Relationship between clinical variables and symptomatic anxiety in late-life depression.

The authors asked whether anxiety that is symptomatic of late-life depression is associated with clinical variables besides depression and, if so, how much of the variance is explained by this association. Severity of anxiety in 101 elderly patients with major depression was measured at index assessment and at antidepressant response. The following clinical variables were selected to determine whether they were associated with severity of anxiety: depression severity, burden of chronic physical illness, cognitive functioning, negative life events, life difficulties, and intensity of psychosocial support. Anxiety had a statistically significant association with severity of depression and life events at index assessment and with severity of depression and life difficulties at antidepressant response. In linear-regression models, depression severity accounted for the largest proportion of the variance in anxiety at both index assessment and response; life events and life difficulties accounted for only 3% and 4% of variance, respectively. In this group of elderly depressed patients, medical burden, cognitive impairment, and negative psychosocial circumstances did not contribute in a clinically significant way to variance in severity of symptomatic anxiety.     

The influence of positive and negative emotional associations on semantic processing in depression: An fMRI study

In depression, patients suffer from emotional and cognitive deficits, among others in semantic processing. If these semantic deficits are cognitive or interact with emotional dysfunctions, is still an open question. The aim of the current study was to investigate the influence of emotional valence on the neural correlates of semantic priming in major depression. In a lexical decision task, positive, negative, and neutral word pairs were presented during fMRI measurement. Nineteen inpatients and 19 demographically matched controls were recruited. Behaviorally, positive and neutral valence induced a priming effect whereas negative valence induced no effect (controls) or even inhibition (slower RT for related stimuli) in patients. At the neural level, the semantic relation effect revealed similar neural activation in right middle frontal regions for patients and controls. Group differences emerged in the right fusiform gyrus and the ACC. Activity associated with positive valence differed at the DLPFC and amygdala and for negative valence at putamen and cerebellum. The activation of amygdala and DLPFC correlated negatively with the severity of depression. To conclude, semantic processing deficits in depression are modulated by emotional valence of the stimulus on the behavioral as well as on neural level in right‐lateralized prefrontal areas and the amygdala. The results highlighted an influence of depression severity on emotion information processing as the severity of symptoms correlated negatively with neural responses to positively and negatively valenced information. Hence, the dysfunctional emotion processing may further enhance the cognitive deficits in depression. Hum Brain Mapp 35:471–482, 2014. © 2012 Wiley Periodicals, Inc.     

Effects of sertraline on depressive symptoms and attentional and executive functions in major depression

Reports on the severity and reversibility of cognitive disturbances in major depression in the literature diverge due to methodological biases. The present study, using a precise methodology, examined attention and executive functions in 20 relatively young, depressed patients presenting a first or second episode of unipolar major depression without psychotic or melancholic characteristics and all being treated with the same psychopharmacological treatment (sertraline) to investigate the changes in potential attentional and executive loss during a subacute period of treatment of 7 weeks. We compared their performance with a group of 26 control subjects who were administered the same cognitive tests. This study confirmed psychomotor slowing associated with attentional and executive disturbance in adults with major depression. Conscious attentional interference for words with a negative emotional valence also was shown. After the first weeks of treatment, the effect of the antidepressant treatment with sertraline was accompanied by a beneficial effect on psychomotor slowing on attentional and executive functions.     

Patient predictors of response to psychotherapy and pharmacotherapy: findings in the NIMH Treatment of Depression Collaborative Research Program.

