Comparison of DSM-III-R chronic major depression and major depression superimposed on dysthymia (double depression): validity of the distinction

The nosology of chronic depression has become increasingly complex since the publication of the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987), but there are few data available to evaluate the validity of the distinctions between the subtypes of chronic depression. The validity of the distinction between DSM-III-R chronic major depression (CMD) and major depression superimposed on dysthymia (double depression, DD) was examined. Participants were 635 patients with chronic depression in a 12-week trial of antidepressant medications. Patients with CMD, DD, and a 3rd group with a chronic major depressive episode superimposed on dysthymia (DD/CMD) were compared on demographic and clinical characteristics, family history, and response to treatment. Few differences were evident, although the depression of patients with DD/CMD tended to be more severe.     

The impact of sleep deprivation on decision making: a review

Few sleep deprivation (SD) studies involve realism or high-level decision making, factors relevant to managers, military commanders, and so forth, who are undergoing prolonged work during crises. Instead, research has favored simple tasks sensitive to SD mostly because of their dull monotony. In contrast, complex rule-based, convergent, and logical tasks are unaffected by short-term SD, seemingly because of heightened participant interest and compensatory effort. However, recent findings show that despite this effort, SD still impairs decision making involving the unexpected, innovation, revising plans, competing distraction, and effective communication. Decision-making models developed outside SD provide useful perspectives on these latter effects, as does a neuropsychological explanation of sleep function. SD presents particular difficulties for sleep-deprived decision makers who require these latter skills during emergency situations.     

Do you remember proposing marriage to the Pepsi machine? False recollections from a campus walk

During a campus walk, participants were given familiar or bizarre action statements (e.g., “Check the Pepsi machine for change” vs. “Propose marriage to the Pepsi machine”) with instructions either to perform the actions or imagine performing the actions (Group 1) or to watch the experimenter perform the actions or imagine the experimenter performing the actions (Group 2). One day later, some actions were repeated, along with new actions, on a second walk. Two weeks later, the participants took a recognition test for actions presented during the first walk, and they specified whether a recognized action was imagined or performed. Imagining themselves or the experimenter performing familiar or bizarre actions just once led to false recollections of performance for both types of actions. This study extends previous research on imagination inflation by demonstrating that these false performance recollections can occur in a natural, real-life setting following just one imagining.     

Sequential analysis of visual habituation in preschool children

The study breaks down the data from a preschool (mean age of students, 63 months) visual habituation experiment using a second-by-second analysis of the entire process, including fixation time and onsets for habituation and recovery trials and for each intertrial interval. The results parallel those suggested by Cohen, DeLoach, and Rissman (Child Development, 1975, 46, 611–617), for infants and are described using a two-process model of visual attention.     

Relations between nutrition and cognitive performance in Egyptian toddlers

Two relatively unexplored questions--which specific components of chronic mild child malnutrition are associated with specific behavioral and cognitive deficits and do psychosocial child rearing factors moderate the nutrition-development relationship?--were investigated in a longitudinal study involving 153 toddlers from the Egyptian village of Kalama. Beginning at study entry at age 18 months and continuing until 30 months, food intake information was obtained for 2 consecutive days each month. During the same period, researchers visited the homes twice a month to observe both toddler behavior and caregiver styles. Finally, standardized infant development tests were administered at 24 months and 30 minutes and the capacity for exploratory, symbolic play was assessed. Specific components of nutritional intake at 18-23 months of age were confirmed to be uniquely related to specific developmental outcomes at 24 months of age. Changes in toddler intake from 18-30 months also predicted 30-month cognitive performance. At 24 months, general mental competence was associated positively with fat intake, total kilocalories, and total protein intake while symbolic play capacity was related only to total protein intake. Significant increases in predictive variance occurred when the model was expanded to encompass caregiver behaviors as well as nutritional factors. For example, when nonverbal response to child vocalizations was used as the environmental measure, there was evidence of both coactive and synergistic interactions for comparisons involving cognitive development indicators. For symbolic play, an increase in predictive variance was found when the model included the multiplicative interaction of animal kilocalories by nonverbal response to vocalizations. Also observed was a buffering effect against poor psychosocial rearing conditions given the presence of adequate nutritional intake. These findings suggest the feasibility of multidimensional risk profiles, the provision of specific nutrients targeted at specific deficits, and multidisciplinary interventions.     

Affect in early memories of borderline patients

Psychoanalytically oriented observers using the framework of object relations theory noted that patients with borderline personality organization manifest serious pathology in their capacity to use internalized imagery to cope with the vicissitudes of separation-individuation. This study examined one source of such imagery, the affect associated with a specific sample of early memories, including the earliest recollections of parents. Patients with borderline personality disorder were compared with paranoid schizophrenics and patients with neurotic character pathology. Forty-five outpatients, 15 in each group, participated in the study. It was found that borderline patients had significantly fewer positively toned early memories than neurotics or paranoid schizophrenics. Only the neurotic group, had a majority of affectively positive memories. The results are generally consistent with object relations theories of borderline psychopathology.     

Reflections on the process of psychotherapeutic change as applied to medical situations

This article takes the basic ideas on the process of changing implicit knowledge put forward in this special issue, and extends them beyond psychotherapy to include other therapeutic relationships that occur in medicine. One vignette, from an encounter between a medical student and a dying patient, illustrates how a “moment of meeting” changes the student as well as the patient. The second shows how therapeutic interventions for new mothers with their newborn infants involve “moments of meeting” that alter the mother's implicit knowledge of her baby and of herself as a mother. © 1998 Michigan Association for Infant Mental Health