Evidence for the continuous latent structure of mania in the Epidemiologic Catchment Area from multiple latent structure and construct validation methodologies

BACKGROUND

Although psychiatric diagnostic systems have conceptualized mania as a discrete phenomenon, appropriate latent structure investigations testing this conceptualization are lacking. In contrast to these diagnostic systems, several influential theories of mania have suggested a continuous conceptualization. The present study examined whether mania has a continuous or discrete latent structure using a comprehensive approach including taxometric, information-theoretic latent distribution modeling (ITLDM) and predictive validity methodologies in the Epidemiologic Catchment Area (ECA) study.

METHOD

Eight dichotomous manic symptom items were submitted to a variety of latent structural analyses, including factor analyses, taxometric procedures and ITLDM, in 10105 ECA community participants. In addition, a variety of continuous and discrete models of mania were compared in terms of their relative abilities to predict outcomes (i.e. health service utilization, internalizing and externalizing disorders, and suicidal behavior).

RESULTS

Taxometric and ITLDM analyses consistently supported a continuous conceptualization of mania. In ITLDM analyses, a continuous model of mania demonstrated 6.52:1 odds over the best-fitting latent class model (LCM) of mania. Factor analyses suggested that the continuous structure of mania was best represented by a single latent factor. Predictive validity analyses demonstrated a consistent superior ability of continuous models of mania relative to discrete models.

CONCLUSIONS

The present study provided three independent lines of support for a continuous conceptualization of mania. The implications of a continuous model of mania are discussed.

Cognitive Therapy for Co-Occurring Depression and Behaviors Associated With Passive-Aggressive Personality Disorder

The following case study illustrates the use of cognitive therapy for treating depression that co-occurs with behaviors associated with passive-aggressive personality disorder (PAPD). Depression and co-occurring PAPD-associated behaviors present several challenges for treatment, including the transient nature of PAPD-associated behaviors and the effect of these behaviors on the effective treatment and remission of depression. Cognitive therapy was initially effective at treating depression and PAPD tendencies. As treatment progressed, dysfunctional interactions with the environment resulted in the reemergence of PAPD-associated behaviors as these behaviors were reinforced and assertive behaviors punished. With the continued use of cognitive therapy, PAPD tendencies were once again reduced and depressive status remained in remission. The present case study highlights the importance of targeting behaviors associated with personality pathology when co-occurring with depression.

A longitudinal investigation of the impact of life stress on HIV treatment adherence

Suboptimal antiretroviral adherence is associated with poorer HIV outcomes. Psychosocial factors, including life stress, depression and coping, may influence adherence behavior. This prospective investigation sought to examine the impact of life stress (acute life events, chronic stress, and perceived stress), depression, and coping style on adherence to HIV treatment regimes over time. Participants were 87 treatment-seeking HIV-infected individuals recruited from an urban HIV clinic. They completed clinician-administered interviews and self-report questionnaires at baseline and 3-month follow-up. Acute life events and chronic stress prospectively predicted decreases in treatment adherence more strongly among individuals in a major depressive episode (n = 21) compared to non-depressed individuals (n = 66). Coping style did not appear to be the mechanism by which life stress influenced adherence among depressed HIV-infected individuals. These findings demonstrate that life stress has toxic effects for depressed individuals and suggest that treatment adherence interventions with depressed individuals could be enhanced via development of stress management skills.

Maternal responses to child frustration and requests for help in dyads with fragile X syndrome

BACKGROUND

Variability in behaviour displayed by children with fragile X syndrome (FXS) may be partially attributable to environmental factors such as maternal responsivity. The purpose of this study was to explore variables associated with maternal behaviour during a task designed to elicit frustration in their children with FXS.

METHODS

Forty-six mother-child dyads, in which the child had full-mutation FXS, were observed in their homes during a task designed to elicit frustration in the child. Each child was given a wrong set of keys and asked to open a box to retrieve a desired toy. Mothers were provided with the correct set of keys and instructed to intervene when they perceived their child was getting too frustrated. Child-expressed frustration and requests for help and maternal behaviours (comforting, negative control, and encouraging/directing) were observed and coded. Maternal variables (e.g. depression, stress, education levels), child variables (e.g. autistic behaviours, age, medication use) and child behaviours (frustration, requests for help) were explored as predictors of maternal behaviour.

