the frontal CNV reduction as a state-dependent effect. The central CNV reduction might reflect impairment in forming stable stimulus-response associations, the relative frontal enhancement might reflect the out-patients' attempt at compensating that impairment.     

Representations of causality and depression. A factorial approach to the resignation model in the depressed patient

The present study investigates causal attributions for stressful life events within the context of Beck's cognitive theory of affective disorders and Seligman's learned helplessness model of depression. The aim was to assess the validity of the depressive attributional style proposed by Seligman, with a clinically depressed population for negative life events. This study presents a factor analysis of the causal attributions of depressed psychiatric in patients measured in relation to one negative life event per subject. The experimental procedure consisted in asking 71 ward depressed patients (51 females and 20 males) to answer 15 items along a seven point scale in order to assess the causes, consequences and control attributed. Statistical treatment using both multidimensional analyses (to describe the dimensions of causality) and univariate comparisons show: 1. The existence of a three dimensional solution, which is interpreted in terms of Seligman's reformulated helplessness model, and which confirms the notion of a "depressive attributional style". 2. A positive relationship between intensity of depression and the tendency to generalize the effects of negative life events (dimension of globality in Seligman's model and generalizability in Beck's). As this relationship is a function of the level of depression it is considered as a psychological state rather than as a personality trait. 3. Inter-sex differences with regard to the attribution of personal versus universal control, with female patients indicating more personal helplessness in relation to others. The results are discussed in relation to epidemiological data and personality theory.     

父母教养方式对缓解期抑郁症患者归因方式的影响

目的:探讨父母教养方式对抑郁症缓解期归因方式的影响。方法:采用父母教养方式问卷和归因方式问卷对116例抑郁症患者治疗前后及112例正常志愿者进行测查。结果:对照分析显示抑郁症患者对负性事件的内在性及正性事件的持久性、整体性归因和总体指标具有相对稳定性。教养方式中父母温暖理解、母亲偏爱与正性事件整体性、持久性及总体指标成正相关,与负性事件内在性负相关;父母拒绝否认、惩罚严厉、过度干涉与正性事件整体性、持久性及总体指标负相关,与负性事件内在性正相关。父母教养方式对抑郁症患者负性事件的内在性归因,正性事件持久性、整体性归因及总体指标有较好的预测。结论:抑郁症患者在缓解期也存在负性归因,调节教养方式可改变归因。     

强迫症患者的事件相关脑电位实验研究

背景 强迫症在辅助诊断上目前还缺乏客观的实验室依据。近年来国内外对强迫症的事件相关脑电位进行了研究,结果并不一致。分析其主要原因与所使用仪器、技术性能有关。为此本研究使用国际标准化的美国Nicolet脑电生理仪,并以较成熟的关联性负变、P300及失匹性负波3种事件相关脑电位为手段,并设临床上较多见的抑郁症和广泛性焦虑症为疾病对照,进一步探讨强迫症的脑电生理机制,为临床诊断及治疗提供参考依据。 方法 应用美国Nicolet Spirit 脑诱发电位仪,采用光和声成对刺激以及“听觉靶-非靶刺激序列”技术,对38例强迫症、20例抑郁症和18例广泛性焦虑症及28名正常人的关联性负变(CNV)、P300及失匹性负波(MMN)作了检测。3组疾病组病例均选自2002年5月至2005年12月上海市精神卫生中心,经2名以上的高年资医师确诊并符合中国精神障碍分类方案第三版（CCMD-3）中的强迫症和抑郁症及广泛性焦虑症诊断标准;听力均正常,并无躯体疾病或其他精神疾病,均为右利手。3组对象均未使用过精神科药物。结果 ①CNV：M1波幅抑郁症组[(5±4)μV]和广泛性焦虑症组[(7±4)μV]低于正常组[(14±6)μV]和强迫症组(16±6)μV,指令信号后负变化的出现率抑郁症组(60%)、强迫症组(45%)和广泛性焦虑症组(35%)均高于正常组(4%),上述组间差异均有统计学意义（P<0.05或P<0.01）。②P300：在靶刺激中,N2潜伏期在4组间的差异有统计学差异(P<0.01),其中强迫症组[(276±22)ms]和抑郁症组[(277±22)ms]的潜伏期均长于正常组[(259±14)ms],广泛性焦虑症组短于抑郁症组和强迫症组(P<0.01);P3波幅在4组间的差异亦有统计学差异(P<0.01),其中强迫症组[(3.4士1.6)μV]、抑郁症组[(2.9±1.3)μV]和广泛性焦虑症组[(3.3士1.3)μV]均低于正常组[(5.9土2.1)μV]。在非靶刺激中,广泛性焦虑症组P2波幅低于强迫症组和正常组(P<0.05)。③MMN：强迫症组、抑郁症组及正常组之间潜伏期和波幅的差异有统计学差异(P<0.05或P<0.01)。其中强迫症组和抑郁症组的潜伏期长于正常组(P<0.05);强迫症组的波幅高于正常组(P<0.05),抑郁症组的波幅低于正常组(P<0.05)和强迫症组(P<0.01)。结论 ERPs波幅一高一低变异特点可能对鉴别强迫症和抑郁症有参考意义。     

