Meta-analysis of sleep deprivation in the acute treatment of bipolar depression.

BACKGROUND: Sleep deprivation (SD) is an antidepressant intervention with multiple administration formats that has been investigated primarily with uncontrolled clinical trials and qualitative reviews of the literature. The validity and applicability of these findings to the treatment of bipolar depression (BPD) is uncertain. METHODS: A PRISMA-based systematic review of the literature and meta-analysis were conducted to determine the efficacy of SD in the treatment of BPD and to identify moderator variables that influence response rate. RESULTS: From a sample of 15 studies covering 384 patients, the overall, mean response rate to SD was 47.6% (CI 36.0%, 59.5%). This response rate compared post-SD to pre-SD depression scores, and not to a placebo control condition. Of several potential moderating variables examined, the use of adjunctive pharmacotherapy achieved statistical significance with response rates of 59.4% [CI 48.5, 69.5] for patients using adjunctive medication vs 27.4% [CI 17.8, 39.8] for patients not using adjunctive medication. CONCLUSIONS: This meta-analysis of SD in the treatment of BPD found an overall, response rate of almost 50%, reinforcing earlier estimates of efficacy. The use of adjunctive pharmacotherapy had a statistically significant moderating effect on SD response suggesting that clinical practice should routinely pair these interventions. These findings provide a higher level of evidence supporting the use of SD, especially when used with medication, and should inform future management guidelines for the treatment of BPD.

Monitoring processes in extended emotion regulation.

The extended process model of emotion regulation (ER) posits that dynamic ER processes monitor and adjust the implementation of ER strategies over time. When an initial ER strategy is ineffective, monitoring processes allow one to flexibly switch to a new, possibly more effective strategy. The present study employed a novel experimental task to explore these dynamic ER processes. Sixty-eight adult female participants each completed 40 trials. In each trial, participants first were assigned to use either distraction or reappraisal for the either low- or high-intensity negative image presented. Then, they were presented with a choice between continuing to use the assigned strategy or switching strategies before viewing the negative image again. Results showed that the combinations of ER strategies and image intensities generated different affect states for the choice context. The magnitude of intermediate negative affect was positively associated with a greater probability of choosing to switch strategies. Finally, for higher intermediate negative affect, negative affect was lower after choosing to switch strategies. For lower intermediate negative affect, negative affect remained low regardless of continuing or switching strategies. These findings support the extended process model and contribute to a growing body of empirical support for dynamic models of ER.

The differential influence of computerized neuropsychological assessment across psychopathology.

Objective: Novel technologies have transformed neuropsychological test administration so that research examining the equivalency of computerized versions of traditional tests is needed. This study examined the relationship between psychological symptom severity and performance on the Wisconsin Card Sorting Test (WCST) using the manual versus computerized administration.Method: Eighty-five participants were randomly assigned to the manual or computerized WCST administration and also completed the Dot Counting Test, Depression Anxiety Stress Scales, and Short UPPS-P Impulsive Behavior Scale. Moderation analyses examined the effects of depressive, anxiety, and impulsivity symptom severity on WCST performance.Results: For Perseverative Responses (PR), the methods of administration (MOAs) were equivalent regardless of psychological symptom severity. For failures to maintain set (FMS), MOA itself influenced performance, with participants making at least twice as many FMS on the computerized WCST. MOA also significantly moderated the relationship between FMS and impulsivity severity, including Lack of Perseverance, Sensation Seeking, and Positive Urgency. Individuals with greater Positive Urgency made more FMS on the manual WCST, and individuals with greater Lack of Perseverance made more FMS on the computerized WCST.Conclusions: Findings suggest that equivalence between the manual and computerized versions of the WCST depends on the WCST subscale and the type of psychological symptom. New normative data need to be developed for the computerized WCST, along with a more consistent method of scoring and interpreting WCST subscales.

Patterns of depressive symptom remission during the treatment of seasonal affective disorder with cognitive-behavioral therapy or light therapy.