RESULTS

Almost all mothers intervened to help their children and most used encouraging/directing behaviours, whereas very few used comforting or negative control. Child age and child behaviours during the frustrating event were significant predictors of encouraging/directing behaviours in the mothers. Children whose mothers reported higher depressive symptomology used fewer requests for help, and mothers of children with more autistic behaviours used more negative control.

CONCLUSIONS

The results of this study suggest that child age and immediate behaviours are more strongly related to maternal responsivity than maternal traits such as depression and stress.

A comparison of the predictive abilities of dimensional and categorical models of unipolar depression in the National Comorbidity Survey

BACKGROUND

Taxometric research on depression has yielded mixed results, with some studies supporting dimensional solutions and others supporting taxonic solutions. Although supplementary tests of construct validity might clarify these mixed findings, to date such analyses have not been reported. The present study represents a follow-up to our previous taxometric study of depression designed to evaluate the relative predictive validities of dimensional and categorical models of depression.

METHOD

Two sets of dimensional and categorical models of depression were constructed from the depression items of the Composite International Diagnostic Interview: (1) empirically derived models obtained using latent structure analyses and (2) rationally selected models, including an additive depressive symptoms scale (dimensional) and DSM major depressive episodes (categorical). Both sets of dimensional and categorical models were compared in terms of their abilities to predict various clinically relevant outcomes (psychiatric diagnoses and impairment).

RESULTS

Factor analyses suggested a two-factor model ('cognitive-affective' and 'somatic' symptoms) and latent class analyses suggested a three-class model ('severe depression', 'moderate depression' and 'cognitive-affective distress'). In predictive analyses that simultaneously included dimensional and categorical models as predictors, the dimensional models remained significant unique predictors of outcomes while the categorical models did not.

CONCLUSIONS

Both dimensional models provided superior predictive validity relative to their categorical counterparts. These results provide construct validity evidence for the dimensional findings from our previous taxometric study and thus inspire confidence in dimensional conceptualizations of depression. It remains for future research to evaluate the construct validity of the taxonic solutions reported in the literature.

Initial Treatment Success Followed By Failure

This article presents a diagnostically complicated case involving comorbid major depressive disorder with psychotic features, social phobia and personality pathology (including avoidant, paranoid, and obsessive compulsive traits). “Mr. X” was a 45-year-old single White male who was unemployed and living with his parents at the time of treatment. He presented with severe anxiety (Beck Anxiety Inventory = 43) and depression (Beck Depression Inventory = 41) as well as active psychotic symptoms (e.g., self-depreciating auditory hallucinations). Although a cognitive case formulation and treatment plan led to initial success in terms of improvements in symptomatology and functional impairment, we speculate that failure to adequately address core toxic beliefs (e.g., “I am inadequate”) ultimately contributed to a precipitous return of symptomatology, followed by a suicide attempt and premature treatment termination. We discuss the challenges of working within a cognitive framework with this client and suggest alternative approaches that might have proven more successful.

Annihilation of an AB/BA interface pair in superfluid helium-3 as a simulation of cosmological brane interaction

This study presents measurements of the transport of quasiparticle excitations in the B phase of superfluid 3He at temperatures below 0.2Tc. We find that creating and then removing a layer of A-phase superfluid leads to a measurable increase in the thermal impedance of the background B phase. This increase must be due to the survival of defects created as the AB and BA interfaces on either side of the A-phase layer annihilate. We speculate that a new type of defect may have been formed. The highly ordered A-B interface may be a good analogy for branes discussed in current cosmology. If so, these experiments may provide insight into how the annihilation of branes can lead to the formation of topological defects such as cosmic strings.

Rumination, negative cognition, and their interactive effects on depressed mood

Response styles theory posits that rumination represents a trait vulnerability to depression. Recent evidence has suggested that rumination predicts changes in depression more strongly among individuals with high levels of negative cognition. Three studies evaluated this model of interactive vulnerabilities. Study 1 provided empirical support for the distinction between rumination and negative cognitive content. The next 2 studies investigated the interactive model in the laboratory. Study 2 randomly assigned participants to either ruminate or distract following a sad mood induction. This study found that rumination was more strongly associated with dysphoria among individuals who report high levels of negative cognition. Similarly, Study 3 found that rumination and negative cognition interact to predict changes in dysphoria across a no-task delay period following a sad mood induction. These studies provide support for an interactive model in which rumination amplifies the deleterious effects of negative cognition.

