Dysfunctional Attitudes,Attributional Styles,and Phase of Illness in Bipolar Disorder

Whereas an abundance of studies have been devoted to the study of cognitive vulnerability in unipolar depression, comparatively less is known regarding the cognitive styles of patients with bipolar disorder. This study examined the cognitive styles of 395 of the first 500 bipolar patients enrolled in the NIMH Systematic Treatment Enhancement Program for Bipolar Disorder as a function of mood state at study entry. Patients completed diagnostic and mood assessments and two measures of cognitive style: The Dysfunctional Attitudes Scale (DAS) and the Attributional Style Questionnaire (ASQ). Patients in mixed episodes exhibited significantly more negative dysfunctional attitudes and negative attributional styles than euthymic patients and significantly more dysfunctional attitudes than manic/hypomanic patients. The implications of these findings are discussed in relation to episode vulnerability, mood-state dependency of cognitive style, and cognitive-behavioral treatment.     

全程护理干预对双相情感障碍患者认知功能的影响

目的 探讨全程护理干预对双相情感障碍患者认知功能的影响.方法 将100例双相情感障碍患者随机分A组与B组,每组50例,两组均维持原用抗精神病药物以及情绪稳定剂治疗,A组进行全程护理干预,B组予以认知治疗.观察16周.于干预前及干预8周、16周末,采用韦氏成人智力量表、韦氏记忆量表、威斯康星卡片分类测验进行评定分析.结果 干预16周末,A组韦氏记忆量表及韦氏成人智力量表各因子评分均较干预前显著升高(P＜0.05或0.01)、威斯康星卡片各因子评分均较干预前显著下降(P＜0.05或0.01);B组韦氏记忆量表长时记忆、短时记忆分较干预前显著升高(P＜0.05或0.01),威斯康星卡片总测验数较干预前显著下降(P＜0.05);A组韦氏记忆量表及韦氏成人智力量表各因子评分均显著高于B组(P＜0.05或0.01)、威斯康星卡片各因子评分均显著低于B组(P＜0.05).结论 全程护理干预能显著改善双相情感障碍患者的认知功能,提高临床疗效,降低复发率,有利于促进患者的全面康复.     

Aberrant reward processing in Parkinson's disease is associated with dopamine cell loss

Dopamine has been implicated in reward-related impulsivity, but the exact relationship between dopamine, reward and impulsivity in humans remains unknown. We address this question in Parkinson's disease (PD), which is characterized by severe dopamine depletion. PD is associated primarily with motor and cognitive inflexibility, but can also be accompanied by reward-related impulsivity. This paradoxical symptom of PD has often been attributed to dopaminergic overstimulation by antiparkinson medication, which is necessary to relieve the motor and cognitive inflexibility. However, factors other than medication may also contribute to aberrant impact of reward. Here we assess whether cognitive inflexibility and aberrant reward impact in PD are two sides of the same coin, namely dopamine cell loss. To measure dopamine cell loss, we employed ¹²³I-FP-CIT Single Photon Emission Computed Tomography (SPECT) in 32 PD patients (10 never-medicated patients and 22 patients after withdrawal of all medication for > 12 h) and related the values to behavior on a rewarded task-switching paradigm. Dopamine cell loss was associated not only with cognitive inflexibility (under low reward), but also with aberrant impact of reward. These effects could not be attributed to medication use. Relative to controls (n = 26), aberrant reward processing in PD was particularly expressed as reduced capacity to maintain (i.e., repeat) the current task-set under high reward. Our findings demonstrate that factors intrinsically related to PD may underlie the paradoxical symptoms of inflexibility and reward-related impulsivity in PD. The present results concur with observations that low baseline dopamine states predispose to drug and other addictions.     