BACKGROUND: To elucidate mechanisms related to remission in winter seasonal affective disorder (SAD), we explored the course of individual depressive symptom offset across two distinct treatment modalities that show comparable outcomes at treatment endpoint: cognitive-behavioral therapy for SAD (CBT-SAD) and light therapy (LT). METHOD: One hundred seventy-seven adults with SAD in a depressive episode were randomized to 6-weeks of CBT-SAD (n = 88) or LT (n = 89). Symptoms were assessed via the 29-item Structured Interview Guide for the Hamilton Rating Scale for Depression-SAD Version (SIGH-SAD) at pretreatment and weekly during treatment. Survival analyses were conducted for the 17 SIGH-SAD items endorsed by more than 40 participants at pretreatment. Within each of the included symptoms, data from participants who endorsed the symptom at pretreatment and who had 3 or fewer weeks missing were included. RESULTS: For most (13/17; 76%) symptoms, CBT-SAD and LT did not differ in time to remission. However, for four symptoms (early insomnia, psychic anxiety, hypersomnia, and social withdrawal), LT led to symptom remission more quickly than CBT-SAD. CONCLUSIONS: Symptom remission progressed comparably across CBT-SAD and LT for most symptoms. Despite the fact that the two treatments led to similar remission rates and improvements at treatment endpoint, for early insomnia, psychic anxiety, hypersomnia, and social withdrawal, LT led to symptom remission faster than CBT-SAD. These results suggest different mechanisms and pathways to the same therapeutic end. Speedier remission of early insomnia and hypersomnia is consistent with the theory that SAD is related to a pathological circadian phase-shift that can be corrected with LT.

Dynamic processes in emotion regulation choice.

Because emotion regulation (ER) processes operate over time, they potentially change the context in which subsequent ER processes occur. To test this proposal, fifty-two healthy participants completed the ER choice task. Thirty standardized low- and high-intensity negative images were used to generate different emotional contexts in which participants selected between distraction or reappraisal strategies to decrease the intensity of their negative emotion. Participants then implemented their selected strategy and rated their negative emotion. Using a dynamic perspective, we examined as predictors of ER strategy choice, in addition to current stimulus intensity, several contextual factors from the immediately preceding trial: preceding stimulus intensity and strategy choice, and the intensity of negative affect following the previous strategy implementation and thus preceding the current trial. Results replicated earlier findings that participants are more likely to choose distraction for high-intensity images. Extending earlier findings, selecting reappraisal in the preceding trial and greater negative affect preceding the current trial were associated with lower odds of choosing distraction. The lack of significant interactions among the current and preceding trial factors suggests that these effects on ER choice were direct and not through moderating the effect of current stimulus intensity. These findings support dynamic theories of ER.

Understanding the Impairment Associated With Depressive Symptoms.

Relatively little theory or research has addressed the mediating processes through which depressive symptoms lead to impairment. To conceptualize the nature of impairment in depression, we conducted semistructured interviews of 18 psychiatric patients experiencing depressive symptoms about how their depressive symptoms create impairment. Interviews were audio recorded and transcribed, and thematic analysis methods were used to identify content areas and themes. Three content areas were identified: domains of impairment (types of behavior that are impaired), experience of impairment (nature and severity of impairment), and pathways to impairment (processes connecting symptoms to impairment). Pathways included direct connections between symptom and impairment, as well as indirect pathways mediated by other symptoms and by cognitive responses to symptoms. Patients' examples of the impairment phenomena are presented. In addition, patterns of association were observed between particular pathways and symptom type (vegetative versus cognitive/affective). Increased understanding of clients' explanations for impairment may improve clinical intervention and assessments.

Maximizing Outcome in Light Treatment: Patient Behavior as the Light Treatment Delivery System.

The effectiveness of light treatment depends on the treatment being properly received by the patient. Examination of the typical light treatment prescription shows that delivery of each component of the prescription consists of a behavior on the part of the patient. Light treatment delivery, and thus light treatment effectiveness, can be maximized by conceptualizing the treatment as a behavior change in the patient and by the application of well-established behavior change techniques.

Illness Attitudes Associated with Seasonal Depressive Symptoms: An Examination Using a Newly Developed Implicit Measure.

The Dual Vulnerability Model of seasonal depression posits that seasonal vegetative symptoms are due to a physiological vulnerability, but cognitive and mood symptoms are the result of negative appraisal of vegetative changes. In addition, rumination may be associated with stronger negative attitudes toward vegetative symptoms. This is the first study to examine implicit attitudes toward vegetative symptoms. We hypothesized that illness attitudes about fatigue moderate the relationship between the severity of vegetative symptoms and the severity of cognitive symptoms and that the illness attitudes are associated with rumination. This study also developed an implicit method to assess the appraisal of fatigue as indicating illness. Results supported both hypotheses. Illness attitudes toward fatigue moderated the relationship between vegetative symptoms and cognitive symptoms. Ruminative response style was positively associated with implicit illness attitudes towards fatigue. The study provides support for the role of negative appraisals of vegetative symptoms in the development of cognitive and mood seasonal depressive symptoms.