Social anxiety, depressive symptoms, and post-event rumination: affective consequences and social contextual influences

Using a self-presentation perspective, we hypothesized that during social interactions in which social attractiveness could be easily appraised by others, more socially anxious individuals would be more prone to ruminate and rumination would have more adverse emotional consequences. After assessing social anxiety and depressive symptoms, unacquainted college students participated in 45-min structured social interactions manipulated to induce personal self-disclosure or mimic superficial, small-talk. Affective experiences were assessed immediately after and 24h after social interactions. Results found that social anxiety was associated with negative post-event rumination more strongly among those with elevated depressive symptoms. Further, at higher levels of social anxiety, post-event rumination was associated with increases in NA following personal disclosure interactions and decreases in NA following small-talk interactions. Individuals with more depressive symptoms experienced increases in NA following small-talk interactions, but not personal disclosure interactions. Contrary to expectation, positive relations between social anxiety and rumination were not mediated by self-presentation concerns during interactions. Fitting with relevant theory, findings implicated symptom and social contextual variables that moderate the affective consequences of rumination.

Adult attachment security and college student substance use

Previous research has demonstrated strong links between quality of adult attachment styles and various forms of psychological distress. A burgeoning literature further points to a relationship between insecure attachment and drug use, particularly alcohol consumption. In the present study, we expanded upon the existing literature by examining the relationship between adult attachment style and use of cigarettes, alcohol, and marijuana in a sample of 212 college students. Moreover, based on our previous work [Hankin, B.L., Kassel, J.D., and Abela, J.R.Z. (2005). Adult attachment dimensions and specificity of emotional distress symptoms: prospective investigations of cognitive risk and interpersonal stress generation as mediating mechanisms. Personality and Social Psychology Bulletin, 31, 136-151.], we proposed a conceptual model positing that adult attachment style influences both frequency of drug use and stress-motivated drug use through its impact on dysfunctional attitudes and self-esteem. Initial correlational analyses indicated significant (positive) associations between anxious attachment (tapping neediness and fear of abandonment) and both drug use frequency and stress-motivated drug use. Simultaneous regression analyses revealed that, for drug use frequency, the influence of anxious attachment operated primarily through its effect on dysfunctional attitudes and self-esteem. Regarding drug use attributable to negative affect reduction, anxious attachment demonstrated direct, independent effects on both cigarette smoking and alcohol use. These findings highlight the potential importance of adult attachment styles as a risk factor for drug use among college students.

Non-treatment-related sudden gains in depression: The role of self-evaluation

A number of studies have demonstrated that recovery from depression is often marked by precipitous improvements during the course of treatment. The present research examined sudden gains occurring outside of the context of treatment in a sample of college students with current major depressive disorder (n=60), and tested whether variables pertaining to cognitive style, hope, self-evaluation, and life events would be associated with these gains. Results indicated that 60% of the sample experienced sudden gains, with over half of those sudden gains reversing before the end of the 9-week observation period. Sudden gainers were significantly less depressed at the end of the observation period but were no more likely to have achieved remission compared to non-sudden gainers. Although changes in cognitive style did not precede sudden gains, individuals with sudden gains had significantly higher self-esteem at baseline compared to non-sudden gainers. Furthermore, decreases in the frequency of social comparison occurred in the week prior to sudden gains. These results suggest that sudden gains do occur outside of the context of treatment and that self-evaluation processes may play an important role in recovery from depression.

Life stress and the long-term treatment course of recurrent depression: III. Nonsevere life events predict recurrence for medicated patients over 3 years

Research has consistently documented the significance of severe life events for onset of major depression. Theory, however, suggests other forms of stress are relevant for depression's recurrence. Nonsevere life events were tested in relation to depression for 126 patients with recurrent depression in a 3-year randomized maintenance protocol. Life stress was assessed every 12 weeks and rated along dimensions of severity, focus, and independence. A significant interaction between specific types of nonsevere life events and medication was found. For medicated patients, subject-focused independent nonsevere life events predicted recurrence; for unmedicated patients, these events predicted fewer recurrences. Other nonsevere life events did not predict recurrence. The findings underscore the potential importance of specific stressors for triggering recurrences of depression.

