Panic disorder and depression: A psychodynamic exploration of comorbidity

Eight of twenty-one patients presenting for treatment in an open trial of brief psychodynamic psychotherapy for panic disorder also carried the diagnosis of major depression. For the patients who completed the study, depression remitted as well as panic disorder. The authors highlight psychodynamic factors that they hypothesize may contribute to the significant overlap between panic disorder and depression, and describe three videotaped cases to illustrate these points.     

Children's understanding of physical illnesses and psychological states

Abstract

The present study set out to compare 5.7, and 9-year-old children's understanding of a physical illness (chicken pox) with their understanding of a psychological state (depression). In addition, information about personal experience of the illnesses and external sources of information was elicited, in order to assess the effects of both age and experience. Children at all ages showed a basic intact knowledge of both chicken pox and depression, although older children had a more sophisticated understanding of depression, and had acquired this knowledge from a greater number of sources. The clinical implications of the findings, and their relationship to both neo-Piagetian and more recent theories of conceptual development in childhood are discussed.     

Supportive psychotherapy of a psychodynamic orientation as an adjunctive treatment for drug-induced depression: A case study

Abstract

Treatment for drug-induced depression usually consists of cessation or reduction of the causative agent and psychopharmacologic management. In addition, psychotherapy can be useful as an adjunctive treatment. The author presents case material related to a young woman with an inborn physical illness, who became depressed during the course of interferon treatment for a medical complication, hepatitis virus infection. In addition to the cessation of interferon and pharmacologic management, supportive psychotherapy of a psychodynamic orientation was started in order to address the patient’s low self-esteem and anxiety about her future. During the course of psychotherapy, it was understood that the premature cessation of interferon was, to her, a narcissistic injury. It was also important to explore the meanings of her inborn illness and her guilty feelings. After reviewing various formulations of depression, the author discusses the case material from an integrative perspective, which describes vicious cycles of depression.     

Implications of research for the treatment of depressive disorders during childhood

Basic research into the prevalence, natural course, and phenomena of comorbidity of depressive disorders during childhood are reviewed and implications of this research for treating depressed youths are noted. Results of investigations into the biological aspects of depression are integrated into a multifactorial model of depressive disorders during childhood and the efficacy of pharmacological interventions is discussed. Cognitive theory is integrated with attachment theory to explain a possible avenue to the development of depressive disorders during childhood. Interpersonal therapy has emerged as a potentially effective intervention for depressed youths. Basic tenets of this treatment model are compared and contrasted to a cognitive-behavioral treatment model, and a hybrid treatment referred to as “cognitive therapy within the interpersonal context” is proposed.     

Breakdown of Intimacy. Insights into the world of a depressive lock-in

Breakdowns are states in which the continuity of being was destroyed. A breakdown has happened but could not be experienced. It is not possible to observe these states because they are beyond our intuition. We have to paraphrase them as ‘shadow’, ‘non-existence’, or ‘black hole’. In these dynamics, the development of a Super-Ego precedes the development of the ego. Under such a Super-Ego, the unthinkable turns into omniscience – no intimacy is left.

This process is demonstrated using the example of a treatment in which a patient regresses into a severe autistoid depression (major depression). In a depressive lock-in, all mental life collapsed and intrapsychic and interpsychic communication was not possible, neither of the depression nor of the panic. The ‘me’ is threatened with dissolution, the ‘not-me’ is flattened into a two-dimensional non-existence. For the analyst, it is nearly impossible to understand anything, to build up any empathy, i.e., to grasp the depression intuitively. Finally, intimacy gets lost – until it is possible to communicate this agony (e.g., by projective identification).     

Mood variability and the intensity of depressive states

Little is known about the relationship between the variability of moods and the tendency to experience depressed mood. The moods of twenty-five student subjects were measured over a period of some 30 days using scales assessing positive affect and negative affect. An index of mood variability was computed. This was correlated with two measures of average level of depression. The results showed a strong correlation between variability of moods and level of depression. High levels of mood variability accompanied high levels of depressive state in this nonclinical sample.     

