Changes in personality pathology after pharmacotherapy and combined therapy for depressed patients

The central question addressed by this article is whether courses of treatment consisting of pharmacotherapy or pharmacotherapy combined with psychotherapy (combined therapy) produce different changes in personality pathology at follow-up after 40 weeks. We also examined whether recovery from depression has an influence on outcome. The study population consisted of 128 outpatients in whom personality pathology and severity of depression were determined at the start of the study. For 72 patients, personality pathology and severity of depression were determined again after 40 weeks. Of the group of 72 patients, 25 patients received only pharmacotherapy for 6 months, and 47 patients received combined treatment (pharmacotherapy and psychodynamic supportive psychotherapy). The antidepressant protocol provides for three successive steps in case of intolerance or inefficacy: fluoxetine, amitriptyline, and moclobemide. The combined therapy condition consisted of 16 sessions of Short Psychodynamic Supportive Psychotherapy in addition to pharmacotherapy. In the combined therapy condition there was a significant reduction in personality pathology in patients who recovered from depression but also in patients who had not. In the pharmacotherapy condition the significant decrease was restricted to patients who recovered from depression. The results were most striking for Cluster C psychopatology. Patients with cluster B pathology changed the least. Depressed patients with comorbid personality pathology appear to benefit most from a combination of pharmacotherapy and a form of short, psychodynamic, supportive psychotherapy.     

Modified group therapy for psychotic and depressed patients

This paper describes a group treatment program for chronically ill patients which has been found to be more economical than traditional modalities of treatment of such patients and to minimize transference and countertransference problems. Technical guidelines and the theoretical rationale are discussed, as are the therapeutic factors in such a group. Case vignettes are given to illustrate both the group process and the individual patient's use of the group.The authors are deeply grateful to the residents of the department who, as cotherapists, shared in the planning and work of the coffee lounge groups. Invaluable to us also were the interest and ideas of Dr. Donald Miller who served as a consultant to this project.This is a revised version of a paper presented at Grand Rounds, Montefiore Hospital and Medical Center, Bronx, N.Y. in September, 1975.Miss Emery is, and Mrs. Levitan was, a social worker at Montefiore Hospital and Medical Center, Bronx, N.Y. Mrs. Levitan was formerly Principal Associate in Psychiatry (Social Work), Albert Einstein College of Medicine. Dr. Gadlin is Director of the Group Therapy Training Program at Montefiore Hospital and Medical Center, and Assistant Professor, Albert Einstein College of Medicine.     

Mindfulness-based cognitive therapy reduces overgeneral autobiographical memory in formerly depressed patients

Previous research on depressed and suicidal patients and those with posttraumatic stress disorder has shown that patients' memory for the past is overgeneral (i.e., patients retrieve generic summaries of past events rather than specific events). This study investigated whether autobiographical memory could be affected by psychological treatment. Recovered depressed patients were randomly allocated to receive either treatment as usual or treatment designed to reduce risk of relapse. Whereas control patients showed no change in specificity of memories recalled in response to cue words, the treatment group showed a significantly reduced number of generic memories. Although such a memory deficit may arise from long-standing tendencies to encode and retrieve events generically, such a style is open to modification.     

Cognitive-behavior therapy for depressed cancer patients in a medical care setting

Major depression is the most common psychiatric disorder among cancer patients and is associated with decreased quality of life, significant deterioration in recreational and physical activities, relationship difficulties, sleep problems, more rapidly progressing cancer symptoms, and more metastasis and pain relative to nondepressed cancer patients. Although some research has explored the utility of psychological interventions with cancer patients, only one study to date has explored the potential benefits of cognitive-behavior therapy among cancer patients with well-diagnosed depression. Addressing this gap in the literature, this study represents an open clinical trial to assess the effectiveness of a brief Cognitive-Behavioral Treatment for Depression (CBTD) among depressed cancer patients in a medical care setting. Results revealed strong treatment integrity, good patient compliance, excellent patient satisfaction with the CBTD protocol, and significant pre-post treatment gains across a breadth of outcome measures assessing depression, anxiety, quality of life, and medical outcomes. These gains also were associated with strong effect sizes and generally maintained at 3-month follow-up. Behavioral activation interventions, especially when paired with cognitive techniques, may represent a practical medical care treatment that may improve psychological outcomes and quality of life among cancer patients. Study limitations and future research directions are discussed.     