The intramembrane protease Sppl2a is required for B cell and DC development and survival via cleavage of the invariant chain.

B cell development requires tight regulation to allow for the generation of a diverse repertoire while preventing the development of autoreactive cells. We report, using N-ethyl-N-nitrosourea (ENU)-induced mutagenesis, the identification of a mutant mouse (chompB) with a block in early B cell development. The blockade occurs after the transitional 1 (T1) stage and leads to a decrease in mature B cell subsets and deficits in T cell-dependent antibody responses. Additionally, chompB mice have decreases in myeloid dendritic cells (DCs). The mutation was mapped to the intramembrane protease signal peptide peptidase-like 2a (Sppl2a), a gene not previously implicated in immune cell development. Proteomic analysis identified the invariant chain (CD74) as a key substrate of Sppl2a and suggests that regulated intramembrane proteolysis of CD74 by Sppl2a contributes to B cell and DC survival. Moreover, these data suggest that modulation of Sppl2a may be a useful therapeutic strategy for treatment of B cell dependent autoimmune disorders.

Why depressive symptoms cause distress: the clients' perspective.

BACKGROUND: Depressive symptoms are associated with distress, but research has not focused on the processes underlying this association. METHOD: We interviewed 18 patients experiencing depressive symptoms to identify the various reasons why depressive symptoms cause distress. Digital recordings were transcribed and grounded theory methods were used in analyzing the data and building theory. RESULTS: We identified 14 reasons for why patients find depressive symptoms distressing. These reasons frequently were particular thoughts, behaviors, or subsequent outcomes in response to the symptom; in other cases, the experience of the symptom itself directly caused distress. CONCLUSIONS: We present a general model of direct and indirect symptom-distress relationships that may help target clinical interventions for depression.

Differential item functioning for lesbians, bisexual, and heterosexual women in the center for epidemiological studies depression scale.

This study assessed whether the Center for Epidemiological Studies Depression Scale (CES-D) functions equivalently in assessing depressive symptom severity in lesbian, bisexual, and heterosexual women. Using differential item functioning methods, the authors examined (a) whether there is a bias in CES-D total scores and in individual item scores and (b) whether there are differences across female sexuality groups in the construct of depression assessed by the CES-D. Data were collected anonymously online from 273 women. The CES-D total score was unbiased across groups, but there were biases and construct differences in some individual symptoms. Thus, the findings suggest not only that researchers and clinicians can feel secure in using the CES-D in women of different sexual orientations but also that there may be interesting group differences in the manifestation of particular depressive symptoms.

Real-time predictors of suicidal ideation: mobile assessment of hospitalized depressed patients.

Suicidal ideation is a risk factor for suicide attempt and completion. Cross-sectional or retrospective studies cannot capture the dynamic course and possible predictors of suicidal ideation as it occurs in daily life. This study utilizes an experience sampling paradigm to identify real-time predictors of suicidal ideation in inpatients with major depressive disorder. Thirty-one depressed patients admitted to a psychiatric unit were signaled by a mobile device to record suicidal ideation, affect, and other symptoms, multiple times a day over 1 week. Participants completed a total of 1350 questionnaires. Seventy-four percent of the sample reported suicidal ideation during the week. Time-lagged analyses revealed that momentary ratings of Sadness, Tension, and Boredom (as well as suicidal ideation itself) predicted subsequent suicidal thoughts in the following hours. Baseline severity of depression and past suicide attempts were both correlated with mean ideation severity during the week. A number of predictors identified in prior research (e.g. hopelessness) were unrelated to subsequent suicidal ideation in the current study. Momentary interventions that guide individuals through activities designed to reduce levels of Sadness, Tension, and Boredom in real-time (e.g., thought challenging, relaxation, behavioral activation) may be especially warranted.

Comparing retrospective reports to real-time/real-place mobile assessments in individuals with schizophrenia and a nonclinical comparison group.

Retrospective reports are often used as the primary source of information for important diagnostic decisions, treatment, and clinical research. Whether such reports accurately represent individuals' past experiences in the context of a serious mental illness such as schizophrenia is unclear. In the current study, 24 individuals with schizophrenia and 26 nonclinical participants used a mobile device to complete multiple real-time/real-place assessments daily, over 7 consecutive days. At the end of the week, participants were also asked to provide a retrospective report summarizing the same period. Comparison of the data captured by the 2 methods showed that participants from both groups retrospectively overestimated the intensity of negative and positive daily experiences. In the clinical group, overestimations for affect were greater than for psychotic symptoms, which were relatively comparable to their retrospective reports. In both samples, retrospective reports were more closely associated with the week's average than the most intense or most recent ratings captured with a mobile device. Multilevel modeling revealed that much of the variability in weekly assessments was not explained by between-person differences and could not be captured by a single retrospective estimate. Based on the findings of this study, clinicians and researchers should be aware that while retrospective summary reports of the severity of certain symptoms compare relatively well with average momentary ratings, they are limited in their ability to capture variability in one's affective or psychotic experiences over time.

