Previous research shows deficits in Executive Function (EF) in patients with anxiety and depression. Recent studies have shown that EF measured by neuro-imaging and neuropsychological tests predicts treatment outcomes for depression, but it is unclear whether they predict outcomes for anxiety. Neuro-imaging and neuropsychological tests are effective but intensive procedures that may not always be accessible to clinicians.
Obsessive compulsive disorder in adults assignment to turn in for gradeCASCHU3937
This document discusses obsessive compulsive disorder (OCD) in adults. It provides an overview of OCD, including its neurological and biological underpinnings such as involvement of cortico-striatal pathways and neurotransmitters like serotonin. Treatment options for OCD discussed include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), and emerging interventions like deep brain stimulation. The document concludes by discussing future directions for research on OCD including use of neuroimaging to predict treatment response and identify biological markers.
This research report summarizes a study examining the neural effects of cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD). The study involved 21 adults with GAD and 11 healthy controls. Participants underwent functional MRI while viewing facial emotions before and after CBT (or a comparable waiting period for controls). Results showed that before treatment, those with GAD had blunted responses in brain regions involved in emotion processing when viewing happy faces, and greater connectivity between the amygdala and insula. After CBT, individuals with GAD showed attenuated activation in the amygdala and anterior cingulate in response to threat-related faces, as well as heightened insular responses to happy faces. The findings provide evidence
This document summarizes a presentation on cognitive remediation for schizophrenia. Cognitive remediation aims to improve cognitive processes like attention, memory, and executive function through behavioral training interventions. It relies on neuroplasticity to strengthen connections in the brain. Exercises target basic sensory skills, discrete cognitive abilities, and more complex skills. Studies find cognitive remediation improves cognition, functioning, and motivation, especially when treatment is more intensive, motivational factors are incorporated, and exercises are personalized. Typical programs involve cognitive assessment, goal setting, group sessions 2+ times per week for 3-4 months using drill and strategy practice, and bridging to real-world skills.
This document summarizes research on cognitive remediation therapy (CRT) for various mental health conditions. It discusses CRT approaches for schizophrenia, including evidence that CRT improves cognitive functioning and psychosocial outcomes. It also explores using CRT for other disorders like bipolar disorder, depression, Alzheimer's, and ADHD. For many conditions, initial studies show benefits of CRT for cognition, symptoms, and functioning, though more research is still needed.
Stimulant medication is the most common treatment for ADD/ADHD, but about 60-65% of cases persist into adulthood. Short-acting stimulants have the highest abuse potential, with 46% of adults with ADHD using them and nearly 80% of patients abusing them. There is interest in alternative treatments due to concerns about side effects and stigma of behavioral therapy. Recent research has investigated brain training games to improve cognition, with some studies finding they can enhance memory, attention, and executive functions in both young and old. The proposed study will examine whether brain training games targeted at improving attention are effective for adults with ADD/ADHD by comparing pre- and post-training Stroop test attention scores between those
This study investigated how anxiety affects the interference of emotional stimuli on goal-directed behavior. Participants completed a visual search task where they identified targets primed by emotional or neutral faces. Response times were measured. Results showed that emotional faces interfered with task performance for all participants by slowing response times. Higher anxiety participants were slower overall compared to lower anxiety participants. Surprisingly, neutral face primes were processed similarly to negative primes rather than as a true control, also slowing response times. The effect of emotional interference on goal-directed behavior was found to be complex and potentially dependent on the type of emotional stimulus used.
PROPOSAL: Memory Self Efficacy and Treatment Outcomes in Transient Ischemic A...KyleDishman
Research Proposal:
THESIS: “Does memory self-efficacy (as monitored and diagnosed by a professional) play a positive role in effects of cognitive behavioral therapy in stroke patients.”
Obsessive compulsive disorder in adults assignment to turn in for gradeCASCHU3937
This document discusses obsessive compulsive disorder (OCD) in adults. It provides an overview of OCD, including its neurological and biological underpinnings such as involvement of cortico-striatal pathways and neurotransmitters like serotonin. Treatment options for OCD discussed include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), and emerging interventions like deep brain stimulation. The document concludes by discussing future directions for research on OCD including use of neuroimaging to predict treatment response and identify biological markers.
