Diagnosing depression in patients with physical diseases using the beck depression inventory (BDI)

Abstract

Four-hundred-and-forty-three patients with a physical illness (355 with coronary heart disease and 88 with chronic pain), 150 unemployed persons and 623 subjects from the normal population in Jämtland, Sweden were tested using the BDI (Beck Depression Inventory). The aim of the study was to investigate whether scores on both the physical and non-physical components of the BDI differed between the patients and the other groups, or whether only the physical component was significantly higher in the patient group, and in such a case whether this could be interpreted as symptomatic of physical disease and not of depression. A cutoff score of ≥ 10 to determine mild depression and two different alternative physical and non-physical components were used. Forty-three percent of the patients with coronary heart disease and 50% of patients with chronic pain were categorized as being at least mildly depressed. Factor analyses indicated that a physical component comprising five items was the most meaningful and could best discriminate the physical symptoms. The patients' scores were significantly higher than those of the other two groups on the physical component but only higher than the normal population sample on the nun-physical component. This supports the idea that the items for physical symptoms in the BDI might be confounding when determining depression in patients with physical diseases. The non-physical component seems to be the best indicator of depression and is recommended as a complement to the total BDI scale when determining the degree of depression in patients suffering from a physical disease.     

Differences in High and Low Anxiety Sensitive Women's Responses to a Laboratory‐Based Cold Pressor Task

Anxiety sensitivity (AS) has been linked to a variety of disabling chronic health conditions, including pain‐related conditions. A recent study has found that healthy women with high AS reported significantly higher levels of sensory and affective pain on an experimental cold pressor task compared to women with low AS. However, this study found no differences between AS groups for pain tolerance or pain threshold. In the present study, which was designed to replicate and extend these findings, 90 undergraduate university women were selected for inclusion in 1 of 2 AS groups (high or low) based on their screening scores on a 16‐item measure of AS. Participants were tested individually on a lab‐based cold pressor task using a variety of self‐report and observer‐measured variables. Data analyses revealed that, as expected, the high AS participants reported significantly more fear in response to the cold pressor on a relevant item of the McGill Pain Questionnaire – Short Form (SF‐MPQ) than did the low AS participants. Also as expected, the high AS participants reported more pain in response to the cold pressor on the Present Pain Index (PPI) of the SF‐MPQ than did the low AS participants. High AS participants did not differ from low AS participants on other aspects of the cold pressor response (e.g. pain threshold, pain tolerance, pain recovery). These results support the role of pain‐related fear as a mediating variable between AS and increased perceived pain intensity.     

Internet-Delivered Acceptance and Values-Based Exposure Treatment for Fibromyalgia: A Pilot Study

Background: Acceptance and commitment therapy (ACT) is a promising treatment option for fibromyalgia (FM). Studies have shown that many cognitive behavioral protocols can be transferred to the Internet with sustained efficacy. However, no study has investigated the effect on an Internet-delivered ACT-based protocol for FM. This study evaluated the efficacy, acceptability, and the health economic effects of an Internet-delivered acceptance and values-based exposure treatment for FM. Methods: This open pilot trial included 41 self-referred women with a FM diagnosis. The 10-week Internet-delivered treatment included acceptance, mindfulness, work with life-values, and systematic exposure to FM symptoms and FM-related situations. Participants also had regular contact with an assigned online therapist. Assessments were made at pretreatment, post-treatment, and 6-month follow-up. Results: The treatment was completed by 70% of the participants. Attrition rates were low, with 98% completing the post-treatment assessment and 90% completing the 6-month follow-up assessment. Multiple imputations were used to replace missing values. Pre- to post-treatment within-group effect sizes were in the moderate to large range (Cohen's d = 0.62–1.56) on measures of FM symptoms and impact, disability, quality of life, depression, anxiety, fatigue, and psychological flexibility. All improvements were maintained at follow-up. Economical analyses revealed significant societal cost reductions that offset the treatment costs within 2 months of treatment completion. Conclusions: An Internet-delivered psychological treatment based on acceptance and exposure principles seems to be an efficacious, acceptable, and cost-effective treatment for FM. Randomized controlled trials are needed to confirm these results.     

Deconstructing Frith and Snowling's homograph-reading task: Implications for autism spectrum disorders

The poor performance of autistic individuals on a test of homograph reading is widely interpreted as evidence for a reduction in sensitivity to context termed “weak central coherence”. To better understand the cognitive processes involved in completing the homograph-reading task, we monitored the eye movements of nonautistic adults as they completed the task. Using single trial analysis, we determined that the time between fixating and producing the homograph (eye-to-voice span) increased significantly across the experiment and predicted accuracy of homograph pronunciation, suggesting that participants adapted their reading strategy to minimize pronunciation errors. Additionally, we found evidence for interference from previous trials involving the same homograph. This progressively reduced the initial advantage for dominant homograph pronunciations as the experiment progressed. Our results identify several additional factors that contribute to performance on the homograph reading task and may help to reconcile the findings of poor performance on the test with contradictory findings from other studies using different measures of context sensitivity in autism. The results also undermine some of the broader theoretical inferences that have been drawn from studies of autism using the homograph task. Finally, we suggest that this approach to task deconstruction might have wider applications in experimental psychology.     

