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Douglas KM, Sperry SH, Dean OM, Fries GR, Gomes FA, Pavón JJ, Morton E, Mitchell RHB, Van Rheenen TE, Verdolini N, Xu N, Hosang GM, Huber RS. Supporting career development for early- and mid-career professionals working in the bipolar disorder field: Key initiatives to be implemented by the International Society for Bipolar Disorders Early- and Mid-Career Committee. Bipolar Disord 2024; 26:211-215. [PMID: 38622803 DOI: 10.1111/bdi.13416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Sarah H Sperry
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Olivia M Dean
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University and Barwon Health, Geelong, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Gabriel R Fries
- Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Fabiano A Gomes
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Joanna Jiménez Pavón
- Mood Disorder Clinic, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Emma Morton
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Rachel H B Mitchell
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Tamsyn E Van Rheenen
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Victoria, Australia
| | - Norma Verdolini
- Department of Mental Health, Local Health Unit Umbria 1, Mental Health Center of Perugia, Perugia, Italy
| | - Ni Xu
- Peking University Sixth Hospital, Beijing, China
- Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, China
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Georgina M Hosang
- Centre for Psychiatry & Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
| | - Rebekah S Huber
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Wright K, Koenders M, Douglas KM, Faurholt-Jepsen M, Lewandowski KE, Miklowitz DJ, Morton E, Murray G, Richardson T, de Siqueira Rotenberg L, Sperry SH, Van Meter AR, Vassilev AB, Weiner L, Weinstock LM, Mesman E. Psychological therapies for people with bipolar disorder: Where are we now, and what is next? ISBD Psychological Interventions Taskforce-Position paper. Bipolar Disord 2024. [PMID: 38632696 DOI: 10.1111/bdi.13418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Kim Wright
- Department of Psychology, University of Exeter, Exeter, UK
| | - Manja Koenders
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kathryn E Lewandowski
- McLean Hospital Schizophrenia and Bipolar Disorder Program, Belmont, Massachusetts, USA
- Harvard Medical School Department of Psychiatry, Boston, Massachusetts, USA
| | - David J Miklowitz
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Emma Morton
- School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Thomas Richardson
- School of Psychology, University of Southampton, Southampton, Hampshire, UK
| | - Luisa de Siqueira Rotenberg
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Sarah H Sperry
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Anna R Van Meter
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Luisa Weiner
- Laboratoire de Psychologie des Cognitions UR 4440, Université de Strasbourg, Strasbourg, France
| | - Lauren M Weinstock
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
| | - Esther Mesman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Jiménez-Pavón J, Dean OM, Hosang GM, Douglas KM, Huber RS, Mitchell RHB. From knowledge gaps to career opportunities: The early- to Mid-Career Committee's impact on increasing resources for bipolar disorder professionals. Bipolar Disord 2023; 25:698-699. [PMID: 37985471 DOI: 10.1111/bdi.13395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Joanna Jiménez-Pavón
- Mood Disorder Clinic, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Olivia M Dean
- Deakin University and Barwon Health, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University and Barwon Health, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Georgina M Hosang
- Centre for Psychiatry & Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Rebekah S Huber
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Rachel H B Mitchell
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
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Douglas KM, Thwaites B, Frawley E, Hammar Å. Tailoring cognitive interventions to individuals' cognitive profiles: commentary on 'Prevalence of cognitive impairments and strengths in the early course of psychosis and depression' by Stainton et al. Psychol Med 2023; 53:5958-5960. [PMID: 37522515 DOI: 10.1017/s0033291723002076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Bridgette Thwaites
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Emma Frawley
- The Center for Neuroimaging, Cognition & Cognitive Genomics, School of Psychology, University of Galway, Galway, Ireland
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Region Skåne, Sweden
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Skirrow PM, Johnstone G, Douglas KM, Faulkner JW. Measuring memory: A survey of neuropsychological practice amongst New Zealand psychologists. Appl Neuropsychol Adult 2023:1-8. [PMID: 37656817 DOI: 10.1080/23279095.2023.2251635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
This study sought to explore patterns of memory assessment in neuropsychological practice within New Zealand (NZ), to compare it to that previously described in Europe, North America and Australia, and to consider the implications for neuropsychology training in NZ. 80 NZ-registered psychologists completed an online survey asking them how frequently they utilized 50 commonly used tests of memory. Participants were also asked about their main areas of specialty, work context and demographic information. Whilst participants appeared, broadly, to utilize a similar set of 'core' tests to their colleagues in Europe, Australia and North America, there were a number of tests and test domains that were rarely utilized by NZ psychologists, in contrast to overseas samples. Furthermore, several of the tests in common usage have been shown to have significant validity issues for use with an NZ population. Overall, this study suggests that most NZ psychologists employ a similar approach to memory assessment, typically relying upon a small number of well-known tests. This appears to contrast with a greater variability of practice shown in studies of European, North American and Australian psychologists and raises several interesting questions for the future development of neuropsychology in NZ.
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Affiliation(s)
- Paul M Skirrow
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Grace Johnstone
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Josh W Faulkner
- School of Psychology, Victoria University, Wellington, New Zealand
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Sperry SH, Douglas KM, Dean OM, Fries GR, Gomes FA, Hosang GM, Morton E, Sandorffy B, Van Rheenen TE, Xu N, Huber RS. Barriers to and facilitators of success for early and Mid-Career professionals focused on bipolar disorder: A global needs survey by the International Society for Bipolar Disorders. Bipolar Disord 2023; 25:379-390. [PMID: 37391923 DOI: 10.1111/bdi.13365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
INTRODUCTION The International Society for Bipolar Disorders created the Early Mid-Career Committee (EMCC) to support career development of the next generation of researchers and clinicians specializing in bipolar disorder (BD). To develop new infrastructure and initiatives, the EMCC completed a Needs Survey of the current limitations and gaps that restrict recruitment and retention of researchers and clinicians focused on BD. METHODS The EMCC Needs Survey was developed through an iterative process, relying on literature and content expertise of workgroup members. The survey included 8 domains: navigating transitional career stages, creating and fostering mentorship, research activities, raising academic profile, clinical-research balance, networking and collaboration, community engagement, work-life balance. The final survey was deployed from May to August 2022 and was available in English, Spanish, Portuguese, Italian, and Chinese. RESULTS Three hundred participants across six continents completed the Needs Survey. Half of the participants self-identified as belonging to an underrepresented group in health-related sciences (i.e., from certain gender, racial, ethnic, cultural, or disadvantaged backgrounds including individuals with disabilities). Quantitative results and qualitative content analysis revealed key barriers to pursuing a research career focused on BD with unique challenges specific to scientific writing and grant funding. Participants highlighted mentorship as a key facilitator of success in research and clinical work. CONCLUSION The results of the Needs Survey are a call to action to support early- and midcareer professionals pursuing a career in BD. Interventions required to address the identified barriers will take coordination, creativity, and resources to develop, implement, and encourage uptake but will have long-lasting benefits for research, clinical practice, and ultimately those affected by BD.
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Affiliation(s)
- Sarah H Sperry
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Olivia M Dean
- Deakin University and Barwon Health, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University and Barwon Health, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Gabriel R Fries
- Faillace Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Fabiano A Gomes
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Georgina M Hosang
- Centre for Psychiatry & Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, UK
| | - Emma Morton
- Department of Psychiatry, University of British Columbia, Canada
| | - Bronya Sandorffy
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Ni Xu
- Peking University Sixth Hospital, Beijing, China
- Peking University Institute of Mental Health, Beijing, China
- NHC Key Laboratory of Mental Health (Peking University), Beijing, China
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Rebekah S Huber
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
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Barczyk ZA, Foulds JA, Porter RJ, Douglas KM. Childhood trauma and cognitive functioning in mood disorders: A systematic review. Bipolar Disord 2023; 25:263-277. [PMID: 36949602 DOI: 10.1111/bdi.13321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Cognitive impairment is a core feature of mood disorders and has been identified as an important treatment target. A better understanding of the factors contributing to cognitive impairment in mood disorders would be beneficial in developing interventions to address cognitive impairment. One key factor is childhood trauma. The aim of this review was to systematically synthesise and review research examining associations between reported childhood trauma and cognitive functioning in mood disorders. METHODS Studies in adult samples examining the relationship between objective cognitive function and reported childhood trauma in major depressive disorder and/or bipolar disorder (in-episode or euthymia) were identified. Searches were conducted on PubMed, Embase and PsycINFO until January 2022. A narrative review technique was used due to the heterogeneity of group comparisons, cognitive tests and data analysis across studies. RESULTS Seventeen studies met the criteria for inclusion (mood disorders N = 1723, healthy controls N = 797). Evidence for childhood trauma being related to poorer cognitive functioning was consistent across global cognitive functioning and executive function domains for euthymic patients and psychomotor speed for in-episode patients. There was mixed evidence for verbal learning and memory and executive function for in-episode patients. Identification of patterns within other domains was difficult due to limited number of studies. CONCLUSION Findings from this review suggest childhood trauma is associated with poorer cognitive functioning in people with mood disorders. Targeted interventions to improve cognition may be warranted for this group.