This research report summarizes a study examining the neural effects of cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD). The study involved 21 adults with GAD and 11 healthy controls. Participants underwent functional MRI while viewing facial emotions before and after CBT (or a comparable waiting period for controls). Results showed that before treatment, those with GAD had blunted responses in brain regions involved in emotion processing when viewing happy faces, and greater connectivity between the amygdala and insula. After CBT, individuals with GAD showed attenuated activation in the amygdala and anterior cingulate in response to threat-related faces, as well as heightened insular responses to happy faces. The findings provide evidence
This document summarizes a presentation on cognitive remediation for schizophrenia. Cognitive remediation aims to improve cognitive processes like attention, memory, and executive function through behavioral training interventions. It relies on neuroplasticity to strengthen connections in the brain. Exercises target basic sensory skills, discrete cognitive abilities, and more complex skills. Studies find cognitive remediation improves cognition, functioning, and motivation, especially when treatment is more intensive, motivational factors are incorporated, and exercises are personalized. Typical programs involve cognitive assessment, goal setting, group sessions 2+ times per week for 3-4 months using drill and strategy practice, and bridging to real-world skills.
This document summarizes research on cognitive remediation therapy (CRT) for various mental health conditions. It discusses CRT approaches for schizophrenia, including evidence that CRT improves cognitive functioning and psychosocial outcomes. It also explores using CRT for other disorders like bipolar disorder, depression, Alzheimer's, and ADHD. For many conditions, initial studies show benefits of CRT for cognition, symptoms, and functioning, though more research is still needed.
Stimulant medication is the most common treatment for ADD/ADHD, but about 60-65% of cases persist into adulthood. Short-acting stimulants have the highest abuse potential, with 46% of adults with ADHD using them and nearly 80% of patients abusing them. There is interest in alternative treatments due to concerns about side effects and stigma of behavioral therapy. Recent research has investigated brain training games to improve cognition, with some studies finding they can enhance memory, attention, and executive functions in both young and old. The proposed study will examine whether brain training games targeted at improving attention are effective for adults with ADD/ADHD by comparing pre- and post-training Stroop test attention scores between those
This study investigated how anxiety affects the interference of emotional stimuli on goal-directed behavior. Participants completed a visual search task where they identified targets primed by emotional or neutral faces. Response times were measured. Results showed that emotional faces interfered with task performance for all participants by slowing response times. Higher anxiety participants were slower overall compared to lower anxiety participants. Surprisingly, neutral face primes were processed similarly to negative primes rather than as a true control, also slowing response times. The effect of emotional interference on goal-directed behavior was found to be complex and potentially dependent on the type of emotional stimulus used.
PROPOSAL: Memory Self Efficacy and Treatment Outcomes in Transient Ischemic A...KyleDishman
Research Proposal:
THESIS: “Does memory self-efficacy (as monitored and diagnosed by a professional) play a positive role in effects of cognitive behavioral therapy in stroke patients.”
The Reduction of Anxiety on the Ability to Make DecisionsAbbie Frank
A research study I had done in my Cognition psychology class to look at the reduction of anxiety using yoga and animal assisted therapy and the affects they can have on decision making.
The study aimed to develop a new scale called the Psychiatric Nurse Job Stressor Scale (PNJSS) to reliably and validly measure stressors among Japanese psychiatric nurses. Researchers administered a 63-item questionnaire to 302 nurses and analyzed their responses. Through statistical analysis including factor analysis, they identified a 22-item, 4-factor structure for the PNJSS measuring psychiatric nursing ability, patient attitudes, nursing attitudes, and communication. The PNJSS demonstrated good reliability and validity for evaluating psychiatric nurse job stressors in Japan.
The document summarizes a study that examined the effects of mindfulness meditation on working memory capacity, affect, and decision making ability. Sixteen stressed college students were randomly assigned to either a 30-day mindfulness meditation training program or a nature sounds control group. Measures of working memory capacity, positive affect, and decision making were taken before and after the 30 days. Results showed that the meditation group had significantly higher working memory capacity after training compared to controls. However, there were no significant effects on positive affect or decision making ability between the groups.
Interventions to Improve Cognitive Functioning After TBILoki Stormbringer
This document discusses interventions to improve cognitive functioning after traumatic brain injury (TBI). It begins by introducing a case study of a veteran experiencing cognitive issues after multiple blast exposures during deployment. It then provides an overview of TBI, noting that while injuries are acute, cognitive deficits can persist chronically and impact individuals, families, and society. It discusses the importance of recognizing and treating chronic cognitive dysfunction, and how a combination of physical and psychological trauma from combat experiences could result in a complex "combined combat neurotrauma syndrome." The document advocates considering multiple levels of brain functioning and integrating behavioral and pharmacological therapies to effectively improve post-TBI cognitive functioning.
