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Groves SJ, Douglas KM, Crowe MT, Inder M, Jordan J, Carlyle D, Beaglehole B, Mulder R, Lacey C, Luty S, Eggleston K, Frampton C, Bowie CR, Porter RJ. Cognitive predictors of response to interpersonal and social rhythm therapy in mood disorders. Bipolar Disord 2024. [PMID: 39085171 DOI: 10.1111/bdi.13469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
BACKGROUND There has been increasing interest in examining the potential moderating effects that cognitive functioning has on treatment outcome in bipolar disorder (BD) and major depressive disorder (MDD). Therefore, the aim of this exploratory study was to examine the relationship between baseline cognitive function and treatment outcome in individuals with mood disorders who completed 12 months of interpersonal and social rhythm therapy (IPSRT), and were randomised to receive adjunctive cognitive remediation (CR) or no additional intervention. METHODS Fifty-eight patients with mood disorders (BD, n = 36, MDD, n = 22), who were randomised to IPSRT-CR or IPSRT, underwent cognitive testing at baseline and completed follow-up mood measures after 12 months. General linear modelling was used to examine the relationship between baseline cognitive function (both objective and subjective) and change in mood symptom burden, and functioning, from baseline to treatment-end. RESULTS Poorer baseline attention/executive function was associated with less change in mood symptom burden, particularly depressive symptoms, at treatment-end. Additionally, slower psychomotor speed at baseline was associated with less improvement in mania symptom burden. Subjective cognitive function at baseline was not related to change in mood symptom burden at treatment-end, and neither objective nor subjective cognitive function was associated with functional outcome. LIMITATIONS Due to the exploratory nature of the study, there was no correction for multiple comparisons. CONCLUSION Aspects of objective cognitive function were associated with treatment outcomes following psychotherapy. Further large-scale research is required to examine the role that cognitive function may have in determining various aspects of mood disorder recovery.
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Affiliation(s)
- Samantha J Groves
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marie T Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Maree Inder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jenny Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Dave Carlyle
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ben Beaglehole
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Department of Māori/Indigenous Health Innovation, Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Sue Luty
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Kate Eggleston
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Chris Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | | | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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Thai M, Olson EA, Nickels S, Dillon DG, Webb CA, Ren B, Killgore WDS, Rauch SL, Rosso IM, Pizzagalli DA. Neural and behavioral markers of inhibitory control predict symptom improvement during internet-delivered cognitive behavioral therapy for depression. Transl Psychiatry 2024; 14:303. [PMID: 39043642 PMCID: PMC11266709 DOI: 10.1038/s41398-024-03020-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 06/24/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024] Open
Abstract
Poor inhibitory control contributes to deficits in emotion regulation, which are often targeted by treatments for major depressive disorder (MDD), including cognitive behavioral therapy (CBT). Brain regions that contribute to inhibitory control and emotion regulation overlap; thus, inhibitory control might relate to response to CBT. In this study, we examined whether baseline inhibitory control and resting state functional connectivity (rsFC) within overlapping emotion regulation-inhibitory control regions predicted treatment response to internet-based CBT (iCBT). Participants with MDD were randomly assigned to iCBT (N = 30) or a monitored attention control (MAC) condition (N = 30). Elastic net regression was used to predict post-treatment Patient Health Questionnaire-9 (PHQ-9) scores from baseline variables, including demographic variables, PHQ-9 scores, Flanker effects (interference, sequential dependency, post-error slowing), and rsFC between the dorsal anterior cingulate cortex, bilateral anterior insula (AI), and right temporoparietal junction (TPJ). Essential prognostic predictor variables retained in the elastic net regression included treatment group, gender, Flanker interference response time (RT), right AI-TPJ rsFC, and left AI-right AI rsFC. Prescriptive predictor variables retained included interactions between treatment group and baseline PHQ-9 scores, age, gender, Flanker RT, sequential dependency effects on accuracy, post-error accuracy, right AI-TPJ rsFC, and left AI-right AI rsFC. Inhibitory control and rsFC within inhibitory control-emotion regulation regions predicted reduced symptom severity following iCBT, and these effects were stronger in the iCBT group than in the MAC group. These findings contribute to a growing literature indicating that stronger inhibitory control at baseline predicts better outcomes to psychotherapy, including iCBT.
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Affiliation(s)
- Michelle Thai
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Elizabeth A Olson
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Stefanie Nickels
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Daniel G Dillon
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christian A Webb
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Boyu Ren
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Psychiatric Biostatistics Laboratory, McLean Hospital, Belmont, MA, USA
| | - William D S Killgore
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Scott L Rauch
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Isabelle M Rosso
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Imaging Center, McLean Hospital, Belmont, MA, USA
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Göke K, McClintock SM, Mah L, Rajji TK, Lee HH, Nestor SM, Downar J, Noda Y, Daskalakis ZJ, Mulsant BH, Blumberger DM. Cognitive Profiles in Treatment-Resistant Late-Life Depression and their Impact on Treatment Outcomes. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00197-6. [PMID: 39053577 DOI: 10.1016/j.bpsc.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Late-life depression (LLD) is associated with cognitive impairment, yet substantial heterogeneity exists among patients. Data on the extent of cognitive impairments is inconclusive, particularly in patients with treatment-resistant depression (TRD). We investigated the cognitive profiles of patients with treatment-resistant vs. nonresistant LLD and aimed to identify distinct cognitive subgroups. Additionally, we examined whether cognitive subgroups differentially responded to treatment with bilateral repetitive transcranial magnetic stimulation (rTMS). METHODS 165 patients with LLD were divided into treatment-resistant and nonresistant groups and compared to healthy controls (HC) on measures of executive function, information processing speed, verbal learning, and memory. Cluster analysis identified subgroups based on cognitive scores. Demographic and clinical variables, as well as outcomes with bilateral rTMS, were compared between cognitive subgroups. RESULTS Patients with LLD, particularly TRD, exhibited significantly worse cognitive performance than HC. A three-cluster solution was found, including "Cognitively Intact" (n = 89), "Cognitively Diminished" (n = 29), and "Impaired Memory" (n = 47) subgroups. Both the "Cognitively Diminished" and "Impaired Memory" subgroups had more anxiety symptoms and a higher proportion of patients with TRD than the "Cognitively Intact" group, though the latter did not survive multiple comparison correction. No significant differences were observed in outcomes to rTMS treatment. CONCLUSIONS Patients with LLD exhibited impairments across cognitive domains, which were more pronounced in TRD. Three identified cognitive subgroups responded similarly to rTMS treatment, indicating its effectiveness across cognitive profiles, especially when medications are not tolerated. Future research should examine the relationship among cognitive subgroups, cognitive decline, and neurodegeneration.
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Affiliation(s)
- Katharina Göke
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto
| | - Shawn M McClintock
- Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Linda Mah
- Institute of Medical Science, University of Toronto; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Tarek K Rajji
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Hyewon H Lee
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sean M Nestor
- Institute of Medical Science, University of Toronto; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jonathan Downar
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Faculty of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California, San Diego Health, California, United States
| | - Benoit H Mulsant
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Sakalauskaitė L, Hansen LS, Dubois JM, Ploug Larsen M, Feijóo GM, Carstensen MS, Woznica Miskowiak K, Nguyen M, Harder Clemmensen LK, Petersen PM, Martiny K. Rationale and design of a double-blinded, randomized placebo-controlled trial of 40 Hz light neurostimulation therapy for depression (FELIX). Ann Med 2024; 56:2354852. [PMID: 38767238 PMCID: PMC11107857 DOI: 10.1080/07853890.2024.2354852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a debilitating condition that affects more than 300 million people worldwide. Current treatments are based on a trial-and-error approach, and reliable biomarkers are needed for more informed and personalized treatment solutions. One of the potential biomarkers, gamma-frequency (30-80 Hz) brainwaves, are hypothesized to originate from the excitatory-inhibitory interaction between the pyramidal cells and interneurons. The imbalance between this interaction is described as a crucial pathological mechanism in neuropsychiatric conditions, including MDD, and the modulation of this pathological interaction has been investigated as a potential target. Previous studies attempted to induce gamma activity in the brain using rhythmic light and sound stimuli (GENUS - Gamma Entrainment Using Sensory stimuli) that resulted in neuroprotective effects in Alzheimer's disease (AD) patients and animal models. Here, we investigate the antidepressant, cognitive, and electrophysiological effects of the novel light therapy approach using 40 Hz masked flickering light for patients diagnosed with MDD. METHODS AND DESIGN Sixty patients with a current diagnosis of a major depressive episode will be enrolled in a randomized, double-blinded, placebo-controlled trial. The active treatment group will receive 40 Hz masked flickering light stimulation while the control group will receive continuous light matched in color temperature and brightness. Patients in both groups will get daily light treatment in their own homes and will attend four follow-up visits to assess the symptoms of depression, including depression severity measured by Hamilton Depression Rating Scale (HAM-D17), cognitive function, quality of life and sleep, and electroencephalographic changes. The primary endpoint is the mean change from baseline to week 6 in depression severity (HAM-D6 subscale) between the groups.
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Affiliation(s)
- Laura Sakalauskaitė
- New Interventions in Depression Group (NID-Group), Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Electrical and Photonics Engineering, The Technical University of Denmark
- OptoCeutics ApS, Lyngby, Denmark
| | | | - Julie Margrethe Dubois
- New Interventions in Depression Group (NID-Group), Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Malina Ploug Larsen
- New Interventions in Depression Group (NID-Group), Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Marcus S. Carstensen
- Department of Electrical and Photonics Engineering, The Technical University of Denmark
- OptoCeutics ApS, Lyngby, Denmark
| | - Kamilla Woznica Miskowiak
- Neurocognition and Emotion in Affective Disorders (NEAD) Group, Copenhagen Affective Disorders Research Center (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Paul Michael Petersen
- Department of Electrical and Photonics Engineering, The Technical University of Denmark
| | - Klaus Martiny
- New Interventions in Depression Group (NID-Group), Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
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Li YT, Zhang C, Han JC, Shang YX, Chen ZH, Cui GB, Wang W. Neuroimaging features of cognitive impairments in schizophrenia and major depressive disorder. Ther Adv Psychopharmacol 2024; 14:20451253241243290. [PMID: 38708374 PMCID: PMC11070126 DOI: 10.1177/20451253241243290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/14/2024] [Indexed: 05/07/2024] Open
Abstract
Cognitive dysfunctions are one of the key symptoms of schizophrenia (SZ) and major depressive disorder (MDD), which exist not only during the onset of diseases but also before the onset, even after the remission of psychiatric symptoms. With the development of neuroimaging techniques, these non-invasive approaches provide valuable insights into the underlying pathogenesis of psychiatric disorders and information of cognitive remediation interventions. This review synthesizes existing neuroimaging studies to examine domains of cognitive impairment, particularly processing speed, memory, attention, and executive function in SZ and MDD patients. First, white matter (WM) abnormalities are observed in processing speed deficits in both SZ and MDD, with distinct neuroimaging findings highlighting WM connectivity abnormalities in SZ and WM hyperintensity caused by small vessel disease in MDD. Additionally, the abnormal functions of prefrontal cortex and medial temporal lobe are found in both SZ and MDD patients during various memory tasks, while aberrant amygdala activity potentially contributes to a preference to negative memories in MDD. Furthermore, impaired large-scale networks including frontoparietal network, dorsal attention network, and ventral attention network are related to attention deficits, both in SZ and MDD patients. Finally, abnormal activity and volume of the dorsolateral prefrontal cortex (DLPFC) and abnormal functional connections between the DLPFC and the cerebellum are associated with executive dysfunction in both SZ and MDD. Despite these insights, longitudinal neuroimaging studies are lacking, impeding a comprehensive understanding of cognitive changes and the development of early intervention strategies for SZ and MDD. Addressing this gap is critical for advancing our knowledge and improving patient prognosis.
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Affiliation(s)
- Yu-Ting Li
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Chi Zhang
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
- Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Jia-Cheng Han
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Yu-Xuan Shang
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Zhu-Hong Chen
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Guang-Bin Cui
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi’an 710038, Shaanxi, China
| | - Wen Wang
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi’an 710038, Shaanxi, China
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Beaglehole B, Porter R, Douglas K, Lacey CJ, de Bie A, Jordan J, Mentzel C, Thwaites B, Manuel J, Murray G, Frampton C, Glue P. Protocol for a randomised controlled trial of ketamine versus ketamine and behavioural activation therapy for adults with treatment-resistant depression in the community. BMJ Open 2024; 14:e084844. [PMID: 38692731 PMCID: PMC11086269 DOI: 10.1136/bmjopen-2024-084844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/03/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION Although short-term benefits follow parenteral ketamine for treatment-resistant major depressive disorder (TR-MDD), there are challenges that prevent routine use of ketamine by clinicians. These include acute dissociative effects of parenteral ketamine, high relapse rates following ketamine dosing and the uncertain role of psychotherapy. This randomised controlled trial (RCT) seeks to establish the feasibility of evaluating repeated oral doses of ketamine and behavioural activation therapy (BAT), compared with ketamine treatment alone, for TR-MDD. We also aim to compare relapse rates between treatment arms to determine the effect size of adding BAT to oral ketamine. METHODS AND ANALYSIS This is a prospectively registered, two-centre, single-blind RCT. We aim to recruit 60 participants with TR-MDD aged between 18 and 65 years. Participants will be randomised to 8 weeks of oral ketamine and BAT, or 8 weeks of oral ketamine alone. Feasibility will be assessed by tracking attendance for ketamine and BAT, acceptability of treatment measures and retention to the study follow-up protocol. The primary efficacy outcome measure is the Montgomery-Asberg Depression Rating Scale (MADRS) measured weekly during treatment and fortnightly during 12 weeks of follow-up. Other outcome measures will assess the tolerability of ketamine and BAT, cognition and activity (using actigraphy). Participants will be categorised as non-responders, responders, remitters and relapsed during follow-up. MADRS scores will be analysed using a linear mixed model. For a definitive follow-up RCT study to be recommended, the recruitment expectations will be met and efficacy outcomes consistent with a >20% reduction in relapse rates favouring the BAT and ketamine arm will be achieved. ETHICS AND DISSEMINATION Ethics approval was granted by the New Zealand Central Health and Disability Ethics Committee (reference: 2023 FULL18176). Study findings will be reported to participants, stakeholder groups, conferences and peer-reviewed publications. TRIAL REGISTRATION NUMBER UTN: U1111-1294-9310, ACTRN12623000817640p.
