Recognition of depressed affect in hospitalized psychiatric patients: staff and patient perceptions

A comparison of self-report vs. observer rating of depressed mood in a heterogenous inpatient population revealed wide variations in concordance among diagnostic groups. Patients diagnosed as having Affective Psychosis and "Other' illnesses showed the highest correlation between four self-report scales and an observer rating scale. Patients with a diagnosis of depressive Neurosis showed only modest correlation, while Schizophrenics revealed no significant correlation, on these instruments, suggesting inconsistent communication of affect from Schizophrenic patients to observers. In contrast, when self-report scales were intercorrelated, patients in all four diagnostic categories showed highly significant correlations, indicating that they were consistently reporting their affective state on these instruments. The implications of these findings for future research as well as for practical clinical management are discussed.     

Life stressors and social resources affect posttreatment outcomes among depressed patients.

Examined pre- and posttreatment changes in life stressors and social resources and their association with treatment outcomes in a 12-mo follow-up of 424 Ss (aged 18–83 yrs) with unipolar depression. Assessment measures included the Family Environment Scale, Work Environment Scale, and Health and Daily Living Form. As expected, Ss reported significant, multidimensional improvements in their functioning at follow-up. There were modest increases in Ss' social resources but, suprisingly, no overall decrease in stressors. Life stress and resource factors were significantly related to Ss' functioning at follow-up, even after considering the severity of their dysfunction at treatment intake and their length of treatment. Implications for developing a general body of knowledge about the process of recovery and relapse in behavioral disorders are discussed. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cue-elicited negative affect in impulsive smokers.

Impulsivity is associated with cigarette smoking, but the nature of this relationship and the mechanisms that maintain it are relatively unknown. The relationship has often been thought to reflect appetitive processes, but research suggests that an affective pathway exists as well. The present study tested the effect of impulsivity on affective responses to an environmental smoking cue. Adult smokers (N=62) were exposed to a neutral cue and a smoking cue in separate experimental sessions in a repeated-measures design. Mixed-effects regression analyses showed that larger postexposure increases in negative affect were associated with high scores on 2 facets of impulsivity: urgency, t(179)=6.16, p     

Individual differences in negative affect repair.

The extant literature implicates affect repair ability as one source of individual differences in negative affect. Emerging from this literature are three regulatory traits that should predict repair ability (negative mood regulation expectancies, monitoring, labeling), yet no experimental examination of this possibility exists. Two studies explored this issue. Participants (Ns = 305, 146) watched negative affect-inducing videos and completed a repair or control writing task, before and after which they reported their affect. Results revealed wide individual differences in repair ability. Specifically, participants with high expectancies of repair success and those who attend to and understand their affect experienced the largest decreases in negative affect and largest increases in positive affect following the repair tasks. These findings advance understanding of individual differences in affect regulation and have implications for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the bipolarity of positive and negative affect

Is positive affect (PA) the bipolar opposite of, or is it independent of, negative affect (NA)? Previous analyses of this vexing question have generally labored under the false assumption that bipolarity predicts an invariant latent correlation between PA and NA. The predicted correlation varies with time frame, response format, and items selected to define PA and NA. The observed correlation also varies with errors inherent in measurement. When the actual predictions of a bipolar model are considered and error is taken into account, there is little evidence for independence of what were traditionally thought opposites. Bipolarity provides a parsimonious fit to existing data.     

Interplay of concurrent positive and negative interpersonal events in the prediction of daily negative affect and fatigue for rheumatoid arthritis patients.

Objective: The purpose of this study was to examine the interaction of daily concurrent positive interpersonal events (PIE) and negative interpersonal events (NIE) on the daily experience of negative affect and fatigue in a sample of men and women with rheumatoid arthritis. Two hypotheses were made. The blunting hypothesis predicted that NIE would nullify the beneficial influence of PIE on outcome measures, and the buffering hypothesis predicted that PIE would offset the adverse influence of NIE. Design: Participants completed up to 30 consecutive daily diaries. Multilevel modeling was used to examine the day-to-day dependencies among study variables. Main Outcome Measures: The primary outcomes were daily negative affect and fatigue. Results: In support of the blunting hypothesis, on days when NIE were diminished, PIE were associated with a greater reduction in fatigue. In contrast, consistent with the buffering hypothesis, on days when PIE were elevated, NIE were associated with a lesser increase in negative affect. Conclusion: The examination of concurrent PIE and NIE provides a unique perspective on the role of interpersonal events in affective and physiological outcomes, beyond that which can be gained from the examination of either type of event in isolation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Extending the activity restriction model of depressed affect: Evidence from a sample of breast cancer patients.