The document describes a study that tested whether performance on the Memory for Intentions Screening Test (MIST) could accurately predict conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD) within one year. Thirty participants without dementia were given neuropsychological tests including the MIST and re-tested one year later. Logistic regression found that only MIST performance significantly predicted conversion to AD, with 83% prediction success. A MIST cutoff score of 18 had 86% accuracy in distinguishing those who did and did not develop dementia within a year.
Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyenepicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Dr Johan Vlaeyen. In this talk, Dr Vlaeyen discusses the mechanisms, assessment and treatment of fear avoidance in patients with chronic pain. Edinburgh, UK. www.nbpa.org.uk
1) The study examined whether symptom change in computerized cognitive behavioral therapy (cCBT) for depression is mediated by changes in cognitive skills, and whether dorsolateral prefrontal cortex (DLPFC) activity as measured by pupil reactivity moderates this process.
2) The results found that symptom change was partially mediated by acquisition of cognitive skills, and that pupil reactivity moderated the effect of treatment on skill acquisition, such that those with low-moderate pupil reactivity showed greater skill improvements.
3) For participants with low-moderate pupil reactivity, skill change mediated subsequent reductions in depression symptoms, but this was not seen for those with high pupil reactivity, providing evidence that pupil reactivity
This document summarizes research on treating generalized anxiety disorder (GAD) in young adults. It discusses two treatment approaches: emotion regulation therapy (ERT) and applied relaxation therapy (ART). ERT focuses on improving emotion regulation skills, while ART teaches relaxation techniques. Previous studies found ERT more effectively reduced GAD symptoms and targeting mechanisms underlying the disorder. The document proposes a new study comparing the effectiveness of ERT and ART at reducing GAD symptoms and behavioral prevention in young adults. It describes the study methodology, including recruiting a diverse sample of 40 young adults with GAD who will be randomly assigned to ERT or ART and assessed before and after treatment using reliable anxiety and behavioral measures. The goal is to provide more evidence that E
Impact of drug therapy on various neurological conditions and its effects on rehabilitation; conditions like stroke, parkinson's disease,vertigo and also its effects on various impairments like spasticity, sensory impairments, cognition
Wearable Technology and Stress DetectionTorren Lamont
This document discusses developing a wearable device to detect stress levels in students with autism and communicate that information to teachers and students in real-time. It aims to detect stress early before a student is aware or displays signs of stress, to help preempt meltdowns. The document reviews literature on defining and measuring stress, how stress affects those with autism differently, and existing stress-detecting technology. It identifies a gap in developing individualized stress detection algorithms and integrating detection with communication systems to inform teachers and students to enable self-corrective behaviors. The research aims to address this by developing such an individualized stress detection and notification system using the Microsoft Band 2.
efficacy of a dilemma focused intervention for unipolar depressionGuillem Feixas
This study aims to test whether adding a dilemma-focused intervention to cognitive behavioral therapy (CBT) can increase the efficacy of treating unipolar depression. The study will compare CBT alone to CBT plus individual dilemma-focused therapy, which targets cognitive conflicts identified in each patient using repertory grid technique. It is hypothesized that directly addressing these conflicts can enhance outcomes of psychotherapy for depression by resolving internal dilemmas that may otherwise hinder change. The study seeks to contribute to psychological treatment of depression by improving existing cognitive models of the disorder.
Targeting abnormal neural circuits in mood and anxiety disorders:from the la...Kaan Y
My article presentation at the Journal Club on 22 January 2008
Targeting abnormal neural circuits in mood and anxiety disorders: from the laboratory to the clinic
Kerry J Ressler & Helen S Mayberg
VOLUME 10 NUMBER 9
SEPTEMBER 2007
1116-1124
NATURE NEUROSCIENCE
For a free full text of the article:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2444035
The document discusses the history and current state of evidence-based practices in children's mental health. It notes that while research has identified hundreds of evidence-based therapies and interventions, many children still have unmet mental health needs. It summarizes the levels of evidence for different psychosocial and pharmacological treatments, as well as home- and community-based services. However, it states that significant challenges remain in implementing evidence-based practices into real-world mental health systems and services.
