Validation of distinct amnesic and executive type memory deficit in a psychiatric sample based on retrieval performance

Studies of localized brain dysfunctions have revealed connections between patterns of cognitive dysfunction and specific profiles of memory impairment. The amnesic type of memory impairment is defined by deficits in both free recall and recognition memory, whereas the dysexecutive memory impairment is characterized by retrieval deficits, i.e. a disproportional impairment in free recall relative to recognition memory. The present study tests whether classifications of psychiatric patients into recall impaired only (= RO group) and Recall and Recognition impaired (= RR group) correspond to the executive type and amnesic type of memory impairment. The alternative hypothesis is that the two groups merely differ in degree of neuropsychological and psychiatric disturbance. Forty-four subjects impaired on California Verbal Learning Test (CVLT) were selected from a larger database of 103 impaired and non-impaired subjects with schizophrenia or recurrent major depression. Subjects were classified into RO and RR groups and compared on measures of memory strategy (recency effect and interference on CVLT), overall neuropsychological function (Stroop Test and WAIS-R similarity) and psychiatric symptom load (positive and negative symptoms). Repeated measures ANOVA showed no effects of group, i.e. the RR group did not perform consistently below the RO group with regard to memory strategy, neuropsychological function or psychiatric symptom load. Two out of three analyses showed group x test interaction, supporting the dissociation of distinct executive and amnesic profiles among psychiatric patients. The RO group was more susceptible to interference but had better recency score than the RR group. The RO had higher negative symptoms while the RR group had higher positive symptoms.     

Postpartum exuberance: Not all women in a highly positive emotional state in the postpartum period are denying depression and distress

The question addressed in this study was whether or not mothers who scored low on self-report depression scales—so-called “deniers”—were denying their symptoms and suffering from an illusion of mental health. The findings did not support the interpretation that low-scoring mothers were denying other symptoms. Rather, low-scoring mothers: 1) experienced a wide range of emotions and similar levels of positive emotions compared to mid-symptom mothers; 2) changed their reported levels of depressive symptoms over the course of the study; 3) reported a variety of symptoms at levels similar to those of mothers in the mid symptom range; and 4) were affected negatively by having a diagnosis of depression, in a manner similar to mothers in the mid and high symptom groups. Furthermore, low symptom mothers consistently reported the most positive profiles of maternal adaptation with higher levels of maternal self-esteem and a high ratio of self-reported positive to negative affect. Thus, they appeared to be experiencing a heretofore underdescribed highly positive normal postpartum state that we have labeled “postpartum exuberance.” Postpartum exuberance, as well as a compromise of affective functioning associated with any lifetime diagnosis of depression regardless of the mothers' current level of depressive symptoms, highlights the complexity of emotional reactivity during the postpartum period. © 1997 Michigan Association for Infant Mental Health     

Overanxious disorder: An examination of developmental differences

Differences between a clinical sample of younger (ages 5 to 11) and older (ages 12 to 19) children meeting DSM-III criteria for overanxious disorder (OAD) were examined. Younger and older children were compared in terms of (1) the rates of OAD diagnoses occurring in the two age groups, (2) sociodemographic characteristics, (3) symptom expression, (4) association with other forms of maladjustment, and (5) self-reported anxiety and depression. The prevalence of OAD diagnoses and sociodemographic characteristics did not differ. Although younger and older OAD children showed similar rates of most specific DSM-III OAD symptoms, older children presented with a higher total number of overanxious symptoms than younger children. Older children more frequently exhibited a concurrent major depression or simple phobia, whereas younger OAD children more commonly had coexisting separation anxiety or attention deficit disorders. Older OAD children reported significantly higher levels of anxiety and depression on self-report measures. Findings indicated that the expression of OAD varies by developmental level.     