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Affiliation(s)
- Ben Beaglehole
- Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Katie Douglas
- Psychological Medicine, University of Otago, Christchurch, New Zealand
| | | | - Aroha de Bie
- Te Whatu Ora-Health New Zealand Waitaha Canterbury, Christchurch, Canterbury, New Zealand
| | - Jennifer Jordan
- Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Charlie Mentzel
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | | | - Jenni Manuel
- Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | | | - Paul Glue
- Psychological Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand
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Nesbit MO, Ahn S, Zou H, Floresco SB, Phillips AG. Potentiation of prefrontal cortex dopamine function by the novel cognitive enhancer d-govadine. Neuropharmacology 2024; 246:109849. [PMID: 38244888 DOI: 10.1016/j.neuropharm.2024.109849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/13/2023] [Accepted: 01/16/2024] [Indexed: 01/22/2024]
Abstract
Cognitive impairment is a debilitating feature of psychiatric disorders including schizophrenia, mood disorders and substance use disorders for which there is a substantial lack of effective therapies. d-Govadine (d-GOV) is a tetrahydroprotoberberine recently shown to significantly enhance working memory and behavioural flexibility in several prefrontal cortex (PFC)-dependent rodent tasks. d-GOV potentiates dopamine (DA) efflux in the mPFC and not the nucleus accumbens, a unique pharmacology that sets it apart from many dopaminergic drugs and likely contributes to its effects on cognitive function. However, specific mechanisms involved in the preferential effects of d-GOV on mPFC DA function remain to be determined. The present study employs brain dialysis in male rats to deliver d-GOV into the mPFC or ventral tegmental area (VTA), while simultaneously sampling DA and norepinephrine (NE) efflux in the mPFC. Intra-PFC delivery or systemic administration of d-GOV preferentially potentiated medial prefrontal DA vs NE efflux. This differential effect of d-GOV on the primary catecholamines known to affect mPFC function further underscores its specificity for the mPFC DA system. Importantly, the potentiating effect of d-GOV on mPFC DA was disrupted when glutamatergic transmission was blocked in either the mPFC or the VTA. We hypothesize that d-GOV acts in the mPFC to engage the mesocortical feedback loop through which prefrontal glutamatergic projections activate a population of VTA DA neurons that specifically project back to the PFC. The activation of a PFC-VTA feedback loop to elevate PFC DA efflux without affecting mesolimbic DA release represents a novel approach to developing pro-cognitive drugs.
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Affiliation(s)
- Maya O Nesbit
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Soyon Ahn
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Haiyan Zou
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Stan B Floresco
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Anthony G Phillips
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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8
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Bhattacharya M, Kashyap H, Reddy YJ. Cognitive Training in Obsessive-Compulsive Disorder: A Systematic Review. Indian J Psychol Med 2024; 46:110-118. [PMID: 38725718 PMCID: PMC11076946 DOI: 10.1177/02537176231207781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background Cognitive training (CT) for illness-linked neuropsychological deficits has been attempted in psychiatric disorders and, more recently, in obsessive-compulsive disorder (OCD). However, studies are few and far between, with a limited understanding of factors contributing to efficacy. This article aims to provide a comprehensive critical review of studies employing CT in OCD. Methods This systematic review follows the Preferred Reporting of Items for Systematic Review and Meta-Analyses Protocols. Empirical studies that used any form of CT/remediation in individuals with OCD were included. Results Eight articles met the criteria for inclusion, of which five were randomized controlled trials, two were case series, and one was an open-label trial. The studies have predominantly demonstrated improved trained cognitive functions, with only two showing generalization to untrained domains like clinical symptoms and socio-occupational functioning. Conclusion There are few controlled trials of CT in OCD, which limits conclusions of efficacy. Given the sparse research in the area, the review summarizes the current status of research and examines important methodological considerations that may inform future studies.
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Affiliation(s)
- Mahashweta Bhattacharya
- Dept. of Clinical Psychology, National Institute of Mental health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
- Obsessive-Compulsive Disorder Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
- Accelerator Program for Discovery in Brain Disorders using Stem cells (ADBS), Government of India
| | - Himani Kashyap
- Dept. of Clinical Psychology, National Institute of Mental health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
- Obsessive-Compulsive Disorder Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Y.C. Janardhan Reddy
- Obsessive-Compulsive Disorder Clinic, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
- Accelerator Program for Discovery in Brain Disorders using Stem cells (ADBS), Government of India
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Ainsworth NJ, Marawi T, Maslej MM, Blumberger DM, McAndrews MP, Perivolaris A, Pollock BG, Rajji TK, Mulsant BH. Cognitive Outcomes After Antidepressant Pharmacotherapy for Late-Life Depression: A Systematic Review and Meta-Analysis. Am J Psychiatry 2024; 181:234-245. [PMID: 38321915 DOI: 10.1176/appi.ajp.20230392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVE The authors evaluated whether treatment of late-life depression (LLD) with antidepressants leads to changes in cognitive function. METHODS A systematic review and meta-analysis of prospective studies of antidepressant pharmacotherapy for adults age 50 or older (or mean age of 65 or older) with LLD was conducted. MEDLINE, EMBASE, and PsycInfo were searched through December 31, 2022. The primary outcome was a change on cognitive test scores from baseline to after treatment. Secondary outcomes included the effects of specific medications and the associations between changes in depressive symptoms and cognitive test scores. Participants with bipolar disorder, psychotic depression, dementia, or neurological disease were excluded. Findings from all eligible studies were synthesized at a descriptive level, and a random-effects model was used to pool the results for meta-analysis. RESULTS Twenty-two studies were included. Thirteen of 19 studies showed an improvement on at least one cognitive test after antidepressant pharmacotherapy, with the most robust evidence for the memory and learning (nine of 16 studies) and processing speed (seven of 10 studies) domains and for sertraline (all five studies). Improvements in depressive symptoms were associated with improvement in cognitive test scores in six of seven relevant studies. The meta-analysis (eight studies; N=493) revealed a statistically significant overall improvement in memory and learning (five studies: effect size=0.254, 95% CI=0.103-0.404, SE=0.077); no statistically significant changes were seen in other cognitive domains. The evaluated risk of publication bias was low. CONCLUSION Antidepressant pharmacotherapy of LLD appears to improve certain domains of cognitive function, particularly memory and learning. This effect may be mediated by an improvement in depressive symptoms. Studies comparing individuals receiving pharmacotherapy with untreated control participants are needed.
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Affiliation(s)
- Nicholas J Ainsworth
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Tulip Marawi
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Marta M Maslej
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Daniel M Blumberger
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Mary Pat McAndrews
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Argyrios Perivolaris
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Bruce G Pollock
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Tarek K Rajji
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health (CAMH), Toronto (Ainsworth, Marawi, Maslej, Blumberger, Pollock, Rajji, Mulsant); Department of Psychiatry, Temerty Faculty of Medicine (Ainsworth, Blumberger, Pollock, Mulsant), Institute of Medical Science, Temerty Faculty of Medicine (Marawi, Perivolaris), and Department of Psychology (McAndrews), University of Toronto, Toronto; Krembil Brain Institute, University Health Network, Toronto (McAndrews); Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto (Perivolaris); Toronto Dementia Research Alliance, Toronto (Rajji)
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10
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Kassel MT, Kryza-Lacombe M, Insel PS, Rhodes E, Satre DD, Nelson JC, Tosun D, Mathews CA, Mackin RS. Hoarding Symptoms in Late Life Depression are Associated With Greater Executive Dysfunction and Disability and Poorer Response to Depression Treatment. Am J Geriatr Psychiatry 2024; 32:137-147. [PMID: 37770349 PMCID: PMC10872841 DOI: 10.1016/j.jagp.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVES Late life depression (LLD) and hoarding disorder (HD) are common in older adults and characterized by executive dysfunction and disability. We aimed to determine the frequency of co-occurring HD in LLD and examine hoarding severity as an additional contributor to executive dysfunction, disability, and response to psychotherapy for LLD. DESIGN Cross-sectional. SETTING Outpatient psychiatry program. PARTICIPANTS Eighty-three community-dwelling adults ages 65-90 with LLD. INTERVENTION Problem-solving therapy. MEASUREMENTS Measures of executive function, disability, depression, and hoarding severity were completed at post-treatment. Pearson's chi-squared tests evaluated group differences in rates of cognitive impairment, disability, and depression treatment response between participants with HD (LLD+HD) and LLD only. Separate linear regressions assessed associations between hoarding severity and executive function, disability, and psychotherapy response. Covariates included age, education, gender, and depression severity. RESULTS 30.1% (25/83) of LLD participants met HD criteria. Relative to LLD, LLD+HD participants demonstrated greater impairment rates on measures of executive function (Letter-Number-Sequencing, X2(1)=4.0, p = 0.045; Stroop-Interference, X2(1) = 4.8, p = 0.028). Greater hoarding severity was associated with poorer executive functioning performance (Letter-Number-Sequencing (t[70] = -2.1, β = -0.05, p = 0.044), Digit-Span (t[71] = -2.4, β = -0.07, p = 0.019), Letter-Fluency (t[ 71] = -2.8, β = -0.24, p = 0.006)). Rates of disability were significantly higher for LLD+HD (88.0%) than LLD (62.3%), (X2[1] = 5.41, p = 0.020) and higher hoarding severity was related to greater disability (t[72] = 2.97, β = 0.13, p = 0.004). Depression treatment response rates were significantly lower for LLD+HD (24.0%) compared to LLD (48.3%), X2(1) = 4.26, p = 0.039, and HD status predicted psychotherapy response, t(67) = -2.15, β = -15.6, p = 0.035. CONCLUSIONS We found 30.1% co-occurrence of HD in LLD, which was accompanied by greater executive dysfunction, disability, and poorer response to depression treatment. Results underscore the need for increased screening of hoarding behaviors in LLD and tailored interventions for this LLD+HD group.
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Affiliation(s)
- Michelle T Kassel
- Mental Illness Research, Education, and Clinical Centers (MTK, MKL, ER, RSM), San Francisco Veterans Affairs Health Care System, San Francisco, CA; Department of Psychiatry and Behavioral Sciences (MTK, MKL, PSI, ER, DDS, JCN, RSM), University of California San Francisco, San Francisco, CA.
| | - Maria Kryza-Lacombe
- Mental Illness Research, Education, and Clinical Centers (MTK, MKL, ER, RSM), San Francisco Veterans Affairs Health Care System, San Francisco, CA; Department of Psychiatry and Behavioral Sciences (MTK, MKL, PSI, ER, DDS, JCN, RSM), University of California San Francisco, San Francisco, CA
| | - Philip S Insel
- Department of Psychiatry and Behavioral Sciences (MTK, MKL, PSI, ER, DDS, JCN, RSM), University of California San Francisco, San Francisco, CA
| | - Emma Rhodes
- Mental Illness Research, Education, and Clinical Centers (MTK, MKL, ER, RSM), San Francisco Veterans Affairs Health Care System, San Francisco, CA; Department of Psychiatry and Behavioral Sciences (MTK, MKL, PSI, ER, DDS, JCN, RSM), University of California San Francisco, San Francisco, CA
| | - Derek D Satre
- Department of Psychiatry and Behavioral Sciences (MTK, MKL, PSI, ER, DDS, JCN, RSM), University of California San Francisco, San Francisco, CA; Division of Research (DDS), Kaiser Permanente Northern California, Oakland, CA
| | - J Craig Nelson
- Department of Psychiatry and Behavioral Sciences (MTK, MKL, PSI, ER, DDS, JCN, RSM), University of California San Francisco, San Francisco, CA
| | - Duygu Tosun
- Department of Radiology and Biomedical Imaging (DT), University of California San Francisco, San Francisco, CA
| | - Carol A Mathews
- Department of Psychiatry and Center for OCD, Anxiety and Related Disorders (CAM), University of Florida, Gainesville, FL
| | - R Scott Mackin
- Mental Illness Research, Education, and Clinical Centers (MTK, MKL, ER, RSM), San Francisco Veterans Affairs Health Care System, San Francisco, CA; Department of Psychiatry and Behavioral Sciences (MTK, MKL, PSI, ER, DDS, JCN, RSM), University of California San Francisco, San Francisco, CA
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11
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van der Kolk BA, Wang JB, Yehuda R, Bedrosian L, Coker AR, Harrison C, Mithoefer M, Yazar-Klosinki B, Emerson A, Doblin R. Effects of MDMA-assisted therapy for PTSD on self-experience. PLoS One 2024; 19:e0295926. [PMID: 38198456 PMCID: PMC10781106 DOI: 10.1371/journal.pone.0295926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION There is a resurgence of interest in the therapeutic potential of psychedelic substances such as 3,4-methylenedioxymethamphetamine (MDMA). Primary findings from our randomized, double-blind, placebo-controlled, multi-site Phase 3 clinical trial of participants with severe PTSD (NCT03537014) showed that MDMA-assisted therapy induced significant attenuation in the Clinician-Administered PTSD Scale for DSM-5 compared to Therapy with placebo. Deficits in emotional coping skills and altered self-capacities constitute major obstacles to successful completion of available treatments. The current analysis evaluated the differential effects of MDMA-assisted therapy and Therapy with placebo on 3 transdiagnostic outcome measures and explored the contribution of changes in self-experience to improvement in PTSD scores. METHODS Participants were randomized to receive manualized therapy with either MDMA or placebo during 3 experimental sessions in combination with 3 preparation and 9 integration therapy visits. Symptoms were measured at baseline and 2 months after the last experimental session using the 20-item Toronto Alexithymia Scale (TAS-20), the 26-item Self Compassion Scale (SCS), and the 63-item Inventory of Altered Self-Capacities (IASC). RESULTS 90 participants were randomized and dosed (MDMA-assisted therapy, n = 46; Therapy with placebo, n = 44); 84.4% (76/90) had histories of developmental trauma, and 87.8% (79/90) had suffered multiple traumas. MDMA-assisted therapy facilitated statistically significant greater improvement on the TAS-20, the SCS, and most IASC factors of interpersonal conflicts; idealization disillusionment; abandonment concerns; identity impairment; self-awareness; susceptibility to influence; affect dysregulation; affect instability; affect skill deficit; tension reduction activities; the only exception was identity diffusion. CONCLUSION Compared with Therapy with placebo, MDMA-assisted therapy had significant positive effects on transdiagnostic mental processes of self-experience which are often associated with poor treatment outcome. This provides a possible window into understanding the psychological capacities facilitated by psychedelic agents that may result in significant improvements in PTSD symptomatology.