The Effects of Rumination and Distraction Tasks on Psychophysiological Responses and Mood in Dysphoric and Nondysphoric Individuals

Prior experimental manipulations of ruminative and distractive response style have not included psychophysiological measures or investigated the statistical relation between rumination and the conceptually-related constructs of worry and neuroticism. Dysphoric (n =84) and nondysphoric participants (n =86) were randomly assigned to either a rumination task (i.e., self-focused attention) or a distraction task. Results supported prior findings that distraction and rumination differentially impact depressed mood in dysphoric individuals; dysphoric ruminators reported significantly higher levels of postexperiment depressed mood than did dysphoric distractors, even after neuroticism, worry, or response style were included in the empirical model. However, post- rumination worry ratings were significantly higher than postdistraction worry ratings, regardless of initial dysphoria status. Of the psychophysiological responses measured, a significant difference in postrumination systolic blood pressure was found between nondysphoric men (M = 119.88; SE = 1.29) and nondysphoric women (M = 114.88; SE = 1.20). The implications of these results for future response style studies are discussed     

舍曲林联合认知行为疗法对抑郁症患者认知功能的影响

目的 探讨舍曲林联合认知行为疗法对抑郁症患者认知功能的影响.方法 将60例抑郁症患者按照随机数字表法分为研究组与对照组,各30例.两组均给予舍曲林治疗,研究组联合认知行为疗法治疗,观察治疗全程.干预前后采用抑郁自评量表及汉密顿抑郁量表评定两组的抑郁状况,采用威斯康星卡片分类测验评定患者的执行功能.结果 干预后两组抑郁自...     

Using fMRI to decompose the neural processes underlying the Wisconsin Card Sorting Test

The specific role of particular cerebral regions with regard to executive functions remains elusive. We conducted a functional magnetic resonance imaging (fMRI) study to segregate different network components underlying the Wisconsin Card Sorting Test (WCST), a test widely applied clinically to assess executive abilities. Three different test variants of the WCST, differing in task complexity (A > B > C), were contrasted with a high-level baseline condition (HLB). Cognitive subcomponents were extracted in a serial subtraction approach (A-C, A-B, B-C). Imaging data were further subjected to a correlational analysis with individual behavioral parameters. Contrasting A with the HLB revealed the entire neural network underlying WCST performance, including frontoparietal regions and the striatum. Further analysis showed that, within this network, right ventrolateral prefrontal cortex related to simple working memory operations, while right dorsolateral prefrontal cortex related to more complex/manipulative working memory operations. The rostral anterior cingulate cortex (ACC) and the temporoparietal junction bilaterally represented an attentional network for error detection. In contrast, activation of the caudal ACC and the right dorsolateral prefrontal cortex was associated with increased attentional control in the context of increasing demands of working memory and cognitive control. Non-frontal activations were found to be related to (uninstructed relative to instructed) set-shifting (cerebellum) and working memory representations (superior parietal cortex, retrosplenium). The data provide neural correlates for the different cognitive components involved in the WCST. They support a central role of the right dorsolateral prefrontal cortex in executive working memory operations and cognitive control functions but also suggest a functional dissociation of the rostral and caudal ACC in the implementation of attentional control.     

奥氮平对精神分裂症患者认知控制的影响

目的探讨奥氮平对精神分裂症患者认知控制的长期影响。方法对36例服用奥氮平维持治疗与30例服用氯丙嗪维持治疗的精神分裂症患者,于治疗前及治疗6mo末采用威斯康星卡片分类测验和连线测验评估患者的认知控制能力。结果威斯康星卡片分类测评治疗前两组各分值差异均无显著性(P>0.05);治疗6mo末两组总分类数、错误数、持续错误数、非持续错误数分值较治疗前均有显著或极显著下降(P<0.05或0.01);奥氮平组持续错误数分值显著低于氯丙嗪组(P<0.05);治疗6mo末两组连线测验A和B时间、A和B错误数、A和B犯规数均较治疗前有显著下降(P<0.05);两组连线测验各指标比较均无显著性差异(P均>0.05)。结论奥氮平长期维持治疗能显著改善精神分裂症患者的认知控制能力。     

