Psychiatrische Beiträge

JOURNAL CLUB

Psychiatrische Beitr?ge     

Suicidality and its relationship to treatment outcome in depressed adolescents

This study investigates the impact of suicidality on treatment outcome in 107 depressed adolescents who participated in a clinical trial, and received either cognitive-behavioral (CBT), systemic-behavioral-family (SBFT), or non-directive-supportive therapy (NST). Suicidal depressed adolescents had a higher dropout rate and were more likely to be depressed at the end of treatment, in large part due to the particularly poor response of suicidal patients to NST. The relationship between suicidality and treatment response was mediated by severity of depression and hopelessness at intake. Hopelessness should be specifically targeted early in treatment. Suicidal depressed adolescents should not receive NST but a specific treatment like CBT.     

Effectiveness of cognitive-behavioral therapy for adolescent depression: a benchmarking investigation

In this study, we examined the effectiveness of cognitive-behavioral therapy (CBT) for adolescent depression. Outcomes of 80 youth treated with CBT in an outpatient depression specialty clinic, the Services for Teens at Risk Center (STAR), were compared to a "gold standard" CBT research benchmark. On average, youths treated with CBT in STAR experienced significantly slower symptom improvement than youths in the CBT benchmark. However, outcomes for STAR teens were more similar to the research benchmark when accounting for differences in referral source (clinical versus advertisement) between the datasets. Results support further efforts to test the effectiveness of CBT in clinically representative community practice settings and samples.     

Possible involvement of the vagus nerve in monitoring plasma catecholamine levels

In their article Miyashita and Williams (Neurobiology of Learning and Memory 2006, 85, 116-124) describe the effect of peripheral administration of epinephrine on neural discharge in vagal afferent fibers. It seems that described data supports the hypothesis of the vagus nerve participation in monitoring plasma catecholamine levels and consequently modifying brain functions. However, do these results indicate indeed that afferent vagus nerve pathways are activated by circulating epinephrine? Catecholamines influence virtually all tissues and many functions. Vagus nerve participates significantly in monitoring of those effects. Therefore epinephrine-induced increases of afferent vagus nerve activity described by Miyashita and Williams may reflect not only exclusive activation of beta-adrenergic receptors but also an activation of other types of receptors on vagal sensory nerve endings, e.g., mechanosensors, chemoreceptors, and osmosensors. Discussion is focused on the possibility that the increase in afferent vagus nerve activity may reflect activation of mechanoreceptors of the vagus nerve endings in the epinephrine-activated heart.     

Altered Emotional Processing in Pediatric Anxiety,Depression, and Comorbid Anxiety-Depression

The goal of this study was to examine some of the mechanisms underlying emotion regulation in childhood affective disorders by examining the impact of distracting emotional information during performance on a working memory task (Emotional n-back or E-n-back). The sample included 75 children (38 girls and 37 boys) between 8 and 16 years of age meeting criteria for: Anxiety disorder (ANX, n = 17), Major depressive disorder (MDD, n = 16), Comorbid anxiety and depression (CAD, n = 24), or Low-risk normal control (LRNC, n = 18). Results showed that the MDD and CAD groups had significantly longer reaction times on negative emotional backgrounds compared to neutral backgrounds, whereas the LRNC group had significantly longer reaction times on positive backgrounds. These results suggest altered processing of emotional information particularly associated with depression. Because the E-n-back task engages higher-order cognitive processes, these results suggest that these alterations in processing emotional information also interfere with the cognitive processes that govern how attentional resources are allocated. Further, research is needed to replicate this study and delineate underlying neural mechanisms.     

Predictive validity of an Implicit Association Test for assessing anxiety

The Implicit Association Test (IAT) was adapted to measure anxiety by assessing associations of self (vs. other) with anxiety-related (vs. calmness-related) words. Study 1 showed that the IAT-Anxiety exhibited good internal consistency and adequate stability. Study 2 revealed that the IAT-Anxiety was unaffected by a faking instruction. Study 3 examined the predictive validity of implicit and explicit measures and showed that the IAT-Anxiety was related to changes in experimenter-rated anxiety and performance decrements after failure. Study 4 found that several behavioral indicators of anxiety during a stressful speech were predicted by the IAT. Taken together, these studies show that the IAT-Anxiety is a reliable measure that is able to predict criterion variables above questionnaire measures of anxiety and social desirability.     

Heterarchy of cognition: the depths and the highs of a framework for memory research

To celebrate the levels-of-processing approach, I describe a multilevel evolutionary architecture for human behaviour and cognition. New experimental data on human eye movements are presented that demonstrate a possibility of splitting visual perceptual activity at least on two hierarchical but closely interrelated levels of processing. Furthermore, data from behavioural studies of human memory and neuroimaging testify that within the domain of cognition proper two higher levels can be differentiated. I call them "conceptual structures" and "metacognitive coordinations" and provide evidence that the latter may residue in the phylogenetically new structures of prefrontal and particularly right prefrontal cortices. From this point of few, the most natural framework for an analysis of the levels-of-processing effects on human memory is to consider them as interactions within the main gradients of evolution and development of the corresponding neurophysiological mechanisms. Finally, several new, still unanswered questions for the future research are formulated.     

Varieties of Group Self-Centeredness and Dislike of the Specific Other

This investigation tests relationships between three kinds of group self-centeredness and their relationship with negativity towards specific outgroups. A questionnaire study with 270 undergraduates focused on three prominent kinds of group self-centeredness: ethnocentrism, fundamentalism, and anthropocentrism. Although overall ethnocentrism, fundamentalism, and anthropocentrism were positively intercorrelated, fundamentalism was positively associated with one ethnocentrism dimension (intragroup) and negatively with the other (intergroup). A path analysis showed that each kind of group self-centeredness was related only to negativity to specific and relevant outgroups and not to other outgroups. Implications of the research, particularly for the study of religiosity and prejudice, are discussed.     

The Root of Dance Therapy: A Consideration of Movement,Dancing, and Verbalization vis-à-vis Dance/Movement Therapy

How and when does dance become therapy? And why is there a need for such intervention? The author, one of the great choreographer Balanchine's prima ballerinas and a professional choreographer in her own right as well, ranges far in seeking societal as well as individual causes for the creation of a new psychotherapy. She uses her passionate adherence to dance per se as a vantage point from which to view humanity's trials and tribulations. She also opens a door into the realm of professional, performing dancers who wanted to give their dancing to the world. Her ironic wit takes note of the nondancers who want to be dance therapists. She also draws a loving portrait of one of the originators of dance therapy in the United States, Marian Chace, who became her friend and mentor.     

Markets as a structural solution to knowledge-sharing dilemmas

The authors propose a new structural solution to the knowledge-sharing dilemma. They show that simple auction mechanisms, which impose a rigid set of rules designed to standardize interactions and communication among participants, can prevent some of the detrimental effects associated with conflict of interest in freely interacting groups. The authors report results of two experiments that show that transparent conflicts of interest lead to a breakdown of information sharing, learning, and knowledge transfer in freely interacting groups, but not in simple markets and auctions. In these settings, participants were able to identify the best candidate in a voting game and to learn the solution to an intellective reasoning task, allowing participants to successfully transfer their insights to a series of new intellective tasks (tackled up to four weeks later), despite the conflicts of interests among traders. The authors explain their findings within the theoretical framework of collective induction.