OBJECTIVE: The authors investigated patient characteristics predictive of treatment response in the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program. METHOD: Two hundred thirty-nine outpatients with major depressive disorder according to the Research Diagnostic Criteria entered a 16-week multicenter clinical trial and were randomly assigned to interpersonal psychotherapy, cognitive-behavior therapy, imipramine with clinical management, or placebo with clinical management. Pretreatment sociodemographic features, diagnosis, course of illness, function, personality, and symptoms were studied to identify patient predictors of depression severity (measured with the Hamilton Rating Scale for Depression) and complete response (measured with the Hamilton scale and the Beck Depression Inventory). RESULTS: One hundred sixty-two patients completed the entire 16-week trial. Six patient characteristics, in addition to depression severity previously reported, predicted outcome across all treatments: social dysfunction, cognitive dysfunction, expectation of improvement, endogenous depression, double depression, and duration of current episode. Significant patient predictors of differential treatment outcome were identified. 1) Low social dysfunction predicted superior response to interpersonal psychotherapy. 2) Low cognitive dysfunction predicted superior response to cognitive-behavior therapy and to imipramine. 3) High work dysfunction predicted superior response to imipramine. 4) High depression severity and impairment of function predicted superior response to imipramine and to interpersonal psychotherapy. CONCLUSIONS: The results demonstrate the relevance of patient characteristics, including social, cognitive, and work function, for prediction of the outcome of major depressive disorder. They provide indirect evidence of treatment specificity by identifying characteristics responsive to different modalities, which may be of value in the selection of patients for alternative treatments.     

孕晚期抑郁对新生儿神经行为的影响

目的探讨孕晚期抑郁情绪对新生儿神经行为的影响。方法以2015-09—2017-06在我院进行产检,妊娠周期≥28周的276例妊娠期妇女为研究对象,采用爱丁堡抑郁自评量表(EPDS)和负性认知加工偏向量表对妊娠晚期妇女进行调查,婴儿神经国际量表(INFANIB)对新生儿神经行为进行评估,观察妊娠晚期抑郁情绪下负性认知的情况以及对新生儿神经行为的影响。结果 276例孕晚期妊娠妇女中抑郁情绪阳性33例,阴性243例,其中抑郁阳性妊娠妇女负性认知加工偏向负性记忆偏向、负性解释偏向、负性沉思偏向及总分均明显高于抑郁阴性妊娠妇女(P0.05);276例新生儿中INFANIB评分显示临界值108例,正常168例,神经行为异常临界值以上发生率39.13%,妊娠晚期妇女负性注意力偏向和负性沉思偏向与INFANIB临界值新生儿呈负相关(P0.05),与EPDS无明显相关性(P0.05)。结论孕晚期妊娠妇女抑郁发生率较高,其在负性认知加工偏向中的表现特点与新生儿神经行为异常有显著的相关性。     

Impact of cognitive impairment on the phenomenology of geriatric depression.

OBJECTIVE: Dementia and depressive syndromes demonstrate substantial symptom overlap. As a result, it is challenging to differentiate depression symptoms from nonspecific symptoms of an underlying dementia syndrome. The author addressed the impact of cognitive impairment on the phenomenology of depression symptoms by determining whether more impaired patients were more likely to endorse certain self-report depressive symptoms independent of their underlying level of depression severity. METHODS: Author used data from 576 geriatric rehabilitation inpatients for MIMIC model analyses examining the impact of cognitive impairment on both depression severity and endorsement of symptom clusters. Depressive symptoms were measured with the Geriatric Depression Scale, and cognitive impairment was measured with the Mattis Dementia Rating Scale total score. RESULTS: The reliability (internal consistency) of self-reported depressive symptoms did not change as a function of cognitive impairment. More severe cognitive impairment was associated with greater depression severity but was also associated with two depression symptom clusters after controlling for underlying levels of depression severity. Patients who were more impaired endorsed greater social withdrawal and less psychomotor agitation, independent of their underlying depression severity. Level of cognitive impairment alone did not affect the endorsement of depressed mood and positive affect. CONCLUSIONS: Certain symptoms on depression inventories may be endorsed at a greater level by cognitively impaired patients, independent of their level of underlying depression severity. These symptoms may be nonspecific features of the underlying dementia syndrome and may not be specific to depressive episodes, but instead may represent other syndromes, such as apathy.     