Visual and Verbal Depressive Cognition: Implications for the Rumination–Depression Relationship

The present studies evaluated whether experiencing depressive cognition as visual (i.e., in the form of visual mental imagery) or verbal (i.e., in the form of verbal thought) was differentially associated with the strength of the rumination–depression relationship. Visual mental imagery is consistently found to be more emotionally arousing than verbal thought. This may especially be the case when individuals dwell on their visual or verbal depressive cognition in the form of depressive rumination. In Study 1, 41.2% of participants reported a visual depressive cognitive style and 57.1% reported a verbal depressive cognitive style. For both males and females, rumination was associated with similarly severe depressive symptoms when individuals reported experiencing visual depressive cognitions compared with verbal depressive cognitions. Study 2 replicated and extended Study 1, taking into account that some individuals may experience depressive cognition both visually and verbally. 23.8% of participants reported a visual depressive cognitive style, 38.9% a verbal depressive cognitive style, and 37.3% a both visual and verbal depressive cognitive style. Rumination was significantly associated with depressive symptom severity for all depressive cognitive styles (visual, verbal, both), though depressive cognitive style significantly moderated the relationship between rumination and depressive symptom severity such that there was a stronger relationship for individuals who had a visual depressive cognitive style than a verbal depressive cognitive style, especially for females. Findings suggest that dwelling on depressed affect (i.e., rumination) may be more strongly related to depressive symptom severity when individuals tend to experience depressive cognitions as visual. Examination of depressive cognition as both visual and verbal is necessary to fully understand how individuals think about their depressed affect and may eventually inform tailoring of interventions based on visual/verbal styles of depressive cognition.     

Quality of life among the elderly. State of mood and loneliness in two selected groups

Cognitively impaired and intact elderly subjects from a longitudinal project were interviewed in a follow-up study about their present state of mood and how often they experienced loneliness. In all, 315 subjects were involved in the study. The dropout rate was high, about 50%, due to death and to the fact that some elderly persons—especially those with slightly impaired cognitive function—declined to participate. The present state of mood was measured by the Geriatric Depression Scale and loneliness was assessed by the question, ‘Do you experience loneliness often, sometimes, seldom or never?’ Most subjects (4 out of 5), above all those who were cognitively intact, reported basic satisfaction with their lives. The greatest difference in response between the two cognitive groups was found in the question about having an empty life. Loneliness and sad mood prevailed especially among subjects with cognitive difficulties. In summary, experiencing loneliness had a negative influence on the state of mood in both cognitive groups, particularly among persons with cognitive impairment.     

以倾听技巧为基础的认知疗法对脑出血患者心境状态及认知功能的干预效果

目的 探究以倾听技巧为基础的认知疗法对脑出血患者心境状态及认知功能的干预效果。方法 选取我院2017年5月～2019年1月脑出血患者92例,依据建档顺序分组,各46例。对照组采取常规护理,研究组在对照组基础上给予以倾听技巧为基础的认知疗法。比较两组健康知识掌握程度、心境状态[焦虑(SAS)、抑郁(SDS)]评分、认知功能(MMSE)评分、应对方式(MCMQ)评分及护理服务满意度。结果 经Ridit检验可知,研究组健康知识掌握程度优于对照组(P＜0.05);出院后3个月,研究组SAS、SDS评分低于对照组(P＜0.05);研究组出院后3个月MMSE评分高于对照组,MCMQ量表中屈服、回避评分低于对照组,面对评分高于对照组(P＜0.05);研究组护理服务满意度93.48%高于对照组73.91%(P＜0.05)。结论 以倾听技巧为基础的认知疗法应用于脑出血患者可显著强化健康知识掌握情况,改善心境状态与认知功能,还可调节应对方式,提高护理服务满意度。     