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Affiliation(s)
- Zoe A Barczyk
- Department of Psychological Medicine, University of Otago, Christchurch, 8011, New Zealand
| | - James A Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, 8011, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, 8011, New Zealand
- Specialist Mental Health Services, Canterbury District Health Board, Christchurch, 8024, New Zealand
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, 8011, New Zealand
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Kew BM, Porter RJ, Douglas KM, Glue P, Mentzel CL, Beaglehole B. Ketamine and psychotherapy for the treatment of psychiatric disorders: systematic review. BJPsych Open 2023; 9:e79. [PMID: 37128856 DOI: 10.1192/bjo.2023.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Ketamine is an effective short-term treatment for a range of psychiatric disorders. A key question is whether the addition of psychotherapy to ketamine treatment improves outcomes or delays relapse. AIM To identify all studies combining psychotherapy with ketamine for the treatment of psychiatric disorders to summarise their effects and make recommendations for future research. METHOD The review protocol was prospectively registered with PROSPERO (registration number CRD42022318120). Potential studies were searched for in MEDLINE, Embase, PsycINFO, SCOPUS, the Cochrane library and Google Scholar. Eligible studies combined ketamine and psychotherapy for the treatment of psychiatric disorders and did not use case reports or qualitative designs. Key findings relating to psychotherapy type, diagnosis, ketamine protocol, sequencing of psychotherapy and study design are reported. Risk of bias was assessed using modified Joanna Briggs critical appraisal tools. RESULTS Nineteen studies evaluating 1006 patients were included in the systematic review. A variety of supportive individual and group, manualised and non-manualised psychotherapies were used. The majority of studies evaluated substance use disorders, post-traumatic stress disorder and treatment-resistant depression. Ketamine protocols and sequencing of ketamine/psychotherapy treatment varied substantially between studies. Outcomes were largely positive for the addition of psychotherapy to ketamine treatment. CONCLUSION The combination of psychotherapy and ketamine offers promise for the treatment of psychiatric disorders, but study heterogeneity prevents definitive recommendations for their integration. Larger randomised controlled trials using manualised psychotherapies and standardised ketamine protocols are recommended to clarify the extent to which the addition of psychotherapy to ketamine improves outcomes over ketamine treatment alone.
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Affiliation(s)
- Bess M Kew
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Paul Glue
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Charlotte L Mentzel
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Ben Beaglehole
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Huber RS, Douglas KM, Sperry SH, Gomes FA, Van Rheenen TE, Xu N, Hosang GM. The Early Mid-Career Committee (EMCC) of the International Society for Bipolar Disorders: Aspirations and goals. Bipolar Disord 2022; 24:781-783. [PMID: 36543335 DOI: 10.1111/bdi.13269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Rebekah S Huber
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Sarah H Sperry
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Fabiano A Gomes
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Ni Xu
- Peking University Sixth Hospital, Beijing, China.,Peking University Institute of Mental Health, Beijing, China.,NHC Key Laboratory of Mental Health (Peking University), Beijing, China.,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Georgina M Hosang
- Centre for Psychiatry & Mental Health, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
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Douglas KM, Strawbridge R, Miskowiak KW. Can biomarkers aid the stratification of individuals with mood disorders for cognitive remediation interventions? Bipolar Disord 2022; 24:571-573. [PMID: 36184951 DOI: 10.1111/bdi.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Douglas KM, Groves S, Crowe MT, Inder ML, Jordan J, Carlyle D, Wells H, Beaglehole B, Mulder R, Lacey C, Luty SE, Eggleston K, Frampton CMA, Bowie CR, Porter RJ. A randomised controlled trial of psychotherapy and cognitive remediation to target cognition in mood disorders. Acta Psychiatr Scand 2022; 145:278-292. [PMID: 34800298 DOI: 10.1111/acps.13387] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/04/2021] [Accepted: 11/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the impact of a treatment package combining Interpersonal and Social Rhythm Therapy (IPSRT) and cognitive remediation (CR), vs IPSRT alone, on cognition, functioning, and mood disturbance outcomes in mood disorders. METHODS A pragmatic randomised controlled trial in adults with bipolar disorder (BD) or major depressive disorder (MDD), recently discharged from mental health services in Christchurch, New Zealand, with subjective cognitive difficulties. Individuals were randomised to a 12-month course of IPSRT with CR (IPSRT-CR), or without CR (IPSRT). In IPSRT-CR, CR was incorporated into therapy sessions from approximately session 5 and continued for 12 sessions. The primary outcome was change in Global Cognition (baseline to 12 months). RESULTS Sixty-eight individuals (BD n = 26, MDD n = 42; full/partial remission n = 39) were randomised to receive IPSRT-CR or IPSRT (both n = 34). Across treatment arms, individuals received an average of 23 IPSRT sessions. Change in Global Cognition did not differ between arms from baseline to treatment-end (12 months). Psychosocial functioning and longitudinal depression symptoms improved significantly more in the IPSRT compared with IPSRT-CR arm over 12 months, and all measures of functioning and mood symptoms showed moderate effect size differences favouring IPSRT (0.41-0.60). At 18 months, small to moderate, non-significant benefits (0.26-0.47) of IPSRT vs IPSRT-CR were found on functioning and mood outcomes. CONCLUSIONS Combining two psychological therapies to target symptomatic and cognitive/functional recovery may reduce the effect of IPSRT, which has implications for treatment planning in clinical practice and for CR trials in mood disorders.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Samantha Groves
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Older Persons' Specialist Health and Rehabilitation Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Marie T Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Maree L Inder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Dave Carlyle
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Hayley Wells
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ben Beaglehole
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Suzanne E Luty
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Kate Eggleston
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | | | | | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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Douglas KM, Inder ML, Crowe MT, Jordan J, Carlye D, Lacey C, Beaglehole B, Mulder R, Eggleston K, Donovan KA, Frampton CMA, Bowie CR, Porter RJ. Randomised controlled trial of Interpersonal and Social Rhythm Therapy and group-based Cognitive Remediation versus Interpersonal and Social Rhythm Therapy alone for mood disorders: study protocol. BMC Psychiatry 2022; 22:115. [PMID: 35164720 PMCID: PMC8845377 DOI: 10.1186/s12888-022-03747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with mood disorders frequently experience cognitive impairment, which impacts on the long-term trajectory of the disorders, including being associated with persisting difficulties in occupational and psychosocial functioning, residual mood symptoms, and relapse. Current first-line treatments for mood disorders do little to improve cognitive function. Targeting cognition in clinical research is thus considered a priority. This protocol outlines a prospectively-registered randomised controlled trial (RCT) which examines the impact of adding group-based Cognitive Remediation (CR) to Interpersonal and Social Rhythm Therapy (IPSRT-CR) for individuals with mood disorders. METHODS This is a pragmatic, two-arm, single-blinded RCT comparing IPSRT-CR with IPSRT alone for adults (n = 100) with mood disorders (Major Depressive Disorder or Bipolar Disorder) with subjective cognitive difficulties, on discharge from Specialist Mental Health Services in Christchurch, New Zealand. Both treatment arms will receive a 12-month course of individual IPSRT (full dose = 24 sessions). At 6 months, randomisation to receive, or not, an 8-week group-based CR programme (Action-based Cognitive Remediation - New Zealand) will occur. The primary outcome will be change in Global Cognition between 6 and 12 months (treatment-end) in IPSRT-CR versus IPSRT alone. Secondary outcomes will be change in cognitive, functional, and mood outcomes at 6, 12, 18, and 24 months from baseline and exploratory outcomes include change in quality of life, medication adherence, rumination, and inflammatory markers between treatment arms. Outcome analyses will use an intention-to-treat approach. Sub-group analyses will assess the impact of baseline features on CR treatment response. Participants' experiences of their mood disorder, including treatment, will be examined using qualitative analysis. DISCUSSION This will be the first RCT to combine group-based CR with an evidence-based psychotherapy for adults with mood disorders. The trial may provide valuable information regarding how we can help promote long-term recovery from mood disorders. Many issues have been considered in developing this protocol, including: recruitment of the spectrum of mood disorders, screening for cognitive impairment, dose and timing of the CR intervention, choice of comparator treatment, and choice of outcome measures. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry, ACTRN12619001080112 . Registered on 6 August 2019.