Mood and performance: test of a conceptual model with a focus on depressed mood

Objectives. The present study tested a conceptual model of mood–performance relationships (J. Appl. Sport Psychol. 12 (2000) 16) which proposed that depressed mood would influence the intensity and inter-relationships of other mood responses, and moderate the anger–performance and tension–performance relationships.Design. To promote ecological validity, the model was tested in a field setting using a cross-sectional design.Methods. A sample of 451 schoolchildren [age: mean=12.4 years, standard deviation (SD)=1.3 years] completed the Profile of Mood States — Adolescents (POMS-A; J. Sports Sci. 17 (1999) 861) and stated a performance goal, approximately 10 minutes before a running event. Participants were divided into a depressed mood group (n=273) and a no-depression group (n=178) on the basis of responses to the POMS-A depression subscale.Results. As hypothesised, the depressed mood group reported higher scores for anger, confusion, fatigue and tension, and lower scores for vigour. Inter-correlations among these mood dimensions were stronger in the depressed mood group, who set easier goals and performed less well. Vigour was associated with facilitated performance regardless of depression. Anger was associated with debilitated performance in the depressed mood group and with facilitated performance in the no-depression group. Some support was shown for a moderating effect of depressed mood on the tension–performance relationship. The hypothesised curvilinear anger–performance and tension–performance relationships in the no-depression group did not emerge.Conclusion. The Lane and Terry model was generally, but not totally, supported. Future research should continue to investigate the mechanisms underlying mood–performance relationships.     

Wechsler performance IQ deficit in depressed children

The original analysis of data on 100 consecutive school age children referred for evaluation of school difficulties showed no differences in IQ among the children with depression and those without depression. Reanalysis of those data shows that a significant number of the depressed children (but not the nondepressed children) have a 15-IQ point Wechsler Performance IQ deficit. This supports the contention that a major subgroup of depressed individuals have right cerebral-hemisphere dysfunction.     

Marital attributions in spouses of depressed patients

Causal attributions (i.e., locus, stability, globality) and responsibility attributions (i.e., bad intent, selfish motivation, blame) were assessed in the spouses of 27 depressed psychiatric inpatients and 30 nondepressed dyads to test predictions derived from Hooley's (1987) symptom-controllability model of marital distress. Results indicated that (1) depressed patients and their spouses were less dyadically adjusted than nondepressed spouses, (2) causal and responsibility attributions about depressive behaviors predicted lower dyadic adjustment, and (3) attributions of causality mediated the relationship between group status (depressed or nondepressed) and dyadic adjustment among spouses who had higher expectations for their partner to change. Results suggest that among spouses with a high expectancy for change, depression may be a risk factor for marital distress.     

Changes in the health state of schizophrenic patients in neuroleptic therapy

The state of health of 135 schizophrenic patients was examined during therapy with a nigrostriatal (Haloperidol) and a mesolimbic (Clozapin) neuroplegic drug, and compared with the situation during treatment without neuroplegics. Among the methods used was the state of health scale of von Zerssen; the neuroleptic threshold was tested using Haase's handwriting test. There was evidence that the patient's health was primarily affected, but individual differential treatment with neuroplegics produced a significant improvement in this important respect. Contrary to Haase, we noticed nothing to convince us of a link between the antipsychotic efficacy of the neuroplegics under investigation and the neuroleptic threshold.     

Memory complaint and memory performance in the depressed elderly

Depressed and nondepressed elderly subjects recruited in the context of a large epidemiological study of health were compared on measures of self-reported memory disturbance and an objective index of memory performance (free recall). Three groups were studied including (a) subjects meeting Research Diagnostic Criteria (RDC) for major depression, (b) subjects with high levels of self-reported depressive symptoms who did not meet RDC for major depression, and (c) subjects with low levels of self-reported depressive symptoms. Subjects with high depression symptom levels reported significantly higher levels of memory complaint than did subjects with low symptom levels. However, there were no differences in self-reported memory disturbance as a function of depression diagnosis. Further, there were no significant differences between groups on the free-recall measure, either as a function of symptom level or diagnosis. It is argued that symptom severity rather than diagnosis of depression is important in determining impairment in depressed elderly people.     