轻、中度颅脑创伤后认知障碍的临床研究

目的轻、中度颅脑创伤患者伤后不同时段认知障碍,临床干预以及预后的关系。方法回顾分析入院治疗的轻重度颅脑创伤合并认知障碍患者180例,依照所用药物分成治疗组A、治疗组B和对照组,治疗组A应用盐酸多奈哌齐,治疗组B应用石杉碱甲,对照组应用吡拉西坦,治疗周期为12周。治疗前及治疗后以及停止治疗3个月分别应用简明精神状态检测量表(MMSE)、威斯康星卡片分类测验系统(WCST)和格拉斯哥预后评分(GOS)评价疗效。结果治疗12周后MMSE和WCST评分均较治疗前提高。治疗组MMSE和WCST评分提高较对照组明显,治疗组A的GOS预后优良率优于治疗组B。治疗结束3个月后的MMSE和WCST评分以及GOS预后情况存在显著差异,治疗组A效果最好。结论盐酸多奈哌齐对轻、中度颅脑创伤后认知障碍有积极治疗作用,对长期预后存在较好效果。     

奥氮平与氯丙嗪对精神分裂症患者认知功能的影响

目的：比较奥氮平与氯丙嗪对精神分裂症患者认知功能的影响。方法将96例精神分裂症患者随机分为奥氮平组和氯丙嗪组,每组48例,分别口服奥氮平和氯丙嗪治疗,观察8周。于治疗前后采用威斯康星卡片分类测验、韦氏记忆测验及河内塔测验对两组患者的认知功能进行测评分析。结果治疗8周末,奥氮平组威斯康星卡片分类测验完成分类数、正确应答数、概念化水平百分数及持续性应答数和韦氏记忆测验评分均较治疗前显著升高（P＜0．01）,奥氮平组显著高于氯丙嗪组（ P＜0．05或0．01）;两组持续性错误数和河内塔测验的完成时间和移动次数均较治疗前显著降低（P＜0．01）,奥氮平组显著低于氯丙嗪组（P＜0．01）。结论奥氮平能显著改善精神分裂症患者的认知功能,优于氯丙嗪。     

首发精神分裂症患者听感觉门控P50及认知功能的相关性研究

目的 探讨首发精神分裂症患者听感觉门控P50与威斯康星卡片分类测验之间的相关性.方法 采用配对听觉条件、测试刺激范式及威斯康星卡片分类测验对51名首发精神分裂症患者和51名健康常人进行检测,并进行相关性分析.结果 患者组听感觉门控P50抑制明显高于对照组(P<0.01);威斯康星卡片分类测验结果显示,患者组完成分类数和正确分类数显著低于对照组,而错误数和持续错误数显著高于对照组(P<0.01);患者组听感觉门控P50抑制与威斯康星卡片分类测验指标间无相关性.结论 首发精神分裂症患者存在认知功能损害与额叶功能缺陷,反映出可能存在不同的神经发生机制.     

Cognitive Therapy Skills Predict Cognitive Reactivity to Sad Mood Following Cognitive Therapy for Depression

Both patients’ competence in the coping skills taught in cognitive therapy (CT) and patients’ endorsement of dysfunctional cognitions following a sad mood induction [i.e., their cognitive reactivity (CR)] have been found to predict risk of relapse following a successful course of CT for depression. We examined the relationship between these constructs, specifically whether CT skills would be related to less CR following a mood induction among patients who responded to a course of CT. In a sample of 28 depressed patients, post-treatment CT skills were significantly related to less CR in response to a sad mood induction procedure (β = ?.29). This relation was not accounted for by individual differences in mood reactivity. We discuss these findings as a key step in developing a more complete understanding of the role of CT coping skills and CR as markers of patients’ vulnerability to relapse.     