The role of negative interpretations of grief reactions in emotional problems after bereavement

This study explored the role of negative interpretations of grief reactions in emotional problems after bereavement, with 234 individuals who had been confronted with the death of a close relative. It was found that negative interpretations of grief reactions were highly associated with the degree to which these reactions were experienced as distressing, the degree to which mourners engaged in avoidance behaviours and the severity of symptoms of traumatic grief and depression, even when controlling for the frequency of grief reactions and the influence of relevant background variables. Furthermore, behavioural and cognitive avoidance strategies were significantly related to the severity of traumatic grief and depression. Negative interpretations of grief reactions and rumination explained most variance in symptom severity, when controlling for the shared variance between the predictor variables. The results have implications for the treatment of emotional problems after bereavement.     

Fear of cognitive dyscontrol in relation to depression symptoms: comparisons between original and alternative measures of anxiety sensitivity

Previous research has found that a facet of anxiety sensitivity (AS), referred to as fear of cognitive dyscontrol or fear of mental incapacitation, is associated with severity of depressed mood. Other research has extended the “fear of fear” concept to include fear of losing control over emotion in general (including depression). Because anxiety and depression share the common feature of general distress (Clark & Watson, 1991. Journal of Abnormal Psychology, 93, 19–30), the present study took a conservative approach and statistically controlled for the effect of trait anxiety and negative affectivity before contributions of AS to depression were examined. In a large college student sample (N=348), facets of the original and alternative measures of AS were evaluated in attempts to predict severity of depression symptoms. Fear of cognitive dyscontrol facets from both measures of AS were significant predictors in the regression analyses. A new set of items reflective of control over emotions was also significant and both cognitive and emotional control added to the prediction of depression symptoms in a complementary fashion. Implications of these findings for identifying a proposed “depression sensitivity” are discussed.     

Emotion and psychosis: links between depression, self-esteem, negative schematic beliefs and delusions and hallucinations

BACKGROUND: The role of emotion in psychosis is being increasingly recognised. Cognitive conceptualisations of psychosis (e.g. [Garety, P.A., Kuipers, E.K., Fowler, D., Freeman, D., Bebbington, P.E., 2001. A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189-195]) emphasise a central, normal, direct and non-defensive role for negative emotion in the development and maintenance of psychosis. This study tests specific predictions made by Garety et al. [Garety, P.A., Kuipers, E.K., Fowler, D., Freeman, D., Bebbington, P.E., 2001. A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189-195] about the role of emotion and negative evaluative beliefs in psychosis. METHODS: 100 participants who had suffered a recent relapse in psychosis were recruited at baseline for the Prevention of Relapse in Psychosis (PRP) trial. In a cross-sectional analysis, we examined the role of depression, self-esteem and negative evaluative beliefs in relation to specific positive symptoms (persecutory delusions, auditory hallucinations and grandiose delusions) and symptom dimensions (e.g. distress, negative content, pre-occupation and conviction). RESULTS: Analysis indicated that individuals with more depression and lower self-esteem had auditory hallucinations of greater severity and more intensely negative content, and were more distressed by them. In addition, individuals with more depression, lower self-esteem and more negative evaluations about themselves and others had persecutory delusions of greater severity and were more pre-occupied and distressed by them. The severity of grandiose delusions was related inversely to depression scores and negative evaluations about self, and directly to higher self-esteem. CONCLUSIONS: This study provides evidence for the role of emotion in schizophrenia spectrum-disorders. Mood, self-esteem and negative evaluative beliefs should be considered when conceptualising psychosis and designing interventions.     

