Depressive Symptoms Negatively Impact Montreal Cognitive Assessment Performance: A Memory Clinic Experience.

OBJECTIVE: The Montreal Cognitive Assessment (MoCA) is a general cognitive screening tool that has shown sensitivity in detecting mild levels of cognitive impairment in various clinical populations. Although mood dysfunction is common in referrals to memory clinics, the influence of mood on the MoCA has to date been largely unexplored. METHOD: In this study, we examined the impact of mood dysfunction on the MoCA using a memory clinic sample of individuals with depressive symptoms who did not meet criteria for a neurodegenerative disease. RESULTS: Half of the group with depressive symptoms scored below the MoCA-suggested cutoff for cognitive impairment. As a group, they scored below healthy controls, but above individuals with Alzheimer's disease and frontotemporal dementia. A MoCA subtask analysis revealed a pattern of executive/attentional dysfunction in those with depressive symptoms. CONCLUSIONS: This observed negative impact of depressive symptomatology on the MoCA has interpretative implications for its utility as a cognitive screening tool in a memory clinic setting.

Ganser syndrome with work-related onset in a patient with a background of immigration.

INTRODUCTION: A substantial proportion of the recently published cases of dissociative disorders have a background of immigration (Fujiwara et al., 2008). Among the dissociative disorders, Ganser syndrome is an uncommon form that has as central symptom the giving of approximate answers to questions (vorbeireden). The predisposing and triggering factors of Ganser syndrome are poorly defined. Furthermore, this condition might cooccur with other psychiatric disorders. Here we describe a patient with a background of immigration, who, after an objectively minor work-related head injury, developed severe and persistent psychiatric symptoms, with features of Ganser syndrome. METHODS: The patient was assessed medically, psychiatrically, and by neuropsychological testing. RESULTS: The patient is a man with no known previous psychiatric history, who lived in several countries and encountered a series of stressful experiences in the process of migration. Several years after immigrating to his current country of residency, he developed severe psychiatric symptoms of Major Depressive Disorder, with Psychotic Features and Ganser syndrome. The symptoms, which emerged after a mild head injury, have persisted for more than a year, despite treatment. CONCLUSIONS: The similarity between this case and other reports suggests that psychosocial stresses accompanying immigration may have a catalytic effect in triggering and maintaining dissociative symptomatology.

Comparing depression screening tools in persons with multiple sclerosis (MS).

OBJECTIVE: Depression is more common among persons with multiple sclerosis (MS) than the general population. Depression in MS is associated with reduced quality of life, transition to unemployment, and cognitive impairment. Two proposed screening measures for depression in MS populations are the Hospital Anxiety and Depression Scale (HADS) and the Beck Depression Inventory-Fast Screen (BDI-FS). Our objective was to compared the associations of the BDI-FS and the HADS-D scores with history of depressive symptoms, fatigue, and functional outcomes to determine the differential clinical utility of these screening measures among persons with MS. METHOD: We reviewed charts of 133 persons with MS for demographic information; scores on the HADS, BDI-FS, a fatigue measure, and a processing speed measure; and employment status. RESULTS: Structural equation modeling results indicated the HADS-D predicted employment status, disability status, and processing speed more effectively than did the BDI-FS, whereas both measures predicted fatigue. CONCLUSIONS: This study suggests the HADS-D is more effective than the BDI-FS in predicting functional outcomes known to be associated with depression among persons with MS. (PsycINFO Database Record

Dialectical Behavior Group Therapy is Feasible and Reduces Emotional Dysfunction in Multiple Sclerosis.

We examined whether dialectical behavior therapy (DBT) was feasible and effective in multiple sclerosis (MS). A convenience sample of 20 patients with anxiety or depression symptoms received either DBT (n = 10) or standard medical care (n = 10). The DBT protocol was found to be feasible in the MS population studied (e.g., good retention and acceptability). For the DBT group, significant improvements were demonstrated in self-rated and clinician-rated depressive symptoms, clinician-rated anxiety symptoms, self-rated general psychopathology symptoms, and quality of life. In contrast, the standard medical care group retained for exploratory purposes showed no significant improvements. This pilot work provides preliminary support for the utility of DBT in MS, but further work is needed to clarify this benefit using a large, randomized controlled approach.

Inhibiting reactions to emotional versus non-emotional response cues in schizophrenia: Insights from a motor-process paradigm.

Recent models of schizophrenia suggest deficient use of contextual response cues when confronted with countermanding emotional cues. It is important to clinically validate these models by testing patients diagnosed with schizophrenia on tasks with competing emotional and contextual response determinants. Control and schizophrenia groups completed a novel task that elicited motor responses consistent with, or in opposition to, pre-potent emotional actions (i.e., approach vs. avoidance). An analogous non-emotional task was also used to examine cue-conflict impairment more generally. The groups demonstrated statistically equivalent performance decrements on incongruent versus congruent trials on both tasks. However, within the schizophrenia group, the incongruency effect was significantly greater in the emotional versus non-emotional task. These data suggest that, while patients with schizophrenia were able to employ contextual response cues to override competing emotional responses, they were slower to resolve emotional versus non-emotional response conflict. When patients were subdivided according to the presence or absence of disorganized symptoms, this effect was confined to patients with disorganized symptoms.

The mediating role of processing speed in the relationship between depressive symptoms and cognitive function in multiple sclerosis.

INTRODUCTION: Although disorders of mood and cognition are frequently observed in multiple sclerosis, their relationship remains unclear. We aimed to investigate whether this mood-cognition relationship is mediated by inefficient processing speed, a deficit typically associated with mood symptomatology in the psychiatric literature and a common deficit observed in multiple sclerosis patients. METHOD: In this study, comprehensive cognitive data and self-reported mood data were retrospectively analyzed from 349 patients with relapsing remitting multiple sclerosis. We performed a bootstrapping analysis to examine whether processing speed provided an indirect means by which depressive symptoms influenced cognitive functioning, specifically memory and executive function. RESULTS: We observed that processing speed mediated the relationship between depressive symptoms and measures of memory and executive function. Interestingly, exploratory analyses revealed that this mediational role of processing speed was specific to MS patients who were younger, had a lower disability level, and had fewer years since MS diagnosis. CONCLUSIONS: Together, these findings have implications for mood and cognitive intervention with multiple sclerosis patients.