Cognitive conflicts in major depression: Between desired change and personal ...Guillem Feixas
Article in British Journal of Clinical Psychology (early view). Abstract:
Objectives
The notion of intra-psychic conflict has been present in psychopathology for more than a century within different theoretical orientations. However, internal conflicts have not received enough empirical attention, nor has their importance in depression been fully elaborated. This study is based on the notion of cognitive conflict, understood as implicative dilemma, and on a new way of identifying these conflicts by means of the repertory grid technique. Our aim is to explore the relevance of cognitive conflicts among depressive patients.
Design
Comparison between persons with a diagnosis of major depressive disorder and community controls.
Methods
161 patients with major depression and 110 non-depressed participants were assessed for presence of implicative dilemmas and level of symptom severity. The content of these cognitive conflicts was also analysed.
Results
Repertory grid analysis indicated conflict (presence of implicative dilemma/s) in a greater proportion of depressive patients than in controls. Taking only those grids with conflict, the average number of implicative dilemmas per person was higher in the depression group.
In addition, participants with cognitive conflicts displayed higher symptom severity. Within the clinical sample, patients with implicative dilemmas presented lower levels of global functioning and a more frequent history of suicide attempts.
Conclusions
Cognitive conflicts were more prevalent in depressive patients and were associated with clinical severity. Conflict assessment at pre-therapy could aid in treatment planning to fit patient characteristics.
Practitioner Points
• Internal conflicts have been postulated in clinical psychology for a long time but there is little evidence about its relevance due to the lack of methods to measure them.
• We developed a method for identifying conflicts using the Repertory Grid Technique.
• Depressive patients have higher presence and number of conflicts than controls.
• Conflicts (implicative dilemmas) can be a new target for intervention in depression.
Cautions/Limitations
• A cross-sectional design precluded causal conclusions.
• The role of implicative dilemmas in the causation or maintenance of depression cannot be ascertained from this study.
Role of atypical antipsychotics in the treatement of generalized anxiety diso...Paul Coelho, MD
This review article examines the evidence for using atypical antipsychotics as adjunctive therapy or monotherapy to treat generalized anxiety disorder (GAD). The most evidence has been collected for quetiapine, which approximately 50% of participants tolerated, most commonly experiencing sedation and fatigue. Among those who continued treatment, significant reductions in anxiety were demonstrated when used as adjunctive therapy or monotherapy. While atypical antipsychotics show promise based on evidence from other disorders, their use for GAD remains off-label and careful consideration of risks and benefits is needed, especially regarding long-term use.
- Poor mental health was found to exacerbate age-related cognitive declines, especially in executive function.
- Structural equation modeling showed that poor mental health, as assessed by the GHQ-12, interacted with age to predict worse performance on tasks of visual search and recognition memory.
- Executive function was found to mediate the relationship between the age x mental health interaction and performance on visual search and recognition memory tasks.
Contents lists available at ScienceDirect Journal of AffecAlleneMcclendon878
This study examined changes in emotion regulation strategies of expressive suppression and cognitive reappraisal during cognitive behavioral therapy (CBT) for social anxiety disorder (SAD). Thirty-four patients with SAD received 16-20 sessions of CBT. Self-report and electrocortical measures of emotion regulation were administered weekly and monthly. The results showed that CBT led to decreased use of expressive suppression, increased self-efficacy in cognitive reappraisal, and decreased unpleasantness in response to SAD-related stimuli. Decreases in expressive suppression and electrocortical reactivity predicted subsequent reductions in social anxiety. This suggests decreased expressive suppression may be a mechanism of change in CBT for SAD.
Neurofeedback shows promise as a treatment for anxiety, depression, and other conditions. Research indicates it can significantly reduce test anxiety and symptoms of generalized anxiety. Studies found neurofeedback reduced anxiety scores more than relaxation training or no treatment. Clinical reports also suggest neurofeedback may effectively treat mild to severe depression. It has produced significant, enduring changes in mood and depression symptoms in approximately 80% of patients. Neurofeedback also seems to have minimal risks and be less invasive than other treatments like antidepressants. More research is still needed, but it qualifies as an evidence-based treatment for certain anxiety disorders and could be an effective alternative treatment for modifying dysfunctional brain patterns associated with psychiatric conditions.