La dépression vasculaire : évolution des malades et du concept

Late life depression differs from early life depression by no history of mood disorders, and by presence of vascular risk factors, cognitive decline and hyperintensities on MRI. A sub-type of depression is the vascular depression. We present a 6.2 years follow-up of five vascular depressed patients. The severity of depression was high with suicide attempt in three cases. Apathy and pharmacological resistance were reported. Non pharmacological management was more efficacious. Vascular dementia was the final diagnosis for three patients whose two had neuropathological diagnosis. It would be necessary to ameliorate the delimitation of the definition of vascular depression to distinguish them from mild cognitive impairment and from vascular dementia. The specificity of the treatment and the characteristics of the follow-up are arguments to realize a MRI when a patient has a late life depression.     

Evaluation of the integrated cognitive model of depression and its specificity in a migrant population

This study empirically tested the specificity of the integrated cognitive model (ICM) of depression, which postulates that negative life events interact with dysfunctional attitudes to increase the frequency and severity of automatic thoughts, subsequently affecting depressive symptoms. We also examined the three competing models: the linear mediation model, the alternative etiologies model, and the symptom model. We anticipated that we might examine these models more appropriately using data from a population at an increased risk of developing depressive symptoms. As such, two-wave panel data were obtained from a group of 107 Korean migrants who had been in Australia less than 1 year. Structural equation modeling revealed that the ICM provided an adequate and much better fit than the three competing models. The ICM was also found to support the cognitive specificity theory of depression and anxiety. These findings suggest that dysfunctional attitudes can be a common cognitive moderator of depression and anxiety, whereas automatic thoughts and anxious self-statements can be specific cognitive mediators of anxiety and depression, respectively.     

Disrupted reward circuits is associated with cognitive deficits and depression severity in major depressive disorder

Neuroimaging studies have demonstrated that major depressive disorder (MDD) patients show blunted activity responses to reward-related tasks. However, whether abnormal reward circuits affect cognition and depression in MDD patients remains unclear. Seventy-five drug-naive MDD patients and 42 cognitively normal (CN) subjects underwent a resting-state functional magnetic resonance imaging scan. The bilateral nucleus accumbens (NAc) were selected as seeds to construct reward circuits across all subjects. A multivariate linear regression analysis was employed to investigate the neural substrates of cognitive function and depression severity on the reward circuits in MDD patients. The common pathway underlying cognitive deficits and depression was identified with conjunction analysis. Compared with CN subjects, MDD patients showed decreased reward network connectivity that was primarily located in the prefrontal-striatal regions. Importantly, distinct and common neural pathways underlying cognition and depression were identified, implying the independent and synergistic effects of cognitive deficits and depression severity on reward circuits. This study demonstrated that disrupted topological organization within reward circuits was significantly associated with cognitive deficits and depression severity in MDD patients. These findings suggest that in addition to antidepressant treatment, normalized reward circuits should be a focus and a target for improving depression and cognitive deficits in MDD patients.     

Validité cross-culturelle de la théorie cognitive de la dépression : une comparaison franco/nord-américaine

This prospective study provided a direct comparison of French and American samples on variables central to cognitive theory of depression. Using the Experience Sampling Method and identical measures across sites, subjects were signaled five times daily for one week to provide reports of negative events, attributions, and depressed moods. Controlling for effects associated with gender and trait anxiety and depression, significant differences emerged between French and American samples concerning the average severity of daily negative events, depressed moods, and causal attributions. However, the relationships between these variables (the fundamental hypothesis of cognitive theory) was largely unaffected by sample source. The results underscore the importance of cultural factors for the experience of specific variables, but provide support for the generalizability of the theory’s tenets across French and American populations.     

Relationship of cognitive functioning, adaptive life skills, and negative symptom severity in poor-outcome geriatric schizophrenia patients

The authors assessed whether cognitive functioning and negative symptoms are related to functional outcome across severity of negative symptoms and examined relationships between symptom domains in patients with high versus low negative symptom severity. The interrelationships between cognitive functioning and functional skills in poor-outcome geriatric schizophrenic patients were compared between those who were in the first (n = 81) and the fourth quartiles (n = 127) of negative symptom severity based on the normative data in the Positive and Negative Syndrome Scale. It was found that negative symptoms and cognitive functioning were the strongest correlates of functional status in geriatric poor-outcome schizophrenic patients--regardless of negative symptom severity. Interestingly, the greater the severity of negative symptoms, the less strongly negative symptoms were related to functional outcome. The present findings demonstrate that the relationship of cognitive functioning to social and adaptive functioning remains significant despite differing levels of negative symptom severity.     