Prenatal depression effects on early development: A review

This review of recent research on prenatal depression suggests that it is a strong predictor of postpartum depression and is more common than postpartum depression. Prenatal depression has been associated with excessive activity and growth delays in the fetus as well as prematurity, low birthweight, disorganized sleep and less responsiveness to stimulation in the neonate. Infants of depressed mothers have difficult temperament, and later in development attentional, emotional and behavioral problems have been noted during childhood and adolescence, as well as chronic illnesses in adulthood. Several variables have confounded the effects of prenatal depression including comorbid anxiety and anger as well as stressful life events. Potential mediating variables are low prenatal maternal dopamine and serotonin levels and elevated cortisol and norepinephrine. The associated intrauterine artery resistance may limit blood flow, oxygen and nutrients to the fetus. Some studies also suggest the heritability of developmental problems for the children of prenatally depressed mothers, including ADHD and antisocial behavior. Multivariate, longitudinal research is needed to disentangle these confounding and mediating variables.     

Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: a meta-analysis

ABSTRACT

Mindfulness-based cognitive therapy (MBCT) appears to be a promising intervention for the prevention of relapse in major depressive disorder, but its efficacy in patients with current depressive symptoms is less clear. Randomized clinical trials of MBCT for adult patients with current depressive symptoms were included (k = 13, N = 1046). Comparison conditions were coded based on whether they were intended to be therapeutic (specific active controls) or not (non-specific controls). MBCT was superior to non-specific controls at post-treatment (k = 10, d = 0.71, 95% confidence interval [CI] [0.47, 0.96]), although not at longest follow-up (k = 2, d = 1.47, [?0.71, 3.65], mean follow-up = 5.70 months across all studies with follow-up). MBCT did not differ from other active therapies at post-treatment (k = 6, d = 0.002, [?0.43, 0.44]) and longest follow-up (k = 4, d = 0.26, [?0.24, 0.75]). There was some evidence that studies with higher methodological quality showed smaller effects at post-treatment, but no evidence that effects varied by inclusion criterion. The impact of publication bias appeared minimal. MBCT seems to be efficacious for samples with current depressive symptoms at post-treatment, although a limited number of studies tested the long-term effects of this therapy.     

Forensic-psychologic-psychiatric assessment from the viewpoint of perpetrators--data from a survey

In this contribution, various aspects of the expert/culprit-relationship and of the communication behavior styles between the included persons within the scope of forensic-psychological-psychiatric expertise, are discussed. A survey is given on results gained with a questionnaire study (n = 93 culprits; Department of Forensic Psychiatry, Charité Berlin) of the most important expectations, of the social-relevant attitudes towards the assessment and physicians before the forensic investigation as well as of the experiences of own feelings, stress and of the culprit's reflections on the physician/proband relationship after the assessment. A good partnership relation between experts and culprits presupposes that the expert not only possesses a high profession but also the necessary interpersonal-social competence.     

Vegetative phenomena in the course of depressive states]

Depressive psychoses are accompanied by vegetative disorders. Third-order blood-pressure waves are an expression of vasomotor rhythms which through diencephalic and limbic structures tend to adjust the blood pressure to the respective overall psychovegetative situation. In the case of depressions with an axious increase of impulse, statistical evidence was obtained, within the framework of clinical improvement, for a correlation between a decreasing score of depression and an increasing frequency of third-order waves. The same central trends of these quantities suggest that both of them are different manifestations of a common functional disorder in the limbic system and diencephalon.     

On the structure of global development goals

The design of global development goals has been beset by deep flaws, inconsistencies, and manifest unfairness to some developing countries. Momentum has now peaked for the creation of Sustainable Development Goals to replace the Millennium Development Goals. This comment addresses three challenges that arise in setting development goals, and recommends feasible development goals that can meaningfully guide development cooperation, and focus the attention of policy makers on the worst-off.     

Paraconsistent logic from a modal viewpoint

In this paper we study paraconsistent negation as a modal operator, considering the fact that the classical negation of necessity has a paraconsistent behavior. We examine this operator on the one hand in the modal logic S5 and on the other hand in some new four-valued modal logics.     