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Affiliation(s)
- Katie M. Douglas
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Maree L. Inder
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marie T. Crowe
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jennifer Jordan
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Dave Carlye
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Cameron Lacey
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.29980.3a0000 0004 1936 7830Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Ben Beaglehole
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Roger Mulder
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Kate Eggleston
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Katherine A. Donovan
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Christopher M. A. Frampton
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Christopher R. Bowie
- grid.410356.50000 0004 1936 8331Department of Psychology, Queen’s University, Kingston, ON Canada
| | - Richard J. Porter
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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13
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Sukhapure M, Eggleston K, Fenton A, Frampton C, Porter RJ, Douglas KM. Changes in Mood, Anxiety, and Cognition with Polycystic Ovary Syndrome Treatment: A Longitudinal, Naturalistic Study. Neuropsychiatr Dis Treat 2022; 18:2703-2712. [PMID: 36411778 PMCID: PMC9675344 DOI: 10.2147/ndt.s385014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Individuals with polycystic ovary syndrome (PCOS) are at increased risk of depression and anxiety symptoms and impairment in aspects of cognitive function. However, there is little evidence regarding effects of standard treatment for PCOS on these features of the syndrome. The aim of this study was to examine the effect of 12 weeks of naturalistic treatment of PCOS, with usual medications, on depression symptoms, anxiety symptoms and cognitive function. PATIENTS AND METHODS Thirty-three participants with PCOS received 12 weeks of individualised treatment based on clinical presentation. Changes in depression and anxiety symptoms were assessed with the self-report Hospital Anxiety and Depression Scale at baseline and 12 weeks, and cognitive function was assessed at the same time-points with a battery of tests spanning cognitive domains of verbal learning and memory, visuospatial learning and memory, psychomotor speed, attention and executive function. Outcomes were compared with a control group of 40 healthy participants. RESULTS Participants with PCOS (mean age = 29.2 years; mean Body Mass Index = 27.4) were treated with a variety of medications, predominantly spironolactone (n = 22) and oral contraceptives (n = 16). Depression and anxiety symptoms improved significantly over the course of treatment, with moderate effect sizes (Cohen's d 0.43-0.55, p < 0.05). Effect sizes of the difference in change from that of the control group were moderate but did not reach statistical significance. Women undergoing PCOS treatment demonstrated significant improvements in aspects of cognitive function, but improvement did not differ significantly from controls and effect size changes were similar, suggesting practise effects in both groups. CONCLUSION Our study provides preliminary evidence that treatment of PCOS may be associated with improvement in psychiatric aspects of the syndrome, particularly depressive symptoms.
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Affiliation(s)
- Mayouri Sukhapure
- Department of Psychological Medicine, University of Otago, Christchurch, Canterbury, New Zealand.,Centre for Healthy Brain Ageing, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate Eggleston
- Department of Psychological Medicine, University of Otago, Christchurch, Canterbury, New Zealand.,Specialist Mental Health Services, Canterbury District Health Board, Christchurch, Canterbury, New Zealand
| | - Anna Fenton
- Department of Endocrinology, Canterbury District Health Board, Christchurch, Canterbury, New Zealand.,Oxford Women's Health, Christchurch, Canterbury, New Zealand
| | - Christopher Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, Canterbury, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, Canterbury, New Zealand.,Specialist Mental Health Services, Canterbury District Health Board, Christchurch, Canterbury, New Zealand
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, Canterbury, New Zealand
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14
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Groves SJ, Douglas KM, Milanovic M, Bowie CR, Porter RJ. Systematic review of the effects of evidence-based psychotherapies on neurocognitive functioning in mood disorders. Aust N Z J Psychiatry 2021; 55:944-957. [PMID: 34278831 DOI: 10.1177/00048674211031479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Neurocognitive impairment is considered a core feature of mood disorders. Research has shown that neurocognitive impairment often persists beyond mood symptom resolution and can have significant deleterious effects on interpersonal relationships, academic achievement, occupational functioning and independent living. As such, neurocognitive impairment has become an important target for intervention. In this systematic review, we aimed to examine the extant literature to ascertain whether current standard evidence-based psychotherapies can improve neurocognitive functioning in mood disorders. METHOD Studies examining changes in neurocognitive functioning following evidence-based psychotherapy were identified using MEDLINE, PsycINFO and Web of Science databases. Given the heterogeneity of study procedures, treatment protocols and patient samples, a narrative rather than meta-analytic review technique was employed. RESULTS Nineteen studies (21 articles) met inclusion criteria. There was preliminary evidence of improved executive functioning following evidence-based psychotherapy for Major Depressive Disorder and Bipolar Disorder. There was also some signal of reduced negative biases in emotional information processing following psychotherapy in depression. Due to methodological variability across studies however, it was difficult to draw clear conclusions. CONCLUSION Findings from the current review suggest that evidence-based psychotherapies may influence some aspects of neurocognitive functioning in mood disorders. This continues to be an ongoing area of importance and warrants further research.
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Affiliation(s)
- Samantha J Groves
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | | | | | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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15
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Abstract
Cognitive impairment plays a key role in determining the course of illness and functional outcomes in mood disorders. This article summarises and discusses important papers within this thematic series of BJPsych Open that contribute to a greater understanding of the complexity of 'Cognition in Mood Disorders'.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, New Zealand
| | - Richard J Porter
- Specialist Mental Health Services, Canterbury District Health Board, New Zealand; and Department of Psychological Medicine, University of Otago, New Zealand
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, UK
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Abstract
BACKGROUND Emotional cognition and effective interpretation of affective information is an important factor in social interactions and everyday functioning, and difficulties in these areas may contribute to aetiology and maintenance of mental health conditions. In younger people with depression and anxiety, research suggests significant alterations in behavioural and brain activation aspects of emotion processing, with a tendency to appraise neutral stimuli as negative and attend preferentially to negative stimuli. However, in ageing, research suggests that emotion processing becomes subject to a 'positivity effect', whereby older people attend more to positive than negative stimuli. AIMS This review examines data from studies of emotion processing in Late-Life Depression and Late-Life Anxiety to attempt to understand the significance of emotion processing variations in these conditions, and their interaction with changes in emotion processing that occur with ageing. METHOD We conducted a systematic review following PRISMA guidelines. Articles that used an emotion-based processing task, examined older persons with depression or an anxiety disorder and included a healthy control group were included. RESULTS In Late-Life Depression, there is little consistent behavioural evidence of impaired emotion processing, but there is evidence of altered brain circuitry during these processes. In Late-Life Anxiety and Post-Traumatic Stress disorder, there is evidence of interference with processing of negative or threat-related words. CONCLUSIONS How these findings fit with the positivity bias of ageing is not clear. Future research is required in larger groups, further examining the interaction between illness and age and the significance of age at disease onset.
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Affiliation(s)
- Vanessa Gray
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago; and Canterbury District Health Board, Christchurch, New Zealand
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17
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Abstract
BACKGROUND Cognitive impairment is a core feature of depression and has a negative effect on a person's functioning, in psychosocial and interpersonal areas, and on workforce performance. Cognitive impairment often persists, even with the remittance of mood symptoms. One potential way of improving treatment of cognitive impairment would be to identify variables that predict cognitive change in patients with depression. AIMS To systematically examine findings from studies that investigate baseline variables and how they predict, or correlate with, cognitive change in mood disorders, and to examine methodological issues from these studies. METHOD Studies that directly measured associations between at least one baseline variable and change in cognitive outcome in patients with current major depressive episode were identified using PubMed and Web of Science databases. Narrative review technique was used because of the heterogeneity of patient samples, outcome measures and study procedures. The review was registered on PROSPERO with registration number CRD42020150975. RESULTS Twenty-four studies met the inclusion criteria. Evidence from the present review for prediction of cognitive change from baseline variables was limited for demographic factors, with some preliminary evidence for depression, cognitive and biological factors. Identification of patterns across studies was difficult because of methodological variability across studies. CONCLUSIONS Findings from the present review suggest there may be some baseline variables that are useful in predicting cognitive change in mood disorders. This is an area warranting further research focus.
