Variability in the semantic errors produced by brain-injured patients

One of the most common types of errors produced by aphasic patients during oral word production is semantic errors. However, although aphasia semantic errors are often treated as a single homogenous group, there are, in fact, several subtypes defined by the nature of the error-target relationship: paradigmatic, if the two words are category coordinates; syntagmatic, if they are associatively related but from different semantic categories; and superordinate, if the meaning of the error is broader than the meaning of the target. The goal of this study was to investigate whether or not these various subtypes of semantic errors have a similar processing origin. With this objective, we compared the patterns of semantic errors made by a group of Alzheimer patients in a picture-naming task with those made by a group of aphasic patients. We examined the percentages of the different error types, the degree of association between target and error, and the frequency values both of errors and targets. The results suggest that the three subtypes of semantic errors have different origins: the superordinate appear to arise at the semantic level, the syntagmatic at the lexical level, and the paradigmatic at both levels of processing.     

Depression, Anxiety and Anger in Subtypes of Irritable Bowel Syndrome Patients

The present study aimed to elucidate the differences in depression, anxiety, anger, and quality of life in a sample of non-psychiatric IBS patients, starting from the hypothesis that IBS subtypes may have different symptomatic expressions of negative emotions with different outcomes on quality of life measures. Forty-two constipation-predominant IBS (C-IBS) subjects and 44 diarrhea-predominant IBS (D-IBS) subjects, after an examination by a gastroenterologist and a total colonoscopy, underwent a clinical interview and psychometric examination for the assessment of depression, anxiety, anger and quality of life. IBS subtypes showed different symptomatic profiles in depression, anxiety and anger, with C-IBS patients more psychologically distressed than D-IBS subjects. Affective and emotional symptoms should be considered as specific and integral to the syndrome, and recognizing the differences between IBS subtypes may have relevant implications for treatment options and clinical outcome.     

The Puzzle of Regional Brain Activity in and Anxiety: The Importance of Subtypes and Comorbidity

The literature on brain activity in depression and anxiety is reviewed with an on highlighting discrepancies and inconsistencies. In particular, and posterior asymmetries have been reported for both depression anxiety, but the magnitude and direction of these asymmetries has been We propose that by identifying subtypes of depression and anxiety of these inconsistencies can be explained. In addition, we review suggesting that issues of comorbidity are important to consider in to account for regional brain activity in depression and anxiety.     

Depression at 3 Months Poststroke in the Elderly: Predictors and Indicators of Prevalence

The prevalence and determinants of depression in 79 elderly patients were assessed at 3 months poststroke. Predictor variables included gender, age, history of previous stroke, and hemispheric location of stroke. Indicator variables included two measures of physical functioning and seven aspects of cognitive functioning. Results indicated that 56% of patients had impairment in activities of daily living, and 39% reported clinically significant levels of depression. Prevalence of cognitive impairment ranged from 31% on a measure of basic cognitive functioning, through to 89% on a measure of complex attention. The results from a hierarchical multiple regression analysis showed that the combination of predictor and indicator variables explained 53% of the variance in depression scores. The three individual variables of history of previous stroke, physical functioning, and simple attention all made significant unique contributions to the variance in depression scores. The contribution of these findings to the ongoing debate concerning lesion location and poststroke depression is discussed.     

Heterogeneity in the Unemployment Experience: A Cluster Analytic Investigation1

Two hundred forty-seven unemployed individuals completed a battery of scales assessing constructs relevant to the unemployment situation. These constructs included: financial situation, employment commitment, job-seeking confidence, time structure, mental health, cognitive impairment, physical symptoms, and unemployment negativity (how upset an individual is about being unemployed). The results on a subset of these variables were cluster analyzed to assess whether the unemployed individuals in this sample formed meaningful subtypes. The cluster analysis revealed four distinct subtypes of unemployed individuals. The subtypes that were identified can help us to understand the heterogeneity inherent in the unemployment experience. The differences among the subtypes also have implications for designing outplacement and intervention workshops for the unemployed.     

Group comparisons of DSM-IV subtypes of chronic depression: validity of the distinctions, part 2

The nosology of chronic depression in Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV, American Psychiatric Association, 1994) is highly complex and requires clinicians to differentiate among several chronic course subtypes. This study replicates an earlier investigation (J. McCullough et al., 2000; see record 2000-05424-007) that found few differences among Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.; DSM-III-R; American Psychiatric Association, 1987) categories of chronic depression. In the present study, 681 outpatients with chronic major depression, double depression, recurrent major depression without full interepisode recovery, and chronic major depression superimposed on antecedent dysthymia were compared. Few differences were observed on a broad range of demographic, clinical, psychosocial, family history, and treatment response variables. The authors suggest that chronic depression should be viewed as a single, broad condition that can assume a variety of clinical course configurations.     