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Affiliation(s)
| | - Julie B. Wang
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Rachel Yehuda
- James J. Peters Veterans Affairs Medical Center, Bronx, NY, United States of America
- Center for Psychedelic Psychotherapy and Trauma Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Leah Bedrosian
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Allison R. Coker
- University of California, San Francisco, San Francisco, CA, United States of America
- Multidisciplinary Association for Psychedelic Studies (MAPS), San Jose, CA, United States of America
| | - Charlotte Harrison
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Michael Mithoefer
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States of America
| | - Berra Yazar-Klosinki
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Amy Emerson
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, United States of America
| | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies (MAPS), San Jose, CA, United States of America
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12
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Berdzenishvili E, Roinishvili M, Okruashvili M, Kenchadze V, Chkonia E. Impact of subjective sleep quality on objective measures of neurocognitive dysfunction in patients with major depressive disorder. Ind Psychiatry J 2024; 33:154-159. [PMID: 38853813 PMCID: PMC11155662 DOI: 10.4103/ipj.ipj_136_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 06/11/2024] Open
Abstract
Background Sleep disturbances are prevalent in major depressive disorder (MDD). MDD and sleep disturbances are both linked to cognitive impairments. Studies exploring the mechanisms and impact of sleep disturbances on neurocognitive functioning in depressed patients are lacking and proper assessment and therapeutic interventions for sleep disturbances are not part of clinical management of MDD. Aim We investigated the association between subjective sleep quality and neurocognitive dysfunction in patients with MDD. Materials and Methods Patients with moderate MDD episode were matched and assigned to two groups with poor and good sleep quality. We used Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. To measure frontotemporally mediated cognitive functioning, following tests were administered: Wisconsin Card Sorting Test (WCST) and degraded continuous performance test (CPT-DS). Two-tailed independent samples t tests or Mann-Whitney U tests and Pearson's correlation coefficient were performed for the statistical analysis of sleep latency, sleep duration, overall sleep quality, CPT d' value, WCST correct answers, errors, and perseverative errors. Results Participants with MDD and poor sleep quality performed worse on cognitive tests compared to patients with MDD and good sleep quality. Scores of subjective sleep on PSQI positively correlated with WCST errors (r (60) =0.8883 P = .001) and negatively correlated with WCST correct answers (r (60) = -.869 P = .001) and measures of CPT-DS d' value (r (60) = -.9355 P = .001). Conclusions Poor sleep quality, notably sleep duration and sleep latency, worsens the neurocognitive impairments of MDD patients. As these impairments are found to be associated with treatment outcomes, sleep disturbances should be additionally assessed and treated in MDD episode.
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Affiliation(s)
| | - Maya Roinishvili
- Institute of Cognitive Neurosciences, Agricultural University of Georgia, Tbilisi, Georgia
| | | | - Vaja Kenchadze
- I. Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Eka Chkonia
- Department of Psychiatry, Tbilisi State Medical University, Tbilisi, Georgia
- Institute of Cognitive Neurosciences, Agricultural University of Georgia, Tbilisi, Georgia
- Tbilisi Mental Health Centre, Tbilisi, Georgia
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13
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Taboada Gjorup AL, Tolentino Júnior JC, van Duinkerken E, Marques AC, do Carmo Filho A, Joaquim AM, Neves VV, Schmidt SL. Association between attention performance and the different dimensions of DSM-5 depression symptoms. Front Psychiatry 2023; 14:1291670. [PMID: 38179242 PMCID: PMC10765948 DOI: 10.3389/fpsyt.2023.1291670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/20/2023] [Indexed: 01/06/2024] Open
Abstract
Objective Depressive symptoms can be assessed with self-reported questionnaires, such as the Patient Health Questionary-9 (PHQ-9). Previous studies have suggested that the PHQ-9 items can be grouped into somatic and non-somatic clusters. However, the classification of the PHQ-9 item "concentration difficulties" into somatic or non-somatic is still controversial. This controversy may be explained by difficulties experienced by subjects in accurately evaluating their attention problems. The primary objective of this study was to determine the correlation between objective attentional performance and the two clusters of depressive symptoms in hospital employees working in stressful conditions. Methods The participants filled out the PHQ-9 to identify their depressive symptoms. Based on the PHQ-9, the somatic or non-somatic symptoms were measured without considering the question about subjective concentration difficulties. Then, a brief version of the Continuous Visual Attention Test (CVAT) was applied to assess four attentional subdomains. The CVAT is a Go/No-go task that measures number of correct responses (focused attention), number of incorrect responses (behavior-inhibition), average reaction time of correct responses (RT-alertness), and variability of reaction time (VRT-sustained attention). The entire task lasted 90 s. Correlation analyses assessed the relationships between attentional performance and the two dimensions of depressive symptoms. Results After applying the inclusion/exclusion criteria, 359 individuals were selected. Their age ranged from 20 to 70 years (mean = 40.5, SD = 10.37), and the majority was female (67.6%). A predominance in somatic depressive symptoms was present in 231 (64%) participants, whereas 59 (16%) showed a predominance of non-somatic symptoms. Sixty-nine participants (20%) did not show any predominance. Higher somatic scores were associated with higher RTs, whereas higher non-somatic scores were related to an increase in the number of incorrect responses. Conclusion The predominance of the somatic cluster was related to lower alertness, whereas the predominance of non-somatic cluster was associated with impulsivity/hyperactivity. This result may explain the difficulties associated with correctly classifying the item concentration difficulties. A brief attentional task can be used as an auxiliary tool to correctly identify the different dimensions of attention that are associated with different clusters of depressive symptoms.
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Affiliation(s)
- Ana Lucia Taboada Gjorup
- Post-Graduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Julio César Tolentino Júnior
- Post-Graduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Eelco van Duinkerken
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - André Casarsa Marques
- Post-Graduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Aureo do Carmo Filho
- Post-Graduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Alan Marques Joaquim
- Post-Graduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Vithória Vidotti Neves
- Post-Graduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Sergio Luis Schmidt
- Post-Graduate Program in Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
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14
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Gülpen J, Brouwer ME, Geurtsen GJ, van Dis EAM, Denys DAJP, Bockting CL. Treatments for partial remission of major depressive disorder: a systematic review and meta-analysis. BMJ MENTAL HEALTH 2023; 26:1-9. [PMID: 37914347 PMCID: PMC10626872 DOI: 10.1136/bmjment-2023-300827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023]
Abstract
QUESTION Partial remission of major depressive disorder (MDD) is a debilitating and distressing clinical state related to chronicity, morbidity and relapse. Although one-third of patients remit partially, evidence for treatment efficacy is unclear. We provide an overview of treatment options and their efficacy. STUDY SELECTION AND ANALYSIS Embase, PsycINFO, Medline and SCOPUS were systematically searched through February 2023. Included were randomised controlled trials (RCTs) examining any treatment in patients with partially remitted MDD aged 13-65 years, reporting data on severity, remission or relapse. FINDINGS Seven RCTs examining psychotherapy including 1024 patients were eligible. There were not enough RCTs to examine effects of pharmacotherapy. Psychotherapy was associated with lower depressive symptom severity at post-treatment (Hedges' g=0.50; 95% CI 0.23 to 0.76), but not at follow-up up to 1 year (Hedges' g=0.36; 95% CI -0.30 to 1.02) or longer (Hedges' g=0.02; 95% CI -0.09 to 0.12). Psychotherapy was associated with superior remission rates at post-treatment (OR 2.57; 95% CI 1.71 to 3.87) and follow-up 6 months or longer (OR 1.75; 95% CI 1.21 to 2.53), although not with improved relapse rates at post-treatment (OR 0.17; 95% CI 0.01 to 4.83) or follow-up 6 months or longer (OR 0.46; 95% CI 0.21 to 1.03). Overall methodological quality was poor. CONCLUSIONS Psychotherapy targeting partial remission may be effective in lowering depressive symptom severity and patients may potentially achieve full remission twice as likely. Yet, long-term and prophylactic effects are lacking. Given the risk of chronicity, more high-quality RCTs are needed. PROSPERO REGISTRATION NUMBER CRD42020188451.
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Affiliation(s)
- Joost Gülpen
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Marlies E Brouwer
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Gert J Geurtsen
- Department of Medical Psychology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Eva A M van Dis
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Damiaan A J P Denys
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Amsterdam, The Netherlands
| | - Claudi L Bockting
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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15
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Malekizadeh H, Saed O, Rashtbari A, Sajjadi M, Ahmadi D, Ronold EH. Deficits in specific executive functions manifest by severity in major depressive disorder: a comparison of antidepressant naïve inpatient, outpatient, subclinical, and healthy control groups. Front Psychiatry 2023; 14:1225062. [PMID: 37854445 PMCID: PMC10580982 DOI: 10.3389/fpsyt.2023.1225062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/12/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Previous research has highlighted the executive function (EF) deficits present in depressed patients; however, conflicting results exist regarding the impact of depression severity on the size of these deficits. This study aimed to compare deficits in EF between antidepressant naïve inpatient and outpatient depressed, a group with subclinical depression symptoms, and a healthy control group while controlling for education, sex, and age. Methods In cross-sectional research, 245 antidepressant naive participants (46 inpatient, 68 outpatient, 65 subclinical, and 67 healthy control individuals) were recruited by convenience sampling. The Structured Clinical Interview for DSM-5 Disorders (SCID-5) and Beck Depression Inventory-II (BDI-II) were used to assess depression. EF was measured using several neuropsychological tests, including the Stroop Color-Word Test, the Wisconsin Card Sorting Test, and the N-back Test, which assessed the components of Inhibition, Shifting, and Updating, respectively. Multivariate analysis of covariance revealed a significant difference between the groups in EF components (p < 0.001). Pairwise comparisons further showed that inpatient and outpatient patients had more depressive symptoms and worse EF performance than subclinical and healthy control groups (p < 0.05). Results In the analysis of EF measures, a significant difference was found among the four groups, with post-hoc tests revealing variations in specific EF components. Overall, patients with more severe depressive symptoms show more deficits in EF. Additionally, correlations between clinical characteristics and EF measures varied across patient groups, but many correlations became non-significant after adjusting for the false discovery rate (FDR). Discussion This study emphasizes the impact of depression severity on deficits in the EF of depressed patients and at-risk populations. Consequently, it is important to consider executive dysfunctions as an underlying vulnerability in the development and persistence of depressive disorder.
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Affiliation(s)
- Hossein Malekizadeh
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Omid Saed
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Alireza Rashtbari
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mozhdeh Sajjadi
- Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Davoud Ahmadi
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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Yuan D, Wu J, Li S, Zhang R, Zhou X, Zhang Y. Network analysis of cold cognition and depression in middle-aged and elder population: the moderation of grandparenting. Front Public Health 2023; 11:1204977. [PMID: 37674685 PMCID: PMC10479032 DOI: 10.3389/fpubh.2023.1204977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023] Open
Abstract
Background Cognitive decline and negative emotions are common in aging, especially decline in cold cognition which often co-occurred with depression in middle-aged and older adults. This study analyzed the interactions between cold cognition and depression in the middle-aged and elder populations using network analysis and explored the effects of grandparenting on the cold cognition-depression network. Methods The data of 6,900 individuals (≥ 45 years) from the China Health and Retirement Longitudinal Study (CHARLS) were used. The Minimum Mental State Examination (MMSE) and the Epidemiology Research Center Depression Scale-10 (CESD-10) were used to assess cold cognition and depressive symptoms, respectively. Centrality indices and bridge centrality indices were used to identify central nodes and bridge nodes, respectively. Results Network analysis showed that nodes "language ability" and "depressed mood" were more central nodes in the network of cold cognition and depression in all participants. Meantime, nodes "attention," "language ability" and "hopeless" were three key bridge nodes connecting cold cognition and depressive symptoms. Additionally, the global connectivity of the cold cognition and depression network was stronger in the non-grandparenting than the grandparenting. Conclusion The findings shed a light on the complex interactions between cold cognition and depression in the middle-aged and elder populations. Decline in language ability and depressed mood can serve as predictors for the emergence of cold cognitive dysfunction and depression in individuals during aging. Attention, language ability and hopelessness are potential targets for psychosocial interventions. Furthermore, grandparenting is effective in alleviating cold cognitive dysfunction and depression that occur during individual aging.
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Affiliation(s)
- Dongling Yuan
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jialing Wu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shansi Li
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ruoyi Zhang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiao Zhou
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Zhang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
- Medical Psychological Institute of Central South University, Central South University, Changsha, China
- National Clinical Research Center on Mental Disorders (Xiangya), Changsha, China
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Pan WG, Hu XY, Zhu DD, Li L, Bao F, Ren L, Mao PX, Ma X, Ren YP, Tang YL. The cognitive effects of adjunctive repetitive transcranial magnetic stimulation for late-onset depression: a randomized controlled trial with 4 week follow-up. Front Psychiatry 2023; 14:1240261. [PMID: 37614650 PMCID: PMC10442575 DOI: 10.3389/fpsyt.2023.1240261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/27/2023] [Indexed: 08/25/2023] Open
Abstract
Objectives Cognitive impairment is common and linked to poor outcomes in patients with late-onset depression (LOD). The cognitive effects of repetitive transcranial magnetic stimulation (rTMS) for LOD are not well understood. This study aimed to investigate the effects of rTMS on cognitive function in elderly patients with LOD. Methods In total, 58 elderly patients (aged 60 to 75 years) with depression were enrolled and randomly assigned to an active rTMS group or a sham group. The participants received active or sham rTMS over the left dorsolateral prefrontal cortex for 4 weeks, 5 days a week, at a frequency of 10 Hz rTMS and 120% of the motor threshold (MT). Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) at baseline, the end of the 4 week treatment period, and at the 4 week follow-up. Results The active rTMS group showed significant improvements in immediate memory and attention scores on the RBANS compared to the sham group. However, no significant differences were observed between the two groups in other cognitive domains assessed by the RBANS. No serious adverse events related to rTMS treatment were observed. Conclusion Treatment with 120% MT rTMS was associated with improvement in cognitive defects related to the active phase of LOD. These findings suggest that rTMS could provide early improvements in cognitive function in clinical settings for elderly patients with LOD.Clinical trial registration: https://www.chictr.org.cn/showproj.html?proj=40698, identifier ChiCTR1900024445.
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Affiliation(s)
- Wei-gang Pan
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xiao-yue Hu
- Department of Psychiatry, Xicheng District Pingan Hospital, Beijing, China
| | - Dan-di Zhu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Li Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Feng Bao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Li Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Pei-xian Mao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xin Ma
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yan-ping Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi-lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GE, United States
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GE, United States
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18
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Franke Föyen L, Sennerstam V, Kontio E, Lekander M, Hedman-Lagerlöf E, Lindsäter E. Objective cognitive functioning in patients with stress-related disorders: a cross-sectional study using remote digital cognitive testing. BMC Psychiatry 2023; 23:565. [PMID: 37550693 PMCID: PMC10405463 DOI: 10.1186/s12888-023-05048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Patients with stress-related mental disorders often report cognitive impairment, but studies investigating objective cognitive impairment in patients with stress-related disorders have produced inconsistent findings. AIM The primary aim of this study was to investigate objective cognitive functioning in patients diagnosed with the stress-related disorders adjustment disorder or exhaustion disorder, compared to a healthy normative group. Secondary aims were to conduct subgroup analyses of cognitive functioning between the diagnostic groups and explore associations between self-reported symptoms and cognitive functioning. METHODS Cognitive test results on a digitally self-administered cognitive test battery from 266 patients (adjustment disorder, n = 131; exhaustion disorder, n = 135) were cross-sectionally compared with results from a healthy normative group (N = 184 to 692) using one-tailed t-tests. ANOVAs were conducted for subgroup analyses, and regression analyses for associations between self-reported symptoms and cognitive functioning. Effect sizes were calculated. RESULTS Patients performed significantly worse than the normative group on all measures with small to moderate effect sizes ranging from d = -.13 to -.57. Those diagnosed with exhaustion disorder performed worse than norms on more measures than did patients with adjustment disorder, but no significant differences between diagnostic groups were found on any measure. Self-reported memory impairment was weakly associated with one of two memory measures. No clear associations between self-reported burnout symptoms and objective cognitive functioning were found. CONCLUSIONS This study adds to the literature indicative of small to moderate objective cognitive impairments in patients diagnosed with stress-related mental disorders. Further exploration into mechanisms of cognitive functioning in different populations is needed for development of theoretical models that may explain the weak correlation between self-reported symptoms and objective measures. TRIAL REGISTRATION ClinicalTrial.gov: NCT04797273. Trial registration date 15 March 2021. This study was also pre-registered on Open Science Framework (osf.io) with https://doi.org/10.17605/OSF.IO/TQXZV .