Acceptance and Commitment Therapy (ACT) is a form of cognitive behavioral therapy that uses mindfulness and behavioral activation to increase psychological flexibility. ACT has been shown to effectively treat a broad range of mental health issues by focusing on six core processes: acceptance, defusion, presence, self-awareness, values identification, and committed action. ACT reduces dysfunctional thoughts and behaviors while increasing effective action and alleviating distress. Studies have found ACT reduces OCD and depression symptoms, prevents psychosis rehospitalization, and improves general mental health and workplace stress coping. ACT is delivered flexibly in individual sessions, groups, or self-help formats.
1PAGE 21. What is the question the authors are asking .docxfelicidaddinwoodie
1
PAGE
2
1. What is the question the authors are asking?
They asked about a reduction in judgmental biases regarding the cost and probability associated with adverse social events as they are presumed as being mechanisms for the treatment of Social Anxiety Disorder (SAD). Also, the authors poised on the changes in judgmental biases as mechanisms to explain cognitive-behavioral therapy for social anxiety disorder. On top of that, they stated that methodological limitations extant studies highlight the possibility that rather than causing symptom relief, a significant reduction in judgmental biases tends to be consequences of it or correlate. Considerably, they expected cost bias at mid-treatment to be a predictor of the treatment outcome.
2. Why do the authors believe this question is important?
According to the authors, this question was relevant as methodological limitations of present studies reflect on the possibility that instead of causing symptom belief, a significant reduction in judgmental biases can be consequences or correlated to it. Additionally, they ought to ascertain the judgment bias between treated and non-treated participants. Significantly, this was important as they had to determine the impact of pre and post changes in cost and probability of the treatment outcomes. But, probability bias at mid-treatment was a predictor of the treatment outcome contrary to the cost bias at mid-treatment that could not be identified as a significant predictor of the treatment outcome.
3. How do they try to answer this question?
They conducted a study to evaluate the significant changes in judgmental bias as aspects of cognitive-behavioral therapy for social anxiety disorders. To do this, they conducted a study using information from two treatment studies; an uncontrolled trial observing amygdala activity as a response to VRE (Virtual Reality Exposure Therapy) with the use of functional magnetic resonance imaging and a randomized control trial that compared Virtual Reality Exposure Therapy with Exposure Group Therapy for SAD. A total of 86 individuals who met the DSM-IV-TR criteria for the diagnosis of non-generalized (n=46) and generalized (n=40) SAD participated. After completing eight weeks of the treatment protocol, the participants who identified public speaking as their most fearsome social situation were included. The SCID (Structured clinical interview for the DSM-IV) was used to ascertain diagnostic and eligibility status on Axis 1 conditions within substance abuse, mood and anxiety disorder modules. The social anxiety measures were measured with the use of BFNE (Brief Fear of Negative Evaluation), a self-reporting questioner that examined the degree to which persons fear to be assessed by other across different social settings. Additionally, the OPQ (Outcome Probability Questionnaire) self-reporting questionnaire was used to evaluate individual’s estimate on the probability that adverse, threatening events will occur at t ...
Cognitive behavioural therapy (CBT) leads to significant improvements in functioning and quality of life for chronic pain conditions like low back pain. Several studies show CBT is as effective or more effective than other therapies or medications for issues like reducing catastrophizing thoughts, pain levels, and disability. While evidence is limited, online CBT and web-based interventions show promise in improving outcomes for chronic low back pain. Overall, CBT aims to help patients better manage their pain by changing maladaptive thoughts and behaviors.
The Reduction of Anxiety on the Ability to Make DecisionsAbbie Frank
A research study I had done in my Cognition psychology class to look at the reduction of anxiety using yoga and animal assisted therapy and the affects they can have on decision making.
The study aimed to develop a new scale called the Psychiatric Nurse Job Stressor Scale (PNJSS) to reliably and validly measure stressors among Japanese psychiatric nurses. Researchers administered a 63-item questionnaire to 302 nurses and analyzed their responses. Through statistical analysis including factor analysis, they identified a 22-item, 4-factor structure for the PNJSS measuring psychiatric nursing ability, patient attitudes, nursing attitudes, and communication. The PNJSS demonstrated good reliability and validity for evaluating psychiatric nurse job stressors in Japan.
The document summarizes a study that examined the effects of mindfulness meditation on working memory capacity, affect, and decision making ability. Sixteen stressed college students were randomly assigned to either a 30-day mindfulness meditation training program or a nature sounds control group. Measures of working memory capacity, positive affect, and decision making were taken before and after the 30 days. Results showed that the meditation group had significantly higher working memory capacity after training compared to controls. However, there were no significant effects on positive affect or decision making ability between the groups.