Autobiographical recall training in elderly adults with subjective memory complaint: a pilot study

Subjective memory complaint is a self-reported memory impairment which affects elderly people. This problem does not interfere with daily living activities but could decrease quality of life. This study's purpose was to verify whether a specific, newly developed, autobiographical recall training could modify self-perception of memory of subjects with subjective memory complaint. Seven elderly subjects (4 women and 3 men; mean age 65.5 yr., SD=11) with such complaint, evidenced through a specific questionnaire, attended the training course and were prospectively assessed on standard neuropsychological tests, depressive symptomatology, and self-perception of memory. Self-perception of memory, as assessed by scores on a formalized questionnaire, improved significantly after the training, while depressive symptoms did not change. Neuropsychological performances were normal before and after the training, but a statistically significant improvement was observed only on the phonological fluency test. Thus the present pilot study suggested that the training may be effective in improving self-perception of memory and metamnestic capacity in elderly people with subjective memory complaints but not in changing subjects' depressive symptoms. This requires replication of this work with a much larger sample so statistical power is adequate.     

Executive Functioning in Adolescent Depressive Disorders

Previous research on executive functioning within adolescent depression has provided somewhat inconsistent results, although the majority of research has identified at least partial evidence of executive functioning deficits in adolescent depression. The present study attempted to explore adolescent depression, specifically depressive disorder diagnoses and self-reported depressive/anxious symptoms, as well as executive functioning through the retrospective chart review of an inpatient/outpatient adolescent sample. The total sample (N = 155) was divided into four groups. The psychiatric inpatient sample was subdivided into a Major Depression Group (n = 22), Minor Depression Group (n = 28), Inpatient Control Group (n = 73) based on the discharge diagnoses. The Outpatient Control Group (n = 33) consisted of a group of adolescents who received evaluations at a neuropsychological evaluation clinic. Analyses of variance between the four clinical groups and follow-up pairwise comparisons revealed lowered executive functioning performance in major and minor depression groups compared to the outpatient control. Lowered working memory/simple attention was identified in minor and major depression, while lowered cognitive flexibility/set shifting was only identified in major depression, suggesting a continuum of executive dysfunction and depression severity. More generally, the inpatient groups displayed lower executive functioning than the outpatient control, with no identified executive functioning differences between inpatient groups. Additionally, no negative correlations were observed between self-reported depressive/anxious symptoms and executive functioning. These results are consistent with the majority of related research, and highlight the importance of executive functions in adolescent depression, and more broadly in adolescent psychopathology.     

Verbal Memory Dysfunction in Depressed Outpatients With and Without Borderline Personality Disorder

This study contrasts memory functions with emotional words between two groups of patients presenting with symptoms of major depressive disorder (MDD)—20 patients with a comorbid diagnosis of borderline personality disorder (BPD) and 20 patients without BPD—and a group of 20 community adult controls. BPD patients showed poorer recall and recognition memory performances than controls, while MDD patients and controls did not differ significantly on these tasks. BPD patients showed a lower accuracy of recognition memory than MDD patients, despite negligible differences between the two patient groups in the severity of depressive symptoms and in the general level of psychopathology. Controls and BPD patients showed positive word selectivity in recall, while MDD patients showed nonsignificant selectivity differences. These findings provide additional data regarding memory disturbances specific to MDD versus BPD. The selectivity differences are consistent with theories of mood-congruent memory in depression and may serve as a cognitive marker for differentiating BPD from prototypical MDD.     

The Effect of Anxiety on the Cognitive Functioning in Non-clinical Schizotypal Individuals

Schizotypal personality disorder (SPD) is characterized by eccentric behavior and perceptual distortions that closely resemble the patterns observed in those with schizophrenia. Schizophrenia and related personality disorders (i.e., SPD) are associated with deficits in sustained attention, slower than normal reaction times, and manifestations of working memory deficits and erratic cognitive tasks. The present study used the schizotypal personality scale (STA) to compare cognitive abilities of self-reported low schizotypic tendency subjects with high schizotypic tendency subjects. The group scores on the STA differed significantly. Those with high STA scores also tended to have higher state and trait anxiety scores based on the State-Trait Anxiety Inventory (STAI). The groups did not significantly differ on any of the demographic variables tested, including age, education, self-rated health status, and medication. Along with an executive function test, two computerized tasks tested subjects on reaction time and memory. Even when covariates (i.e., state, trait anxiety scores) were analyzed, there were no significant differences between the groups and tasks, although the gathered data showed trends in the expected direction.     