DSM-V and the stigma of mental illness.

Stigma associated with mental illness has been shown to have devastating effects on the lives of people with psychiatric disorders, their families, and those who care for them. In the current article, the relationship between diagnostic labels and stigma is examined in the context of the forthcoming DSM-V. Three types of negative outcomes are reviewed in detail - public stigma, self-stigma, and label avoidance. The article illustrates how a clinical diagnosis may exacerbate these forms of stigma through socio-cognitive processes of groupness, homogeneity, and stability. Initial draft revisions recently proposed by the DSM-V work groups are presented, and their possible future implications for stigma associated with mental illness are discussed.

Accuracy of hospitalized depressed patients' and healthy controls' retrospective symptom reports: an experience sampling study.

A growing body of literature suggests that retrospective recall of psychiatric symptoms is often inaccurate and may distort knowledge about the course of illness and impact treatment. The current study examined the accuracy of retrospective recall of a variety of depressive symptoms in hospitalized depressed patients and nonclinical controls. Using the Experience Sampling Method, we compared average momentary symptom reports of 1 week to retrospective summaries of the same period. The depressed group exhibited negative biases in their recall of experienced anhedonia, sadness, confusion, and suicidality, but were relatively accurate in recall of helplessness, detachment, and self-control. Controls exhibited a different pattern; they were relatively accurate in their retrospective recall of confusion, suicidality and sadness, but exhibited positive biases in recall of anhedonia, helplessness, detachment, and self-control. Both groups exhibited comparable negative biases in their recall of experienced tension, difficulty concentrating, guilt, and fear. The findings suggest that for maximum accuracy in the assessment of depressive symptoms, scientists and practitioners should supplement retrospective self-reports with momentary measures, and consider using ambulatory assessment in cognitive behavioral treatments of depression.

Static stretching impairs sprint performance in collegiate track and field athletes.

Previous research has shown that static stretching (SS) can diminish the peak force output of stretch-shortening cycle actions while performing a dynamic warm-up (DW) protocol has been shown to enhance performance in similar activities. The purpose of this study was to establish whether the deleterious effects of SS would wash out the performance enhancements obtained from the DW. Eleven males and 11 females, who were athletes of a NCAA Division I track team, performed a DW followed with either a SS or rest (NS) condition. After warm-up was completed, three 40 m sprints were performed to investigate the effects of the SS condition on sprint performance when preceded by DW. Time(s) were obtained from timing gates placed at 0, 20, and 40 m respectively. Testing was conducted over 2 days with a 1 week washout period. Testing order was balanced to eliminate possible order effect. Time for the NS versus the SS group was significantly faster for the second 20 m with a time of 2.41 versus 2.38 seconds (P < or = .05), and for the entire 40 m with a time of 5.6 +/- 0.4 versus 5.7 +/- 0.4 seconds (P < or = .05). The results of this study suggest that performing a SS protocol following a DW will inhibit sprint performance in collegiate athletes.

Tobacco chippers show robust increases in smoking urge after alcohol consumption.

OBJECTIVE AND RATIONALE: Heavy social drinkers often engage in occasional cigarette smoking, especially in the context of consuming large quantities of alcohol. The current study assessed alcohol's effects on smoking urge as a function of alcohol dose and time course in tobacco chippers with heavy social drinking patterns. METHOD: The study assessed 39 chippers who underwent three separate evening sessions. Each subject received a placebo (1% volume alcohol as a taste mask), a low alcohol dose (two to three drinks equivalent), and a high alcohol dose (four to five drinks equivalent) in random order. No smoking was permitted during the sessions and the participants were abstinent from smoking for at least 3 h before arrival. Throughout the session, cigarette craving was assessed by the Brief Questionnaire of Smoking Urges and alcohol response was assessed by the Biphasic Alcohol Effects Scale (BAES). RESULTS: The results showed that alcohol significantly increased cigarette craving in a dose-dependent manner (p<0.001). At the high alcohol dose, craving was heightened during the rising portion of the blood alcohol curve (BAC). There was a strong relationship between BAC and craving for positive reinforcement and this relationship was partially mediated by BAES stimulation, but not sedation. CONCLUSIONS: The findings show that alcohol directly increases smoking urge in chipper smokers. Tobacco chippers may crave cigarettes more during heavier than during lighter drinking bouts, and this effect appears to be driven by heightened stimulation levels rather than as a means to offset alcohol's sedative effects.