Survey data from 95 women with Stage 1 (n?=?36), Stage 2 (n?=?49), or Stage 3 (n?=?10) breast cancer both confirm and extend prior research indicating that restriction of normal activities is an important factor in depressed affect. Illness severity was directly related to more restricted routine activities, and more activity restriction was associated with higher public self-consciousness and less social support. Beyond the effects of age, self-consciousness, illness severity, and social support, activity restriction explained significant additional variance in symptoms of depression. Moreover, activity restriction mediated the impact of pain, public self-consciousness, and social support on depressed affect, which implies that these factors foster symptoms of depression by disrupting normal activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the independence of positive and negative affect.

Three separate but mutually compatible explanations are offered for N. M. Bradburn's (1969) finding that positive and negative affects are statistically independent: (1) In terms of a higher-order generalization, numbers of experienced desirable and undesirable episodes are generally uncorrelated. (2) The independence is a function of a response mode and scoring procedure that differ from those used elsewhere. (3) Short-term affective states are linked with more stable personality dispositions. 500 undergraduates served as Ss. Findings support each of these explanations: (a) Numbers of desirable and undesirable recent life events were statistically independent and correlated with positive and negative affect in the predicted manner. (b) Amending the response format from counting the number of positive and negative experiences to requiring reports of the proportion of time each was experienced yielded an intercorrelation of –.54 compared to –.01 in the original format. (c) Positive and negative affects were significantly associated with extraversion and neuroticism, respectively, but not with the other dispositional measure. Each explanation had value within 3 different conceptual and methodological frameworks. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Film-induced negative affect triggers overeating in restrained eaters.

We tested the effects of film-induced negative affect (i.e., exposure to a frightening film) in 60 women classified as either restrained or unrestrained eaters on the basis of their responses to the Revised Restraint Scale (C. P. Herman and J. Polivy, 1980). Exposure to the frightening film, in contrast to a neutral film, was associated with increases in anxiety, sadness, and anger. High restraint subjects exposed to the frightening film ate more than did equally restrained subjects exposed to a neutral film or low restraint subjects exposed to either film. Thus, negative affect triggered overeating among restrained eaters. Although unrestrained eaters exposed to the frightening film ate less than those who viewed the neutral film, this difference was not statistically significant. These results suggest that negative affect may prompt overeating in persons who attempt to restrict their caloric intake. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

ST-segment elevation in right precordial leads implies depressed right ventricular function after acute inferior myocardial infarction

BACKGROUND: The prognosis of acute inferior myocardial infarction is worse when it is complicated by right ventricular infarction. ST elevation in the right precordial leads is one of the reliable methods for detecting acute right ventricular infarction. The purpose of the study was to examine the relation between ST elevation in the right precordial electrocardiographic leads during acute inferior infarction and the severity of right ventricular systolic dysfunction. METHODS: This study analyzed the relation between ST elevation > or = 0.1 mV in V4R and the severity of right ventricular systolic dysfunction in 43 consecutive patients (men/women: 35/8; average age 62+/-9 years) with acute inferior myocardial infarction with a rapid-response Swan-Ganz catheter to measure the right ventricular ejection fraction (RVEF). RESULTS: RVEF was significantly lower in patients with ST elevation (n = 18) than in those without (n = 25) (33%+/-6% vs 40%+/-9%, p = 0.010). If the infarct-related lesion was located in the proximal right coronary artery, RVEF tended to be lower than if the lesion was located in the distal right coronary artery or the left circumflex coronary artery (33%+/-10% vs 37%+/-9% vs 42%+/-9%, p = 0.101). Logistic regression analysis demonstrated that ST elevation in V4R was the only independent predictor of depressed RVEF (odds ratio = 5.31, 95% confidence interval = 1.28 to 22.1, p = 0.022). CONCLUSION: ST elevation in lead V4R during acute inferior myocardial infarction predicts right ventricular systolic dysfunction.     