The Effect of Anxiety on the Cognitive Functioning in Non-clinical Schizotypal Individuals

Schizotypal personality disorder (SPD) is characterized by eccentric behavior and perceptual distortions that closely resemble the patterns observed in those with schizophrenia. Schizophrenia and related personality disorders (i.e., SPD) are associated with deficits in sustained attention, slower than normal reaction times, and manifestations of working memory deficits and erratic cognitive tasks. The present study used the schizotypal personality scale (STA) to compare cognitive abilities of self-reported low schizotypic tendency subjects with high schizotypic tendency subjects. The group scores on the STA differed significantly. Those with high STA scores also tended to have higher state and trait anxiety scores based on the State-Trait Anxiety Inventory (STAI). The groups did not significantly differ on any of the demographic variables tested, including age, education, self-rated health status, and medication. Along with an executive function test, two computerized tasks tested subjects on reaction time and memory. Even when covariates (i.e., state, trait anxiety scores) were analyzed, there were no significant differences between the groups and tasks, although the gathered data showed trends in the expected direction.     

Severity of Emotional and Behavioral Problems Among Poor and Typical Readers

The purpose of this study was to examine the severity of behavioral and emotional problems among adolescents with poor and typical single word reading ability (N = 188) recruited from public schools and followed for a median of 2.4 years. Youth and parents were repeatedly assessed to obtain information regarding the severity and course of symptoms (depression, anxiety, somatic complaints, aggression, delinquent behaviors, inattention), controlling for demographic variables and diagnosis of ADHD. After adjustment for demographic variables and ADHD, poor readers reported higher levels of depression, trait anxiety, and somatic complaints than typical readers, but there were no differences in reported self-reported delinquent or aggressive behaviors. Parent reports indicated no differences in depression, anxiety or aggression between the two groups but indicated more inattention, somatic complaints, and delinquent behaviors for the poor readers. School and health professionals should carefully assess youth with poor reading for behavioral and emotional symptoms and provide services when indicated.     

Relations among self-reported depressive symptoms in clinic-referred children versus adolescents.

Although there is consensus regarding the existence of childhood depression, disagreement remains as to whether symptoms are developmentally isomorphic. Previous studies focused on developmental differences in symptom levels; analyses of relations among symptoms may be more appropriate, however. Here both approaches were used to compare the Children's Depression Inventory responses from 1,030 clinic-referred children and adolescents. Four of nine symptom categories showed significant developmental differences in their correlations with total score. Externalizing behavior and guilt were more strongly related to depression in children than adolescents; affective symptoms and concerns about the future showed the reverse pattern. Results illustrate the importance of considering relations among symptoms as well as differences in symptom levels when evaluating theoretical claims about developmental differences in the nature of clinical syndromes.     

Mood and the self-reference bias in recall

Hypotheses linking a negative recall bias (or negative self-schema) with vulnerability to depression were tested using an experimental mood-induction task. Extent of bias in student subjects was found to be unstable over a 4-month period, but different measures of memory bias within one session were highly correlated. Marginally significant correlations in the expected direction were found between estimates of recall bias and mood state, whether measured at the same or at different times. Change in mood following induction did not relate to change in bias, suggesting that the observed differences in recall are not a simple function of transient mood state alone. Equally, the initial recall bias did not predict the extent of mood shift following induction, as would be expected if a negative self-schema determined ease of mood shift in a negative direction. However, significant correlations were found between negative recall bias and self-reported frequency and severity of depression, lending equivocal support to the negative self-schema model.     

Selective reminding procedure in depression and dementia

Patients with mild dementia of the Alzheimer's type (DAT), patients with major depression, and normal elderly control subjects were administered a verbal learning task using the selective reminding procedure. Depressed patients were impaired on total recall and the proportion of items retained from one trial to the next without reminding and did not benefit from imagery in retaining items over consecutive trials. The DAT patients were impaired on all measures derived from the test, including storage and recognition memory. With the exception of the ability to benefit from imagery, all of the measures distinguished depressed and mild DAT patients. These findings are consistent with deficient encoding in DAT and performance deficits as a function of effortful cognitive processing in depression.     

Obsessive-compulsive disorder with comorbid major depression: what is the role of cognitive factors?