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Affiliation(s)
- Zoe A Barczyk
- Department of Psychological Medicine, University of Otago, New Zealand
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago; and Clinical Research Unit, Canterbury District Health Board, New Zealand
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18
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Douglas KM, Peckham AD, Porter RJ, Hammar Å. Continuing the debate: Cognitive enhancement therapy for mood disorders. Bipolar Disord 2020; 22:532-533. [PMID: 32356358 PMCID: PMC7606484 DOI: 10.1111/bdi.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Katie M. Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand,Corresponding author:
| | | | - Richard J. Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Norway,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Norway
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19
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Douglas KM, Milanovic M, Porter RJ, Bowie CR. Clinical and methodological considerations for psychological treatment of cognitive impairment in major depressive disorder. BJPsych Open 2020; 6:e67. [PMID: 32594951 PMCID: PMC7345587 DOI: 10.1192/bjo.2020.53] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cognitive impairment is considered a core feature of major depressive disorder (MDD) and research into psychological treatments aiming to address cognitive impairment are gaining momentum. Compared with the well-established research base of cognitive treatment trials in schizophrenia, including meta-analyses, mood disorder research is much more preliminary. AIMS To focus on identifying the important factors to consider in developing larger-scale psychological treatment trials targeting cognitive impairment in mood disorders. Trial design recommendations have been published for cognitive treatment trials in bipolar disorder. METHOD An in-depth discussion of methodological considerations in the development of cognitive treatment trials for MDD. RESULTS Methodological considerations include: screening for, and defining, cognitive impairment; mood state when cognitive intervention begins; medication monitoring during cognitive interventions; use of concomitant therapy; level of therapist involvement; duration and dose of treatment; choice of specific cognitive training exercises; home practice; improving adherence; appropriate comparison therapies in clinical trials; and choice of primary outcomes. CONCLUSIONS As well as guidance for clinical trial development, this review may be helpful for clinicians wanting to provide cognitive interventions for individuals with MDD.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, New Zealand
| | | | - Richard J Porter
- Department of Psychological Medicine, University of Otago; and Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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Porter RJ, Inder M, Douglas KM, Moor S, Carter JD, Frampton CM, Crowe M. Improvement in cognitive function in young people with bipolar disorder: Results from participants in an 18-month randomised controlled trial of adjunctive psychotherapy. Aust N Z J Psychiatry 2020; 54:272-281. [PMID: 31735057 DOI: 10.1177/0004867419887794] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the effects of 18 months of intensive stabilisation with medication management and Interpersonal and Social Rhythm Therapy or Non-specific Supportive Clinical Management on cognitive function in young people with bipolar disorder. Determinants of change in cognitive function over the 18 months of the trial were also examined. METHOD Patients aged 15-36 years with Bipolar I Disorder, Bipolar II Disorder and Bipolar Not Otherwise Specified were recruited. From a battery of cognitive tests, change scores for pre-defined domains of cognitive function were created based on performance at baseline and follow-up. Change was compared between the two therapy groups. Regression analysis was used to determine the impact of a range of clinical variables on change in cognitive performance between baseline and follow-up. RESULTS One hundred participants were randomised to Interpersonal and Social Rhythm Therapy (n = 49) or Non-specific Supportive Clinical Management (n = 51). Seventy-eight patients underwent cognitive testing at baseline and 18 months. Across both groups, there were significant improvements in a Global Cognitive Composite score, Executive Function and Psychomotor Speed domains from baseline to 18 months. Lower scores at baseline on all domains were associated with greater improvement over 18 months. Overall, there was no difference between therapies in change in cognitive function, either in a global composite score or change in domains. CONCLUSION While there was no difference between therapy groups, intensive stabilisation with psychological therapy was associated with improved cognitive function, particularly in those patients with poorer cognitive function at baseline. However, this was not compared with treatment as usual so cannot be attributed necessarily to the therapies.
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Affiliation(s)
- Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Maree Inder
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Stephanie Moor
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Janet D Carter
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Christopher Ma Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
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Douglas KM, Groves S, Porter RJ, Jordan J, Wilson L, Melzer TR, Wise RG, Bisson JI, Bell CJ. Traumatic imagery following glucocorticoid administration in earthquake-related post-traumatic stress disorder: A preliminary functional magnetic resonance imaging study. Aust N Z J Psychiatry 2019; 53:1167-1178. [PMID: 31146540 DOI: 10.1177/0004867419851860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Post-traumatic stress disorder involves excessive retrieval of traumatic memories. Glucocorticoids impair declarative memory retrieval. This preliminary study examined the effect of acute hydrocortisone administration on brain activation in individuals with earthquake-related post-traumatic stress disorder compared with earthquake-exposed healthy individuals, during retrieval of traumatic memories. METHOD Participants exposed to earthquakes with (n = 11) and without post-traumatic stress disorder (n = 11) underwent two functional magnetic resonance imaging scans, 1-week apart, in a double-blind, placebo-controlled, counter-balanced design. On one occasion, they received oral hydrocortisone (20 mg), and on the other, placebo, 1 hour before scanning. Symptom provocation involved script-driven imagery (traumatic and neutral scripts) and measures of self-reported anxiety. RESULTS Arterial spin labelling showed that both post-traumatic stress disorder and trauma-exposed controls had significantly reduced cerebral blood flow in response to retrieval of traumatic versus neutral memories in the right hippocampus, parahippocampal gyrus, calcarine sulcus, middle and superior temporal gyrus, posterior cingulate, Heschl's gyrus, inferior parietal lobule, angular gyrus, middle occipital gyrus, supramarginal gyrus, lingual gyrus and cuneus, and the left prefrontal cortex. Hydrocortisone resulted in non-significant trends of increasing subjective distress and reduced regional cerebral blood flow in the left inferior frontal gyrus, left anterior cingulate gyrus, middle temporal gyrus, cerebellum, postcentral gyrus and right frontal pole, during the trauma script. CONCLUSION Findings do not fit with some aspects of the accepted neurocircuitry model of post-traumatic stress disorder, i.e., failure of the medial prefrontal cortex to quieten hyperresponsive amygdala activity, and the potential therapeutic benefits of hydrocortisone. They do, however, provide further evidence that exposure to earthquake trauma, regardless of whether post-traumatic stress disorder eventuates, impacts brain activity and highlights the importance of inclusion of trauma-exposed comparisons in studies of post-traumatic stress disorder.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Samantha Groves
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand.,New Zealand Brain Research Institute, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Jenny Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Lynere Wilson
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Tracy R Melzer
- New Zealand Brain Research Institute, Christchurch, New Zealand.,Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Richard G Wise
- Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff
| | | | - Caroline J Bell
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
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22
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Affiliation(s)
- KM Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - AD Peckham
- McLean Hospital and Harvard Medical School, United States
| | - RJ Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Å Hammar
- Department of Biological and Medical Psychology, University of Bergen, Norway,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Norway
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23
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Affiliation(s)
- Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch 4345, New Zealand.
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch 4345, New Zealand
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24
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Averill IRE, Beaglehole B, Douglas KM, Jordan J, Crowe MT, Inder M, Lacey CJ, Frampton CM, Bowie CR, Porter RJ. Activation therapy for the treatment of inpatients with depression - protocol for a randomised control trial compared to treatment as usual. BMC Psychiatry 2019; 19:52. [PMID: 30709391 PMCID: PMC6359820 DOI: 10.1186/s12888-019-2038-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/25/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Inpatients with depression have a poor long term outcome with high rates of suicide, high levels of morbidity and frequent re-admission. Current treatment often relies on pharmacological intervention and focuses on observation to maintain safety. There is significant neurocognitive deficit which is linked to poor functional outcomes. As a consequence, there is a need for novel psychotherapeutic interventions that seek to address these concerns. METHODS We combined cognitive activation and behavioural activation to create activation therapy (AT) for the treatment of inpatient depression and conducted a small open label study which demonstrated acceptability and feasibility. We propose a randomised controlled trial which will compare treatment as usual (TAU) with TAU plus activation therapy for adult inpatients with a major depressive episode. The behavioural activation component involves therapist guided re-engagement with previously or potentially rewarding activities. The cognitive activation aspect utilises computer based exercises which have been shown to improve cognitive function. DISCUSSION The proposed randomised controlled trial will examine whether or not the addition of this therapy to TAU will result in a reduced re-hospitalisation rate at 12 weeks post discharge. Subjective change in activation and objectively measured change in activity levels will be rated, and the extent of change to neurocognition will be assessed. TRIAL REGISTRATION Unique trial number: U1111-1190-9517. Australian New Zealand Clinical Trials Registry (ANZCTR) number: ACTRN12617000024347p .