Interventions to Improve Cognitive Functioning After TBILoki Stormbringer
This document discusses interventions to improve cognitive functioning after traumatic brain injury (TBI). It begins by introducing a case study of a veteran experiencing cognitive issues after multiple blast exposures during deployment. It then provides an overview of TBI, noting that while injuries are acute, cognitive deficits can persist chronically and impact individuals, families, and society. It discusses the importance of recognizing and treating chronic cognitive dysfunction, and how a combination of physical and psychological trauma from combat experiences could result in a complex "combined combat neurotrauma syndrome." The document advocates considering multiple levels of brain functioning and integrating behavioral and pharmacological therapies to effectively improve post-TBI cognitive functioning.
The document describes a study that tested whether performance on the Memory for Intentions Screening Test (MIST) could accurately predict conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD) within one year. Thirty participants without dementia were given neuropsychological tests including the MIST and re-tested one year later. Logistic regression found that only MIST performance significantly predicted conversion to AD, with 83% prediction success. A MIST cutoff score of 18 had 86% accuracy in distinguishing those who did and did not develop dementia within a year.
Assessment Of Fear Avoidance In Chronic Pain - Dr Johan W S Vlaeyenepicyclops
Lecture given to the North British Pain Association on 16th May 2008 by Dr Johan Vlaeyen. In this talk, Dr Vlaeyen discusses the mechanisms, assessment and treatment of fear avoidance in patients with chronic pain. Edinburgh, UK. www.nbpa.org.uk
1) The study examined whether symptom change in computerized cognitive behavioral therapy (cCBT) for depression is mediated by changes in cognitive skills, and whether dorsolateral prefrontal cortex (DLPFC) activity as measured by pupil reactivity moderates this process.
2) The results found that symptom change was partially mediated by acquisition of cognitive skills, and that pupil reactivity moderated the effect of treatment on skill acquisition, such that those with low-moderate pupil reactivity showed greater skill improvements.
3) For participants with low-moderate pupil reactivity, skill change mediated subsequent reductions in depression symptoms, but this was not seen for those with high pupil reactivity, providing evidence that pupil reactivity
This document summarizes research on treating generalized anxiety disorder (GAD) in young adults. It discusses two treatment approaches: emotion regulation therapy (ERT) and applied relaxation therapy (ART). ERT focuses on improving emotion regulation skills, while ART teaches relaxation techniques. Previous studies found ERT more effectively reduced GAD symptoms and targeting mechanisms underlying the disorder. The document proposes a new study comparing the effectiveness of ERT and ART at reducing GAD symptoms and behavioral prevention in young adults. It describes the study methodology, including recruiting a diverse sample of 40 young adults with GAD who will be randomly assigned to ERT or ART and assessed before and after treatment using reliable anxiety and behavioral measures. The goal is to provide more evidence that E
Impact of drug therapy on various neurological conditions and its effects on rehabilitation; conditions like stroke, parkinson's disease,vertigo and also its effects on various impairments like spasticity, sensory impairments, cognition
Wearable Technology and Stress DetectionTorren Lamont
This document discusses developing a wearable device to detect stress levels in students with autism and communicate that information to teachers and students in real-time. It aims to detect stress early before a student is aware or displays signs of stress, to help preempt meltdowns. The document reviews literature on defining and measuring stress, how stress affects those with autism differently, and existing stress-detecting technology. It identifies a gap in developing individualized stress detection algorithms and integrating detection with communication systems to inform teachers and students to enable self-corrective behaviors. The research aims to address this by developing such an individualized stress detection and notification system using the Microsoft Band 2.
efficacy of a dilemma focused intervention for unipolar depressionGuillem Feixas
This study aims to test whether adding a dilemma-focused intervention to cognitive behavioral therapy (CBT) can increase the efficacy of treating unipolar depression. The study will compare CBT alone to CBT plus individual dilemma-focused therapy, which targets cognitive conflicts identified in each patient using repertory grid technique. It is hypothesized that directly addressing these conflicts can enhance outcomes of psychotherapy for depression by resolving internal dilemmas that may otherwise hinder change. The study seeks to contribute to psychological treatment of depression by improving existing cognitive models of the disorder.