Acute effects of passive muscle stretching on sprint performance.

The results of previous research have shown that passive muscle stretching can diminish the peak force output of subsequent maximal isometric, concentric and stretch-shortening contractions. The aim of this study was to establish whether the deleterious effects of passive stretching seen in laboratory settings would be manifest in a performance setting. Sixteen members (11 males, 5 females) of a Division I NCAA track athletics team performed electronically timed 20 m sprints with and without prior stretching of the legs. The experiment was done as part of each athlete's Monday work-out programme. Four different stretch protocols were used, with each protocol completed on a different day. Hence, the test period lasted 4 weeks. The four stretching protocols were no-stretch of either leg (NS), both legs stretched (BS), forward leg in the starting position stretched (FS) and rear leg in the starting position stretched (RS). Three stretching exercises (hamstring stretch, quadriceps stretch, calf stretch) were used for the BS, FS and RS protocols. Each stretching exercise was performed four times, and each time the stretch was maintained for 30 s. The BS, FS and RS protocols induced a significant (P < 0.05) increase (approximately 0.04 s) in the 20 m time. Thus, it appears that pre-event stretching might negatively impact the performance of high-power short-term exercise.

Racial group differences in help-seeking behaviors.

The authors evaluated variations in help-seeking behaviors among Blacks and Whites and the role of cognitive-affective variables as mediators of these variations. Participants were 70 Black and 66 White community college students who completed the SCL-90-R (L. R. Derogatis, 1977, 1994), the Revised Multidimensional Health Locus of Control (T. Bekhuis et al., 1995), the Symptom Interpretation Questionnaire (J. M. Robbins & L. J. Kirmayer, 1991), and a measure of help-seeking behaviors and demographic information. Relative to White college students, Black college students significantly less frequently used psychological or social services and significantly more frequently used religious services. The authors accounted for group differences in religious help-seeking behaviors by beliefs in the power of God and by normalizing symptom attributions. The cognitive-affective variables that were studied did not account for differences in psychological help-seeking behaviors. The authors inferred that to better meet the needs of Black college students, collaboration between mental health services and religious services would likely be beneficial.

Bright light therapy for winter depression--is phase advancing beneficial?

Bright light is the recommended treatment for winter seasonal affective disorder (SAD). Previously we showed that the antidepressant effect of morning (but not evening) light was greater than placebo after 3 weeks of treatment. Here, we determined if the magnitude and direction of circadian rhythm phase shifts produced by the bright light in the previous study were related to the antidepressant effects. Twenty-six SAD patients from the original sample of 96 had their rectal temperature continuously monitored while they participated in a placebo-controlled parallel design conducted over six winters. After a baseline week, there were three treatments for 4 weeks-morning light, evening light, or morning placebo. Bright light was produced by light boxes (approximately 6000 lux). Placebos were sham negative ion generators. All treatments were 1.5 h in duration. Depression ratings were made weekly by blind raters. Circadian phase shifts were determined from changes in the timing of the core body temperature minimum (Tmin). Morning light advanced and evening light delayed the Tmin by about 1 h. The placebo treatment did not alter circadian phase. As the sleep schedule was held constant, morning light increased and evening light decreased the Tmin to wake interval, or phase angle between circadian rhythms and sleep. Phase advance shifts and increases in the phase angle were only weakly associated with antidepressant response. However, there was an inverted U-shaped function showing that regardless of treatment assignment the greatest antidepressant effects occurred when the phase angle was about 3h, and that patients who moved closer to this phase angle benefited more than those who moved farther from it. However 46% of our sample had a phase angle within 30 min of this 3 h interval at baseline. So it does not appear that an abnormal phase angle can entirely account for the etiology of SAD. A majority (75%) of the responders by strict joint criteria had a phase angle within this range after treatment, so it appears that obtaining the ideal phase relationship may account for some, but not all of the antidepressant response. In any case, regardless of the mechanism for the antidepressant effect of morning light, it can be enhanced when patients sleep at the ideal circadian phase and reduced when they sleep at a more abnormal circadian phase.