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Affiliation(s)
- Ian R. E. Averill
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand ,0000 0001 0040 0934grid.410864.fSpecialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Ben Beaglehole
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand ,0000 0001 0040 0934grid.410864.fSpecialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Katie M. Douglas
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Jennifer Jordan
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Marie T. Crowe
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Maree Inder
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Cameron J. Lacey
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Christopher M. Frampton
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Christopher R. Bowie
- 0000 0004 1936 8331grid.410356.5Department of Psychology, Queen’s University, Kingston, Canada
| | - Richard J. Porter
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand ,0000 0001 0040 0934grid.410864.fSpecialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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Bell CJ, Frampton CM, Colhoun HC, Douglas KM, McIntosh VV, Carter FA, Jordan J, Carter JD, Smith RA, Marie LM, Loughlin A, Porter RJ. Earthquake brain: Impairment of spatial memory following long-term earthquake-related stress. Aust N Z J Psychiatry 2019; 53:37-47. [PMID: 30052053 DOI: 10.1177/0004867418789498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The primary aim of this study was to investigate neuropsychological function in patients with earthquake-related posttraumatic stress disorder, compared with earthquake-exposed but resilient controls. We hypothesised that individuals with posttraumatic stress disorder would have poorer neuropsychological performance on tests of verbal and visuospatial learning and memory compared with the earthquake-exposed control group. The availability of groups of healthy patients from previous studies who had been tested on similar neuropsychological tasks prior to the earthquakes allowed a further non-exposed comparison. METHOD In all, 28 individuals with posttraumatic stress disorder and 89 earthquake-exposed controls completed tests of verbal and visuospatial learning and memory and psychomotor speed. Further comparisons were made with non-exposed controls who had been tested before the earthquakes. RESULTS No significant difference in performance on tests of verbal or visuospatial memory was found between the earthquake-exposed groups (with and without posttraumatic stress disorder), but the posttraumatic stress disorder group was significantly slowed on tests of psychomotor speed. Supplementary comparison with historical, non-exposed control groups showed that both earthquake-exposed groups had poorer performance on a test of visuospatial learning. CONCLUSION The key finding from this study is that there were no differences in verbal or visuospatial learning and memory in individuals with posttraumatic stress disorder compared with similarly earthquake-exposed controls. Compared with non-exposed controls, both earthquake-exposed groups had poorer performance on a test of visuospatial (but not verbal) learning and memory. This offers preliminary evidence suggesting that it is earthquake (trauma) exposure itself, rather than the presence of posttraumatic stress disorder that affects aspects of neuropsychological functioning. If replicated, this may have important implications for how information is communicated in a post-disaster context.
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Affiliation(s)
- Caroline J Bell
- 1 Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,2 Canterbury District Health Board, Christchurch, New Zealand
| | - Chris M Frampton
- 1 Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Helen C Colhoun
- 2 Canterbury District Health Board, Christchurch, New Zealand
| | - Katie M Douglas
- 1 Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | | | | | - Jennifer Jordan
- 1 Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,2 Canterbury District Health Board, Christchurch, New Zealand
| | - Janet D Carter
- 3 Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Rebekah A Smith
- 2 Canterbury District Health Board, Christchurch, New Zealand.,3 Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Leila Ma Marie
- 3 Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Alex Loughlin
- 3 Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Richard J Porter
- 1 Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,2 Canterbury District Health Board, Christchurch, New Zealand
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Averill IR, Crowe M, Frampton CM, Beaglehole B, Lacey CJ, Jordan J, Wilson LD, Douglas KM, Porter RJ. Clinical response to treatment in inpatients with depression correlates with changes in activity levels and psychomotor speed. Aust N Z J Psychiatry 2018; 52:652-659. [PMID: 29417833 DOI: 10.1177/0004867417753549] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Monitoring clinical response to treatment in depressed inpatients, particularly identifying early improvement, may be sub-optimal. This may impact adversely on patients through longer admissions and sub-optimal pharmacotherapy. Psychomotor speed is a prominent neuropsychological function which changes as recovery occurs. This study examines simple techniques used to quantify psychomotor change and their potential to contribute to monitoring recovery. METHODS Activity levels were continuously monitored in patients diagnosed with a major depressive episode from four acute psychiatric wards using two actigraphs (commercial and scientific) for 3 weeks and linear regression used to calculate a gradient to express rate of change. Psychomotor speed was assessed using the simple Coin Rotation Task. Mood and functioning were rated using the Quick Inventory of Depressive Symptoms, Clinical Global Impression Scale and Functioning Assessment Short Test. The assessments were completed at baseline and follow-up (3 weeks), and correlations were calculated for all change measures. RESULTS In all, 24 inpatients were recruited but not all completed baseline and follow-up measures. Change in activity count ( N = 16) and psychomotor speed ( N = 13) correlated significantly with improvement in clinical measures of depressive symptoms. Actigraphs were acceptable to hospital inpatients. LIMITATIONS The limited size of this pilot study precludes the analysis of predictive power or the influence of other variables such as depression subtypes, age, gender or variations related to medications. CONCLUSION Early change in simple activity and psychomotor speed warrant further investigation for utility in measuring treatment response in depressed inpatients.
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Affiliation(s)
- Ian Re Averill
- 1 Clinical Research Unit, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,2 Specialist Mental Health Services, Hillmorton Hospital, Christchurch, New Zealand
| | - Marie Crowe
- 1 Clinical Research Unit, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Chris M Frampton
- 1 Clinical Research Unit, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ben Beaglehole
- 1 Clinical Research Unit, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,2 Specialist Mental Health Services, Hillmorton Hospital, Christchurch, New Zealand
| | - Cameron J Lacey
- 1 Clinical Research Unit, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,3 West Coast District Health Board, Greymouth, New Zealand
| | - Jennifer Jordan
- 1 Clinical Research Unit, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Lynere D Wilson
- 1 Clinical Research Unit, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,4 Pegasus Health, Christchurch, New Zealand
| | - Katie M Douglas
- 1 Clinical Research Unit, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard J Porter
- 1 Clinical Research Unit, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,2 Specialist Mental Health Services, Hillmorton Hospital, Christchurch, New Zealand
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Douglas KM, Gallagher P, Robinson LJ, Carter JD, McIntosh VV, Frampton CM, Watson S, Young AH, Ferrier IN, Porter RJ. Prevalence of cognitive impairment in major depression and bipolar disorder. Bipolar Disord 2018; 20:260-274. [PMID: 29345037 DOI: 10.1111/bdi.12602] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/05/2017] [Accepted: 12/15/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The current study examines prevalence of cognitive impairment in four mood disorder samples, using four definitions of impairment. The impact of premorbid IQ on prevalence was examined, and the influence of treatment response. METHODS Samples were: (i) 58 inpatients in a current severe depressive episode (unipolar or bipolar), (ii) 69 unmedicated outpatients in a mild to moderate depressive episode (unipolar or bipolar), (iii) 56 outpatients with bipolar disorder, in a depressive episode, and (iv) 63 outpatients with bipolar disorder, currently euthymic. Cognitive assessment was conducted after treatment in Studies 1 (6 weeks of antidepressant treatment commenced on admission) and 2 (16-week course of cognitive behaviour therapy or schema therapy), allowing the impact of treatment response to be assessed. All mood disorder samples were compared with healthy control groups. RESULTS The prevalence of cognitive impairment was highest for the inpatient depression sample (Study 1), and lowest for the outpatient depression sample (Study 2). Substantial variability in rates was observed depending on the definition of impairment used. Correcting cognitive performance for premorbid IQ had a significant impact on the prevalence of cognitive impairment in the inpatient depression sample. There was minimal evidence that treatment response impacted on prevalence of cognitive impairment, except in the domain of psychomotor speed in inpatients. CONCLUSIONS As interventions aiming to improve cognitive outcomes in mood disorders receive increasing research focus, the issue of setting a cut-off level of cognitive impairment for screening purposes becomes a priority. This analysis demonstrates important differences in samples likely to be recruited depending on the definition of cognitive impairment and begins to examine the importance of premorbid IQ in determining who is impaired.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Peter Gallagher
- Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, UK
| | - Lucy J Robinson
- Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, UK
| | - Janet D Carter
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | | | | | - Stuart Watson
- Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, UK
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London & Maudsley NHS Foundation Trust, London, UK
| | - I Nicol Ferrier
- Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, UK
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Clinical Research Unit, Canterbury District Health Board, Christchurch, New Zealand
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Abstract
Background: Research suggests that only 50% of patients with major depression respond to psychotherapy or pharmacological treatment, and relapse is common. Therefore, there is interest in elucidating factors that help predict clinical response. Cognitive impairment is a key feature of depression, which often persists beyond remission; thus, the aim of this systematic review was to determine whether baseline cognitive functioning can predict treatment outcomes in individuals with depression. Method: Studies examining cognitive predictors of treatment response in depression were identified using Pub Med and Web of Science databases. Given the heterogeneity of outcome measures, the variety of treatment protocols, and the differing ways in which data was presented and analyzed, a narrative rather than meta-analytic review technique was used. Results: 39 studies met inclusion criteria. Findings in younger adult samples were inconclusive. There was some evidence for a predictive effect of executive function and to a lesser extent, psychomotor speed, on treatment response. There was no evidence of learning or memory being associated with treatment response. In older-aged samples, the evidence was much more consistent, suggesting that poor executive function predicts poor response to SSRIs. Conclusions: Findings from the present review suggest that certain aspects of cognitive functioning, particularly executive function, may be useful in predicting treatment response in depression. This is certainly the case in elderly samples, with evidence suggesting that poor executive functioning predicts poor response to SSRIs. With further research, baseline cognitive functioning may serve as a factor which helps guide clinical decision making. Moreover, cognitive deficits may become targets for specific pharmacological or psychological treatments, with the hope of improving overall outcome.