Individuals with obsessive-compulsive disorder (OCD) commonly experience comorbid mood disturbances such as major depressive disorder (MDD). Previous studies that have compared OCD patients with and without MDD have revealed differences in demographic characteristics, clinical severity, and symptom presentation between these two patient groups. Previous studies have not, however, examined whether there are differences with respect to cognitive processes. The present study therefore aimed to address this gap in the literature. Eighty patients with OCD and no unipolar mood disorders were compared with 34 OCD patients with comorbid major depression on measures of OCD symptoms, cognitions, and insight, as well as on measures of depression and functional impairment. Whereas depressed OCD patients evidenced higher scores than non-depressed OCD patients on semi-idiographic measures of OCD symptoms and cognitions, this was not the case for nomothetic measures. Functional impairment and the tendency to misinterpret innocuous intrusive thoughts as significant emerged as unique predictors of depression within the entire sample of OCD patients. Results are discussed in terms of (a) the importance of semi-idiographic assessment of OCD, (b) possible explanations for the relationship between OCD symptoms, depression, and cognitive processes, and (c) the psychological treatment of comorbid OCD and MDD.     

Differential Item Functioning of the Symptoms of Major Depression by Race and Ethnicity: An Item Response Theory Analysis

This study examines the psychometric properties, and particularly differential item functioning (DIF) due to racial and ethnic group, of the criteria for a major depressive episode using a large sample (N?=?1,063) of outpatients seeking treatment for mood and anxiety disorders. DIF was evaluated using multiple group confirmatory factor analysis. Item thresholds fell along a continuum with the core features of depressed mood and anhedonia, along with fatigue, being endorsed at lower levels of depression, and change in appetite and suicidal ideation endorsed at more severe levels of depression. Item discriminations, reflecting an item’s ability to discriminate between lower and higher levels of depression, were highest for depressed mood and anhedonia, and lowest for change in appetite and suicidal ideation. When examining model fit among the racial groups we did not find differences in symptom functioning, providing support for the use of these symptoms across diverse groups. This is of particular importance given the paucity of studies examining this question using a semi-structured clinician administered instrument to a clinical sample.     

Impairment in risk-sensitive decision-making in older suicide attempters with depression

Suicidal behavior is a potentially lethal complication of late-life depression. In younger adults, suicide has been linked to abnormal decision-making ability. Given that there are substantial age-related decreases in decision-making ability, and that older adults experience environmental stressors that require effective decision-making, we reasoned that impaired decision-making may be particularly relevant to suicidal behavior in the elderly. We thus compared performance on a probabilistic decision-making task that does not involve working memory ("Cambridge Gamble Task") in four groups of older adults: (1) individuals with major depression and a history of suicide attempt (n = 25), (2) individuals with major depression with active suicidal ideation but no suicide attempt (n = 13), (3) individuals with major depression without suicidality (n = 35), and (4) nondepressed control subjects (n = 22). There was a significant effect of group on quality of decision-making, whereby the suicide attempters exhibited poorer ability to choose the likely outcome, compared with the nonsuicidal depressed and nondepressed comparison subjects. There were no group differences in betting behavior. The suicide attempters differed in several aspects of social problem-solving on a self-report scale. Quality of decision-making was negatively correlated with the score on the impulsive/careless problem-solving subscale. These data suggest that older suicide attempters have a deficit in risk-sensitive decision-making, extending observations in younger adults. More specifically, older suicide attempters seem to neglect outcome probability and make poor choices. These impairments may precipitate and perpetuate suicidal crisis in depressed elders. Identification of decision-making impairment in suicidal elders may help with designing effective interventions.     

Irrational Beliefs in Employees with an Adjustment,a Depressive,or an Anxiety Disorder: a Prospective Cohort Study

It remains unclear if patients with different types of common mental disorders, such as adjustment, anxiety and depressive disorders, have the same irrational ideas. The aim of this prospective cohort study (n = 190) is to investigate differences in level and type of irrational beliefs among these groups and to examine whether a change in irrational beliefs is related to symptom recovery. Irrational beliefs (IBI) and symptoms were measured at four points in time: at baseline, after 3, 6 and 12 months. Results showed that diagnostic groups differed in their level of irrational beliefs and this effect remained over time. Highest levels of irrationality were observed in the double diagnosis group, followed by the anxiety disorder group and the depression group. Participants with adjustment disorders showed the lowest levels of irrationality, comparable to a community sample. We did not find differences in the type of irrational beliefs between diagnostic groups. The level of irrationality declined over time for all diagnostic groups. No differences in decrease were observed between diagnostic groups. The magnitude and direction of change in irrational beliefs were related to the magnitude of recovery of depressive, anxiety and stress symptoms over time. These results support the application of general cognitive interventions, especially for patients with a depressive or an anxiety disorder.     