A subcortical pathway to the right amygdala mediating "unseen" fear

Neuroimaging studies have shown differential amygdala responses to masked ("unseen") emotional stimuli. How visual signals related to such unseen stimuli access the amygdala is unknown. A possible pathway, involving the superior colliculus and pulvinar, is suggested by observations of patients with striate cortex lesions who show preserved abilities to localize and discriminate visual stimuli that are not consciously perceived ("blindsight"). We used measures of right amygdala neural activity acquired from volunteer subjects viewing masked fear-conditioned faces to determine whether a colliculo-pulvinar pathway was engaged during processing of these unseen target stimuli. Increased connectivity between right amygdala, pulvinar, and superior colliculus was evident when fear-conditioned faces were unseen rather than seen. Right amygdala connectivity with fusiform and orbitofrontal cortices decreased in the same condition. By contrast, the left amygdala, whose activity did not discriminate seen and unseen fear-conditioned targets, showed no masking-dependent changes in connectivity with superior colliculus or pulvinar. These results suggest that a subcortical pathway to the right amygdala, via midbrain and thalamus, provides a route for processing behaviorally relevant unseen visual events in parallel to a cortical route necessary for conscious identification.     

Baseline reaction time predicts 12-month smoking cessation outcome in formerly depressed smokers.

Burgeoning evidence points to a positive association between cigarette smoking and depression. Moreover, depressive symptomatology, whether historical, current, or subsyndromal, appears to negatively influence smoking cessation efforts. Whereas depression is typically assessed via clinical interview or self-report, rarely are the known neurocognitive deficits linked to depression (e.g., global slowing) assessed in the context of smoking cessation research. Hence, this study examined whether simple reaction time--color naming of affectively neutral words--is predictive of 12-month smoking cessation outcome among a sample of formerly depressed smokers (N = 28). Results revealed a significant, positive correlation between reaction time and depressive symptoms such that those who exhibited slower reaction times were at heightened risk to relapse. Baseline depressive symptoms, as assessed via self-report, neither correlated with nor predicted smoking cessation outcome. Results from logistic regression analyses further showed that reaction time added incremental variance to the prediction of smoking cessation outcome. Therefore, simple reaction time may capture aspects of depression not typically assessed in self-report questionnaires. These results are discussed in terms of their theoretical and clinical implications for smoking cessation research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heart rate variability in depressed patients and differential effects of paroxetine and amitriptyline on cardiovascular autonomic functions

Twenty-four unmedicated patients with episodes of major depression (DSM-III-R) and an age- and sex-matched group of 24 normal subjects underwent a heart rate analysis. The battery of cardiovascular reflex tests included the coefficient of variation while resting (CVr) and during deep breathing (CVdr), a spectral analysis of heart rate variability, the Valsalva test, and the posture index. The depressed patients showed no significant abnormalities in any of the tests as compared to the healthy subjects. The 24 patients were randomly allocated for treatment with either amitriptyline or paroxetine. During treatment with 20 mg paroxetine per day, patients showed no changes in cardiovascular autonomic function tests after 14 days. However, treatment with 150 mg amitriptyline per day decreased all heart rate parameters significantly due to anticholinergic side effects, except heart rate, which increased significantly. As autonomic side effects are a potential hazard of antidepressant therapy, the data suggest that paroxetine is an appropriate antidepressant for cases with pre-existing cardiovascular autonomic neuropathy.     

Implicit category learning performance predicts rate of cognitive decline in nondemented patients with Parkinson's disease.