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Affiliation(s)
- Ludwig Franke Föyen
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden.
- Gustavsberg University Primary Care Center, Stockholm Health Care Services, Region Stockholm, Sweden.
| | - Victoria Sennerstam
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Gustavsberg University Primary Care Center, Stockholm Health Care Services, Region Stockholm, Sweden
- Osher Center for Integrative Health, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Evelina Kontio
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Gustavsberg University Primary Care Center, Stockholm Health Care Services, Region Stockholm, Sweden
| | - Mats Lekander
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
- Osher Center for Integrative Health, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Gustavsberg University Primary Care Center, Stockholm Health Care Services, Region Stockholm, Sweden
- Osher Center for Integrative Health, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elin Lindsäter
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Gustavsberg University Primary Care Center, Stockholm Health Care Services, Region Stockholm, Sweden
- Osher Center for Integrative Health, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
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Huang SS, Yu YH, Chen HH, Hung CC, Wang YT, Chang CH, Peng SJ, Kuo PH. Functional connectivity analysis on electroencephalography signals reveals potential biomarkers for treatment response in major depression. BMC Psychiatry 2023; 23:554. [PMID: 37528355 PMCID: PMC10394892 DOI: 10.1186/s12888-023-04958-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/13/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The treatment efficacy varies across individual patients with major depressive disorder (MDD). It lacks robust electroencephalography (EEG) markers for an antidepressant-responsive phenotype. METHOD This is an observational study enrolling 28 patients with MDD and 33 healthy controls (mean age of 40.7 years, and 71.4% were women). Patients underwent EEG exams at baseline (week0) and week1, while controls' EEG recordings were acquired only at week0. A resting eye-closing EEG segment was analyzed for functional connectivity (FC). Four parameters were used in FC analysis: (1) node strength (NS), (2) global efficiency (GE), (3) clustering coefficient (CC), and (4) betweenness centrality (BC). RESULTS We found that controls had higher values in delta wave in the indices of NS, GE, BC, and CC than MDD patients at baseline. After treatment with antidepressants, patients' FC indices improved significantly, including GE, mean CC, and mean NS in the delta wave. The FC in the alpha and beta bands of the responders were higher than those of the non-responders. CONCLUSIONS The FC of the MDD patients at baseline without treatment was worse than that of controls. After treatment, the FC improved and was close to the values of controls. Responders showed better FC in the high-frequency bands than non-responders, and this feature exists in both pre-treatment and post-treatment EEG.
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Affiliation(s)
- Shiau-Shian Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei, Taiwan
| | - Yu-Hsiang Yu
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - His-Han Chen
- Department of Psychiatry, Yang Ji Mental Hospital, Keelung, Taiwan
| | - Chia-Chun Hung
- Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei, Taiwan
| | - Yao-Ting Wang
- Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei, Taiwan
| | - Chieh Hsin Chang
- Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei, Taiwan
| | - Syu-Jyun Peng
- Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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20
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Eilertsen SEH, Eilertsen TH. Why is it so hard to identify (consistent) predictors of treatment outcome in psychotherapy? - clinical and research perspectives. BMC Psychol 2023; 11:198. [PMID: 37408027 DOI: 10.1186/s40359-023-01238-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Anxiety and depression are two of the most debilitating psychological disorders worldwide today. Fortunately, effective treatments exist. However, a large proportion of patients do not recover from treatment, and many still have symptoms after completing treatment. Numerous studies have tried to identify predictors of treatment outcome. So far, researchers have found few or no consistent predictors applicable to allocate patients to relevant treatment. METHODS We set out to investigate why it is so hard to identify (consistent) predictors of treatment outcome for psychotherapy in anxiety and depression by reviewing relevant literature. RESULTS Four challenges stand out; a) the complexity of human lives, b) sample size and statistical power, c) the complexity of therapist-patient relationships, and d) the lack of consistency in study designs. Together these challenges imply there are a countless number of possible predictors. We also consider ethical implications of predictor research in psychotherapy. Finally, we consider possible solutions, including the use of machine learning, larger samples and more realistic complex predictor models. CONCLUSIONS Our paper sheds light on why it is so hard to identify consistent predictors of treatment outcome in psychotherapy and suggest ethical implications as well as possible solutions to this problem.
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Affiliation(s)
- Silje Elisabeth Hasmo Eilertsen
- Haugaland DPS/Department of Research and Innovation, Helse Fonna HF, Haugaland DPS v/ Silje Eilertsen, Postboks 2052, Haugesund, Norway.
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21
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Fietz J, Pöhlchen D, Brückl TM, Brem AK, Padberg F, Czisch M, Sämann PG, Spoormaker VI. Data-Driven Pupil Response Profiles as Transdiagnostic Readouts for the Detection of Neurocognitive Functioning in Affective and Anxiety Disorders. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023:S2451-9022(23)00149-0. [PMID: 37348604 DOI: 10.1016/j.bpsc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Neurocognitive functioning is a relevant transdiagnostic dimension in psychiatry. As pupil size dynamics track cognitive load during a working memory task, we aimed to explore if this parameter allows identification of psychophysiological subtypes in healthy participants and patients with affective and anxiety disorders. METHODS Our sample consisted of 226 participants who completed the n-back task during simultaneous functional magnetic resonance imaging and pupillometry measurements. We used latent class growth modeling to identify clusters based on pupil size in response to cognitive load. In a second step, these clusters were compared on affective and anxiety symptom levels, performance in neurocognitive tests, and functional magnetic resonance imaging activity. RESULTS The clustering analysis resulted in two distinct pupil response profiles: one with a stepwise increasing pupil size with increasing cognitive load (reactive group) and one with a constant pupil size across conditions (nonreactive group). A larger increase in pupil size was significantly associated with better performance in neurocognitive tests in executive functioning and sustained attention. Statistical maps of parametric modulation of pupil size during the n-back task showed the frontoparietal network in the positive contrast and the default mode network in the negative contrast. The pupil response profile of the reactive group was associated with more thalamic activity, likely reflecting better arousal upregulation and less deactivation of the limbic system. CONCLUSIONS Pupil measurements have the potential to serve as a highly sensitive psychophysiological readout for detection of neurocognitive deficits in the core domain of executive functioning, adding to the development of valid transdiagnostic constructs in psychiatry.
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Affiliation(s)
- Julia Fietz
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Dorothee Pöhlchen
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Tanja M Brückl
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Anna-Katharine Brem
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland; Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Victor I Spoormaker
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany.
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22
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Pedersen MK, Díaz CMC, Wang QJ, Alba-Marrugo MA, Amidi A, Basaiawmoit RV, Bergenholtz C, Christiansen MH, Gajdacz M, Hertwig R, Ishkhanyan B, Klyver K, Ladegaard N, Mathiasen K, Parsons C, Rafner J, Villadsen AR, Wallentin M, Zana B, Sherson JF. Measuring Cognitive Abilities in the Wild: Validating a Population-Scale Game-Based Cognitive Assessment. Cogn Sci 2023; 47:e13308. [PMID: 37354036 DOI: 10.1111/cogs.13308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/26/2023] [Accepted: 06/05/2023] [Indexed: 06/26/2023]
Abstract
Rapid individual cognitive phenotyping holds the potential to revolutionize domains as wide-ranging as personalized learning, employment practices, and precision psychiatry. Going beyond limitations imposed by traditional lab-based experiments, new efforts have been underway toward greater ecological validity and participant diversity to capture the full range of individual differences in cognitive abilities and behaviors across the general population. Building on this, we developed Skill Lab, a novel game-based tool that simultaneously assesses a broad suite of cognitive abilities while providing an engaging narrative. Skill Lab consists of six mini-games as well as 14 established cognitive ability tasks. Using a popular citizen science platform (N = 10,725), we conducted a comprehensive validation in the wild of a game-based cognitive assessment suite. Based on the game and validation task data, we constructed reliable models to simultaneously predict eight cognitive abilities based on the users' in-game behavior. Follow-up validation tests revealed that the models can discriminate nuances contained within each separate cognitive ability as well as capture a shared main factor of generalized cognitive ability. Our game-based measures are five times faster to complete than the equivalent task-based measures and replicate previous findings on the decline of certain cognitive abilities with age in our large cross-sectional population sample (N = 6369). Taken together, our results demonstrate the feasibility of rapid in-the-wild systematic assessment of cognitive abilities as a promising first step toward population-scale benchmarking and individualized mental health diagnostics.
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Affiliation(s)
- Mads Kock Pedersen
- Center for Hybrid Intelligence, Department of Management, Aarhus University
- Department of Business Development and Technology, Aarhus University
| | | | - Qian Janice Wang
- Center for Hybrid Intelligence, Department of Management, Aarhus University
- Department of Food Science, Aarhus University
| | | | - Ali Amidi
- Department of Psychology and Behavioural Sciences, Aarhus University
| | | | | | - Morten H Christiansen
- Department of Psychology, Cornell University
- School of Communication and Culture, Aarhus University
- Interacting Minds Centre, Aarhus University
| | - Miroslav Gajdacz
- Center for Hybrid Intelligence, Department of Management, Aarhus University
| | - Ralph Hertwig
- Center for Adaptive Rationality, Max Planck Institute for Human Development
| | | | - Kim Klyver
- Department of Entrepreneurship & Relationship Management, University of Southern Denmark
- Entrepreneurship, Commercialization and Innovation Centre (ECIC), University of Adelaide
| | - Nicolai Ladegaard
- Department of Clinical Medicine - Department of Affective Disorders, Aarhus University Hospital
| | - Kim Mathiasen
- Department of Clinical Medicine - Department of Affective Disorders, Aarhus University Hospital
| | | | - Janet Rafner
- Center for Hybrid Intelligence, Department of Management, Aarhus University
| | | | - Mikkel Wallentin
- School of Communication and Culture, Aarhus University
- Interacting Minds Centre, Aarhus University
| | - Blanka Zana
- Center for Hybrid Intelligence, Department of Management, Aarhus University
| | - Jacob F Sherson
- Center for Hybrid Intelligence, Department of Management, Aarhus University
- School of Communication and Culture, Aarhus University
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Bingham KS, Calarco N, Dickie EW, Alexopoulos GS, Butters MA, Meyers BS, Marino P, Neufeld NH, Rothschild AJ, Whyte EM, Mulsant BH, Flint AJ, Voineskos AN. The relationship of white matter microstructure with psychomotor disturbance and relapse in remitted psychotic depression. J Affect Disord 2023; 334:317-324. [PMID: 37149056 DOI: 10.1016/j.jad.2023.04.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/06/2023] [Accepted: 04/29/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Psychomotor disturbance is common in psychotic depression and is associated with relapse. In this analysis, we examined whether white matter microstructure is associated with relapse probability in psychotic depression and, if so, whether white matter microstructure accounts for the association between psychomotor disturbance and relapse. METHODS We used tractography to characterize diffusion-weighted MRI data in 80 participants enrolled in a randomized clinical trial that compared efficacy and tolerability of sertraline plus olanzapine with sertraline plus placebo in the continuation treatment of remitted psychotic depression. Cox proportional hazard models tested the relationships between psychomotor disturbance (processing speed and CORE score) at baseline, white matter microstructure (fractional anisotropy [FA] and mean diffusivity [MD]) in 15 selected tracts at baseline, and relapse probability. RESULTS CORE was significantly associated with relapse. Higher mean MD was significantly associated with relapse in the each of the following tracts: corpus callosum, left striato-frontal, left thalamo-frontal, and right thalamo-frontal. CORE and MD were each associated with relapse in the final models. LIMITATIONS As a secondary analysis with a small sample size, this study was not powered for its aims, and is vulnerable to types I and II statistical errors. Further, the sample size was not sufficient to test the interaction of the independent variables and randomized treatment group with relapse probability. CONCLUSIONS While both psychomotor disturbance and MD were associated with psychotic depression relapse, MD did not account for the relationship between psychomotor disturbance and relapse. The mechanism by which of psychomotor disturbance increases the risk of relapse requires further investigation. CLINICAL TRIAL REGISTRATION Study of the Pharmacotherapy of Psychotic Depression II (STOP-PD II); NCT01427608. URL: https://clinicaltrials.gov/ct2/show/NCT01427608.
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Affiliation(s)
- Kathleen S Bingham
- Centre for Mental Health, University Health Network, Toronto, Canada; Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada.
| | - Navona Calarco
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Erin W Dickie
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| | - George S Alexopoulos
- Department of Psychiatry, Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital, Westchester Division, New York, USA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine and UPMC Western Psychiatric Hospital, Pittsburgh, USA
| | - Barnett S Meyers
- Department of Psychiatry, Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital, Westchester Division, New York, USA
| | - Patricia Marino
- Department of Psychiatry, Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital, Westchester Division, New York, USA
| | - Nicholas H Neufeld
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Anthony J Rothschild
- University of Massachusetts Chan Medical School and UMass Memorial Health Care, Worcester, USA
| | - Ellen M Whyte
- Department of Psychiatry, University of Pittsburgh School of Medicine and UPMC Western Psychiatric Hospital, Pittsburgh, USA
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Alastair J Flint
- Centre for Mental Health, University Health Network, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Canada
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Bernardsdóttir B, Sandahl H, Carlsson J, Mortensen EL, Palic S. Psychotherapy readiness domains as predictors of psychotherapy outcome in trauma-affected refugees. J Affect Disord 2023; 325:248-255. [PMID: 36586606 DOI: 10.1016/j.jad.2022.12.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Little is known about predictors of psychotherapy outcome in trauma-affected refugees. Knowledge on outcome predictors can help clinicians identify patients prior to treatment who are not likely to benefit from standardized psychotherapy and take additional measures to adjust treatment to the individual patient. Given the dynamic nature of psychotherapy readiness domains, they represent potential targets to be worked with in therapy in order to improve outcomes. METHODS Psychotherapy readiness domains (locus of control, cognitive functioning, motivation for therapy, and personality functioning) were examined as potential predictors of psychotherapy outcome in trauma-affected refugees. Secondary analyses were conducted on data from a pragmatic randomized controlled trial. Study participants (N = 190) were refugees with PTSD who received flexible manual-based Cognitive Behavioral Therapy (CBT) at a psychiatric outpatient clinic in Denmark. Psychotherapy readiness domains were assessed via semi-structured interviews at the beginning of psychotherapy. Outcome variables were pre-post change in PTSD symptomology and global level of functioning. RESULTS Multiple regression analyses revealed that higher motivation for psychotherapy predicted improvement in PTSD symptomology and global level of functioning. Moreover, higher cognitive functioning predicted improvement in global level of functioning. LIMITATIONS The predictor rating scales need further psychometric evaluations in cross-cultural contexts. CONCLUSIONS These findings highlight the importance of considering motivation in psychotherapy offered to trauma-affected refugees. Further research is needed to identify potential barriers to motivation in this diverse patient population and to determine whether motivational interventions can lead to improved treatment outcomes.