神经性厌食患者事件相关电位CNV的研究

目的:探讨神经性厌食(AN)患者的事件相关电位CNV的特点以及认知功能损害的神经生物学机制。方法:应用美国Nicolet Spirit脑诱发电位仪,刺激采用纯音"Oddball"诱发模式,对43例AN患者(研究组)和34名健康对照(对照组)进行认知电位CNV的检测。结果:两组CNV主要指标比较,以研究组的PINV时程延长(t=2.44,P=0.02),波幅B降低(t=3.85,P=0.00)以及反应时间延长(t=-2.11,P=0.04);两组间比较,差异有统计学意义。两组CNV其他指标比较,潜伏期A(t=-1.76,P=0.08)、A-S2’(t=1.88,P=0.06)以及B时程(t=-0.65,P=0.52)差异均无统计学意义。结论:AN患者的CNV存在PINV时程延长、波幅B降低、反应时间延长,支持AN患者存在认知功能损害。     

Contingent negative variation as indicator of duration of migraine disease

Amplitudes of early wave contingent negative variation (iCNV) reveal significant differences between migraine patients and healthy controls, indicating a lack of habituation and pronounced attentional functions in migraine patients. CNV amplitudes were recorded in 20 migraine patients. The CNV amplitudes were Pearson correlated with the individual duration of the migraine disease. Only iCNV correlates inversely with the duration (r = -.544). The data show an influence of duration of migraine disease on iCNV amplitudes. It is suggested that iCNV is an indicator of chronicity in persistent migraine.     

Psychophysiological aspects of depressive syndromes

Compared to 30 healthy controls, 59 drug free patients with primary major depression exhibited significantly higher rates of heart beat, respiration, and eye blinking; longer simple and associative reaction times; fewer spontaneous fluctuations of skin resistance, a lower salivation rate, a faster habituation rate of skin resistance orienting response, and a smaller CNV area in the EEG. Skin resistance level, speech pause time, N1P2 amplitudes of acoustically evoked potentials and the postimperative negative variation (PINV) in the EEG did not differ between groups. All deviations are nosologically unspecific; they can be regarded as signs of overarousal, as deficits, or as the result of protective inhibition. In all subjects the investigation was repeated twice, while the patients were treated with either amitriptyline or oxaprotiline, repetition of measurement influenced several variables, but most patient/control differences remained unaffected--irrespective of the drug applied.     

抑郁症、焦虑症患者事件相关电位对照研究

目的:探讨抑郁症、焦虑症患者脑诱发电位的变异特点及临床应用价值.方法:共有46例抑郁症患者(抑郁症组)、41例焦虑症患者(焦虑症组)及42名健康志愿者(正常组),使用美国Nicolet Bravo脑电生理仪进行事件相关电位P300(P300)和关联性负变化(CNV)的检测.并于治疗2个月时对两患者组进行相同项目的随访.结果:与治疗前比较,抑郁症组P300靶N2、P3潜伏期缩短(P＜0.05),靶P3波幅升高(P＜0.01),CNV潜伏期M1缩短(P＜0.01),波幅M1、M2升高(P均＜0.05).焦虑症组P300靶P3潜伏期缩短(P＜0.05),CNV波幅M1下降(P＜0.05),指令信号后负变化(PINV)的出现率下降(P＜0.05).治疗后与正常组比较,抑郁症组P300非靶P2波幅偏低(P＜0.01),P300的双峰P2波和CNV的PINV出现率均偏高(P＜0.05～0.01);焦虑症组CNV的潜伏期M2缩短(P＜0.01).抑郁症组与焦虑症组治疗后比较在P300非靶P2波幅、双峰P2波出现率,CNV潜伏期M2和PINV出现率等指标之间差异有显著性(P均＜0.01).结论:抑郁症、焦虑症患者脑诱发电位有自己的变异特点,在诊断和鉴别诊断方面有一定的价值.     