Social factors and the psychobiology of depression: relations between life stress and rapid eye movement sleep latency.

We examined psychosocial factors (i.e., life stress) and biological factors (i.e., REM sleep latency) that are hypothesized to be of complementary importance for defining depressive subtypes in a sample of 61 nonpsychotic, endogenous major depressives. Subjects were evaluated on several diagnostic scales for life stress, on electroencephalographic sleep data, and on 2 symptom measures for depression. As predicted, persons with severe stress that occurred shortly before depression onset had essentially normal REM latency values; patients without such stress had reduced REM latency values. Both stress and REM latency were also associated with greater severity of self-reported depressive symptoms. Alternative explanations of these findings are discussed, with particular emphasis on different roles of pre-onset and post-onset stressors.     

The assessment of personality characteristics in depressed and dependent psychiatric inpatients

The diagnosis and treatment of depression may be complicated by the presence of excessive dependency needs. Previous research has found stable personality traits useful in identifying depressive subtypes. This study was designed to assess the personality characteristics of 106 psychiatric inpatients. Subjects were grouped according to the presence or absence of two primary dimensions: depression and dependency. Results indicated that both depression and dependency were significantly related to various indices of psychopathology. Main effects were more useful than interactions, implying that depression and dependency both affect symptomology directly rather than interactively. Although the assessment of personality traits may be complicated by the presence of a major psychiatric disorder, results from our study suggest that the assessment of both Axis I and Axis II variables can be useful in understanding the current clinical picture.     

HPA axis and sleep: identifying subtypes of major depression

It is increasingly acknowledged that the diagnosis of major depression encompasses patients who do not necessarily share the same disease biology. Though the diagnostic criteria allow the specification of different subtypes, e.g. melancholic and atypical features, a consensus still has to be reached with regard to the clinical symptoms that clearly delineate these subtypes. Beside clinical characteristics, biological markers may help to further improve identification of biologically distinct endophenotypes and, ultimately, to devise more specific treatment strategies. Alterations of the hypothalamus-pituitary-adrenal (HPA) axis and sleep architecture are not only commonly observed in patients with major depression, but the nature and extent of these alterations can help to identify distinct subtypes. Thus, a HPA overdrive, due to enhanced secretion of corticotropin-releasing hormone (CRH) and an impaired negative feedback via glucocorticoid receptors, seems to be most consistently observed in patients with melancholic features. These patients also show the clearest sleep-electroencephalogram (EEG) alterations, including disrupted sleep, low amounts of slow wave sleep (SWS), a short rapid eye movement (REM) latency and a high REM density. In contrast, patients with atypical features are characterized by reduced activity of the HPA axis and ascending noradrenergic neurons in the locus coeruleus. Though sleep-EEG alterations have been less thoroughly examined in these patients, there are data to suggest that SWS is not reduced and that REM sleep parameters are not consistently altered. While the atypical and melancholic subtypes of major depression may represent the extremes of a spectrum, the distinct clinical features provide an opportunity to further explore biological markers, as well as environmental factors, contributing to these clinical phenotypes. Moreover, dysregulations of the HPA axis and sleep-EEG alterations can also be induced in rodents, thereby allowing alignment of critical biological aspects of a human disease subtype with an animal model. Such "Translational Research" efforts should help to develop targeted therapies for distinct patient populations.     

Disorder-specific Effects of CBT for Anxious and Depressed Youth: A Meta-analysis of Candidate Mediators of Change

The commonalities between anxiety and depression have been discussed before, but few have delineated the potentially different mechanisms through which treatments work for these populations. The current study conducted a comprehensive review of child and adolescent randomized clinical trials that tested cognitive-behavioral therapy (CBT) for anxiety or depression. All studies were required to have assessed both treatment outcomes and at least one theory-specific process target, including behavioral, physiological, cognitive, and coping variables. Using a meta-analytic approach, CBT demonstrated positive treatment gains across anxiety, depression, and general functioning outcomes. CBT for anxiety also produced moderate to large effects across behavioral, physiological, cognitive, and coping processes, with behavioral targets demonstrating potentially the greatest change. CBT for depression produced small effects for cognitive processes but nonsignificant effects for behavioral and coping variables. Findings were generally consistent with CB theory but suggest potentially different mediators in the treatment of anxiety and depression. Results are discussed in terms of implications for mechanisms research, theories of change, and treatment development.     