Walking speed during single and dual tasks in Parkinson's disease: Which characteristics are important?

The impact of dual tasks on gait in Parkinson's disease (PD) reveals lack of automaticity and increased cognitive demands. We explored which characteristics explained walking speed with and without dual task interference and if they reflected the cognitive demands of the task. In 130 people with PD, gait performance was quantified in the home using accelerometers allowing estimates of single and dual task walking speed and interference (difference between dual and single task). Multiple regression analysis was used to explore the effect of 12 characteristics representing four domains (personal, motor symptoms, cognitive, affective) on gait outcomes. Thirty‐seven percent of variance in single task speed was explained by increased fear of falling, sex, age, disease severity, and depression; 34% of variance in dual task speed was explained by increased fear of falling, disease severity, medication, and depression; 12% of variance in interference scores was explained by greater disease severity and impaired executive function. Personal, motor, affective, and cognitive characteristics contribute to walking speed and interference, highlighting the multifactorial nature of gait. Different patterns of characteristics for each outcome indicates the impact of cognitive demand and task complexity, providing cautious support for dual task speed and interference as valid proxy measures of cognitive demand in PD gait. © 2008 Movement Disorder Society     

Social cognitive complexity and depression: cognitive complexity moderates the correlation between depression self-ratings and global self-evaluation

The authors studied the psychometric characteristics of a standardized data-collection method for assessing the complexity of an individual's cognitions about self and other people (social cognitive complexity). A total of 437 college undergraduates were assessed using this method and concurrently assessed for depression, self-deception, impression management, self-esteem, and positive/negative affectivity. It was found that a measure of overall social cognitive complexity was internally consistent and demonstrated concurrent and discriminant validity. In particular, a composite measure of the complexity of both positive and negative cognitions of self and other was associated with greater self-reported depression, after controlling for the other variables studied (, impression management). It was also found that social cognitive complexity moderated the degree of global self-evaluation in self-reported depression, such that global self-evaluation accounted for a considerably higher amount of the variance of depression in low-complex individuals than it did in high-complex individuals.     

Six-month course of mild cognitive impairment and affective symptoms in late-life depression

Mild cognitive impairment (MCI) is frequent in patients with late-life depression. Previous studies indicate that cognitive performance in these patients is not or only marginally improved when they recover from depression. However, recovery from cognitive impairments due to depression may have a longer time course than recovery from affective symptoms. In a group of 34 elderly depressed patients (mean age: 73.4 years) admitted to a gerontopsychiatric day-clinic, severity of depression and cognitive performance were assessed before the initiation of treatment and were reassessed 6 months later. At admission, 18 of 34 patients (53%) fulfilled the criteria for MCI, with a preponderance of impairments in short-term memory and visuospatial capabilities. At the 6-month follow-up, cognitive performance had not significantly improved for the entire group; 12 of 27 patients (44%) still were fulfilling the criteria for MCI. No relationships could be ascertained between cognitive impairment or functional level and severity or course of depression. Patients with diurnal variations of the depressive symptomatology were less likely to fully recover from depression.     