Adolescents with chronic migraine commonly exhibit depressive symptoms

Psychiatric comorbidity in patients with headache contributes to poorer prognosis, chronification of disease, poor response to treatment, increased cost of treatment, and decreased quality of life. The purpose of the present study was to evaluate the depressive symptoms in adolescents with chronic and episodic migraines and healthy adolescents. The study was performed between November 2010 and November 2011. All patients completed a detailed headache questionnaire comprising of demographical and clinical data and were instructed to fill out a headache diary over a 2-month period. The subjects ranged in age from 13 to 19 years. To evaluate depression symptoms, all of the subjects were asked to fill out the Beck Depression Inventory (BDI). A total of 137 participants were evaluated; 44 had episodic migraine (EM), 46 had chronic migraine (CM) and 47 were control subjects. Patients with a history of chronic migraine had significantly higher scores on the BDI than the other participants. Patients with chronic migraine had BDI scores that were 8.8 points higher than controls [95 % CI (β) = 5.0, 12.6] and 5.8 points higher than patients with EM [95 % CI (β) = 2.2, 9.4]. The main finding of this study was that chronic migraine is strongly associated with depression symptoms, regardless of demographic data. Comorbid depression may increase the total burden of migraine and diagnosis and treatment of depression in adolescents with migraine is likely to result in a better prognosis.     

老年期抑郁症的伴随性负变研究

目的 探讨老年期抑郁症患者的伴随性负变(CNV)变化特征.方法 应用美国Nicolet脑诱发电位仪,记录了21例老年期抑郁症患者的CNV,并与33例正常对照者和39例非老年期抑郁症患者的CNV进行比较.结果 老年期抑郁症患者的CNV变化与非老年期抑郁症患者的CNV变异基本类似,但CNV波幅降低更明显,PINV出现率更高,反应时间进一步延长.结论 CNV是评定老年期抑郁症患者大脑综合功能的有效工具.     

How the brain anticipates an attack: a study of neurophysiological periodicity in migraine.

We investigated cortical excitability and the pattern of arousal in migraine patients using contingent negative variation (CNV) and EEG power spectrum analysis performed before and after a migraine attack. Twenty females suffering from migraine without aura and 12 healthy controls were enrolled in the study. In the group of patients, the CNV, EEG power spectrum and hemispheric asymmetry analyses were performed 1-4 days before the first day of an attack and 4 days following the last day with migraine. The recordings in healthy subjects were carried out on a day chosen by the participants. The comparisons were made using non-parametric procedures. After an attack no difference was found between patients and controls in EEG power spectrum, hemispheric asymmetry or CNV components (with the exception of the beta 1 power, which was more pronounced in patients). Before an attack, however, a significant increase in the power of delta and theta frequency bands, in the alpha asymmetry, and in early CNV amplitude were observed. The patients differed from controls both in the extent of cortical excitability and in the arousal pattern found. In such a way migraine is characterized by periodic CNV and EEG power spectrum changes during the pain-free interval. The abnormalities in cortical excitability and arousal were only observed before an attack, and could be used to predict the next migraine episode. We assume that these changes reflect the increased susceptibility of the migrainous brain to precipitating factors and the neurophysiological readiness to generate an attack. The time duration since the last attack must be taken into account when performing studies in the field of migraine research.     

Role of family in development of neurophysiological manifestations in children with migraine

Migraine is a familial disorder. The aim of this study was to compare the relationship between specific neurophysiologic pathogenetic mechanisms of migraine such as abnormal information processing and enhanced cortical excitability on the one hand, and parent-child-interactions and personality traits such as neuroticism and extraversion on the other hand in migraine and healthy families. The correlation and factor analyses demonstrated that the stronger the control over a child and the more intensive the suppression of a child's independence by a parent during a stressful situation in migraine families, the more pronounced the loss of habituation of the contingent negative variation (CNV), and the greater the neuroticism in a migraine child. The CNV amplitude was independent of psychosocial conditions in the family but represented similarities in information processing between parents and their children suffering from migraine. This could be possibly explained by genetic influences on information processing in migraine. In healthy families only the relationship between parameters of parent-child-interaction could be observed. This investigation demonstrates that the neurophysiological disposition to a migraine attack as well as personality traits in migraine could be influenced by psychosocial factors such as parent-child interactions and that different parameters of information processing in headache patients are related to either non-genetic familial conditions (habituation) or functional genetic factors (amplitude).     