Effects of legume forages on ovine gastrointestinal parasite development, migration and survival

Lambs grazing certain legumes have reduced parasite intensities compared to lambs grazing ryegrass swards. Eighteen replicates of white clover (cv. AberHerald), lucerne (cv. Luzelle), red clover (cv. Merviot) and perennial ryegrass (cv. Abersilo) were sown at equivalent field rates in 25 cm diameter PVC pots and maintained outside for 6 months. On day 0, forage in each pot was cut to 50 mm from soil level and the pots were placed in a glasshouse (at 19-25 degrees C and 70% humidity) in a randomised block design. Ten grams sheep faeces containing 2,133 Haemonchus contortus eggs per gram were placed on the soil in each pot. Six replicates of each forage were destructively sampled on days 14, 21 and 29. Forage samples were cut at 50 mm from the soil surface and at the soil surface to give two samples per pot. The number of nematodes was determined by a modification of the Whitehead tray method. The ratio of free-living to infective-stage larvae was determined from at least 10% of the larvae. The number of H. contortus larvae kgdrymatter(-1) (DM) forage was calculated and the data rank transformed prior to analysis by ANOVA. There were fewer larvae on legumes compared with ryegrass on samples from forage above 50 mm (P<0.001) but there was no forage effect on larvae below this height. The sum of larvae present on all forage per kilogram DM showed fewer larvae on red clover compared with ryegrass on day 21 (P<0.05). There was an effect of day on the total number of larvae on forage (P<0.001) but there were no foragexday interactions. Analysis of the data according to the leaf area above 50 mm from the soil surface confirmed these results, that there were fewer larvae on legume forages than ryegrass above this height (P<0.01). Overall, red clover affected the development of H. contortus and all legumes affected larval migration above 50 mm compared with ryegrass but survival of larvae was similar on all forages. Further work is needed to determine if these effects of legume forages would reduce the number of parasitic larvae ingested by livestock under field conditions.

Cognitive-behavioral depression treatment for mothers of children with attention-deficit/hyperactivity disorder

An adaptation of the Coping With Depression Course (CWDC) was evaluated in mothers of children with attention-deficit/hyperactivity disorder (ADHD), a population at risk for depression. Mothers were randomly assigned to receive the CWDC either immediately following an intensive summer treatment program targeting their child's behavior or after a wait-list period. Measures of maternal functioning, cognitions about child behavior, parent-child and marital relationship quality, child behavior, and ADHD-related family impairment were obtained at pretreatment, posttreatment, and 5-month follow-up. The CWDC resulted in improvements in maternal depressive symptoms, maternal self-esteem, child-related cognitions, and family impairment at posttreatment compared to a wait-list control group that were maintained at follow-up. Findings suggest that the CWDC is a promising intervention for mothers of children with ADHD, particularly those with current depressive symptomatology.

A taxometric investigation of unipolar depression in the national comorbidity survey

Ongoing debate has questioned whether unipolar depression is a dimensional or categorical phenomenon. Although past studies using taxometric methods have supported a dimensional interpretation, each has suffered from methodological limitations. The present study was designed to overcome these limitations through reanalysis of the National Comorbidity Survey. Two indicator sets were constructed from the depression-relevant questions of the Composite International Diagnostic Interview. Participants who endorsed the lifetime occurrence of significant depressed mood or anhedonia (n=4,577) were submitted to 2 nonredundant taxometric procedures (maximum eigenvalue and means above minus below a cut), additional consistency tests, and recently developed simulation techniques. All results converged on a dimensional solution. The implications of these findings on assessment, treatment, and research design are discussed.

A prospective investigation of the impact of attachment style on stress generation among clinically depressed individuals

The present study sought to determine if attachment style contributed to the generation of stressful life events among clinically depressed individuals during the course of treatment. Participants (N=68) were interviewed about life stressors experienced during a 3-month treatment protocol using a contextual approach (Life Events and Difficulties Schedule; [Brown, G. W., & Harris, T. O. (1978). Social origins of depression: A study of psychiatric disorder in women. New York: Free Press]). Results suggested interactive effects between severity of depression and attachment style on stress associated with future sociotropic and dependent life events. Mildly depressed individuals who reported a dismissing attachment style (higher levels of avoidant attachment and lower levels of anxious attachment) or preoccupied style (lower levels of avoidant attachment and higher levels of anxious attachment) experienced higher levels of stress associated with sociotropic events. Likewise, a dismissing attachment style predicted stress associated with dependent events among mildly depressed individuals. These effects were not present among our more severely depressed participants.

Mood congruent memory in dysphoria: the roles of state affect and cognitive style

Biases in incidental memory for self-referent adjectives and intentional memory were compared across nondysphoric (ND; n=48), experimentally induced dysphoric (EXP; n=49), and naturally dysphoric (NAT; n=48) individuals. Negative biases, "evenhandedness", and positive biases were demonstrated among NAT, EXP and ND participants, respectively, in terms of incidental memory. Correlation analyses suggested that the effects of cognitive style (self-esteem, dysfunctional attitudes, and attributional style) are limited to negative stimuli. Memory for incidental positive stimuli was only predicted by state affect. Groups did not differ in performance on an intentional memory task. Implications for network and schema models of depression are explored.

