抑郁症的影像遗传学研究:探索基因与环境的交互作用

抑郁症具有中等的遗传度。通过影像遗传学方法探讨抑郁相关基因的多态性对神经活动的影响,发现编码五羟色胺、促肾上腺素释放激素受体、多巴胺等神经递质或受体的基因多态性会影响杏仁核、前扣带等情绪加工脑区的功能或结构,且多数基因与压力生活经历发生交互作用。表明基因与环境的交互作用在抑郁症发病机理中扮演重要角色。未来的研究应拓展遗传和神经影像分析方法,重视环境因素的测量,通过整合遗传、神经影像及环境变量构建抑郁病理模型。     

Dimensions of Oppositional Defiant Disorder in Young Children: Heterotypic Continuity with Anxiety and Depression

There are distinct dimensions of Oppositional Defiant Disorder (ODD) that have been associated with symptoms of other disorders (heterotypic continuity). The present study compared the heterotypic continuity of a two-factor (Pitt-2) model and the three-factor model incorporated into DSM-5 with symptoms of anxiety and depression. Participants were a diverse community sample of 796 children (38.8 % minority, 49.1 % boys) assessed at ages 4, 5 and 6 years. Symptoms were assessed with the dimensional scales of the Diagnostic Interview Schedule for Children-Young Child version and the Child Symptom Inventory. Dimensions of both the two- and three-factor DSM-5 models were associated with later symptoms of anxiety and depression. The association, however, was weak when accounting for initial levels of internalizing symptoms: thus there was little evidence for the unique contributions of ODD dimensions to symptoms of subsequent internalizing disorders for either model.     

抑郁症的脑网络失调:来自图论分析的证据

以脑成像数据为支撑,基于图论的复杂脑网络分析实现了在大尺度上对于大脑的整体定量分析,克服了传统抑郁症病理改变研究仅关注少数几个脑区的缺点。本文主要总结了:(1)基于图论的脑网络分析的概念;(2)基于图论的抑郁症研究现状;(3)以往传统研究的不足,抑郁症脑网络研究的当前总结和未来展望。总体来说:抑郁症病人脑网络的小世界属性依旧存在,但在节点指标上存在明显的异常,且随疾病发展呈线性变化,整个网络趋向于随机化。区域性的异常主要存在于默认网络和前额叶?边缘系统环路。未来研究中,任务状态下的脑网络构建和"最小生长树"技术的应用可能会为抑郁症病人的脑网络异常提供更多的信息。     

Depression and God: The Effects of Major Depressive Disorder on Theology and Religious Identity

Major depressive disorder (MDD) has deep roots in brain function. Recent physiological research ties brain areas involved with depression to areas that process emotions. Among the research surveyed, a link was found between the activity levels of the prefrontal cortex (PFC), the orbitofrontal cortex (OFC), and parts of the anterior cingulate cortex (ACC). These links prove to be useful in understanding how an individual might have problems processing emotional experiences. This relates directly to how a person interacts in a religious environment. Religious leaders should share the physicians’ mantra of primum non nocere, which means “first, do no harm.” Skewed views of God can emerge from "gaps in understanding" related to topics such as sin, substance abuse, divine intimacy, and end-of-life questions.     

Examining Safety Behavior Subtypes Across Distinct Social Contexts in Social Anxiety Disorder and Major Depression

People with social anxiety disorder (SAD) use different types of safety behaviors that have been classified as avoidance vs. impression management. The current study investigated differences in safety behavior subtype use in 132 individuals with principal diagnoses of social anxiety disorder (SAD, n = 69), major depressive disorder (MDD, n = 30), and nonpatient controls (n = 33) across two social contexts: an interpersonal relationship-building task (social affiliation) and a speech task (social performance). We examined whether diagnostic groups differed in safety behavior subtype use and whether group differences varied by social context. We also explored relationships between avoidance and impression management safety behaviors, respectively, and positive and negative valence affective and behavioral outcomes within the social affiliation and social performance contexts. Safety behavior use varied by diagnosis (SAD > MDD > nonpatient controls). The effect of diagnosis on impression management safety behavior use depended on social context: use was comparable for the principal SAD and MDD groups in the social performance context, whereas the SAD group used more impression management safety behaviors than the MDD group in the social affiliation context. Greater use of avoidance safety behaviors related to higher negative affect and anxious behaviors, and lower positive affect and approach behaviors across contexts. Impression management safety behaviors were most strongly associated with higher positive affect and approach behaviors within the social performance context. These findings underscore the potential value of assessing safety behavior subtypes across different contexts and within major depression, in addition to SAD.     