Cluster Subtypes in the Children's Category Test Standardization Sample

Representative profile subtypes, based on subtest error scores, were examined in the standardization sample of the Children's Category Test (CCT; Boll, 1993), with separate analyses for the younger subgroup (ages 5–8 years; CCT-1) and the older subgroup (ages 9–16 years; CCT-2). Two-stage cluster analysis identified three reliable subtypes for the CCT-1, and four reliable subtypes for the CCT-2. Both level and pattern of performance differences contributed to the differentiation of subtypes. The clusters that varied in level of performance differed significantly in age and in level of performance on an independent memory measure, but not in gender or educational background. The distinct patterns of CCT subtest performance exhibited by the other clusters could not be reduced to any of these variables, suggesting that such patterns reflect relatively unique variations in specific aspects of problem solving. Guidelines for the consideration of clinically obtained CCT error subtest profiles are provided.     

Attributional versus preattributional variables in self-esteem and depression: a comparison and test of learned helplessness theory

Predictions made according to the attributional reformulation of learned helplessness theory concerning the cognitive determinants of low self-esteem and depression were tested in two samples of undergraduates; real and hypothetical life events were used. As predicted, internal attributions for hypothetical success and failure were correlated with self-esteem, but there was an unexpected correlation with global attributions for negative outcomes. Two "preattributional" variables, consensus and consistency judgments, were also related to self-esteem and depression. In contrast to learned helplessness theory, a path analysis indicated that these variables were not attributionally mediated. Consensus judgment was as strong a predictor of depression as the number of recent distressing life events that subjects had experienced. Other evidence that links depression to perceived low consensus is described, and a possible etiological role for this variable is outlined.     

An examination of the relation of individual difference variables to loneliness

This study investigated the relation of five individual difference variables (extroversion, depression, self-esteem, neuroticism, and attitude toward others) to loneliness. The relative contributions of two different models that might explain these relations were examined. One model suggests that individual difference variables are related to loneliness through the mediation of social network variables; that is, individual difference variables may reduce people's motivation and/or ability to build and maintain social relationships, which in turn leads to loneliness. The second model, the cognitive bias model, states that both the individual difference variables and loneliness are influenced by the same intrapersonal, cognitive processes. Some people are prone to negative affect and tend to evaluate themselves and their relationships negatively. The relations of self-esteem, neuroticism, and depression to loneliness were hypothesized to reflect the cognitive bias model, while extroversion and attitudes toward others were hypothesized to be related to loneliness through the mediation of social network variables. Eighty-two female and 42 male adults completed measures of loneliness and the five individual difference variables, as well as an instrument assessing their social networks. The results indicated partial support for both models for each of the individual difference variables. Together, the two models did a good job of explaining the correlations of the individual difference variables and loneliness. The implications of these findings, as well as their relation to previous research, are discussed.     

Sex roles and depression: A preliminary investigation of the direction of causality

The present study examined the direction of the relation between sex role self-concept and depression. A total of 23 males and 32 females were given the Personal Attributes Questionnaire and the Beck Depression Inventory at two times separated by a 3-month interval. Results of a cross-lagged panel correlational analysis found no evidence for sex role orientation as a cause of depression. Instead, the data suggested that emotional well being precedes self-perceived instrumentality, but the influence of third variables could not be overlooked. The implications of these data are discussed with particular reference to the need for more complex theoretical formulations of the relation between self-perceived instrumentality and adjustment.     

Use of Technology to Provide Mental Health Care for Racial and Ethnic Minorities: Evidence,Promise, and Challenges

Mental health disparities among racial and ethnic minorities (R&EM) are well documented. Some of the variables driving these disparities are limited care availability, difficulty accessing services, and attitudinal barriers. Although no single approach will eliminate all these obstacles, the use of technology to provide mental health services represents a paradigmatic shift in care delivery that could reduce unmet mental health need. Despite increasing evidence supporting the feasibility and efficacy of behavioral intervention technologies (BITs), such evidence is more limited among R&EM. For BITs to truly reduce disparities in care, these interventions need to overcome common barriers to treatment that disproportionally affect R&EM. This article reviews the empirical support of different BIT modalities with R&EM. We then provide informed clinical recommendations for the use of BITs with these groups, as well as a case example illustrating these guidelines. We conclude this article by discussing future directions that can inform the development and refinement of BIT approaches for R&EM.     