Neuropsychological indicators of preclinical Alzheimer’s disease among depressed older adults

Older adults with major depressive disorder (MDD) may also have preclinical Alzheimer’s disease (AD). Differential diagnosis is quite challenging due to the overlapping symptoms of MDD and AD. In the current study, we predicted that impaired long-term memory (an area most affected in early AD), but not executive function (an area affected in MDD and AD), would distinguish older depressed patients who developed AD from those who did not. Patients (N = 120) assessed as having MDD but not dementia at baseline were administered tests of cognitive function and followed longitudinally for subsequent diagnosis of AD. Using structural equation modeling we found a latent construct of long-term memory to be associated with AD to a greater extent than executive functioning. Additional analyses to enhance clinical utility of findings indicated that individual tests of episodic memory were most predictive of AD status. Tests of long-term memory can be utilized by the clinician when assessing for preclinical AD among depressed elderly.     

A comparison of depressed and nondepressed disturbed children on measures of attributional style,hopelessness, life stress,and temperament

Upon admission to a hospital treatment program, clinically depressed and nondepressed children (aged 9–17 years) were assessed on measures of attributional style, hopelessness, depression, life stress, and child temperament. The depressed group tended to attribute positive events to specific and unstable factors when compared with the nondepressed sample. Group differences also were found on child temperament measures. However, no differences were reported between the diagnostic groups on self-reported depression, hopelessness, or life stress. The findings suggested that there may not be a unique constellation of cognitive characteristics in depressed children when compared with a nondepressed clinical sample. For both depressed and nondepressed groups, treatment did appear to affect self-reported depression and overall ratings of depressogenic attributional style.     

Subclinical and clinical depression: Are analogue studies justifiable?

A group of subclinically depressed students SS (N = 36) was compared with a group of mildly depressed patients MP (N = 48) and a group of severely depressed patients SP (N = 33) on 21 raw symptom severity scores in the Beck Depression Inventory (BDI). Stepwise discriminant function analysis yielded two significant functions, the first representing severity in core symptoms of depression. Symptom severity scores were then adjusted to allow for differences in total BDI scores among the groups and the adjusted scores were reanalysed. Two significant functions were again found, the first representing severity in only three of the core symptoms defining depression according to DSM III. The adjusted scores were further adjusted to equate the groups for differences in score variance and the discriminant analysis was repeated. Again two significant functions were found. The first, clearly representing a dimension of subclinical-clinical depression, was defined by a set of core symptoms smaller than that specified in the DSM III definition of major depression. It is argued that clinical and subclinical depression differ mainly in the absolute severity of the core symptoms defining depression but that subclinical shows a relative emphasis of some, and a relative de-emphasis of other core symptoms. It is concluded that subclinical depression in students offers a fairly accurate ‘model’ of clinical depression and that analogue studies are, to a reasonable extent, justifiable.     

Symptom Expression and Somatization Among Elderly Korean Immigrants

In a study of expression of symptoms of somatization, depression, and other biopsychological conditions, 70 elderly Korean immigrants in the greater Washington, D.C., metropolitan area (35 who met the criteria for major depression and 35 who did not meet those criteria) were administered a Korean version of the Brief Symptom Inventory (BSI). Subjects who met the criteria for depression had the highest mean score on the BSI somatization dimension compared with other normative samples including a sample of psychiatric inpatients. A factor analysis of data from the BSI showed that for elderly Korean immigrants, a factor of somatization was identified that included the items from the original BSI obsessive-compulsive, somatization, and anxiety dimensions. Items loading on the somatization factor suggest that elderly Korean subjects experience body and mind as a unitary system and tend to communicate the distress associated with old age, cultural adjustment, and family and social changes through somatic symptoms.