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Affiliation(s)
- Samantha J Groves
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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Moawad FJ, Molina-Infante J, Lucendo AJ, Cantrell SE, Tmanova L, Douglas KM. Systematic review with meta-analysis: endoscopic dilation is highly effective and safe in children and adults with eosinophilic oesophagitis. Aliment Pharmacol Ther 2017; 46:96-105. [PMID: 28513085 DOI: 10.1111/apt.14123] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 02/22/2017] [Accepted: 04/09/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Oesophageal dilation is frequently used as an adjunct treatment to alleviate symptoms that develop from fibrostenotic remodelling in eosinophilic oesophagitis (EoE). Earlier reports described an increased risk of complications associated with dilation. AIM Perform a systematic review and meta-analysis to assess the efficacy and safety of endoscopic dilation in children and adults with EoE. METHODS Professional librarians searched MEDLINE, EMBASE, the Cochrane library, Scopus, and Web of Science for articles in any language describing studies of dilation in EoE through December 2016. Studies were selected and data were abstracted independently and in duplicate. Random effects modelling was used to generate summary estimates for clinical improvement and complications (haemorrhage, perforation, hospitalisation, and death). RESULTS The search resulted in 3495 references, of which 27 studies were included in the final analysis. The studies described 845 EoE patients, including 87 paediatric patients, who underwent a total of 1820 oesophageal dilations. The median number of dilations was 3 (range: 1-35). Clinical improvement occurred in 95% of patients (95% CI: 90%-98%, I2 : 10%, 17 studies). Perforation occurred in 0.38% (95% CI: 0.18%-0.85%, I2 : 0%, 27 studies), haemorrhage in 0.05% (95% CI: 0%-0.3%, I2 : 0%, 18 studies), and hospitalisation in 0.67% (95% CI: 0.3%-1.1%, I2 : 44%, 24 studies). No deaths occurred (95% CI: 0%-0.2% I2 : 0%, 25 studies). CONCLUSIONS Endoscopic dilation is consistently effective in children and adults with EoE, resulting in improvement in 95% of patients with very low rates (<1%) of major complications.
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Affiliation(s)
- F J Moawad
- Division of Gastroenterology, Scripps Clinic, La Jolla, CA, USA
| | - J Molina-Infante
- Department of Gastroenterology, Hospital San Pedro de Alcantara, Caceres, Spain.,Centro de Investigación Biomédica En Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Madrid, Spain
| | - A J Lucendo
- Centro de Investigación Biomédica En Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Madrid, Spain.,Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Cuidad Real, Spain
| | - S E Cantrell
- Darnall Medical Library, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - L Tmanova
- Darnall Medical Library, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - K M Douglas
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Bell CJ, Colhoun HC, Frampton CM, Douglas KM, McIntosh VVW, Carter FA, Jordan J, Carter JD, Smith RA, Marie LMA, Loughlin A, Porter RJ. Earthquake Brain: Altered Recognition and Misclassification of Facial Expressions Are Related to Trauma Exposure but Not Posttraumatic Stress Disorder. Front Psychiatry 2017; 8:278. [PMID: 29312012 PMCID: PMC5732911 DOI: 10.3389/fpsyt.2017.00278] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/28/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The study investigated facial expression recognition (FER) in posttraumatic stress disorder (PTSD) caused by exposure to earthquakes, and in particular whether people with this condition showed a bias toward interpreting facial expressions as threat-related emotions (i.e., as anger, fear, or disgust). The study included a trauma-exposed control group who had been similarly exposed to the earthquakes but had not developed PTSD. We hypothesized that individuals with PTSD would have increased sensitivity to threat-related facial emotions compared with the trauma-exposed control group. This would be shown by increased accuracy in recognition of threat-related emotions and the misinterpretation of neutral expressions to these emotions (i.e., misidentifying them as anger, fear, or disgust). The availability of a group of healthy controls from a previous study who had been tested on a similar task before the earthquakes allowed a further non-exposed comparison. METHOD Twenty-eight individuals with PTSD (71% female, mean age 42.8 years) and 89 earthquake-exposed controls (66% female, mean age 50.1 years) completed an FER task, which featured six basic emotions. Further comparisons were made with 50 non-exposed controls (64% female, mean age 38.5 years) who had been tested before the earthquakes. RESULTS There was no difference in sensitivity to threat-related facial expressions (as measured by accuracy in recognition of threat-related facial expressions and the misinterpretation of neutral expressions as threatening) in individuals with PTSD compared with similarly earthquake-exposed controls. Supplementary comparison with an historical, non-exposed control group showed that both earthquake-exposed groups had increased accuracy for the identification of all facial emotions and showed a bias in the misclassification of neutral facial expressions to the threat-related emotions of anger and disgust. CONCLUSION These findings suggest that it is exposure to earthquakes and repeated aftershocks, rather than the presence of PTSD that affects FER accuracy and misinterpretation. The importance of these biases in both PTSD and trauma-exposed controls needs further exploration and is an area for future research.
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Affiliation(s)
- Caroline J Bell
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Helen C Colhoun
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Chris M Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | | | - Frances A Carter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
| | - Janet D Carter
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Rebekah A Smith
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Leila M A Marie
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Alex Loughlin
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Canterbury District Health Board, Christchurch, New Zealand
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Porter RJ, Bourke C, Carter JD, Douglas KM, McIntosh VVW, Jordan J, Joyce PR, Frampton CMA. No change in neuropsychological dysfunction or emotional processing during treatment of major depression with cognitive-behaviour therapy or schema therapy. Psychol Med 2016; 46:393-404. [PMID: 26446709 DOI: 10.1017/s0033291715001907] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Impaired neuropsychological functioning is a feature of major depression. Previous studies have suggested that at least some aspects of neuropsychological functioning improve with successful treatment of major depression. The extent to which medications may affect the degree of normalization of these functions is unclear. The aim of the current study was to examine the course of neuropsychological functioning during treatment of major depression with cognitive-behaviour therapy (CBT) or schema therapy (ST). METHOD A total of 69 out-patients with a primary diagnosis of major depression and 58 healthy controls completed mood ratings, neuropsychological measures, and measures of emotional processing at baseline and after 16 weeks. Participants were randomized after baseline assessment to a year-long course of CBT or ST. Patients reassessed at 16 weeks were medication-free throughout the study. RESULTS Significant neuropsychological impairment was evident at baseline in depressed participants compared with healthy controls. After 16 weeks of psychotherapy, mean depression rating scores fell more than 50%. However, no neuropsychological measures showed convincing evidence of significant improvement and emotional processing did not change. CONCLUSIONS Persisting impairment in neuropsychological functioning after the first 16 weeks of CBT or ST suggests a need to modify psychological treatments to include components targeting cognitive functioning.