Nondemented patients with Parkinson's disease (PD) are impaired in learning to categorize simple perceptual stimuli when category membership is defined by a nonlinear relationship between stimulus dimensions but not when the relationship is linear (J. V. Filoteo, W. T. Maddox, D. P. Salmon, & D. D. Song, 2005). In the present study, the authors examined whether performance in either of these 2 category learning conditions was predictive of global cognitive decline following a mean of 1.6 years since the time patients were 1st seen. Results indicated that final block accuracy in the nonlinear condition, but not the linear condition, predicted global cognitive decline. Performance on the Wisconsin Card Sorting Test (WCST) did not significantly predict global cognitive decline, although there was a trend for this to be the case. In addition, the association between nonlinear category learning and global cognitive decline was not impacted by patients' performance on the WCST. Results suggest that nonlinear category learning predicts cognitive decline in nondemented patients with PD and that nonlinear category learning and WCST performances may provide independent measures of integrity of the posterior and anterior caudate, respectively. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sleep deprivation in the treatment of elderly depressed patients

Fifteen elderly depressed patients were treated by 36-hour sleep deprivation (SD). The depression was unipolar in 3 cases, bipolar in 3, and secondary in 4. Nine of the 15 patients responded to SD, and 6 had a remission (1 with SD alone and 5 with SD plus an antidepressant drug). Some of the remaining 6 patients might have responded if the treatment had not been interrupted for various reasons. These favorable results in elderly patients were better than anticipated. SD was well tolerated, although in one patient with bipolar depression a manic attack was precipitated. The effectiveness of SD poses interesting theoretic questions.     

Role of the central nucleus of the amygdala in olfactory heart rate conditioning.

The role of the central nucleus of the amygdala on olfactory heart rate conditioning in the infant rat was investigated. The conditioned stimulus (CS) consisted of a 10-s presentation of grape juice odor that was immediately followed by a 0.5-s, 0.35-mA subcutaneous shock. A sensitization control group was also run. Three days prior to testing, Ss received either bilateral electrolytic lesions of the central nucleus of the amygdala, sham lesions, or were left unperturbed. Results show that damage to the central nucleus of the amygdala severely impaired olfactory heart rate conditioning but that it had no deleterious effect on the heart rate orienting response to that stimulus or on the heart rate unconditioned response (UCR) to shock. Results are analogous to those in previous research on auditory heart rate conditioning and suggest that the central nucleus of the amygdala may constitute a necessary stage in the transduction of the CS into a cardiac conditioned response (CR) regardless of sensory modality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Activity restriction mediates the association between pain and depressed affect: A study of younger and older adult cancer patients.

Associations are reported frequently among pain, functional disability, and symptoms of depression. The purpose of this longitudinal study was to further clarify relations among these variables. In 268 younger (ages 30–64) and older (ages 65–90) cancer outpatients, cross-sectional analyses replicated previous findings showing that effects of pain on symptoms of depression are mediated by functional disability. Longitudinal analyses revealed that as pain increased over time, so did activity restriction, which in turn predicted increases in depressed affect. Comparative analyses indicate that restriction of routine activities that are due to illness and pain may be more distressing to individuals less than 65 years of age than to those 65 years of age or older. The results suggest that older persons are less distressed by restricted activities because of lower expectations about functional status and more experience with illness and disability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temperature, aggression, and the negative affect escape model.

Addresses P. A. Bell's (see record 1992-20144-001) comments on C. A. Anderson's (see record 1989-36724-001) review of the temperature–aggression literature. At a global level, all agree that geographic region studies and most time period studies do not cleanly address the question of the functional shape relating temperature to aggression. In addition, all agree that the negative affect escape model warrants additional empirical investigation. At a more specific level, however, numerous inaccuracies and misinterpretations are noted and corrected. The conclusions of the original review are confirmed. Suggestions for new research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Speed in test performance in depressed patients.

Compared the performance of 2 groups of nonschizophrenic, nonorganic, psychiatric patients—25 depressed (mean age 41.4 yrs) and 25 nondepressed (mean age 37.8 yrs) Ss—on several tests, including the Quick Test, the WAIS, and 10 speed tests and measures of ambiguous figure reversal rates. The 2 groups of Ss were matched for general psychopathology, sex, age, and education. No difference in the performance on power-cognitive (i.e., intelligence) tests was found. Depressed patients performed more slowly on psychomotor speed tests, confirming an earlier study comparing depressed patients and normal controls. Findings generally confirm those of the 1st author et al (1972) and those of several earlier studies summarized by W. R. Miller (see record 1975-20082-001). (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)