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Affiliation(s)
- Berglind Bernardsdóttir
- Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark.
| | - Hinuga Sandahl
- Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
| | - Jessica Carlsson
- Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Sabina Palic
- Competence Center for Transcultural Psychiatry, Mental Health Center Ballerup, Mental Health Services in the Capital Region of Denmark, Ballerup, Denmark
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Cognitive rehabilitation for improving cognitive functions and reducing the severity of depressive symptoms in adult patients with Major Depressive Disorder: a systematic review and meta-analysis of randomized controlled clinical trials. BMC Psychiatry 2023; 23:77. [PMID: 36707847 PMCID: PMC9883940 DOI: 10.1186/s12888-023-04554-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Nearly 40% of patients with Major Depressive Disorder (MDD) have been found to experience cognitive impairment in at least one domain. Cognitive impairment associated with MDD is disproportionately represented in patients that have not fully returned to psychosocial functioning. As awareness regarding cognitive dysfunction in MDD patients grows, so does the interest in developing newer treatments that specifically address these deficits. METHOD In the present study, we conduct a systematic review of controlled randomized clinical trials that used cognitive training and remediation interventions for improving cognitive functions and reducing symptom severity in adult patients with MDD. We selected studies published before March 2022 using search databases including PubMed, ScienceDirect, Scopus, and Google scholar. For conducting the meta-analysis, standard differences in means with the random effect model and with a 95% confidence interval of change in outcome measures from baseline to post-intervention between the cognitive rehabilitation and the control groups were calculated. RESULTS The database search resulted in identifying 756 studies of interest, which ultimately 15 studies with 410 participants in the cognitive rehabilitation group and 339 participants in the control group were included. The meta-analysis of the data extracted from these studies, shows a moderate and significant effect on the executive function (d = 0.59 (95% CI, 0.25 to 0.93) p-value = 0.001, I2 = 15.2%), verbal learning (d = 0.45 (95% CI, 0.12 to 0.78) p-value = 0.007, I2 = 0.00%), and working memory (d = 0.41 (95% CI, 0.18 to 0.64) p-value < 0.001, I2 = 33%) of MDD patients. Although, there were no significant difference between intervention and control group in attention (d = 0.32 (95% CI, -0.01 to 0.66) p-value = 0.058, I2 = 0.00%) or depressive symptoms. CONCLUSION This systematic review and meta-analysis indicate that cognitive rehabilitation is an effective intervention for the executive function, verbal learning, and working memory of MDD patients. Due to the importance of these neuropsychological deficits in day-to-day life and the core symptoms of MDD, cognitive rehabilitation should be considered an important part of treating MDD. Further research in this area and concentrated on these particular deficits is warranted.
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Relationship between baseline cognition and 18-month treatment response in bipolar disorder. J Affect Disord 2022; 318:224-230. [PMID: 36055530 DOI: 10.1016/j.jad.2022.08.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/10/2022] [Accepted: 08/26/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND To date, few studies have examined baseline cognitive function as a predictor of clinical outcome following treatment in bipolar disorder (BD). The aim of this analysis was therefore to examine the relationship between baseline cognitive function and treatment outcome in a sample of young adults with BD receiving Interpersonal Social Rhythm Therapy (IPSRT) or Specialist Supportive Care (SSC) with adjunctive pharmacotherapy. METHODS Eighty-six BD patients underwent baseline cognitive testing and completed 18 months of IPSRT or SCC. Univariate analyses examined the relationship between baseline cognitive function (global and individual cognitive domains) and change in mood symptom burden, and psychosocial functioning, from baseline to treatment-end. RESULTS Baseline global cognition was not predictive of change in mood symptom burden over 18 months of treatment. However, poorer baseline psychomotor speed performance was associated with less improvement in mood symptom burden at treatment-end. Neither baseline global cognition nor individual cognitive domain scores were associated with change in psychosocial functioning. LIMITATIONS Due to the exploratory nature of the study, correction was not made for multiple comparisons. Data was obtained from a relatively small sample and has been the subject of prior analysis, thereby increasing the likelihood of chance findings. CONCLUSION Although global cognition was not associated with outcome, when examining individual domains, poorer baseline psychomotor speed predicted less change in mood symptom burden following 18-months of psychotherapy and pharmacotherapy. This suggests that pre-treatment measures of psychomotor speed may help to identify those who require additional, and more targeted, intervention. Further large-scale research is required.
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Tanguay-Sela M, Rollins C, Perez T, Qiang V, Golden G, Tunteng JF, Perlman K, Simard J, Benrimoh D, Margolese HC. A systematic meta-review of patient-level predictors of psychological therapy outcome in major depressive disorder. J Affect Disord 2022; 317:307-318. [PMID: 36029877 DOI: 10.1016/j.jad.2022.08.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Psychological therapies are effective for treating major depressive disorder, but current clinical guidelines do not provide guidance on the personalization of treatment choice. Established predictors of psychotherapy treatment response could help inform machine learning models aimed at predicting individual patient responses to different therapy options. Here we sought to comprehensively identify known predictors. METHODS EMBASE, Medline, PubMed, PsycINFO were searched for systematic reviews with or without meta-analysis published until June 2020 to identify individual patient-level predictors of response to psychological treatments. 3113 abstracts were identified and 300 articles assessed. We qualitatively synthesized our findings by predictor category (sociodemographic; symptom profile; social support; personality features; affective, cognitive, and behavioural; comorbidities; neuroimaging; genetics) and treatment type. We used the AMSTAR 2 to evaluate the quality of included reviews. RESULTS Following screening and full-text assessment, 27 systematic reviews including 12 meta-analyses were eligible for inclusion. 74 predictors emerged for various psychological treatments, primarily cognitive behavioural therapy, interpersonal therapy, and mindfulness-based cognitive therapy. LIMITATIONS A paucity of studies examining predictors of psychological treatment outcome, as well as methodological heterogeneities and publication biases limit the strength of the identified predictors. CONCLUSIONS The synthesized predictors could be used to supplement clinical decision-making in selecting psychological therapies based on individual patient characteristics. These predictors could also be used as a priori input features for machine learning models aimed at predicting a given patient's likelihood of response to different treatment options for depression, and may contribute toward the development of patient-specific treatment recommendations in clinical guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | - Jade Simard
- Université du Québec à Montréal, Montreal, Quebec, Canada
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Dam VH, Stenbæk DS, Köhler-Forsberg K, Cheng Ip, Ozenne B, Sahakian BJ, Knudsen GM, Jørgensen MB, Frokjaer VG. Evaluating cognitive disturbances as treatment target and predictor of antidepressant action in major depressive disorder: A NeuroPharm study. Transl Psychiatry 2022; 12:468. [PMID: 36347845 PMCID: PMC9643376 DOI: 10.1038/s41398-022-02240-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022] Open
Abstract
Cognitive disturbances in major depressive disorder (MDD) constitute a critical treatment target and hold promise as an early predictor of antidepressant treatment response; yet their clinical relevance is not fully established. Therefore, we here investigate if (1) cognitive performance improves over the course of antidepressant treatment and (2) cognitive performance at baseline is predictive of antidepressant treatment response. In the NeuroPharm study (clinical trial id: NCT02869035), 92 antidepressant-free patients with a moderate to severe depressive episode were assessed with a comprehensive cognitive test battery including both cold (emotion-independent) and hot (emotion-dependent) tasks. Patients were tested before and after 12 weeks of standard antidepressant treatment with escitalopram in flexible doses of 10-20 mg. Performance improved across most cognitive domains over the course of antidepressant treatment. Notably, these improvements were independent of improvement in mood symptoms, emphasizing that cognitive disturbances are a distinct symptom and therefore treatment target in MDD. Results did not suggest that performance on any single cognitive measure at baseline was associated with later clinical response to antidepressant treatment. However, a small cluster of patients (N = 28) with globally disturbed cognition at baseline exhibited poorer clinical response after 8 but not 12 weeks of antidepressant treatment, suggesting that severe cognitive disturbances may delay treatment response. Thus, while pretreatment cognitive performance on individual tests may not be useful as clinical markers of treatment response, profiles capturing performance across different cognitive domains may be useful for stratification of patients with MDD and could be helpful in future intervention trials.
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Affiliation(s)
- Vibeke Høyrup Dam
- Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. .,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Dea Siggaard Stenbæk
- grid.475435.4Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Kristin Köhler-Forsberg
- grid.475435.4Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XFaculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cheng Ip
- grid.475435.4Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XFaculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ,Department of Clinical Pharmacology, Lundbeck Pharma A/S, Valby, Denmark
| | - Brice Ozenne
- grid.475435.4Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Barbara Jacquelyn Sahakian
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, UK ,grid.5335.00000000121885934Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Gitte Moos Knudsen
- grid.475435.4Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XFaculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Balslev Jørgensen
- grid.475435.4Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XFaculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ,grid.466916.a0000 0004 0631 4836Psychiatric Center Copenhagen, Copenhagen, Denmark
| | - Vibe Gedsoe Frokjaer
- grid.475435.4Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XFaculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Psychology, University of Copenhagen, Copenhagen, Denmark ,grid.466916.a0000 0004 0631 4836Psychiatric Center Copenhagen, Copenhagen, Denmark
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Barlati S, Lisoni J, Nibbio G, Baldacci G, Cicale A, Ferrarin LC, Italia M, Zucchetti A, Deste G, Vita A. Current Evidence and Theories in Understanding the Relationship between Cognition and Depression in Childhood and Adolescence: A Narrative Review. Diagnostics (Basel) 2022; 12:diagnostics12102525. [PMID: 36292214 PMCID: PMC9600470 DOI: 10.3390/diagnostics12102525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 11/26/2022] Open
Abstract
The present narrative review has covered the current evidence regarding the role of cognitive impairments during the early phase of major depressive disorder (MDD), attempting to describe the cognitive features in childhood, adolescence and in at-risk individuals. These issues were analyzed considering the trait, scar and state hypotheses of MDD by examining the cold and hot dimensions, the latter explained in relation to the current psychological theoretical models of MDD. This search was performed on several electronic databases up to August 2022. Although the present review is the first to have analyzed both cold and hot cognitive impairments considering the trait, scar and state hypotheses, we found that current evidence did not allow to exclusively confirm the validity of one specific hypothesis since several equivocal and discordant results have been proposed in childhood and adolescence samples. Further studies are needed to better characterize possible cognitive dysfunctions assessing more systematically the impairments of cold, hot and social cognition domains and their possible interaction in a developmental perspective. An increased knowledge on these topics will improve the definition of clinical endophenotypes of enhanced risk to progression to MDD and, to hypothesize preventive and therapeutic strategies to reduce negative influences on psychosocial functioning and well-being.
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Affiliation(s)
- Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
| | - Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
- Correspondence:
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
| | - Giulia Baldacci
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
| | - Andrea Cicale
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
| | - Laura Chiara Ferrarin
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
| | - Mauro Italia
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
| | - Andrea Zucchetti
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, 25123 Brescia, Italy
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Ang YS, Bruder GE, Keilp JG, Rutherford A, Alschuler DM, Pechtel P, Webb CA, Carmody T, Fava M, Cusin C, McGrath PJ, Weissman M, Parsey R, Oquendo MA, McInnis MG, Cooper CM, Deldin P, Trivedi MH, Pizzagalli DA. Exploration of baseline and early changes in neurocognitive characteristics as predictors of treatment response to bupropion, sertraline, and placebo in the EMBARC clinical trial. Psychol Med 2022; 52:2441-2449. [PMID: 33213541 PMCID: PMC7613805 DOI: 10.1017/s0033291720004286] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Treatment for major depressive disorder (MDD) is imprecise and often involves trial-and-error to determine the most effective approach. To facilitate optimal treatment selection and inform timely adjustment, the current study investigated whether neurocognitive variables could predict an antidepressant response in a treatment-specific manner. METHODS In the two-stage Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care (EMBARC) trial, outpatients with non-psychotic recurrent MDD were first randomized to an 8-week course of sertraline selective serotonin reuptake inhibitor or placebo. Behavioral measures of reward responsiveness, cognitive control, verbal fluency, psychomotor, and cognitive processing speeds were collected at baseline and week 1. Treatment responders then continued on another 8-week course of the same medication, whereas non-responders to sertraline or placebo were crossed-over under double-blinded conditions to bupropion noradrenaline/dopamine reuptake inhibitor or sertraline, respectively. Hamilton Rating for Depression scores were also assessed at baseline, weeks 8, and 16. RESULTS Greater improvements in psychomotor and cognitive processing speeds within the first week, as well as better pretreatment performance in these domains, were specifically associated with higher likelihood of response to placebo. Moreover, better reward responsiveness, poorer cognitive control and greater verbal fluency were associated with greater likelihood of response to bupropion in patients who previously failed to respond to sertraline. CONCLUSION These exploratory results warrant further scrutiny, but demonstrate that quick and non-invasive behavioral tests may have substantial clinical value in predicting antidepressant treatment response.
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Affiliation(s)
- Yuen-Siang Ang
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Gerard E. Bruder
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - John G. Keilp
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Ashleigh Rutherford
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Daniel M. Alschuler
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Pia Pechtel
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Christian A. Webb
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Thomas Carmody
- Department of Psychiatry, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Maurizio Fava
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cristina Cusin
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Patrick J. McGrath
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Myrna Weissman
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Ramin Parsey
- Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA
| | - Maria A. Oquendo
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Melvin G. McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Crystal M. Cooper
- Department of Psychiatry, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Patricia Deldin
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Madhukar H. Trivedi
- Department of Psychiatry, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Diego A. Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts, USA
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Rostami R, Kazemi R, Nasiri Z, Ataei S, Hadipour AL, Jaafari N. Cold Cognition as Predictor of Treatment Response to rTMS; A Retrospective Study on Patients With Unipolar and Bipolar Depression. Front Hum Neurosci 2022; 16:888472. [PMID: 35959241 PMCID: PMC9358278 DOI: 10.3389/fnhum.2022.888472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/06/2022] [Indexed: 01/10/2023] Open
Abstract
BackgroundCognitive impairments are prevalent in patients with unipolar and bipolar depressive disorder (UDD and BDD, respectively). Considering the fact assessing cognitive functions is increasingly feasible for clinicians and researchers, targeting these problems in treatment and using them at baseline as predictors of response to treatment can be very informative.MethodIn a naturalistic, retrospective study, data from 120 patients (Mean age: 33.58) with UDD (n = 56) and BDD (n = 64) were analyzed. Patients received 20 sessions of bilateral rTMS (10 Hz over LDLPFC and 1 HZ over RDLPFC) and were assessed regarding their depressive symptoms, sustained attention, working memory, and executive functions, using the Beck Depression Inventory (BDI-II) and Neuropsychological Test Automated Battery Cambridge, at baseline and after the end of rTMS treatment course. Generalized estimating equations (GEE) and logistic regression were used as the main statistical methods to test the hypotheses.ResultsFifty-three percentage of all patients (n = 64) responded to treatment. In particular, 53.1% of UDD patients (n = 34) and 46.9% of BDD patients (n = 30) responded to treatment. Bilateral rTMS improved all cognitive functions (attention, working memory, and executive function) except for visual memory and resulted in more modulations in the working memory of UDD compared to BDD patients. More improvements in working memory were observed in responded patients and visual memory, age, and sex were determined as treatment response predictors. Working memory, visual memory, and age were identified as treatment response predictors in BDD and UDD patients, respectively.ConclusionBilateral rTMS improved cold cognition and depressive symptoms in UDD and BDD patients, possibly by altering cognitive control mechanisms (top-down), and processing negative emotional bias.