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Affiliation(s)
- R J Porter
- Department of Psychological Medicine,University of Otago,Christchurch,New Zealand
| | - C Bourke
- Department of Psychological Medicine,University of Otago,Christchurch,New Zealand
| | - J D Carter
- Department of Psychology,University of Canterbury,Christchurch,New Zealand
| | - K M Douglas
- Department of Psychological Medicine,University of Otago,Christchurch,New Zealand
| | - V V W McIntosh
- Department of Psychological Medicine,University of Otago,Christchurch,New Zealand
| | - J Jordan
- Department of Psychological Medicine,University of Otago,Christchurch,New Zealand
| | - P R Joyce
- Department of Psychological Medicine,University of Otago,Christchurch,New Zealand
| | - C M A Frampton
- Department of Psychological Medicine,University of Otago,Christchurch,New Zealand
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Dimitroulas T, Sandoo A, Hodson J, Smith J, Douglas KM, Kitas GD. Associations between asymmetric dimethylarginine, homocysteine, and the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism (rs1801133) in rheumatoid arthritis. Scand J Rheumatol 2015; 45:267-73. [PMID: 26599798 DOI: 10.3109/03009742.2015.1086433] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aim of our study was to determine whether asymmetric dimethylarginine (ADMA) levels are associated with homocysteine (Hcy) and methylenetetrahydrofolate reductase (MTHFR) C677T (rs1801133) gene variants in patients with rheumatoid arthritis (RA). METHOD Serum ADMA and Hcy levels were measured in 201 RA individuals [155 (77.1%) females, median age 67 years (interquartile range 59-73)]. The MTHFR C677T polymorphism was assessed by using the LightCyclerTM System. Initially, ADMA was compared across the categories of MTHFR using a one-way analysis of variance (ANOVA), followed by a multivariate model, which accounted for Hcy, age, erythrocyte sedimentation rate (ESR), and homeostatic model assessment (HOMA). RESULTS In univariable analysis, ADMA differed significantly across the categories of MTHFR (p = 0.037). Patients with the MTHFR 677TT genotype had the highest ADMA levels, with a mean of 0.62 (SE = 0.03), significantly higher than either those patients carrying the MTHFR 677CT (0.55, SE = 0.01) or the MTHFR 677CC (0.55, SE = 0.01) genotype (p = 0.042) in both cases. In the multivariable model, Hcy (p = 0.022) and ESR (p < 0.001) were found to have significant positive associations with ADMA but the relationship between MTHFR gene variants and ADMA was found to be non-significant (p = 0.102). CONCLUSIONS Hcy and ADMA are significantly associated in RA. It is plausible that abnormal Hcy metabolism plays an important role in premature atherosclerosis in RA by promoting ADMA accumulation and leading to the derangement of vascular haemostasis.
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Affiliation(s)
- T Dimitroulas
- a Department of Rheumatology , Dudley Group of Hospitals NHS Trust, Russells Hall Hospital , Dudley , West Midlands , UK
| | - A Sandoo
- a Department of Rheumatology , Dudley Group of Hospitals NHS Trust, Russells Hall Hospital , Dudley , West Midlands , UK.,b School of Sport, Health and Exercise Sciences , Bangor University , Bangor , Gwynedd, Wales , UK
| | - J Hodson
- c Wolfson Computer Laboratory , University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham , UK
| | - J Smith
- a Department of Rheumatology , Dudley Group of Hospitals NHS Trust, Russells Hall Hospital , Dudley , West Midlands , UK
| | - K M Douglas
- a Department of Rheumatology , Dudley Group of Hospitals NHS Trust, Russells Hall Hospital , Dudley , West Midlands , UK
| | - G D Kitas
- a Department of Rheumatology , Dudley Group of Hospitals NHS Trust, Russells Hall Hospital , Dudley , West Midlands , UK.,d Arthritis Research UK Epidemiology Unit , University of Manchester , Manchester , UK
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Abstract
OBJECTIVE Impairment in the retrieval of specific episodes from autobiographical memory is commonly observed in major depression. However, it is unclear whether impairment in retrieval processes is a general characteristic of major depression or is confined to the recollection of personal memories. This study examined the time course of the retrieval of words from semantic memory. METHOD A letter fluency test was administered to 65 inpatients with major depression and 50 healthy controls. A two-parameter model was fit to the decay curve representing the production of words over a 90-second period. One parameter, N, is an estimate of the total number of words that would be generated if the respondent was given unlimited time. The other, tau, is the average of the difference in time between the first word generated and each subsequent word. RESULTS There was evidence of a deficit in the retrieval of words from long-term memory in depressed patients. The significant difference between groups suggested that even if given an extended period of time in which to respond to compensate for possible slowness, the depressed group would not retrieve as many words as the controls. The retrieval failure could not be attributed solely to cognitive slowing or the effects of antidepressant medication. CONCLUSIONS The results extend findings of a deficit in the process of retrieving specific episodes from autobiographical memory and suggest that a generalised impairment in memory retrieval may be characteristic of major depression.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
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Douglas KM, Porter RJ. The effect of childhood trauma on pharmacological treatment response in depressed inpatients. Psychiatry Res 2012; 200:1058-61. [PMID: 22770764 DOI: 10.1016/j.psychres.2012.06.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/25/2012] [Accepted: 06/11/2012] [Indexed: 11/15/2022]
Abstract
Childhood trauma and its association with pharmacological treatment response were examined in depressed inpatients. Treatment non-responders (n=31) reported significantly more severe trauma than treatment responders (n=25) and healthy controls (n=49), suggesting that the experience of childhood trauma in those hospitalised with depression can be detrimental to treatment success.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, P.O. Box 4345, Christchurch 8140, New Zealand.