A 9-YEAR-OLD WITH CONVERSION DISORDER, SUCCESSFULLY TREATED WITH PSYCHOANALYSIS

This paper outlines the successful psychoanalytic treatment of a latency-aged boy with severe conversion disorder. Details of clinical treatment are presented. As no tested treatment has yet been found that reliably treats chronic conversion in children, this case is of importance in demonstrating the usefulness of psychoanalysis as treatment for severe psychopathology. The patient's unconscious fantasy constellations that gave rise to this syndrome are highlighted.     

The Adaptation of Patients During the Hospitalization Period of Bone Marrow Transplantation

A longitudinally study was conducted among 42 bone marrow transplantation (BMT) patients to investigate the association between pretransplant psychosocial variables and psychophysiological outcomes during the immediate convalescence period. Family relationships (cohesion, expressiveness, and conflict) and coping resources (cognitive, social, emotional, spiritual/philosophical, and physical resources) were assessed on the admission day (Day –7 Time 1). Data on psychological distress and pain intensity were obtained on Day +7 (Time 2) and Day +14 (Time 3). The average scores at Times 2 and 3 were computed to indicate the overall adjustments of the patients during the hospitalization period after the day of actual transplant (Day 0). It was shown that higher expressiveness family relationships and higher resources to cope effectively with stressful situations were associated with less psychological distress during the above period. Both pretransplant psychosocial variables were not associated with pain intensity during hospitalization. Allogeneic transplant patients reported higher pain intensity than did autologous transplant patients. Psychological distress and pain intensity were positively correlated with each other. Our findings show that pretransplant family relationships and coping resources associate moderately with psychological distress during the immediate convalescent period of BMT. The present findings support the family-centered approach to BMT care and provide a scientific basis for pretransplant psychosocial interventions.     

Presurgical MMPI-2 Cluster Profiles Predict 1-Year Low-Back Surgery Outcomes

The primary purpose of this study was to examine whether empirically derived cluster profiles based on scores from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) predicted outcomes of surgery at 1 year for patients with low-back pain. On the basis of hierarchical cluster analysis of presurgery MMPI-2 scores for 60 patients, three interpretable and significant subgroups were formed. These consisted of a pathological/neurotic type, a double V-code type, and a normal type. The patents in the normal type were significantly more likely to report beneficial outcomes of surgery in terms of disability and pain than those in the other 2 types. These findings extend previous research and suggest (1) low-back surgery candidates are heterogeneous in their psychological profiles, and (2) MMPI-2 profiles are predictive of low-back surgery outcome. Future research should focus on identifying physiological substrates for these distinct profiles and investigating the effectiveness of presurgical psychological interventions based on profile type.     

对以边沁、密尔为代表的功利主义的分析批判

边沁的功利主义为苦乐原理、效果论和功利原则这样三个理论基点所构成。这是一个有着内在逻辑困境的三原理。苦乐原理由于没有进行内在的质的区分,为密尔所修正,但密尔的修正突出了苦乐原理与效果论的内在不一致;同时,密尔以自我牺牲来补充功利主义,又暴露了功利主义原则的内在矛盾。还有,密尔以平等权利来为功利主义的最大幸福原理辩护,恰恰表明功利原则并非是可以成为一个理论的基础性原则或终极原则。斯马特的行动功利主义则进一步暴露了功利主义的非正义性特性。功利主义的这样三个典范表明仅仅诉诸功利原则无从走出内在逻辑困境。布兰特援引认知理论以及道义论原则,笔认为这才使功利主义从其困境中走出。     

Noise,Economy, and the Emergence of Information Structure in a Laboratory Language

The acceptability of sentences in natural language is constrained not only grammaticality, but also by the relationship between what is being conveyed and such factors as context and the beliefs of interlocutors. In many languages the critical element in a sentence (its focus) must be given grammatical prominence. There are different accounts of the nature of focus marking. Some researchers treat it as the grammatical realization of a potentially arbitrary feature of universal grammar and do not provide an explicit account of its origins; others have argued, however, that focus marking is a (grammaticalized) functional solution to the problem of efficiently transmitting information via a noisy channel. By adding redundancy to highlight critical elements in particular, focus protects key parts of the message from noise. If this information‐theoretic account is true, then we should expect focus‐like behavior to emerge even in non‐linguistic communication systems given sufficient noise and pressures for efficiency. We tested this in an experiment in which participants played a simple communication game in which they had to click cells on a grid to communicate one of two line figures drawn across the grid. We manipulated the noise, available time, and required effort, and measured patterns of redundancy. Because the lines in many cases overlapped, meaning that only some parts of each line could be used to distinguish it from the other, we were able to compare the extent to which effort was expended on adding redundancy to critical (non‐overlapping) and non‐critical (overlapping) parts of the message. The results supported the information‐theoretic account of focus and shed light on the emergence of information structure in language.