Psychophysiological Identification of Depression Subtypes in Older Adults: Problematic Diagnostic Heterogeneity in the DSM-III-R and DSM-IV

The DSM-IV does not subclassify patients with depression on the basis of anxiety level. Hence a significant confound may exist in all outcome studies that employ DSM definitions of depression. To establish that objectively identifiable anxious and nonanxious subtypes of depression do indeed exist, a psychophysiological assessment battery was used with 114 treatment-seeking older adults. Dichotomous criterion categorization as either Nonanxious Depressed or Anxious Depressed was based on (a) DSM-III-R/DSM-IV diagnosis, and (b) standardized questionnaires of psychopathology. Multivariate analyses revealed no differences between groups when DSM criteria were used to classify participants. However, identical analyses using phenomenological diagnostic criteria indicated that anxious and nonanxious depressed participants differed in their psychophysiological response to negative imagery. Although anxious and nonanxious depressed participants evince different psychophysiological response patterns, these differences unfortunately are obscured by the DSM. Consequently, a phenomenological classification system may be more appropriate with affective disorders.     

Subtyping of individuals undergoing treatment for cocaine dependence

To identify subtypes among individuals undergoing treatment for cocaine dependence, we evaluated 115 people with regard to sociodemographic, drug-related and psychopathological characteristics. Ten variables were preselected as the basis for a two-step cluster analysis with the aim of identifying subtypes. Two subtypes were identified (Type A, N = 37, and Type B, N = 78 subjects). The variable that best discriminated the two subtypes was occasional heroin consumption. In addition, there were significant differences in mean age, mean age at onset of cocaine consumption, mean number of years consuming cocaine, and principal route of ingestion. None of the psychopathological variables considered significantly differentiated the two groups.     

Multiaxial taxonomy of fibromyalgia syndrome patients

Pain, disability, and depression are present in various degrees in patients with fibromyalgia syndrome. Cluster analysis was used in this research to ascertain the existence of subgroups of patients in a fibromyalgia sample based on these variables. Two clusters were defined: one characterized by high levels of pain, disability, and depression (n=51) and another characterized by low levels of pain, disability, and depression (n=67). Multivariate analysis of variance (MANOVA) confirmed differences between clusters on these health status factors and a second MANOVA revealed that the subgroup with a poorer health status reported greater passive coping, helplessness, and stress, and less satisfaction with social support, than the subgroup with better health status. Logistic regression indicated that the best discriminator of subgroup membership was helplessness. These results suggest that different approaches to patient management, particularly intervention strategies aimed at reducing helplessness, may be beneficial for patients with high levels of pain, disability, and depression.     

Depression, self-esteem, loneliness, and social support among adolescent mothers participating in the new parents project

The purpose of this pilot study was to examine levels of depression, self-esteem, loneliness, and social support, and the relationships between these variables, among adolescent mothers participating in the New Parents Project (formerly called the Young Parents Project). The sample consisted of 21 adolescent mothers recruited from three primary health care practices in different Midwestern cities. It was found that depression scores were in the high range (CES-DC > 15) for 53% of the participants. Strong, significant relationships were found, except between depression and self-esteem. The implications for enhancement of the New Parents Project, so as to better meet the psychological needs of adolescent mothers, are discussed.     

Of the Same in the Different. What is Wrong with Kuhn's Use of ``Seeing' and ``Seeing as'

Kuhn uses the distinction between `(simple) seeing', and `seeing as' in order to claim that among competing paradigms there cannot be found any middle (experiential) ground; nothing `same' can be located behind such radically different paradigm-worlds. He claims that scientists do not see a common something as this thing at one time and as that thing at another. Each time scientists simply see what they see. To claim the contrary is to claim that scientists arrive at their paradigmatic experiences of the world due to an interpretation of something `same' beyond the paradigms,and Kuhn rejects this. The question of whether a common ground can be found behind two or more different paradigmatic world-views relates to many issues in philosophy of science and in general epistemology (e.g., realism-idealism, relativism-objectivism, etc.). As a first approach to these, in this paper I examine the presuppositions of Kuhn's claim, its consistency in the exposition, and its overall viability. I conclude that the actual way in which Kuhn refers to the historical examples he examines undermines his explicit thesis. But also the paradox he himself recognizes in his thought that `though the world does not change with a change of paradigm, the scientists afterward works in a different world' can be solved only if we start to think seriously about the necessity and nature of a `same in the different' behind the competing paradigmatic world-experiences. This revised version was published online in July 2006 with corrections to the Cover Date.