Self-referential schemas and attentional bias predict severity and naturalistic course of depression symptoms.

Attentional bias and self-referential schemas have been observed in numerous cross-sectional studies of depressed adults and are theorised to maintain negative mood. However, few longitudinal studies have examined whether maladaptive cognition predicts the course of depressive symptoms. Fifty-seven adults with elevated depression symptoms were assessed for negative attentional bias using a dot-probe task with eye-tracking and self-referential schemas using a self-referent encoding task. Participants subsequently completed five weekly depression symptom assessments. Participants with more negative self-referential schemas had higher baseline depression symptoms (r = .55). However, participants who spent more time attending to negative words showed greater symptom worsening over time (r = .42). The findings for negative self-referential schemas replicate past research, while the findings for negative attention bias represent the first evidence showing that attentional biases predict naturalistic symptom course. This work suggests that negative attention biases maintain depression symptoms and represent an important treatment target for neurocognitive therapeutics.

Positive imagery training increases positive self-referent cognition in depression.

Depressed adults often show a bias towards negative self-referent processing at the expense of positive self-referent processing. The current study assessed whether a mental imagery intervention (Positive Self Reference Training-PSRT) delivered via the Internet could improve self-referent processing and depressive symptomatology among adults with moderate or greater depression symptoms. Participants were recruited via online methods and randomly assigned to one of two computerized interventions: active PSRT (n=44) or control training (NTC; n=43). The PSRT involved visualizing the self in response to different positive cues (e.g., an achievement) every other day for two weeks. The NTC provided neutral cues about objects. Self-referential processing of positive and negative adjectives and depression symptoms were measured at baseline, one week, and two weeks after initiating training. Over those two weeks, PSRT participants showed a greater increase in positive self-referent processing than did NTC participants. Negative self-referent processing and symptoms of depression declined comparably in both groups. Similarly, for both groups, increase in positive and decrease in negative self-referent processing was associated with a greater reduction in depression. These results indicate that mental imagery has the potential to improve self-referential processing, especially for positive stimuli, which may, in turn, help reduce depressive symptomatology.

Determining optimal parameters of the self-referent encoding task: A large-scale examination of self-referent cognition and depression.

[Correction Notice: An Erratum for this article was reported online in Psychological Assessment on Aug 2 2018 (see record 2018-38659-001). In this article, there was an error in how exclusions for one of the three samples were reported, which resulted in inaccurate reporting of how many participants did not have complete data. This error did not change the primary results of the article or the conclusions. However, in the second paragraph of the Participant Attrition and Data Filtering section, the number of exclusions for the adolescent sample should be 301, not 163. As a result, n=408 should read n=270 in the abstract; in paragraph 3 of the Method section; and in the Figure 1 legend. In addition, the correct values for the Adolescents sample reported in Tables 1 and 2 are provided in the erratum.] Although the self-referent encoding task (SRET) is commonly used to measure self-referent cognition in depression, many different SRET metrics can be obtained. The current study used best subsets regression with cross-validation and independent test samples to identify the SRET metrics most reliably associated with depression symptoms in three large samples: a college student sample (n = 572), a sample of adults from Amazon Mechanical Turk (n = 293), and an adolescent sample from a school field study (n = 408). Across all 3 samples, SRET metrics associated most strongly with depression severity included number of words endorsed as self-descriptive and rate of accumulation of information required to decide whether adjectives were self-descriptive (i.e., drift rate). These metrics had strong intratask and split-half reliability and high test-retest reliability across a 1-week period. Recall of SRET stimuli and traditional reaction time (RT) metrics were not robustly associated with depression severity. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Impact of an antiretroviral stewardship strategy on medication error rates.

PURPOSE: The impact of an antiretroviral stewardship strategy on medication error rates was evaluated. METHODS: This single-center, retrospective, comparative cohort study included patients at least 18 years of age infected with human immunodeficiency virus (HIV) who were receiving antiretrovirals and admitted to the hospital. A multicomponent approach was developed and implemented and included modifications to the order-entry and verification system, pharmacist education, and a pharmacist-led antiretroviral therapy checklist. Pharmacists performed prospective audits using the checklist at the time of order verification. To assess the impact of the intervention, a retrospective review was performed before and after implementation to assess antiretroviral errors. RESULTS: Totals of 208 and 24 errors were identified before and after the intervention, respectively, resulting in a significant reduction in the overall error rate (p < 0.001). In the postintervention group, significantly lower medication error rates were found in both patient admissions containing at least 1 medication error (p < 0.001) and those with 2 or more errors (p < 0.001). Significant reductions were also identified in each error type, including incorrect/incomplete medication regimen, incorrect dosing regimen, incorrect renal dose adjustment, incorrect administration, and the presence of a major drug-drug interaction. A regression tree selected ritonavir as the only specific medication that best predicted more errors preintervention (p < 0.001); however, no antiretrovirals reliably predicted errors postintervention. CONCLUSION: An antiretroviral stewardship strategy for hospitalized HIV patients including prospective audit by staff pharmacists through use of an antiretroviral medication therapy checklist at the time of order verification decreased error rates.

Effects of maternal separation, early handling, and gonadal sex on regional metabolic capacity of the preweanling rat brain.

This is the first study to assess the effects of mother-infant separation on regional metabolic capacity in the preweanling rat brain. Mother-infant separation is generally known to be stressful for rat pups. Holtzman adolescent rats show a depressive-like behavioral phenotype after maternal separation during the preweanling period. However, information is lacking on the effects of maternal separation on the brains of rat pups. We addressed this issue by mapping the brains of preweanling Holtzman rat pups using cytochrome oxidase histochemistry, which reflects long-term changes in brain metabolic capacity, following two weeks of repeated, prolonged maternal separation, and compared this to both early handled and non-handled pups. Quantitative image analysis revealed that maternal separation reduced cytochrome oxidase activity in the medial prefrontal cortex and nucleus accumbens shell. Maternal separation reduced prefrontal cytochrome oxidase to a greater degree in female pups than in males. Early handling reduced cytochrome oxidase activity in the posterior parietal cortex, ventral tegmental area, and subiculum, but increased cytochrome oxidase activity in the lateral frontal cortex. The sex-dependent effects of early handling on cytochrome oxidase activity were limited to the medial prefrontal cortex. Regardless of separation group, females had greater cytochrome oxidase activity in the habenula and ventral tegmental area compared to males. These findings suggest that early life mother-infant separation results in dysfunction of prefrontal and mesolimbic regions in the preweanling rat brain that may contribute to behavioral changes later in life.