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Affiliation(s)
- Reza Rostami
- Department of Psychology, University of Tehran, Tehran, Iran
- *Correspondence: Reza Rostami
| | - Reza Kazemi
- Department of Cognitive Psychology, Institute for Cognitive Science Studies>, Tehran, Iran
| | - Zahra Nasiri
- Convergent Technologies Research Center, University of Tehran, Tehran, Iran
| | - Somayeh Ataei
- Department of Neuropsychology, Faculty of Psychology, Institute of Cognitive Neuroscience, Ruhr-University Bochum, Bochum, Germany
| | - Abed L. Hadipour
- Department of Cognitive Sciences, University of Messina, Messina, Italy
| | - Nematollah Jaafari
- Unité de Recherche Clinique Intersectorielle en Psychiatrie Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France
- University Poitiers & CHU Poitiers, INSERM U1084, Laboratoire Expérimental et Clinique en Neurosciences, Poitiers, France
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Mohammadnia S, Bigdeli I, Mashhadi A, Ghanaei Chamanabad A, Roth RM. Behavior Rating Inventory of Executive Function - adult version (BRIEF-A) in Iranian University students: Factor structure and relationship to depressive symptom severity. APPLIED NEUROPSYCHOLOGY. ADULT 2022; 29:786-792. [PMID: 32866045 DOI: 10.1080/23279095.2020.1810689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Major depressive disorder is the most common psychiatric illness in Iran, and depression is common among university students in the country. The presence of depression is frequently associated with problems in executive functioning. The Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) is a questionnaire measure designed to assess executive functioning in everyday life in clinical and non-clinical populations. Currently, there is limited empirical validation of the measure for use in Iran. This study evaluated the psychometric properties of a Persian-language BRIEF-A in a sample of Iranian university students (n = 300). The factor structure of the BRIEF-A was examined via a confirmatory factor analysis. We also evaluated whether BRIEF-A scores differed among university students varying in severity of depressive symptoms (Minimal, Mild, Moderate, Severe) as measured by the Beck Depression Inventory - II. Results indicated that a two-factor model structure best fit the data for the BRIEF-A. Acceptable internal consistency was also observed. Furthermore, poorer subjective executive functioning was endorsed by the three depressive subgroups relative to the Minimal symptoms group. Together, these findings support a two-factor model for the Persian translation of the BRIEF-A, and indicate that more severe depressive symptoms in Iranian university students is associated with worse subjective executive functioning.
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Affiliation(s)
- Saeed Mohammadnia
- Department of Psychology, Faculty of Education Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Imanollah Bigdeli
- Department of Psychology, Faculty of Education Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Ali Mashhadi
- Department of Psychology, Faculty of Education Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Ali Ghanaei Chamanabad
- Department of Psychology, Faculty of Education Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Robert M Roth
- Department of Psychiatry, Neuropsychology Program, Geisel School of Medicine at Dartmouth/DHMC, Lebanon, NH, USA
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Ronold EH, Joormann J, Hammar Å. Computerized Working Memory Training in Remission From Major Depressive Disorder: Effects on Emotional Working Memory, Processing Speed, Executive Functions, and Associations With Symptoms. Front Behav Neurosci 2022; 16:887596. [PMID: 35832292 PMCID: PMC9272008 DOI: 10.3389/fnbeh.2022.887596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Remission from major depressive disorder (MDD) is associated with residual symptoms related to reduced functioning, quality of life, and relapse risk. Previous studies have raised questions about mechanisms involved-in and affected by cognitive training. This study investigated the associations and changes among depressive symptoms, rumination, processing speed (PS), executive functioning (EF), and emotional working memory (e-WM) pre- post computerized working memory training (CWMT). Method Twenty-nine remitted participants were included in a pre- post pilot study of within-subject effects of online CWMT. A total of 20 participants completed the intervention and pre- post tests of EF and PS, e-WM, in addition to symptom and rumination measures. Associations between changes in symptoms and cognition were investigated pre- post. Associations between improvements in CWMT, depression history, and changes in cognition were explored. Hypotheses and statistics were preregistered before data were analyzed. Results Manipulation of negatively valanced stimuli in e-WM showed an inverse association with rumination pre-intervention, but the association disappeared post-intervention. Cognitive functioning improved in most conditions with largest effects in EF. Symptoms did not change in the remitted sample. CWMT improvements were related to improvements in some aspects of EF and PS, but also to worse self-reported attention. Depression history was related to less improvement in EF. Limitations Sample size was small and there was dropout from the study. There was no control group, thus precluding practice and placebo effects and causal relationships. Conclusions Computerized WM training improves cognitive functions and could influence associations between e-WM and rumination. This could counteract functional impairment following MDD.
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Affiliation(s)
- Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, United States
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
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Bockting C, Legemaat AM, van der Stappen JGJ, Geurtsen GJ, Semkovska M, Burger H, Bergfeld IO, Lous N, Denys DAJP, Brouwer M. Augmenting neurocognitive remediation therapy to Preventive Cognitive Therapy for partially remitted depressed patients: protocol of a pragmatic multicentre randomised controlled trial. BMJ Open 2022; 12:e063407. [PMID: 35738653 PMCID: PMC9226921 DOI: 10.1136/bmjopen-2022-063407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Major depressive disorder (MDD) affects 163 million people globally every year. Individuals who experience subsyndromal depressive symptoms during remission (ie, partial remission of MDD) are especially at risk for a return to a depressive episode within an average of 4 months. Simultaneously, partial remission of MDD is associated with work and (psycho)social impairment and a lower quality of life. Brief psychological interventions such as preventive cognitive therapy (PCT) can reduce depressive symptoms or relapse for patients in partial remission, although achieving full remission with treatment is still a clinical challenge. Treatment might be more effective if cognitive functioning of patients is targeted as well since cognitive problems are the most persisting symptom in partial remission and predict poor treatment response and worse functioning. Studies show that cognitive functioning of patients with (remitted) MDD can be improved by online neurocognitive remediation therapy (oNCRT). Augmenting oNCRT to PCT might improve treatment effects for these patients by strengthening their cognitive functioning alongside a psychological intervention. METHODS AND ANALYSIS This study will examine the effectiveness of augmenting oNCRT to PCT in a pragmatic national multicentre superiority randomised controlled trial. We will include 115 adults partially remitted from MDD with subsyndromal depressive symptoms defined as a Hamilton Depression Rating Scale score between 8 and 15. Participants will be randomly allocated to PCT with oNCRT, or PCT only. Primary outcome measure is the effect on depressive symptomatology over 1 year. Secondary outcomes include time to relapse, cognitive functioning, quality of life and healthcare costs. This first dual approach study of augmenting oNCRT to PCT might facilitate full remission in partially remitted individuals as well as prevent relapse over time. ETHICS AND DISSEMINATION Ethical approval was obtained by Academic Medical Center, Amsterdam. Outcomes will be made publicly available. TRIAL REGISTRATION NUMBER NL9582.
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Affiliation(s)
- Claudi Bockting
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Amanda M Legemaat
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Gert J Geurtsen
- Department of Medical Psychology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Semkovska
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Huibert Burger
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Isidoor O Bergfeld
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Damiaan A J P Denys
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Marlies Brouwer
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
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Gregory EC, Torres IJ, Blumberger DM, Downar J, Daskalakis ZJ, Vila-Rodriguez F. Repetitive Transcranial Magnetic Stimulation Shows Longitudinal Improvements in Memory in Patients With Treatment-Resistant Depression. Neuromodulation 2022; 25:596-605. [DOI: 10.1016/j.neurom.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/27/2021] [Accepted: 09/13/2021] [Indexed: 10/19/2022]
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Copersino ML, Long MP, Bolton P, Ressler KJ, Seiner SJ, Yip AG. First Acute-Course Electroconvulsive Therapy for Moderate-to-Severe Depression Benefits Patients With or Without Accompanying Baseline Cognitive Impairment. J ECT 2022; 38:74-80. [PMID: 34966040 DOI: 10.1097/yct.0000000000000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Researchers are increasingly investigating therapeutic response associated with new patient subgroups as a way to improve electroconvulsive therapy (ECT) treatment outcomes and reduce adverse events. This study is the first to examine baseline cognitive impairment status as a predictor of clinical outcome in first acute-course ECT patients. METHODS Baseline cognitive function at various thresholds and serial depressive symptom severity data from first-time ECT patients were examined using generalized linear mixed-effects models. RESULTS Of 1345 patients who met the inclusion criteria, 617 had available data at their third assessment visit (~15th treatment visit). There was a robust improvement in depression symptoms over time (P < 0.0001), and cognitive function was not associated with baseline levels of depressive symptoms or serially measured change in self-reported symptom severity during acute-phase ECT. CONCLUSIONS These results indicate that an acute course of ECT for the treatment of moderate-to-severe depression benefits patients with or without accompanying baseline cognitive impairment. These findings may be useful in informing shared decision-making discussions about ECT risks and expected benefits.
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Miskowiak KW, Seeberg I, Jensen MB, Balanzá‐Martínez V, del Mar Bonnin C, Bowie CR, Carvalho AF, Dols A, Douglas K, Gallagher P, Hasler G, Lafer B, Lewandowski KE, López‐Jaramillo C, Martinez‐Aran A, McIntyre RS, Porter RJ, Purdon SE, Schaffer A, Stokes P, Sumiyoshi T, Torres IJ, Van Rheenen TE, Yatham LN, Young AH, Kessing LV, Burdick KE, Vieta E. Randomised controlled cognition trials in remitted patients with mood disorders published between 2015 and 2021: A systematic review by the International Society for Bipolar Disorders Targeting Cognition Task Force. Bipolar Disord 2022; 24:354-374. [PMID: 35174594 PMCID: PMC9541874 DOI: 10.1111/bdi.13193] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cognitive impairments are an emerging treatment target in mood disorders, but currently there are no evidence-based pro-cognitive treatments indicated for patients in remission. With this systematic review of randomised controlled trials (RCTs), the International Society for Bipolar Disorders (ISBD) Targeting Cognition Task force provides an update of the most promising treatments and methodological recommendations. METHODS The review included RCTs of candidate pro-cognitive interventions in fully or partially remitted patients with major depressive disorder or bipolar disorder. We followed the procedures of the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) 2020 statement. Searches were conducted on PubMed/MEDLINE, PsycInfo, EMBASE and Cochrane Library from January 2015, when two prior systematic reviews were conducted, until February 2021. Two independent authors reviewed the studies with the Revised Cochrane Collaboration's Risk of Bias tool for Randomised trials. RESULTS We identified 16 RCTs (N = 859) investigating cognitive remediation (CR; k = 6; N = 311), direct current or repetitive magnetic stimulation (k = 3; N = 127), or pharmacological interventions (k = 7; N = 421). CR showed most consistent cognitive benefits, with two trials showing improvements on primary outcomes. Neuromodulatory interventions revealed no clear efficacy. Among pharmacological interventions, modafinil and lurasidone showed early positive results. Sources of bias included small samples, lack of pre-screening for objective cognitive impairment, no primary outcome and no information on allocation sequence masking. CONCLUSIONS Evidence for pro-cognitive treatments in mood disorders is emerging. Recommendations are to increase sample sizes, pre-screen for impairment in targeted domain(s), select one primary outcome, aid transfer to real-world functioning, investigate multimodal interventions and include neuroimaging.