Behavioral Activation for a Breast Cancer Patient with Major Depression and Coexistent Personality Disorder

Behavioral activation is an empirically validated treatment for depression, with recent applications toward other psychological and medical conditions. However, modification to the treatment protocol may be necessary when symptoms, environment, or personality necessitate. This feasibility study applied Behavioral Activation Treatment for Depression (BATD) in a case of a woman with recurrent major depression and obsessive–compulsive personality disorder (OCPD) undergoing breast cancer treatment. A quasi-experimental design was used, comparing supportive psychotherapy (while she received radiation therapy) followed by eight sessions of BATD. Treatment was designed in accordance with patient and therapist goals of increasing exercise, decreasing fatigue, and reducing interference due to perfectionistic behaviors. The patient exhibited resistance to initiation of BATD, related to symptoms of OCPD, which necessitated modification of treatment strategies and scheduling. Following BATD, the patient reported a significant reduction in depressive symptoms, physical problems, and role limitations—gains not observed following supportive therapy. In addition, she demonstrated less psychological rigidity and interference due to OCPD symptoms within the therapeutic relationship and other interpersonal relationships. Consistent with previous research, results indicate BATD may effectively treat individuals with complex clinical presentations that include personality disorder pathology. In addition, methods of modification to BATD are discussed, as well as future directions for research in this area.     

Suicidal Ideation, Depression, and Conduct Disorder in a Sample of Adolescent and Young Adult Twins

The co-occurrence of suicidal ideation, depression, and conduct disturbance is likely explained in part by correlated genetic and environmental risk factors. Little is known about the specific nature of these associations. Structured interviews on 2,814 twins from the Virginia Twin Study of Adolescent Behavioral Development (VTSABD) and Young Adult Follow-Up (YAFU) yielded data on symptoms of depression, conduct disorder, and adolescent and young adult suicidal ideation. Univariate analyses revealed that the familial aggregation for each trait was explained by a combination of additive genetic and shared environmental effects. Suicidal ideation in adolescence was explained in part by genetic influences, but predominantly accounted for by environmental factors. A mixture of genetic and shared environmental influences explained ideation occurring in young adulthood. Multivariate analyses revealed that there are genetic and shared environmental effects common to suicidal ideation, depression, and conduct disorder. The association between adolescent suicidal ideation and CD was attributable to the same genetic and environmental risk factors for depression. These findings underscore that prevention and intervention strategies should reflect the different underlying mechanisms involving depression and conduct disorder to assist in identifying adolescents at suicidal risk.     

Dimensions of Perfectionism and Self-worth Contingencies in Depression

The current study investigated the role of contingent self-worth in perfectionism and depression. It was hypothesized that perfectionism is associated with depression because perfectionists base their self-worth on being successful and on the need to be actively working toward their goals. A sample of 170 female university students completed measures of conditional self-worth, perfectionism traits, perfectionism cognitions, and depressive symptoms. Structural equation modeling revealed that a factor interpreted as Evaluative Concerns Perfectionism was associated strongly with contingent self-worth, which was, in turn, related to depressive symptomatology. In addition, contingent self-worth mediated the association between perfectionism cognitions and depression. Other analyses revealed that measures of self-oriented perfectionism that are often viewed as highly similar actually differed in terms of their associations with contingent self-worth. The theoretical and practical implications of the associations between perfectionism and contingent self-worth are discussed.     

Ethical Dimensions of Diagnosing: Considerations for Clinical Mental Health Counselors

There are numerous ethical considerations inherent within the process of assigning a Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM‐IV‐TR; American Psychiatric Association, 2000) diagnosis. In this article, general ethics considerations such as informed consent and confidentiality, accuracy of diagnosis, and multiple relationships are examined as they relate to clinical mental health counselors' use of the DSM‐IV‐TR. The article concludes with the authors' suggestions for ethically sensitive diagnostic practices.     

Clinical Supervision and Logotherapy: Discovering Meaning in the Supervisory Relationship

Upon review of the clinical supervision literature, the case is made for implementation of logotherapeutic principles within the context of the supervisory relationship. Logotherapy is a meaning-centered approach that may enhance existing supervision styles and models, especially their tendency to de-emphasize the supervisor-supervisee relationship and the inner experiencing factor of what occurs during the process of supervision. The utility of incorporating elements of logotherapy in clinical supervision is presented within the context of supervisor roles (i.e., mentor, teacher, and evaluator), as well as the content and process of effective supervision (e.g., enhancing knowledge, skills, attitudes, and interpersonal ability of supervisees). The importance of supervisor and supervisee personally meaningful values to the supervision process is then discussed, followed by specific avenues for research. Recommendations for incorporating logotherapy into supervision are offered.     