No Worries, No Cares: An Investigation into Self-Reported "Nondistress" in College Students

An important methodological issue in depressionanalog research is whether individuals who scoreextremely low on self-report measures like the BeckDepression Inventory (BDI) should be included innondepressed control groups. Joiner, Schmidt, and Metalsky(1994) found that college students with BDI scores of 0or 1 evidenced a fake-good test taking style as measuredby the MMPI validity scales. The present study investigated whether very low BDI scores (BDI= 0 or 1; n = 21) might be associated with an elevatedpositive mood state, extreme optimism, positiveattributional style or social desirability. Resultsindicated that the very low scoring BDI subjects scoredhigher on social desirability than the low scoring group(BDI = 2 9, n = 63). Significant differences on mood,symptom and cognitive measures disappeared when social desirability was entered as a covariate.Findings support Kendall, Hollon, Beck, Hammen, andIngram's (1987) recommendation that subjects who score0 or 1 on the BDI should be excluded from a nondepressed control group.     

The Temporal Development of Mood, Cognitive, and Vegetative Symptoms in Recurrent SAD Episodes: A Test of the Dual Vulnerability Hypothesis

Recent literature on seasonal affective disorder (SAD) has begun to focus on diathesis–stress models, including Young and colleagues’ dual vulnerability hypothesis. The dual vulnerability hypothesis posits that individuals must possess both a biological vulnerability to developing vegetative symptoms and a psychological vulnerability to developing mood symptoms in order to develop SAD episodes. However, few studies have directly tested this model until very recently. Research has demonstrated a temporal relation between mood and vegetative symptoms, with vegetative symptoms having an earlier onset than mood symptoms supporting the idea that separate factors related to the two symptom clusters exist. The current study represents a longitudinal assessment of vegetative and mood symptoms, as well as cognitive factors (i.e., rumination, automatic thoughts) that may represent part of the psychological vulnerability shared by SAD sufferers. Furthermore, the present study represents only the second to assess state levels of cognitive factors that may impact recurrent SAD episode severity. Fifty-one individuals participated in the study across two groups, individuals with a history of SAD, and with no history of depression or SADs. Findings supported the dual vulnerability hypothesis, with an early vegetative symptom onset than mood symptom evident for the individuals with a history of SAD. Participants with a history of SAD also reported more ruminative responses and negative automatic thoughts about the seasons. Findings are generally supportive of Young and colleagues’ dual vulnerability hypothesis and directions for future research are suggested.     

Testing the Boundaries of Computerized Cognitive Control Training on Symptoms of Obsessive Compulsive Disorder

Cognitive control training (CCT) uses computer-based exercises to increase prefrontal cortex activation. Recent studies have found that depressed participants who received CCT significantly reduce their negative affect and rumination, and improve focus and concentration (Siegle et al. in Cogn Ther Res 31:235–262, 2007; Calkins et al. 2011). These promising findings raise questions about the degree to which this intervention may have use in other disorders; specifically, can CCT reduce the inflexible thinking characteristic of individuals with OCD? In the present study, we assessed the efficacy of three sessions of CCT, relative to a control intervention, on obsessive–compulsive (OC) symptoms in a community sample of individuals selected on the basis of elevated scores on the OCI-R. We hypothesized that those in the CCT condition would report a greater reduction in OC symptoms than those in the control condition. Additionally we assessed the ability to disengage from unattainable goals by using an unsolvable anagram task. To target the intervention to OC rather than mood symptoms, we excluded participants with elevated depression scores. Forty-eight participants (28 female, mean age 28.9 years) meeting eligibility criteria were randomized to receive three sessions of CCT or the control intervention (a computerized visual task) over a 2-week period. Following training, we did not find a significant difference between groups on OCI-R scores, indicating that this application of CCT was ineffective in meaningfully reducing OC symptoms (d = 0.27). Significant differences were found for affect ratings between groups, with participants in the CCT group showing larger decreases (d = 0.62) in negative affect scores across the three sessions of training. Hence, the CCT intervention may be more specific to mood than a direct modulator of cognitive inflexibility. Examination of the effects of additional sessions of CCT or CCT as an augmentation to exposure therapy remains to be investigated.