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Affiliation(s)
- Kamilla W. Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC)Psychiatric Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark,Department of PsychologyUniversity of CopenhagenCopenhagenDenmark
| | - Ida Seeberg
- Copenhagen Affective Disorder Research Centre (CADIC)Psychiatric Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark,Department of PsychologyUniversity of CopenhagenCopenhagenDenmark
| | - Mette B. Jensen
- Copenhagen Affective Disorder Research Centre (CADIC)Psychiatric Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark
| | - Vicent Balanzá‐Martínez
- Teaching Unit of Psychiatry and Psychological MedicineDepartment of MedicineUniversity of ValenciaCIBERSAMValenciaSpain
| | - Caterina del Mar Bonnin
- Clinical Institute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaSpain
| | | | - Andre F. Carvalho
- IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment)Deakin UniversityGeelongVic.Australia
| | - Annemieke Dols
- Department of Old Age PsychiatryGGZ in GeestAmsterdam UMC, Location VUmcAmsterdam NeuroscienceAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Katie Douglas
- Department of Psychological MedicineUniversity of OtagoChristchurchNew Zealand
| | - Peter Gallagher
- Translational and Clinical Research InstituteFaculty of Medical SciencesNewcastle UniversityNewcastle‐upon‐TyneUK
| | - Gregor Hasler
- Psychiatry Research UnitUniversity of FribourgFribourgSwitzerland
| | - Beny Lafer
- Bipolar Disorder Research ProgramInstitute of PsychiatryHospital das ClinicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil
| | - Kathryn E. Lewandowski
- McLean HospitalSchizophrenia and Bipolar Disorder ProgramBelmontMassachusettsUSA,Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Carlos López‐Jaramillo
- Research Group in PsychiatryDepartment of PsychiatryUniversidad de AntioquiaMedellínColombia
| | - Anabel Martinez‐Aran
- Clinical Institute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaSpain
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, Brain and Cognition Discovery FoundationUniversity of TorontoTorontoCanada
| | - Richard J. Porter
- Department of Psychological MedicineUniversity of OtagoChristchurchNew Zealand
| | - Scot E. Purdon
- Department of PsychiatryUniversity of AlbertaEdmontonCanada
| | | | - Paul Stokes
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric DisordersNational Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
| | - Ivan J. Torres
- Department of PsychiatryUniversity of British ColumbiaVancouverCanada
| | - Tamsyn E. Van Rheenen
- Melbourne Neuropsychiatry CentreDepartment of PsychiatryUniversity of MelbourneCarltonAustralia,Centre for Mental HealthFaculty of Health, Arts and DesignSwinburne UniversityAustralia
| | - Lakshmi N. Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverCanada
| | - Allan H. Young
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Lars V. Kessing
- Copenhagen Affective Disorder Research Centre (CADIC)Psychiatric Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Katherine E. Burdick
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA,Department of PsychiatryBrigham and Women’s HospitalBostonMassachusettsUSA
| | - Eduard Vieta
- Clinical Institute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaSpain
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Goegan SA, Hasey GM, King JP, Losier BJ, Bieling PJ, McKinnon MC, McNeely HE. Naturalistic Study on the Effects of Electroconvulsive Therapy (ECT) on Depressive Symptoms. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:351-360. [PMID: 34903092 PMCID: PMC9065492 DOI: 10.1177/07067437211064020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The effectiveness of ECT under naturalistic conditions has not been well-studied. The current study aimed to 1) characterize a naturalistic sample of ECT patients; and 2) examine the long-term outcomes of ECT on depressive symptoms (Beck Depression Inventory-II; BDI-II) and functional disability symptoms (WHO Disability Assessment Schedule 2.0) in this sample. METHODS Participants were adults who received ECT for a major depressive episode at an ambulatory ECT clinic between September 2010 and November 2020. Clinical and cognitive assessments were completed at baseline (n = 100), mid-ECT (n = 94), 2-4 weeks post-ECT (n = 64), 6-months post-ECT (n = 34), and 12-months post-ECT (n = 19). RESULTS At baseline, participants had severe levels of depressive symptoms (BDI-II: M = 41.0, SD = 9.4), and 62.9% screened positive for multiple psychiatric diagnoses on the MINI International Neuropsychiatric Interview. Depressive symptoms (F(4,49.1) = 49.92, P < 0.001) and disability symptoms (F(3,40.72) = 12.30, P < 0.001) improved significantly following ECT, and this was maintained at 12-months follow-up. Improvement in depressive symptoms trended towards significantly predicting reduction in disability symptoms from baseline to post-ECT, (F(1,56) = 3.67, P = 0.061). Although our clinical remission rate of 27% (BDI-II score ≤ 13 and ≥ 50% improvement) and overall response rate of 41.3% (≥ 50% improvement in BDI-II score) were lower than the rates reported in the extant RCT and community ECT literature, 36% of those treated with ECT were lost to follow-up and did not complete post-ECT rating scales. At baseline, remitters had significantly fewer psychiatric comorbidities, lower BDI-II scores, and lower disability symptoms than non-responders (P < 0.05). CONCLUSIONS Participants were severely symptomatic and clinically complex. ECT was effective at reducing depressive symptoms and functional disability in this heterogeneous sample. Although a large amount of missing data may have distorted our calculated response/remission rates, it is also likely that clinical heterogeneity and severity contribute to lower-than-expected remission and response rates to ECT.
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Affiliation(s)
- Sarah A. Goegan
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
- Clinical Neuropsychology Service, St. Joseph's Healthcare Hamilton (SJHH), Hamilton, Ontario, Canada
| | - Gary M. Hasey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- ECT Clinic, St, Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton (SJHH), Hamilton, Ontario, Canada
| | - Jelena P. King
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
- Clinical Neuropsychology Service, St. Joseph's Healthcare Hamilton (SJHH), Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Bruno J. Losier
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton (SJHH), Hamilton, Ontario, Canada
| | - Peter J. Bieling
- Clinical Neuropsychology Service, St. Joseph's Healthcare Hamilton (SJHH), Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton (SJHH), Hamilton, Ontario, Canada
| | - Margaret C. McKinnon
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton (SJHH), Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
| | - Heather E. McNeely
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
- Clinical Neuropsychology Service, St. Joseph's Healthcare Hamilton (SJHH), Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Transcranial Magnetic Stimulation Indices of Cortical Excitability Enhance the Prediction of Response to Pharmacotherapy in Late-Life Depression. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:265-275. [PMID: 34311121 PMCID: PMC8783923 DOI: 10.1016/j.bpsc.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/16/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Older adults with late-life depression (LLD) often experience incomplete or lack of response to first-line pharmacotherapy. The treatment of LLD could be improved using objective biological measures to predict response. Transcranial magnetic stimulation (TMS) can be used to measure cortical excitability, inhibition, and plasticity, which have been implicated in LLD pathophysiology and associated with brain stimulation treatment outcomes in younger adults with depression. TMS measures have not yet been investigated as predictors of treatment outcomes in LLD or pharmacotherapy outcomes in adults of any age with depression. METHODS We assessed whether pretreatment single-pulse and paired-pulse TMS measures, combined with clinical and demographic measures, predict venlafaxine treatment response in 76 outpatients with LLD. We compared the predictive performance of machine learning models including or excluding TMS predictors. RESULTS Two single-pulse TMS measures predicted venlafaxine response: cortical excitability (neuronal membrane excitability) and the variability of cortical excitability (dynamic fluctuations in excitability levels). In cross-validation, models using a combination of these TMS predictors, clinical markers of treatment resistance, and age classified patients with 73% ± 11% balanced accuracy (average correct classification rate of responders and nonresponders; permutation testing, p < .005); these models significantly outperformed (corrected t test, p = .025) models using clinical and demographic predictors alone (60% ± 10% balanced accuracy). CONCLUSIONS These preliminary findings suggest that single-pulse TMS measures of cortical excitability may be useful predictors of response to pharmacotherapy in LLD. Future studies are needed to confirm these findings and determine whether combining TMS predictors with other biomarkers further improves the accuracy of predicting LLD treatment outcome.
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Porffy LA, Mehta MA, Patchitt J, Boussebaa C, Brett J, D'Oliveira T, Mouchlianitis E, Shergill SS. A Novel Virtual Reality Assessment of Functional Cognition: Validation Study. J Med Internet Res 2022; 24:e27641. [PMID: 35080501 PMCID: PMC8829700 DOI: 10.2196/27641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/05/2021] [Accepted: 10/05/2021] [Indexed: 01/29/2023] Open
Abstract
Background Cognitive deficits are present in several neuropsychiatric disorders, including Alzheimer disease, schizophrenia, and depression. Assessments used to measure cognition in these disorders are time-consuming, burdensome, and have low ecological validity. To address these limitations, we developed a novel virtual reality shopping task—VStore. Objective This study aims to establish the construct validity of VStore in relation to the established computerized cognitive battery, Cogstate, and explore its sensitivity to age-related cognitive decline. Methods A total of 142 healthy volunteers aged 20-79 years participated in the study. The main VStore outcomes included verbal recall of 12 grocery items, time to collect items, time to select items on a self-checkout machine, time to make the payment, time to order coffee, and total completion time. Construct validity was examined through a series of backward elimination regression models to establish which Cogstate tasks, measuring attention, processing speed, verbal and visual learning, working memory, executive function, and paired associate learning, in addition to age and technological familiarity, best predicted VStore performance. In addition, 2 ridge regression and 2 logistic regression models supplemented with receiver operating characteristic curves were built, with VStore outcomes in the first model and Cogstate outcomes in the second model entered as predictors of age and age cohorts, respectively. Results Overall VStore performance, as indexed by the total time spent completing the task, was best explained by Cogstate tasks measuring attention, working memory, paired associate learning, and age and technological familiarity, accounting for 47% of the variance. In addition, with λ=5.16, the ridge regression model selected 5 parameters for VStore when predicting age (mean squared error 185.80, SE 19.34), and with λ=9.49 for Cogstate, the model selected all 8 tasks (mean squared error 226.80, SE 23.48). Finally, VStore was found to be highly sensitive (87%) and specific (91.7%) to age cohorts, with 94.6% of the area under the receiver operating characteristic curve. Conclusions Our findings suggest that VStore is a promising assessment that engages standard cognitive domains and is sensitive to age-related cognitive decline.
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Affiliation(s)
- Lilla Alexandra Porffy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Mitul A Mehta
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Joel Patchitt
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Trafford Centre for Medical Research, University of Sussex, Brighton, United Kingdom
| | - Celia Boussebaa
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Jack Brett
- Faculty of Media and Communications, Bournemouth University, Bournemouth, United Kingdom
| | - Teresa D'Oliveira
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | | | - Sukhi S Shergill
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Kent and Medway Medical School, Canterbuy, United Kingdom.,Kent and Medway National Heath Service and Social Care Partnership Trust, Gillingham, United Kingdom
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Sumiyoshi T, Hoshino T, Mishiro I, Hammer-Helmich L, Ge H, Moriguchi Y, Fujikawa K, Fernandez JL. Prediction of residual cognitive disturbances by early response of depressive symptoms to antidepressant treatments in patients with major depressive disorder. J Affect Disord 2022; 296:95-102. [PMID: 34597893 DOI: 10.1016/j.jad.2021.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/16/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patients with major depressive disorder (MDD) frequently retain cognitive disturbances after recovery from mood symptoms. We investigated the relationship between early response of mood symptoms and/or remission, and residual cognitive disturbances after 6 months of antidepressant treatment. METHODS 518 patients with MDD were followed up for 6 months after antidepressant treatment initiation (first-line or switch from a previous drug). Subjective and objective cognitive disturbances were assessed by the Perceived Deficits Questionnaire - Depression (PDQ-D) and digit symbol substitution test (DSST), respectively. Depressive symptoms, as well as remission and early response to treatment, were assessed using the Montgomery-Asberg Depression Rating Scale (MADRS). Multivariable linear and logistic regression models were used to adjust for confounders. RESULTS Early response of depressive mood (≥50% reduction in MADRS score at month 1) was related with fewer residual subjective cognitive symptoms, as evaluated by the PDQ-D at month 6 (p<0.001). Likewise, early remission status at month 2 was inversely associated with PDQ-D scores at month 6 (p<0.001). Among patients with baseline DSST scores of ≥1 standard deviation below the norm, early response/remission was associated with better performance on the DSST at month 6 (p<0.05). LIMITATIONS The cohort may not be representative of the general MDD patient population, and the possible influence of concomitant medications was not evaluated. CONCLUSIONS These findings suggest that early improvements in depressive symptoms predict better cognitive outcomes in patients with MDD. Grouping of patients by mood and cognition status in early stages of antidepressant treatments may facilitate efforts to improve long-term functional outcomes.
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Affiliation(s)
- Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Tatsuya Hoshino
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Izumi Mishiro
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | | | - Holly Ge
- Health Economics & Epidemiology Statistics, Lundbeck Singapore Pte Limited, Singapore
| | | | - Keita Fujikawa
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
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Pan W, Liu C, Zhu D, Liu Y, Mao P, Ren Y, Ma X. Prediction of Antidepressant Efficacy by Cognitive Function in First-Episode Late-Life Depression: A Pilot Study. Front Psychiatry 2022; 13:916041. [PMID: 35669268 PMCID: PMC9163406 DOI: 10.3389/fpsyt.2022.916041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/02/2022] [Indexed: 11/17/2022] Open
Abstract
UNLABELLED The response rate of treatment for late-life depression (LLD) is only 25-60%. The cognitive impairment associated with LLD often affects the effectiveness of antidepressants and may has the potential ability to predict response. This study seeks a biomarker for baseline cognitive function to predict efficacy of antidepressants. Sixty patients diagnosed with LLD received escitalopram or sertraline treatment for 8 weeks. Clinical symptom was measured using Hamilton Depression Rating Scale-17 (HAMD-17) and cognitive function was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT) before and after 8-week treatment. Patients were divided into treatment effective group (TE) and treatment ineffective group (TI) according to reduction rate in scores of HAMD-17 after treatment. Thirty-eight matched healthy controls (HC) were assessed using RBANS and TMT. There was significant decrease of score of RBANS and increase of score of TMT in patients with LLD compared with HC. Regression analysis revealed that change in HAMD-17 score was significantly positively associated with baseline score of picture naming, figure copy, digit span, and delayed memory. The preliminary findings suggested that working memory, attention, visuospatial, language function, and delayed memory should be examined further as a means of providing the useful objective biomarkers of treatment response. CLINICAL TRIALS REGISTRATION [www.ClinicalTrials.gov], identifier [ChiCTR2100042370].
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Affiliation(s)
- Weigang Pan
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Chaomeng Liu
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Dandi Zhu
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi Liu
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Peixian Mao
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yanping Ren
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xin Ma
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Vicent-Gil M, Portella MJ, Serra-Blasco M, Navarra-Ventura G, Crivillés S, Aguilar E, Palao D, Cardoner N. Dealing with heterogeneity of cognitive dysfunction in acute depression: a clustering approach. Psychol Med 2021; 51:2886-2894. [PMID: 32476636 PMCID: PMC8640365 DOI: 10.1017/s0033291720001567] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/18/2020] [Accepted: 05/08/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Heterogeneity in cognitive functioning among major depressive disorder (MDD) patients could have been the reason for the small-to-moderate differences reported so far when it is compared to other psychiatric conditions or to healthy controls. Additionally, most of these studies did not take into account clinical and sociodemographic characteristics that could have played a relevant role in cognitive variability. This study aims to identify empirical clusters based on cognitive, clinical and sociodemographic variables in a sample of acute MDD patients. METHODS In a sample of 174 patients with an acute depressive episode, a two-step clustering analysis was applied considering potentially relevant cognitive, clinical and sociodemographic variables as indicators for grouping. RESULTS Treatment resistance was the most important factor for clustering, closely followed by cognitive performance. Three empirical subgroups were obtained: cluster 1 was characterized by a sample of non-resistant patients with preserved cognitive functioning (n = 68, 39%); cluster 2 was formed by treatment-resistant patients with selective cognitive deficits (n = 66, 38%) and cluster 3 consisted of resistant (n = 23, 58%) and non-resistant (n = 17, 42%) acute patients with significant deficits in all neurocognitive domains (n = 40, 23%). CONCLUSIONS The findings provide evidence upon the existence of cognitive heterogeneity across patients in an acute depressive episode. Therefore, assessing cognition becomes an evident necessity for all patients diagnosed with MDD, and although treatment resistant is associated with greater cognitive dysfunction, non-resistant patients can also show significant cognitive deficits. By targeting not only mood but also cognition, patients are more likely to achieve full recovery and prevent new relapses.
