Cardiac morbidity risk and depression and anxiety: a disorder, symptom and trait analysis among cardiac surgery patients

The aim of this study was to examine depression and anxiety disorders and their characteristic symptoms (anhedonia/low positive affect and anxious arousal, respectively), along with measures of state negative affect (NA) and Type D personality, in relation to cardiac surgery related morbidity. Patients awaiting elective coronary artery bypass graft surgery (n=158; 20.9% female; 11.4% concomitant valve surgery; age M=64.7, SD=10.6) underwent the structured MINI International Neuropsychiatric Interview to determine current affective disorders. Patients also completed the Mood and Anxiety Symptom Questionnaire and a measure of Type D personality traits. Postoperative cardiac morbidity was confirmed after surgery during the index hospitalization and included stroke,renal failure, ventilation>24 h, deep sternal wound infection, reoperation, arrhythmia and 30-day mortality at any location (n=59, 37.3% of total). After adjustment for age, recent myocardial infarction, heart failure, hypertension, urgency of surgery and time spent on cardiopulmonary bypass generalized anxiety disorder was associated with cardiac morbidity (odds ratio [OR]=3.26, 95% confidence interval [CI] 1.10-9.67, p=0.03). Adjusted analysis of personality traits revealed the NA component of Type D personality was associated with cardiac morbidity (OR=1.07, 95% CI 1.01-1.14, p=0.03). The Mood and Anxiety Symptom Questionnaire subscales were not associated with increased morbidity risk. Affective disorders, affective phenotypes, and personality traits were differentially associated with post-cardiac surgery morbidity outcomes independent of cardiac surgery morbidity risk factors. Concurrent investigation of depression and anxiety with respect to cardiac outcomes warrants further research.     

Decreased Sensitivity to Phonemic Mismatch in Spoken Word Processing in Adult Developmental Dyslexia

Initial lexical activation in typical populations is a direct reflection of the goodness of fit between the presented stimulus and the intended target. In this study, lexical activation was investigated upon presentation of polysyllabic pseudowords (such as p rocodile for crocodile) for the atypical population of dyslexic adults to see to what extent mismatching phonemic information affects lexical activation in the face of overwhelming support for one specific lexical candidate. Results of an auditory lexical decision task showed that sensitivity to phonemic mismatch was less in the dyslexic population, compared to the respective control group. However, the dyslexic participants were outperformed by their controls only for word-initial mismatches. It is argued that a subtle speech decoding deficit affects lexical activation levels and makes spoken word processing less robust against distortion.     

On the dynamics of implicit emotion regulation: Counter-regulation after remembering events of high but not of low emotional intensity

Valence biases in attention allocation were assessed after remembering positive or negative personal events that were either still emotionally hot or to which the person had already adapted psychologically. Differences regarding the current state of psychological adjustment were manipulated experimentally by instructing participants to recall distant vs. recent events (Experiment 1) or affectively hot events vs. events to which the person had accommodated already (Experiment 2). Valence biases in affective processing were measured with a valence search task. Processes of emotional counter-regulation (i.e., attention allocation to stimuli of opposite valence to the emotional event) were elicited by remembering affectively hot events, whereas congruency effects (i.e., attention allocation to stimuli of the same valence as the emotional event) were obtained for events for which a final appraisal had already been established. The results of our study help to resolve conflicting findings from the literature regarding congruent vs. incongruent effects of remembering emotional events on affective processing. We discuss implications of our findings for the conception of emotions and for the dynamics of emotion regulation processes.     

Transference Focused Psychotherapy for Patients with Comorbid Narcissistic and Borderline Personality Disorder

Clinical experience involving the treatment of patients with comorbid borderline and narcissistic personality disorders suggests that this patient population is among the more difficult to treat within the personality disorder spectrum. In this article, we present refinements of Transference Focused Psychotherapy (TFP) based on our clinical experience with and research data on patients with comorbid narcissistic personality disorder/borderline personality disorder (NPD/BPD). We briefly review object relations formulations of severe narcissistic pathology, as well as recent research in attachment and the allied concept of mentalization, which have provided a new lens through which to view narcissistic disorders. The research findings from two randomized clinical trials demonstrating the efficacy and effectiveness of TFP are presented. The data from the two Randomized Clinical Trials (RCT) allowed for the study of the characteristics of the subgroup of borderline personality disorder patients who have comorbid NPD/BPD. Findings on comorbidity, attachment status, capacity for mentalization, and level of personality organization of borderline patients with comorbid NPD/BPD, compared with borderline patients without comorbid narcissistic pathology (BPD), are presented. Clinical implications of the observed group differences are discussed, with a focus on refinements in the technique of TFP. Clinical case material is presented to illustrate the specific challenges posed by narcissistic patients to carrying out TFP in each phase of treatment.     