抑郁和焦虑与心律失常

焦虑抑郁广泛存在于各种心血管疾病中已成共识。心律失常患者合并心理问题在临床上十分常见,焦虑抑郁导致的自主神经对心脏的调节失衡会进一步促使心律失常的发生与发展。对于非器质性心脏病,β受体阻滞剂与抗焦虑药物合用有很好的疗效;器质性心脏病患者并发心律失常时患者的焦虑抑郁会进一步加重,甚至导致恶性室性心律失常的发生,增加器质性心脏病患者的病死率;心律失常介入治疗引起的焦虑抑郁更为常见。临床上对焦虑抑郁症状要有充分的重视,积极识别并诊断,以期进一步提高心律失常患者的生活质量,减少病死率。     

The Dimensions of Life Stress and the Specificity of Disorder

Stress and related concepts have long been associated with ideas about the genesis of mental and physical disorders. The concepts linking stress to disorder, however, have typically been very general in nature. The theme of the present paper is that such nonspecific principles may obscure more specific relations between relatively distinct forms of life stress and particular types of disorder outcome. The historical progression of ideas on this topic is traced and the assumptions behind specificity and nonspecificity models of disorder are outlined. The implications of these developments are next illustrated in regard to current conceptual and operational shortcomings. Recent research that has overcome these limitations and suggests the viability and importance of more specific linkages between particular forms of stress and disorders is selectively reviewed. Finally, the paper concludes with some speculative comments on the problems facing investigators interested in translating stress concepts into operational procedures.     

Three Dimensions of Oppositionality in Autism Spectrum Disorder

In autism spectrum disorder (ASD), symptoms of oppositional defiant disorder (ODD) are common but poorly understood. DSM-5 has adopted a tripartite model of ODD, parsing its features into ‘angry and irritable symptoms’ (AIS), ‘argumentative and defiant behavior’ (ADB) and ‘vindictiveness’. This was based on findings in non-autistic populations that each of these dimensions of oppositionality has a distinct constellation of associations with internalising and externalising psychopathology. We applied the tripartite DSM-5 ODD model to ASD to test its generalisability beyond non-ASD populations; and to elucidate the nature of ODD symptoms in ASD. Participants were 216 verbally-fluent young people (mean age?=?9.6 years, range 3.0 to 16.2 years, 82 % male) with ASD. Cross-sectional parent-and teacher-report data were analysed using bootstrap multiple regression to test the following predictions, derived from studies of non-ASD young people: (1) AIS will be the main predictor of internalising problems; (2) ADB will be the main predictor of ADHD symptoms; (3) all ODD traits will independently predict conduct disorder symptoms; (4) vindictiveness will be the main predictor of aggressive conduct problems. Our findings using both parent and teacher data were consistent with the non-ASD ODD literature. AIS were associated with internalising but not externalising problems; ADB and vindictiveness were associated with externalising but not internalising problems; and vindictiveness was the main predictor of aggression. The DSM-5 tripartite model of ODD appears to be generalisable to ASD: for people with an autistic disorder, AIS, ADB and vindictive dimensions of oppositionality have distinct associations with concurrent psychopathology, suggesting the need to assess them as separate constructs.     

Self-Reported Symptoms of Depression by Changes in Sleeping Patterns and Appetites for Outpatients with a Major Depressive Disorder

To determine whether self-reported symptoms of depression are differentiated by changes in sleeping patterns or appetite, the Beck Depression Inventory-II (BDI-II; Beck et al. 1996) was administered to 1,250 outpatients diagnosed with a major depressive disorder. A series of focused contrasts supported the hypothesis that the mean BDI-II total scores and the majority of the symptom ratings of the outpatients who described increases or decreases in their sleeping patterns or appetites were comparable and higher than the mean BDI-II total scores and symptom ratings of the patients who reported no changes in their sleeping patterns or appetites. However, the patients who were sleeping less described themselves as being more agitated than those who were sleeping more. Decreases and increases in sleep or appetite were both discussed as indicating comparable levels of depressive symptomatology.

Life Stress and Major Depression

ABSTRACT— People have long believed that adversity and stress contribute to emotional problems in general and to depression in particular. A considerable body of research has supported this intuition, documenting a consistent association between major stressful life events and the onset of clinical depression. However, most individuals under stress do not become depressed, sometimes depression develops without prior stress, and distinguishing psychological distress from major depression can be diagnostically challenging. In varying forms and degrees, life stress may play multiple roles in relation to major depression. In this article, we outline the opportunities and obstacles associated with conceptualizing depression from a life-stress perspective and discuss the implications for future research.     

抑郁患者的注意偏向

抑郁患者的注意偏向是抑郁认知研究中的重要问题。该文从研究范式、注意偏向特点及理论解释等方面进行了探讨,在研究范式上有Stroop范式、点探测任务和线索–靶子范式等,在抑郁患者注意偏向的特点上有对象为临床患者、需要阈上刺激、刺激内容针对抑郁患者和刺激强度不能太弱等,在理论解释上有注意成分、注意聚焦变窄、认知负荷和唤醒水平等,并对将来的研究方向进行了探讨