Life stress and adherence to antiretroviral therapy among HIV-positive individuals: a preliminary investigation

The present study sought to investigate the impact of life stress on treatment adherence and viral load of HIV-positive individuals. Three different aspects of life stress were examined in this investigation (perceived stress, acute life events unrelated to the HIV illness, and HIV-related acute life events). Furthermore, we examined whether these relationships were moderated by depressive severity, self-esteem, and neuroticism. Participants (n = 24) were treatment- seeking HIV-positive individuals who completed a series of questionnaires for this investigation. The majority of the participants in this sample were middle-aged, Caucasian males who identified themselves as either homosexual or bisexual, had contracted HIV via sexual contact, and met criteria for AIDS (mean CD4 count = 324). This sample was highly self-selected and varied from the county HIV-positive population in terms of gender, ethnicity, and HIV risk factor. Information on their adherence and viral load was collected from their medical records 6 to 9 months after completion of the psychological measurements. Results indicated that perceived stress, but not acute events, prospectively predicted adherence. Moreover, marginal trends suggested that depressive symptoms and neuroticism moderated the effect of perceived stress on adherence. Neither perceived stress nor acute life events were associated with viral load.

Blink rate in boys with fragile X syndrome: preliminary evidence for altered dopamine function

BACKGROUND

Dopamine, a neurotransmitter involved in motor and cognitive functioning, can be non-invasively measured via observation of spontaneous blink rates. Blink rates have been studied in a number of clinical conditions including schizophrenia, autism, Parkinsons, and attention deficit/hyperactivity disorder with results implicating either hyper or hypo dopaminergic states.

METHODS

This study examined spontaneous blink rate in boys with fragile X syndrome (FXS). Blink rates of boys (4-8 years old) with FXS (n = 6) were compared with those of age-matched typically developing boys (n = 6) during active and passive tasks. Blink rates (blinks per minute) for each task were compared between the two groups. Then, the relation between blink measures and core FXS-related features [problem behaviours, arousal, fmr 1 protein (FMRP)] were examined within the group of boys with FXS.

RESULTS

Blink rate in boys with FXS was significantly higher than typically developing boys during passive tasks. Within the FXS group, there were significant correlations between blink rate and problem behaviours and physiological arousal (i.e. heart activity) but not with FMRP.

CONCLUSIONS

Observed differences in spontaneous blink rate between boys with and without FXS and the relation between blink rate and physiological and behavioural measures in boys with FXS suggests that further work examining dopamine dysfunction as a factor in the pathophysiology of FXS may be warranted.

Sudden gains in cognitive behavioral treatment for depression: when do they occur and do they matter?

Despite the use of efficacious treatments for depression, individuals differ in both the degree to which they recover and the rate at which recovery occurs. Tang and colleagues found that depressed patients who had sudden improvements in their symptomatology not only maintained these gains, but also enjoyed more improvement and higher rates of recovery than those without sudden gains (J. Consulting Clin. Psychol. 67(6) (1999) 894; J. Consulting Clin. Psychol. 70(2) (2002) 444). Our study examined the role of sudden gains in a cognitive-behavioral group treatment for depression. Results indicated that 41.9% of patients experienced sudden gains. Furthermore, sudden gains occurring in the first third of treatment appear to have special importance. Participants enjoying early sudden gains had significantly larger changes in depressive symptom scores over the course of treatment than those without sudden gains and were marginally more likely to be treatment responders compared to those without early sudden gains. In contrast to Tang and DeRubeis (J. Consulting Clin. Psychol. 67(6) (1999) 894), however, sudden gains were not associated with cognitive changes.

Memory and attention in Obsessive-Compulsive Disorder: a review

The present manuscript reviewed studies investigating biases and deficits in memory and attention related to Obsessive-Compulsive Disorder (OCD). Although the research has been mixed concerning memory for verbal information, there is more consistent evidence suggesting impairment for non-verbal information, particularly for complex visual stimuli and the individual's own actions. Further, a number of studies indicate that patients with OCD report less confidence in their judgments about recognition memory. Finally, OCD appears to be associated with an attentional bias favoring threatening information, as well as reduced levels of cognitive inhibition. The manuscript concludes with a number of recommendations for future research.