Cognitive reactivity as outcome and working mechanism of mindfulness-based cognitive therapy for recurrently depressed patients in remission

Major depressive disorder is a prevalent condition with high relapse rates. There is evidence that cognitive reactivity is an important vulnerability factor for the recurrence of depression. Mindfulness-based interventions are designed to reduce relapse rates, with cognitive reactivity as one of the proposed working mechanisms. In a randomised controlled trial we compared the effect of mindfulness-based cognitive therapy (MBCT) with treatment-as-usual (TAU) on cognitive reactivity in recurrently depressed patients (N?=?115). Depressive symptoms, cognitive reactivity, and mindfulness skills were assessed pre and post treatment. Patients in the MBCT group reported a significantly greater reduction in cognitive reactivity than those in the TAU group (d?=?.51). The reduction of cognitive reactivity appeared to mediate the association between MBCT/TAU and decrease of depressive symptoms, using pre and post scores. The current study provides evidence that MBCT reduces cognitive reactivity and preliminary evidence that cognitive reactivity is a working mechanism of MBCT.     

抑郁症患者的语言使用模式

语言使用模式能反映心理状态和精神病理学特征。抑郁症患者与健康人群的语言使用模式存在差异, 识别抑郁症患者的语言使用模式有助于抑郁症的预测和诊断。传统的心理学研究和基于社交媒体的研究均表明, 抑郁症患者更多地使用第一人称单数代词和消极情绪词, 更少地使用第一人称复数代词和积极情绪词。基于社交媒体的研究进一步发现了一些抑郁个体日常生活中的其他语言标志。建议未来的研究进一步确认更具抑郁特异性的语言标志, 并进一步探索语言标志与抑郁症状间的理论联系。     

Cognitive and life stress predictors of relapse in remitted unipolar depressed patients: test of the congruency hypothesis.

Remitted depressed subjects (N = 59) were followed longitudinally to determine whether dependent or self-critical persons are more vulnerable to relapse after exposure to life events that have a bearing on interpersonal or achievement concerns. Regression analyses indicated that congruency effects, as measured by the occurrence of achievement-related adversity in the lives of self-critical subjects, accounted for a significant increment in relapse variance over each variable entered singly. When data from the 2 months just before relapse were analyzed, some evidence of congruency effects in dependent subjects experiencing interpersonal-related adversity was obtained. These findings highlight the dimensional qualities of life even impact and call for greater differentiation in modeling the activation of a diathesis and precipitation of depression after life stress.     

Induction of depressed mood: a test of opponent-process theory

Solomon's (1980) opponent-process theory of acquired motivation has been used to explain many phenomena in which affective or hedonic contrasts appear to exist, but has not been applied to the induction of depressed mood. The purpose of this study, therefore, was to determine whether opponent-process theory can be applied to this area. Velten's (1968) mood-induction procedure was used and subjects were assigned either to a depression-induction condition or to one of two control groups. Self-report measures of depressed mood were taken before, during, and at several points after the mood induction. Results were not totally consistent with a rigorous set of criteria for supporting an opponent-process interpretation. This suggests that the opponent-process model may not be applicable to induced depressed mood. Possible weaknesses in the experimental design, along with implications for opponent-process theory, are discussed.     

Cognitive complaints in elderly depressed and pseudodemented patients

The cognitive complaints of 11 patients with depressive pseudodementia were compared with those of 22 patients with depression alone. Pseudodemented subjects were defined as depressed inpatients showing reversible cognitive impairment as measured by the Mini-Mental State Examination (MMSE); subjects with depression alone had no such impairment. For each group, cognitive complaints were highly correlated with depressive symptoms and were not related to MMSE scores. The pseudodemented group had significantly higher cognitive complaint scores, complaining more of difficulties with concentration and recent memory. Groups did not differ significantly in complaints of difficulties with remote memory.     

Personality and family functioning in families of depressed patients

In this cross-sectional study, the authors attempted to identify correlates of family functioning in 86 couples with a depressed member during the acute phase of the patient's depression. Demographic variables, psychiatric status, and personality traits of both the patient and spouse were investigated as potential predictors of family functioning. Regression analyses indicated that lower levels of personality pathology in the patient, higher levels of patient conscientiousness, and less psychological distress in the spouse were associated with healthier family functioning. Future research implications and clinical importance of these findings are discussed.