抑郁症患者人脸照片诱发的关联性负变研究

目的研究抑郁症患者和健康人的人脸照片诱发的事件相关电位关联性负变（CNV）的特点。方法应用脑电生理仪和反应时间技术,检测38例抑郁症患者的CNV,并与30名健康对照的CNV进行比较。结果抑郁症组CNV主要为延迟型（44.74%）,健康对照主要为正常型（66.67%）,CNV分型有统计学差异（χ2=21.32,P〈0.01）。抑郁症组A点潜伏期为（380±63）ms,健康对照组为（323±59）ms,有统计学差异（t=3.81,P=0.01）;抑郁症组波幅B为（9±6）μV,健康对照组为（16±5）μV,有统计学差异（t=5.13,P〈0.01）。结论抑郁症患者的CNV波形不规则,潜伏期A点延迟,波幅B降低。     

网络游戏成瘾青少年事件相关电位关联性负变的实验研究

目的研究网络游戏成瘾青少年事件相关电位中关联性负变(CNV)的变化特点。方法使用德国BP公司Brain AmpDC型64导事件相关电位工作站,采用经典的CNV实验模式,记录30例青少年的CNV波形,其中网络游戏成瘾组15例和正常对照组15例,脑电分析后比较两组CNV差异。结果网络游戏成瘾组的CNV波形欠规则,与正常对照组进行比较,CNV潜伏期A点延迟(P0.05),CNV平均波幅和命令后伴随负电位(PINV)平均波幅均显著降低(P0.05)。结论网络游戏成瘾青少年CNV的变异特点为网络游戏成瘾青少年病人的发病机制提供一些线索,并为其明确诊断提供了脑电生理依据。     

Topographic CNV activity mapping, presenile mild primary cognitive decline and Alzheimer-type dementia.

The CNV complex evoked with a standard paradigm (S1-2 sec-S2-motor response) and reaction time (RT) to the imperative signal (S2) were recorded and measured in 12 patients with initial presenile idiopathic cognitive decline (PICD), 12 with presenile Alzheimer-type dementia (PAD) and 10 healthy age-matched controls. Significant group differences were obtained for measures of some CNV components, particularly of the late pre-S2 CNV. No significant CNV activity, very prolonged RTs and sometimes characteristic post-imperative negative variations (PINV) were observed in the majority of patients with PAD. These results suggest that similar CNV complex and RT changes to those observed in our patients may constitute a valuable clue in the study of pathophysiological brain functioning in the early stages of presenile idiopathic mental deterioration.     

军人创伤后应激障碍患者的关联性负变异常变化及临床随访

目的　了解军人创伤后应激障碍 (PTSD)患者关联性负变 (CNV)的特征和治疗缓解后CNV的变化。方法　应用美国NicoletBravo型脑诱发电位仪及光、声两种成对刺激方法 ,对 6 6例发病期PTSD患者 (患者组 )和 5 6名健康军人 (对照组 )进行CNV测定以及症状自评量表 (SCL - 90 )和事件影响量表 (IES)评定 ,并对患者组中的 6 0例进行了临床随访。结果　患者组发病期M1潜伏期延迟 (P <0 0 1) ,M2 波幅增高 (P <0 0 1) ,命令信号后负变化(PINV)出现率增高 (P <0 0 1) ;SCL - 90及IES总分及其部分因子分升高 (P <0 0 1) ;CNV变异指标与SCL - 90及IES总分及其部分因子分显著相关 (P <0 0 1或 0 0 5 )。患者组康复期M1潜伏期、M2 波幅和PINV出现率 ,以及SCL- 90与IES总分及其部分因子分均恢复至正常值内 (与发病期比较P <0 0 1,与对照组比较P >0 0 5 ) ,且治疗前后CNV变异指标差值与精神症状减分率显著相关 (P <0 0 1或 0 0 5 )。结论　PTSD患者的CNV变化可能是状态标志。