Comparative study of hostility in depressive patients with and without a suicide attempt history

Hostility in association with depression seems to be connected to suicidal behavior. This study aimed to evaluate hostility and its dimensions in relation to depression in patients who suffered from diagnosed depression with and without a suicide attempt history. The study included 168 participants; 58 patients with depression and suicide attempt history, 55 patients with depression without a suicide attempt history and 55 healthy controls. Hostility was assessed with the Hostility and Direction of Hostility Questionnaire, while depression with the Beck Depression Inventory (BDI). Patients with depression and a suicide attempt history compared with the patients without attempt history presented statistically significantly higher total hostility (28.71 ± 6.43 vs 24.20 ± 7.66), extroverted hostility (17.16 ± 4.37 vs 14.15 ± 4.63), acting out hostility (6.03 ± 2.09 vs 4.73 ± 1.93), and self criticism (6.95 ± 2.12 vs 5.89 ± 2.32). No statistically significant differences were found between the two clinical groups in depression according to the BDI. Moreover depressive patients with suicide attempt history scored higher in all the hostility dimensions than the controls. Therefore, it could be suggested that hostility and especially its extrapunitive dimensions are associated with suicidal behavior, since no differences in depression were recorded between the two clinical groups.     

Definition of psychotherapy from a methodologic viewpoint

Psychotherapy is the psychological treatment of disturbed person-environment relationships, associations or connections which are learned in a lifelong process of socialization. Accordingly, psychotherapy is a process of learning for the patient and a process of educating for the therapeutist, a process which is controlled by specialists in the case of children as well as adults with serious psychic disorders and which is usually a means of self-education in the case of subjects with slight psychic disorders. The primary objective of psychotherapy is to modify both the attitude and behavior in the sense of improving a subject's ability to fulfill his duties in society.     

Postnatal depression and infant cognitive and motor development in the second postnatal year: The impact of depression chronicity and infant gender

A large body of literature has investigated the effects of postnatal depression on infant development. However, the particular circumstances in which depression is associated with adverse effects remain unresolved. Factors, such as the nature of depression (e.g., duration and severity) and the context with respect to other risk and protective factors (e.g., socioeconomic status and child gender) have been suggested as moderators of the effects of postnatal depression on infant outcomes. This study examined the impact of brief and chronic depression in a non-poverty sample of 112 mothers and their infants. Infant language development was assessed at 12 months, and at 15 months the Bayley Scales of Infant Development-II were administered. Chronic maternal depression, lasting throughout the first 12 months postpartum and beyond, was associated with lower infant cognitive and psychomotor development, with the effects being similar for boys and girls, while brief depression did not significantly impact the infant performance. Language development and infant behavior during testing were equivalent across the groups. The relatively high rates of motor development delay associated with chronic maternal depression found in this study are discussed along with the methodological issues and models of cumulative risk.     

Early manifestations of childhood depression: influences of infant temperament and parental depressive symptoms

In this longitudinal study, 83 parents of infants between 3 and 12 months completed questionnaires assessing demographic information, infant temperament, and maternal depression. When these children were at least 18 months of age, parents completed follow‐up questionnaires assessing toddler temperament and depression‐like symptoms. We were primarily interested in the contributions of infant temperament and maternal depression to toddler depressive problems, and the analytic strategy involved controlling for toddler temperament in order to isolate the influence of infancy characteristics. The findings indicated that lower levels of infant regulatory capacity and greater severity of maternal depression were predictive of toddler depression‐like symptoms. Moderator effects of infant temperament were also examined, with the negative affectivity * maternal depression interaction emerging as significant. Follow‐up analyses indicated that the risk for early manifestations of depression was attenuated for children with lower negative affectivity in infancy and parents who reported lower levels of their own depressive symptoms; conversely, children exhibiting higher infant negative emotionality had higher levels of depression‐like symptoms as toddlers, regardless of their parents' level of depression. The present findings further suggest that parental depressive symptoms need not be ‘clinically significant’ to predict toddler affective problems. Copyright © 2008 John Wiley & Sons, Ltd.     

Control beliefs as a mediator of the relation between stress and depressive symptoms among inner-city adolescents

Adolescents' control beliefs were examined as a mediator of the relation between stress and depressive symptoms among a diverse sample of 445 inner-city adolescents. Results indicated that control beliefs significantly mediate the relation between stress and depressive symptoms. The specific direct effects of six individual stress domains (peer, family, school, neighborhood, economic, discrimination) on control beliefs and depressive symptoms were also examined. Results showed that (1) economic stress relates to adolescents' control beliefs, (2) family stress relates to adolescent depressive symptoms, and (3) peer stress relates to both control beliefs and depressive symptoms. Secondary analyses revealed that control beliefs significantly mediate the specific relations between peer stress and depressive symptoms. Results were not found to vary across ethnic groups. The implications of these findings for adolescent mental health and preventive interventions targeting depression are discussed.