Reconsidering Rapid Early Response in Cognitive Behavioral Therapy for Depression

Ilardi and Craighead (1994) observed that 60–70% of symptom improvement in cognitive behavioral therapy (CBT) occurs in the first 4 weeks, and they assumed that cognitive modification techniques are not extensively applied in these weeks. They thus concluded that Beck's cognitive hypothesis of CBT cannot explain this early improvement. However, studies have shown that cognitive modification techniques are applied extensively in early sessions. Also, in most CBT studies there have been two sessions per week for the first 4 weeks and 1 session per week thereafter. Thus, 40–60% of CBT sessions in studies occur in the first 4 weeks, which arguably is enough therapeutic time for cognitive techniques to have a substantial effect on symptoms. Finally, llardi and Craighead's method assumes homogeneity among the patients' time courses, which is inconsistent with empirical data. We conclude that symptom change time course data do not contradict Beck's cognitive hypothesis.     

老年人轻度帕金森病样体征与轻度认知功能损害的关系

目的:比较轻度帕金森病样体征(mild parkinsonian signs,MPS)和无MPS老人的轻度认知功能损害(mildcognitive impairment,MCI)患病情况,探讨MPS与MCI间的关系。方法:以506名大于70岁老年人为研究对象,使用国际通用帕金森病统一评分量表(The unified Parkinson's disease rating scale,UPDRS)第Ⅲ部分缩写版本评定MPS。将研究对象分为MPS组和无MPS组,分析MPS患病的危险因素及MCI患病情况。结果:MPS组较无MPS组的年龄大,患糖尿病及MCI比例高。结论:MPS与MCI的关系密切,不同类型的MPS对MCI的发病影响不同。     

Mild cognitive impairment: Conceptual,assessment, ethical,and social issues

Mild cognitive impairment (MCI) is defined as a condition characterized by newly acquired cognitive decline to an extent that is beyond that expected for age or educational background, yet not causing significant functional impairment. The concept of MCI has received considerable attention in the literature over the past few years, and aspects related to its definition, prevalence, and evolution have been extensively studied and reviewed.Here we attempt to synthesize the implications of the current status of this entity, focusing on the conceptual, methodological, and, in particular, the social and ethical aspects of MCI which have attracted less attention. We discuss the weaknesses of the concept of MCI, which is heterogeneous in etiology, manifestations, and outcomes, and suggest that the emergence of the syndrome at this stage reflects industrial interests related to possible development of drugs for this disorder. On the other hand, the formal diagnosis of MCI, with its implications that the person may develop dementia, may have a grave impact on the psychological state of the individual, at a stage when prediction of outcome is tenuous and possibilities of useful interventions are meager. We present suggestions for the direction of future research in these areas.     

Evaluations of stressful transactions: what's in an appraisal?

Appraisals are the portal to emotional experience and action. Past research has demonstrated that challenge and threat appraisals have different implications for psychological, physiological, and behavioural responses, typically relying on two‐item assessments of appraisals. The present study investigated the predictive utility of a theoretically expanded appraisal measure. Both indexes were used to classify participants as either challenged (task demands were rated as commensurate with coping resources) or threatened (task demands were rated as exceeding resources). Group differences in stress responses were examined. The lengthened appraisal assessment was reliable. Furthermore, compared with the two‐item measure, the expanded measure better distinguished differences in emotional experience and performance. Similar findings were obtained for cardiovascular stress responses. Enhancing the assessment of individual differences in stressor appraisals facilitates our understanding their nature and potential for modification, and the nature of the stress process. Copyright © 2008 John Wiley & Sons, Ltd.     

Interaction effects of education and health status on cognitive change: A 6-year follow-up of the Maastricht Aging Study

Objectives: The aim of this study was to test for interactions between education and health status (i.e., physical, social, and psychological functioning) with respect to baseline cognitive performance and change over 6 years. Method: Longitudinal data from the Maastricht Aging Study of 1344 men and women aged 24–47 and 49–77 were used. Results: Education by health interactions were restricted to the younger group. The components of health status that most consistently interacted with education were physical functioning on cognitive performance at baseline and physical and psychological functioning on cognitive change. Conclusion: These results indicate that high education attenuates age-related decline and lower baseline performance incurred by low health status in persons younger than 50.     

The relationship between cognitive failures, psychoneurotic symptoms and sex

As Broadbent et al's (1) original analysis of the relationship between the Cognitive Failures Questionnaire (CFQ) and the Middlesex Hospital Questionnaire (MHQ) was conducted on an altered version of the MHQ, the present study undertook this same analysis using the full MHQ. In addition, the relationship was examined to see if it was mediated by the differences in the scoring of males and females on each questionnaire. Our results support and strengthen Broadbent et al's conclusion that high rates of cognitive failure are associated with psychoneurotic symptoms. The sex difference on the CFQ is discussed in terms of vulnerability to stress to account for the higher incidence of psychoneurotic symptoms in females.     

长期住院对精神分裂症患者认知功能的影响

目的：探讨长期住院对精神分裂症患者认知功能的影响。方法：对56例长期住院（≥5年）与49例住院时间较短（≤1年）的精神分裂症患者的精神症状和认知功能进行比较，采用阳性与阴性症状量表（PANSS）、韦氏成人智力量表（WAIS-R）、威斯康星卡片分类试验（WCST）等评定患者的认知功能。结果：长期住院（≥5年）组在智商、注意、记忆，以及信息整合与执行功能等均显著较差。结论：长期住院对精神分裂症患者认知功能有负面影响。     

Type 2 diabetes mellitus,cognitive impairment and dementia

Aims We set out to examine the evidence for an association between cognitive impairment or dementia and the presence of Type 2 diabetes mellitus (DM). We also sought evidence of potential mechanisms for such an association. Methods A literature search of three databases was performed and the reference lists of the papers so identified were examined, using English language papers only. Results We found evidence of cross-sectional and prospective associations between Type 2 DM and cognitive impairment, probably both for memory and executive function. There is also evidence for an elevated risk of both vascular dementia and Alzheimer’s disease in Type 2 DM albeit with strong interaction of other factors such as hypertension, dyslipidaemia and apolipoprotein E phenotype. Both vascular and non-vascular factors are likely to play a role in dementia in diabetes. Conclusions Current classification structures for dementia may not be adequate in diabetes, where mixed pathogenesis is likely. Further research into the mechanisms of cognitive impairment in Type 2 DM may allow us to challenge the concept of dementia, at least in these patients, as an irremediable disease. Diabet. Med. 16, 93–112 (1999)     

Obsessional Compulsive Disorder in Adolescent Populations: Experiences of Offering a Combined Pharmacological—Psychological Approach

The use of a standardised protocol for the pharmacological (using Selective Serotonin Re-uptake Inhibitors—SSRIs) and psychological treatment of 10 consecutive adolescent patients with Obsessional Compulsive Disorder is reported. The psychological treatment consisted of exposure to the feared stimulus and cognitive behavioural treatment of anxiety associated with this procedure. The results suggest that there are benefits from both pharmacological and psychological treatments. However, both treatments were difficult to implement. For the SSRIs, some patients reported disinhibition of mood swings and behaviour. For those patients who showed benefits from the pharmacological treatments, there appeared to be a decrease in willingness to attempt psychological methods. The psychological methods require considerable time, which may not be available in clinics, and substantial effort by the patients.