Impact of psychiatric and medical comorbidity on cognitive function in depression

Aim:  The aim of the present study was to investigate the association between cognitive performance and psychiatric and medical comorbidity in major depression.
Methods:  The present study evaluated the cognitive performance of patients ( n  = 96) diagnosed with a major depressive episode in relation to the presence of medical and/or psychiatric comorbidity. Participants were assessed clinically and cognitively using the Mini International Neuropsychiatric Interview and Repeatable Battery for the Assessment of Neuropsychological Status. Four groups of comorbidity were categorized: (i) no comorbidity, (ii) medical comorbidity; (iii) psychiatric comorbidity; and (iv) both medical and psychiatric comorbidity, and subsequently analyzed for differences across six cognitive domains: immediate memory, visuospatial, language, attention, delayed memory, and total score.
Results:  Only 20.8% of the participants did not have a comorbidity of any kind, while psychiatric comorbidities (67.7%) were more frequent than medical comorbidities (39.6%). Education and severity of depressive symptoms negatively influenced cognitive performance. Psychiatric comorbidity alone significantly decreased cognitive performance in the visuospatial/constructional and the language domains and the total score. In addition, increasing numbers of psychiatric comorbidities were related to worse cognitive performance. In contrast, medical illnesses alone had no negative impact on any of the domains of cognitive performance. Evidence was found for additive effects of medical and psychiatric comorbidities in depression on visuospatial/constructional cognitive abilities.
Conclusion:  The strongest predictor of poor cognitive performance in depression was psychiatric comorbidity. The assessment and treatment of cognitive dysfunction in depression should consider the relative impact of psychiatric comorbidity.     

Characteristics Associated with Presence of Depressive Symptoms in Adults with Autism Spectrum Disorder

Evidence suggests that individuals with autism spectrum disorders (ASD) often exhibit associated psychiatric symptoms, particularly related to depression. The current study investigated whether individual characteristics, specifically, severity of ASD symptoms, level of cognitive ability, and/or presence of other psychiatric disorders, are associated with occurrence of depressive symptoms in adults with ASD. Forty-six adults with ASD were administered a standardized psychiatric history interview. Twenty participants (43%) endorsed depressive symptoms. It was found that individuals with less social impairment, higher cognitive ability, and higher rates of other psychiatric symptoms, were more likely to report depressive symptoms. These characteristics may be vulnerability factors for the development of depression, and should be considered when screening and treating adults with ASD.     

Negative Emotions and the Course of Depression During Psychotherapy in Suicidal Older Adults With Depression and Cognitive Impairment

ObjectiveThe study examines the relationship of negative emotions with: 1) non-emotional symptoms (e.g., vegetative and physical symptoms) and 2) the course of depression in suicidal older adults with Major Depressive Disorder (MDD) and cognitive impairment treated with psychotherapy.DesignThe authors identified a subgroup of participants (N = 26) who expressed suicidal ideation at Baseline or Week 12 from a randomized controlled trial (RCT) of two psychosocial interventions, Problem Adaptation Therapy (PATH) and Supportive Therapy for Cognitively Impaired. The authors assessed negative emotions, non-emotional symptoms of depression, depression severity, and suicidal ideation at entry, week 4, week 8, and week 12.ParticipantsParticipants were 65 years and older and had a diagnosis of unipolar depression, varying degrees of cognitive impairment (up to moderate dementia) and suicidal ideation.SettingThe study was conducted in the Outpatient Department of New York Presbyterian/Weill Cornell Medicine in Westchester, NY.MeasurementsNegative emotions and non-emotional items were identified with the 24-item Hamilton Depression Rating Scale (Ham-D).ResultsAmong participants with suicidal ideation, the reduction in negative emotions from baseline to week 4, week 4 to week 8, and week 8 to week 12 was significantly associated with the reduction in non-emotional symptoms of depression at weeks 4, 8, and 12 (F_{(1, 35)} = 6.20, p = 0.02) and with the reduction in overall depression severity at weeks 4, 8, and 12 (F_{(1, 35)} = 26.63, p <0.0001) after controlling for depression severity at baseline (HAM-D total score) and time trends.ConclusionOur findings may guide the treatment of older patients with depression and suicidal ideation to help reduce depression and suicide risk.