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Douglas KM, Porter RJ. Associations between hypothalamic-pituitary-adrenal axis function and facial emotion processing in depressed and control participants. Psychiatry Clin Neurosci 2012; 66:442-50. [PMID: 22834663 DOI: 10.1111/j.1440-1819.2012.02364.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The current study examined the relation between facial emotion processing accuracy and an aspect of hypothalamic-pituitary-adrenal axis function in 64 inpatients with major depression and 49 healthy controls over a 2-week period. METHODS The Dexamethasone Suppression Test and a Facial Expression Recognition Task were completed at baseline and 10-14 days after baseline. Treatment response was determined 6 weeks after baseline by change in the Montgomery-Asberg Depression Rating Scale. RESULTS Increased cortisol response to dexamethasone was significantly correlated with reduced ability to recognize facial expressions of anger, sadness and disgust within the total sample, but these correlations did not remain significant at 10-14 days. Surprisingly, cortisol response to dexamethasone was comparable in acutely depressed inpatients and healthy controls, and did not change over time in relation to treatment response. CONCLUSION The study findings provide preliminary evidence that hypothalamic-pituitary-adrenal axis functioning and processing threat-related facial expressions are related, perhaps through involvement of the amygdala.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
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Tugnet N, Cooper SC, Douglas KM. Methotrexate therapy, rheumatoid arthritis, and life-threatening liver complications: should we be monitoring more closely? Scand J Rheumatol 2012; 41:163-4. [DOI: 10.3109/03009742.2012.657234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND Impaired neuropsychological function and differences in facial emotion processing are features of major depression. Some aspects of these functions may change during treatment and may be useful in assessing treatment response, even at an early stage of treatment. AIMS To examine early and later changes in neuropsychological functioning and facial emotion processing as potential markers of treatment response in major depression. METHOD In total, 68 newly admitted in-patients with a primary diagnosis of major depression and 50 healthy controls completed an assessment, including mood ratings, neuropsychological measures and facial emotion processing measures at three time points (baseline, 10-14 days and 6 weeks). RESULTS Pervasive neuropsychological impairment was evident at baseline in patients with depression compared with healthy controls. During 6 weeks of treatment, only simple reaction time, verbal working memory and the recognition of angry facial expressions showed differential change in those whose depression responded to treatment compared with treatment non-responders in the depression group. None of the measures showed a significant difference between treatment responders and non-responders at 10-14 days. CONCLUSIONS Despite significant impairment in neuropsychological functioning in the depression group, most measures failed to differentiate between treatment responders and non-responders at 10-14 days or at 6 weeks. Simple reaction time, verbal working memory and recognition of angry facial expressions may be useful in assessing response in severe depression but probably not at an early stage.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago - Christchurch, PO Box 4345, Christchurch, New Zealand
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Abstract
Facial emotion processing was examined in patients with severe depression (n = 68) and a healthy control group (n = 50), using the Facial Expression Recognition Task. A negative interpretation bias was observed in the depression group: neutral faces were more likely to be interpreted as sad and less likely to be interpreted as happy, compared with controls. The depression group also displayed a specific deficit in the recognition of facial expressions of disgust, compared with controls. This may relate to impaired functioning of frontostriatal structures, particularly the basal ganglia.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch 8011, New Zealand
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Douglas KM, Porter RJ, Frampton CM, Gallagher P, Young AH. Abnormal response to failure in unmedicated major depression. J Affect Disord 2009; 119:92-9. [PMID: 19285346 DOI: 10.1016/j.jad.2009.02.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 02/19/2009] [Accepted: 02/21/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND An aspect of neuropsychological impairment which has been linked specifically to depression is an abnormal response to failure. That is, a rapid deterioration of performance after receiving feedback that an error was made on the previous task. We aimed to examine this phenomenon in unmedicated, depressed outpatients. METHODS Forty-four patients meeting DSM-IV criteria for major depression, all psychotropicmedication-free for at least six weeks, and 44 demographically matched, healthy control participants completed a computerised simultaneous/delayed matching-to-sample task (S/DMTS). RESULTS Patients with depression were significantly less accurate than controls on the S/DMTS task. Both groups augmented their performance after an error had been made. The probability of making an error following an error was significantly greater in depressed compared with control participants, even when total number of errors was controlled for. Response latencies reduced significantly after an error had been made for both groups. LIMITATIONS Both groups made relatively few errors. This reduced the power of analysis particularly when examining the effect of delay. CONCLUSIONS The abnormal response to negative feedback previously identified in depressed samples was replicated in the current unmedicated, less severely depressed group. The impairment shown in the depressed sample may be due to a reduction in the motivating effect of an error compared with healthy controls. This has possible relevance to both neurobiological and psychological theories of depression.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
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Abstract
Neuropsychological impairment is a core component of major depression, yet its relationship to clinical state is unclear. The aims of the present review were to determine which neuropsychological domains and tasks were most sensitive to improvement in clinical state in major depression and to highlight the methodological issues in such research. Studies that included a baseline and at least one follow-up neuropsychological testing session in adults with major depression were identified using MEDLINE, Web of Science and ScienceDirect databases. Thirty studies were included in the review. Findings in younger adult populations suggested that improvement in mood was most strongly related to improved verbal memory and verbal fluency, while measures of executive functioning and attention tended to remain impaired across treatment. In late-life major depression, improved psychomotor speed was most closely related to treatment response, but there was much inconsistency between study findings, which may be due to methodological issues. In major depression, particular neuropsychological domains are more strongly related to clinical state than others. The findings from the present review suggest that the domains most sensitive to clinical state are verbal learning and memory, verbal fluency and psychomotor speed. In contrast, measures of attention and executive functioning perhaps represent more trait-like markers of major depression. With further methodologically sound research, the changes in neuropsychological function associated with treatment response may provide a means of evaluating different treatment strategies in major depression.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago,Christchurch, Christchurch, New Zealand.
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Abstract
Amusia (commonly referred to as tone-deafness) is a difficulty in discriminating pitch changes in melodies that affects around 4% of the human population. Amusia cannot be explained as a simple sensory impairment. Here we show that amusia is strongly related to a deficit in spatial processing in adults. Compared to two matched control groups (musicians and non-musicians), participants in the amusic group were significantly impaired on a visually presented mental rotation task. Amusic subjects were also less prone to interference in a spatial stimulus-response incompatibility task and performed significantly faster than controls in an interference task in which they were required to make simple pitch discriminations while concurrently performing a mental rotation task. This indicates that the processing of pitch in music normally depends on the cognitive mechanisms that are used to process spatial representations in other modalities.
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Affiliation(s)
- Katie M Douglas
- Department of Psychology, 95 Union St, University of Otago, PO Box 56, Dunedin 9054, New Zealand
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Treharne GJ, Hale ED, Lyons AC, Booth DA, Banks MJ, Erb N, Douglas KM, Mitton DL, Kitas GD. Cardiovascular disease and psychological morbidity among rheumatoid arthritis patients. Rheumatology (Oxford) 2004; 44:241-6. [PMID: 15522922 DOI: 10.1093/rheumatology/keh441] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To examine whether patients with rheumatoid arthritis (RA) with co-morbid cardiovascular disease (CVD) have different psychological morbidity (and psychosocial risk factors for it) compared with RA patients without co-morbid CVD. METHODS Patients with RA and co-morbid CVD (n = 44; hypertension alone for n = 27) were compared with RA patients without CVD (n = 110). Differences in psychological morbidity (depression and anxiety) and psychosocial risk factors for this (arthritis self-efficacy, acceptance, social support and optimism) were examined while controlling statistically for medical and demographic covariates. RESULTS Groups did not differ on RA duration, RA activity, marital status or socioeconomic status, but RA patients with co-morbid CVD were older, less likely to be female and less likely to be in employment than those without CVD. RA patients with co-morbid CVD had significantly higher depression and were more likely to score above cut-offs for depression than RA patients without CVD. No differences existed in anxiety, although anxiety appeared to be more common than depression. Low optimism was identified as a possible psychosocial risk factor for depression. CONCLUSIONS RA patients with co-morbid CVD have higher depression than RA patients without CVD; low optimism is a potentially modifiable risk factor that may mediate this difference. RA patients with co-morbid CVD may benefit from systematic screening for depression and targeted intervention if necessary.
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Affiliation(s)
- G J Treharne
- University of Birmingham, School of Psychology, UK.
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Abstract
This research investigated the intergroup properties of hostile 'flaming' behaviour in computer-mediated communication and how flaming language is affected by Internet identifiability, or identifiability by name and e-mail address/geographical location as is common to Internet communication. According to the Social Identity Model of Deindividuation Effects (SIDE; e.g. Reicher, Spears, & Postmes, 1995) there may be strategic reasons for identifiable groups members to act in a more group-normative manner in the presence of an audience, to gain acceptance from the in-group, to avoid punishment from the out-group, or to assert their identity to the out-group. For these reasons, it was predicted that communicators would produce more stereotype-consistent (group-normative) descriptions of out-group members' behaviours when their descriptions were identifiable to an audience. In one archival and three experimental studies, it was found that identifiability to an in-group audience was associated with higher levels of stereotype-consistent language when communicators described anonymous out-group targets. These results extend SIDE and suggest the importance of an in-group audience for the expression of stereotypical views.
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Affiliation(s)
- K M Douglas
- Australian National University, Canberra, Australia
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Douglas KM, Fisher G, Reeleder D. Compression-sclerotherapy for varicose veins: a Canadian study. Can Med Assoc J 1982; 126:923-7. [PMID: 7074489 PMCID: PMC1863000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In recent years modifications and refinements in treating varicose veins by injecting a sclerosant have given this method an important place in the practitioner's armamentarium. Specific indications and precise technique are essential. Compression-sclerotherapy has been used since 1975 in the vein clinic of Belleville General Hospital, Belleville, Ont. Some patients have also required limited ligation of veins that were deeper or more proximal, or both. A follow-up study of patients 2 or more years after treatment revealed no major complications and a high rate of patient acceptance and satisfaction. The costs of treatment were about one tenth those of conventional inpatient surgery.
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Douglas KM. Anatomy of the Transversalis Muscle and its Relation to Inguinal Hernia. J Anat Physiol 1890; 24:220-6. [PMID: 17231851 PMCID: PMC1328045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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