Language aptitude for pronunciation in advanced second language (L2) Learners: Behavioural predictors and neural substrates

Individual differences in second language (L2) aptitude have been assumed to depend upon a variety of cognitive and personality factors. Especially, the cognitive factor phonological working memory has been conceptualised as language learning device. However, strong associations between phonological working memory and L2 aptitude have been previously found in early-stage learners only, not in advanced learners. The current study aimed at investigating the behavioural and neurobiological predictors of advanced L2 learning. Our behavioural results showed that phonetic coding ability and empathy, but not phonological working memory, predict L2 pronunciation aptitude in advanced learners. Second, functional neuroimaging revealed this behavioural trait to be correlated with hemodynamic responses of the cerebral network of speech motor control and auditory-perceptual areas. We suggest that the acquisition of L2 pronunciation aptitude is a dynamic process, requiring a variety of neural resources at different processing stages over time.     

Processing of non-canonical word-order: A case-series on lesion-induced reorganized language and age-effects in typical development

Complex grammatical structures are mastered late in language acquisition. We studied age-effects on performance in object topicalization in 48 typically developing German-speaking participants (aged 8–30 years) and in five patients (children and adolescents) with lesion-induced atypical language representation. Production was tested by a sentence repetition task, comprehension by an acting out task. Three topicalized conditions with differing disambiguation (agreement, case, and case plus agreement) were contrasted with canonical control sentences.     

Reactive cognitive-control processes in free-report consonant–vowel dichotic listening

The relevance of cognitive-control processes has been frequently discussed and studied in the context of dichotic listening. Experimental and clinical studies indicate that directing attention to either of the two simultaneously presented phonological stimuli, but especially to the left-ear stimulus increases the requirements for cognitive-control processes. Here, we extend this view by reporting the results of a behavioural and a functional magnetic-resonance imaging (fMRI) experiment designed to analyse the involvement of cognitive-control processes also in a free-report dichotic-listening paradigm. It was hypothesised that dichotically presented pairs of stop–consonant–vowel syllables would provide different demands for cognitive-control processes as a function of the spectro-temporal overlap of the two stimuli. Accordingly, in Experiment 1 it was shown that dichotic syllables of high (e.g., /ba/ and /ga/) as opposed to low spectro-temporal overlap (e.g., /ba/ and /ka/) produce significantly faster and more correct answers, and are more often perceived as one syllable. In Experiment 2 it was further shown that pairs of low as compared to high spectro-temporal overlap trigger a more pronounced activation predominately in left-hemispheric, speech-associated brain regions, namely left posterior inferior sulcus/gyrus, bilaterally in pre-supplementary motor and mid-cingulate cortex as well as in the inferior parietal lobe. Taken together, behavioural and functional data indicate a stronger involvement of reactive cognitive control in the processing of low-overlap as opposed to high-overlap stimulus pairs. This supports the notion that higher-order, speech-related cognitive-control processes also are involved in a free-report dichotic-listening paradigm.     

Psychoanalytisch-orientierte Fokaltherapie der Depression bei Krebskranken

Emotional distress connected to a cancer disease may result in comorbid mental and especially depressive disorders. Although psychodynamic therapy is one of the most frequently applied forms of psychotherapy of depression in cancer patients there is a lack of empirical studies which meet the criteria of evidence-based psychotherapy research. This is especially true with regard to randomized controlled trials of psychodynamic psychotherapy. As far as we know no manual for psychodynamic treatment of cancer patients has yet been published. In this article a manual for a 20-session short-term psychodynamic treatment is presented. The treatment is based on Luborsky’s supportive-expressive (SE) therapy. The SE treatment manual of depressions in cancer patients presented here is an adaptation of the general SET manual as well as the SE manual for depression. In the first part the general principles of SE therapy are presented. In the second part a manual specifically adapted to the treatment of depressive cancer patients is described. The treatment manual is presently being used in a large-scale randomized controlled multi-centered study comparing short-term psychodynamic psychotherapy and treatment as usual.