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Affiliation(s)
- Muriel Vicent-Gil
- Mental Health Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Parc Taulí 1, 08208 Sabadell, Catalonia, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Sant Antoni Mª Claret 167, 08025 Barcelona, Catalonia, Spain
| | - Maria J. Portella
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Sant Antoni Mª Claret 167, 08025 Barcelona, Catalonia, Spain
| | - Maria Serra-Blasco
- Mental Health Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Parc Taulí 1, 08208 Sabadell, Catalonia, Spain
| | - Guillem Navarra-Ventura
- Mental Health Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Parc Taulí 1, 08208 Sabadell, Catalonia, Spain
| | - Sara Crivillés
- Mental Health Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Parc Taulí 1, 08208 Sabadell, Catalonia, Spain
| | - Eva Aguilar
- Mental Health Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Parc Taulí 1, 08208 Sabadell, Catalonia, Spain
| | - Diego Palao
- Mental Health Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Parc Taulí 1, 08208 Sabadell, Catalonia, Spain
| | - Narcís Cardoner
- Mental Health Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona (UAB), Biomedical Research Networking Center Consortium on Mental Health (CIBERSAM), Parc Taulí 1, 08208 Sabadell, Catalonia, Spain
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Peciña M, Chen J, Lyew T, Karp JF, Dombrovski AY. μ Opioid Antagonist Naltrexone Partially Abolishes the Antidepressant Placebo Effect and Reduces Orbitofrontal Cortex Encoding of Reinforcement. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:1002-1012. [PMID: 33684624 PMCID: PMC8419202 DOI: 10.1016/j.bpsc.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Like placebo analgesia, the antidepressant placebo effect appears to involve cortical and subcortical endogenous opioid signaling, yet the mechanism through which opioid release affects mood remains unclear. The orbitofrontal cortex (OFC)-which integrates various attributes of a stimulus to predict associated outcomes-has been implicated in placebo effects and is rich in μ opioid receptors. We hypothesized that naltrexone blockade of μ opioid receptors would blunt OFC-dependent antidepressant placebo effects. METHODS Twenty psychotropic-free patients with major depressive disorder completed a randomized, double-blind, placebo-controlled crossover study of 1 oral dose of 50 mg of naltrexone or matching placebo immediately before completing 2 sessions of the antidepressant placebo functional magnetic resonance imaging task. This task manipulates placebo-associated expectancies and their reinforcement while assessing expected and actual mood improvement. RESULTS Behaviorally, manipulations of antidepressant placebo expectancies and their reinforcement had positive, interactive effects on participants' expectancy and mood ratings. The high-expectancy condition recruited the dorsolateral and ventrolateral prefrontal cortex, as well as dorsal attention stream regions. Interestingly, increased dorsolateral and ventrolateral prefrontal cortex brain responses appeared to attenuate the antidepressant placebo effect. The administration of 1 oral dose of naltrexone, compared with placebo, partially abolished the interaction of the expectancy and reinforcement manipulation on mood and blocked reinforcement-induced responses in the right central OFC. CONCLUSIONS Our results show preliminary evidence for the role of μ opioid central OFC modulation in antidepressant placebo effects by positively biasing the value of placebo based on reinforcement and enhancing subsequent hedonic experiences.
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Affiliation(s)
- Marta Peciña
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Jiazhou Chen
- National Institutes of Health, Bethesda, Maryland; The Faculty of Brain Sciences, Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Thandi Lyew
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jordan F Karp
- Department of Psychiatry, University of Arizona, Tucson, Arizona
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Lifetime trauma history and cognitive functioning in major depression and their role for cognitive-behavioral therapy outcome. CLINICAL PSYCHOLOGY IN EUROPE 2021; 3:e4105. [DOI: 10.32872/cpe.4105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 06/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background
While cognitive-behavioral therapy (CBT) is the gold-standard psychological treatment for major depression (MD), non-response and lacking stability of treatment gains are persistent issues. Potential factors influencing treatment outcome might be lifetime trauma history and possibly associated primarily prefrontal-cortex- and hippocampus-dependent cognitive alterations.
Method
We investigated MD and healthy control participants with (MD+T+, n = 37; MD-T+, n = 39) and without lifetime trauma history (MD+T-, n = 26; MD-T-, n = 45) regarding working memory, interference susceptibility, conflict adaptation, and autobiographical memory specificity. Further, MD+T+ (n = 21) and MD+T- groups (n = 16) were re-examined after 25 CBT sessions, with MD-T- individuals (n = 34) invited in parallel in order to explore the stability of cognitive alterations and the predictive value of lifetime trauma history, cognitive functioning, and their interaction for treatment outcome.
Results
On a cross-sectional level, MD+T+ showed the highest conflict adaptation, but MD+T- the lowest autobiographical memory specificity, while no group differences emerged for working memory and interference susceptibility. Clinical improvement did not differ between groups and cognitive functioning remained stable over CBT. Further, only a singular predictive association of forward digit span, but no other facets of baseline cognitive functioning, lifetime trauma history, or their interaction with treatment outcome emerged.
Discussion
These results indicate differential roles of lifetime trauma history and psychopathology for cognitive functioning in MD, and add to the emerging literature on considering cognitive, next to clinical remission as a relevant treatment outcome.
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Impala T, Dobson KS, Kazantzis N. Does the working alliance mediate the therapist competence-outcome relationship in cognitive behavior therapy for depression? Psychother Res 2021; 32:16-28. [PMID: 34210234 DOI: 10.1080/10503307.2021.1946195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Objective: This study examined whether the working alliance mediated the effect of therapist competence on subsequent depression symptomology during Cognitive Behavioral Therapy (CBT). We also tested the potential moderation effect of alliance on subsequent depressive symptomology, based on participants' cognitive aptitude.Method: A total of 86 sessions were coded as the prediction interval across 50 patient-therapist dyads (age M = 39.22, SD = 8.78; 76% female). While accounting for prior depression, competence, and alliance levels, predictors were assessed early treatment (session 1; n = 45 sessions), mid-treatment (session 12; n = 41 sessions), and depressive symptomology was assessed at the subsequent session to the predictor assessments to investigate within-session variability of process variables.Results: Mediation analysis revealed that the effect of early treatment therapist competence on symptom change was mediated by alliance (indirect effect: β = -.17, 95% percentile bootstrap CI [-.32, -.01]). The positive association involving early treatment alliance and next session outcome was conditional upon low cognitive aptitude levels.Conclusions: Our result offers preliminary support for alliance as a mediator of the effect of competence, and that alliance-outcome relations vary as a function of client aptitude. These novel findings require replication and extension.
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Affiliation(s)
- Tara Impala
- Monash University, Melbourne, Australia.,Cognitive Behavior Therapy Research Unit, Melbourne, Australia
| | | | - Nikolaos Kazantzis
- Monash University, Melbourne, Australia.,Cognitive Behavior Therapy Research Unit, Melbourne, Australia
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47
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Galkin SA, Ivanova SA, Bokhan NA. [Executive functions and their role in predicting therapeutic response in patients with depressive disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:40-44. [PMID: 34184476 DOI: 10.17116/jnevro202112105140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To identify differences in executive functions in patients with depressive disorders depending on their sensitivity to antidepressants. MATERIAL AND METHODS The study included 70 patients with depressive disorder. All patients received syndrome-induced psychopharmacotherapy, which included antidepressants and normotimics. The severity of depressive disorder was assessed using the Hamilton Depression Rating Scale (HDRS). The criterion for the effectiveness of therapy (sensitivity) was an improvement in clinical symptoms by 50% or more, as measured with HDRS. The study was performed in two stages (points): at the first point, patients were examined upon admission to the Department before taking medications, and the second point was performed after a 4-week treatment of patients in the hospital. The assessment of executive functions was performed using computer tests Go/Nogo, Corsi and Stroop. RESULTS AND CONCLUSION Patients with depressive disorders who were not sensitive to therapy were characterized by low performance in executive functions compared to patients with a positive therapeutic response. Based on the data obtained, a multiple linear regression equation was constructed to predict the therapeutic response based on individual differences in the results of cognitive tests, regardless of potential clinical and demographic factors.
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Affiliation(s)
- S A Galkin
- Mental Health Research Institute of the Tomsk National Research Medical Center of the Russian Academy of Science, Tomsk, Russia
| | - S A Ivanova
- Mental Health Research Institute of the Tomsk National Research Medical Center of the Russian Academy of Science, Tomsk, Russia.,Siberian State Medical University, Tomsk, Russia
| | - N A Bokhan
- Mental Health Research Institute of the Tomsk National Research Medical Center of the Russian Academy of Science, Tomsk, Russia.,Siberian State Medical University, Tomsk, Russia
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Flint AJ, Bingham KS, Neufeld NH, Alexopoulos GS, Mulsant BH, Rothschild AJ, Whyte EM, Voineskos AN, Marino P, Meyers BS. Association between psychomotor disturbance and treatment outcome in psychotic depression: a STOP-PD II report. Psychol Med 2021; 52:1-7. [PMID: 33766150 DOI: 10.1017/s0033291721000805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Little is known about the relationship between psychomotor disturbance (PMD) and treatment outcome of psychotic depression. This study examined the association between PMD and subsequent remission and relapse of treated psychotic depression. METHODS Two hundred and sixty-nine men and women aged 18-85 years with an episode of psychotic depression were treated with open-label sertraline plus olanzapine for up to 12 weeks. Participants who remained in remission or near-remission following an 8-week stabilization phase were eligible to participate in a 36-week randomized controlled trial (RCT) that compared the efficacy and tolerability of sertraline plus olanzapine (n = 64) with sertraline plus placebo (n = 62). PMD was measured with the psychiatrist-rated sign-based CORE at acute phase baseline and at RCT baseline. Spearman's correlations and logistic regression analyses were used to analyze the association between CORE total score at acute phase baseline and remission/near-remission and CORE total score at RCT baseline and relapse. RESULTS Higher CORE total score at acute phase baseline was associated with lower frequency of remission/near-remission. Higher CORE total score at RCT baseline was associated with higher frequency of relapse, in the RCT sample as a whole, as well as in each of the two randomized groups. CONCLUSIONS PMD is associated with poorer outcome of psychotic depression treated with sertraline plus olanzapine. Future research needs to examine the neurobiology of PMD in psychotic depression in relation to treatment outcome.
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Affiliation(s)
- Alastair J Flint
- The Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Mental Health, University Health Network, Toronto, Canada
| | - Kathleen S Bingham
- The Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Mental Health, University Health Network, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Nicholas H Neufeld
- The Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - George S Alexopoulos
- Department of Psychiatry, Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital, Westchester Division, New York, NY, USA
| | - Benoit H Mulsant
- The Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Anthony J Rothschild
- University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, USA
| | - Ellen M Whyte
- Department of Psychiatry, University of Pittsburgh School of Medicine and UPMC Western Psychiatric Hospital, Pittsburgh, PA, USA
| | - Aristotle N Voineskos
- The Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Patricia Marino
- Department of Psychiatry, Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital, Westchester Division, New York, NY, USA
| | - Barnett S Meyers
- Department of Psychiatry, Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital, Westchester Division, New York, NY, USA
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Potter G, Hatch D, Hagy H, Radüntz T, Gajewski P, Falkenstein M, Freude G. Slower information processing speed is associated with persistent burnout symptoms but not depression symptoms in nursing workers. J Clin Exp Neuropsychol 2021; 43:33-45. [PMID: 33402015 DOI: 10.1080/13803395.2020.1863340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Burnout and depression both occur with chronic work-related stress, and cognitive deficits have been found when symptom severity results in work disability. Less is known about cognitive deficits associated with milder symptoms among active workers, and few studies have examined whether cognitive deficits predict persistent burnout and depression symptoms. The goal of this study was to examine the association of information processing speed and executive function performance to burnout and depression symptoms at baseline and 12-month follow-up in a sample of actively working individuals (N = 372).Method: The design was prospective with laboratory cognitive data at baseline, and burnout and depressive symptoms assessed at baseline and monthly follow-ups. Information processing speed and executive functions were assessed in a task-switching paradigm, including single-task reaction time (RT), switching costs, and mixing costs. Burnout was assessed with the Exhaustion subscale of the Oldenburg Burnout Inventory and depression with the Patient Health Questionnaire-9.Results: Slower RT was modestly associated with higher levels of burnout symptoms both cross-sectionally and prospectively, but switching costs and mixing costs were not associated with burnout symptoms. None of the cognitive measures were associated with depression symptoms cross-sectionally or prospectively.Conclusions: Despite statistically significant findings of slowed RT in acute exhaustion-related burnout, the proportion of variance accounted for in the models was small and did not predict clinically significant levels of distress. The absence of statistically significant findings for depression symptoms suggests the cognitive profile associated with the exhaustion dimension of burnout may be distinct from that of depression, which reflects a more heterogeneous symptomatology. Our data suggest the clinical impact of burnout symptoms on actively working individuals is marginal; nonetheless, it is important to screen and intervene on burnout and depression symptoms in the workplace because they can lead to other forms of work impairment.
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Affiliation(s)
- Guy Potter
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Daniel Hatch
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Hannah Hagy
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Thea Radüntz
- Federal Institute for Occupational Safety and Health, Berlin, Germany
| | - Patrick Gajewski
- Research Centre for Working Environment and Human Factors at TU Dortmund, Dortmund, Germany
| | - Michael Falkenstein
- Research Centre for Working Environment and Human Factors at TU Dortmund, Dortmund, Germany.,Institute for Working, Learning, and Aging, Bochum, Germany
| | - Gabriele Freude
- Federal Institute for Occupational Safety and Health, Berlin, Germany
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Sumiyoshi T, Watanabe K, Noto S, Sakamoto S, Moriguchi Y, Hammer-Helmich L, Fernandez J. Relationship of Subjective Cognitive Impairment with Psychosocial Function and Relapse of Depressive Symptoms in Patients with Major Depressive Disorder: Analysis of Longitudinal Data from PERFORM-J. Neuropsychiatr Dis Treat 2021; 17:945-955. [PMID: 33814911 PMCID: PMC8009536 DOI: 10.2147/ndt.s288108] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/11/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Accumulating evidence suggests the presence of cognitive impairment in patients with major depressive disorder (MDD), which affects their psychosocial function and quality of life (QoL). PERFORM-J (Prospective Epidemiological Research on Functioning Outcomes Related to MDD in Japan) is an observational, multicenter study to assess longitudinal changes in depressive symptoms, psychomotor speed, subjective cognitive function, and psychosocial function. METHODS Five hundred and eighteen Japanese outpatients with MDD initiating new antidepressant monotherapy (first-line or switch from previous drug) as part of their routine medical care participated in this study. Assessments at baseline and over the 6-month observation period included physician-rated depression severity (Montgomery-Åsberg Depression Rating Scale), psychomotor speed (Digit Symbol Substitution Test; DSST), subjective cognition (Perceived Deficits Questionnaire-Depression), psychosocial function (Sheehan Disability Scale), and QoL (EuroQol-5 Dimension-5 Level). RESULTS Antidepressant treatment for 6 months improved depressive symptoms and subjective cognitive impairment (cognitive complaints), whereas psychomotor speed remained impaired (ie, DSST total score was >1 standard deviation below the norm) in 35.6% of patients at 6 months. Impairment of subjective cognition, but not psychomotor speed at month 2 was associated with poor psychosocial function and QoL at 6 months. There was a trend for higher relapse rates at 6 months in patients with greater subjective cognitive impairment at 2 months. CONCLUSION These findings highlight the importance of evaluating cognitive difficulties to predict long-term outcomes in patients with MDD. Early intervention for cognitive complaints may decrease the relapse rate, which warrants further study.
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Affiliation(s)
- Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Shinichi Noto
- Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Shigeru Sakamoto
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | | | | | - Jovelle Fernandez
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
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