Targeting abnormal neural circuits in mood and anxiety disorders:from the la...Kaan Y
My article presentation at the Journal Club on 22 January 2008
Targeting abnormal neural circuits in mood and anxiety disorders: from the laboratory to the clinic
Kerry J Ressler & Helen S Mayberg
VOLUME 10 NUMBER 9
SEPTEMBER 2007
1116-1124
NATURE NEUROSCIENCE
For a free full text of the article:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2444035
The document discusses the history and current state of evidence-based practices in children's mental health. It notes that while research has identified hundreds of evidence-based therapies and interventions, many children still have unmet mental health needs. It summarizes the levels of evidence for different psychosocial and pharmacological treatments, as well as home- and community-based services. However, it states that significant challenges remain in implementing evidence-based practices into real-world mental health systems and services.
Cognitive conflicts in major depression: Between desired change and personal ...Guillem Feixas
Article in British Journal of Clinical Psychology (early view). Abstract:
Objectives
The notion of intra-psychic conflict has been present in psychopathology for more than a century within different theoretical orientations. However, internal conflicts have not received enough empirical attention, nor has their importance in depression been fully elaborated. This study is based on the notion of cognitive conflict, understood as implicative dilemma, and on a new way of identifying these conflicts by means of the repertory grid technique. Our aim is to explore the relevance of cognitive conflicts among depressive patients.
Design
Comparison between persons with a diagnosis of major depressive disorder and community controls.
Methods
161 patients with major depression and 110 non-depressed participants were assessed for presence of implicative dilemmas and level of symptom severity. The content of these cognitive conflicts was also analysed.
Results
Repertory grid analysis indicated conflict (presence of implicative dilemma/s) in a greater proportion of depressive patients than in controls. Taking only those grids with conflict, the average number of implicative dilemmas per person was higher in the depression group.
In addition, participants with cognitive conflicts displayed higher symptom severity. Within the clinical sample, patients with implicative dilemmas presented lower levels of global functioning and a more frequent history of suicide attempts.
Conclusions
Cognitive conflicts were more prevalent in depressive patients and were associated with clinical severity. Conflict assessment at pre-therapy could aid in treatment planning to fit patient characteristics.
Practitioner Points
• Internal conflicts have been postulated in clinical psychology for a long time but there is little evidence about its relevance due to the lack of methods to measure them.
• We developed a method for identifying conflicts using the Repertory Grid Technique.
• Depressive patients have higher presence and number of conflicts than controls.
• Conflicts (implicative dilemmas) can be a new target for intervention in depression.
Cautions/Limitations
• A cross-sectional design precluded causal conclusions.
• The role of implicative dilemmas in the causation or maintenance of depression cannot be ascertained from this study.
Role of atypical antipsychotics in the treatement of generalized anxiety diso...Paul Coelho, MD
This review article examines the evidence for using atypical antipsychotics as adjunctive therapy or monotherapy to treat generalized anxiety disorder (GAD). The most evidence has been collected for quetiapine, which approximately 50% of participants tolerated, most commonly experiencing sedation and fatigue. Among those who continued treatment, significant reductions in anxiety were demonstrated when used as adjunctive therapy or monotherapy. While atypical antipsychotics show promise based on evidence from other disorders, their use for GAD remains off-label and careful consideration of risks and benefits is needed, especially regarding long-term use.
- Poor mental health was found to exacerbate age-related cognitive declines, especially in executive function.
- Structural equation modeling showed that poor mental health, as assessed by the GHQ-12, interacted with age to predict worse performance on tasks of visual search and recognition memory.
- Executive function was found to mediate the relationship between the age x mental health interaction and performance on visual search and recognition memory tasks.
Contents lists available at ScienceDirect Journal of AffecAlleneMcclendon878
This study examined changes in emotion regulation strategies of expressive suppression and cognitive reappraisal during cognitive behavioral therapy (CBT) for social anxiety disorder (SAD). Thirty-four patients with SAD received 16-20 sessions of CBT. Self-report and electrocortical measures of emotion regulation were administered weekly and monthly. The results showed that CBT led to decreased use of expressive suppression, increased self-efficacy in cognitive reappraisal, and decreased unpleasantness in response to SAD-related stimuli. Decreases in expressive suppression and electrocortical reactivity predicted subsequent reductions in social anxiety. This suggests decreased expressive suppression may be a mechanism of change in CBT for SAD.
Neurofeedback shows promise as a treatment for anxiety, depression, and other conditions. Research indicates it can significantly reduce test anxiety and symptoms of generalized anxiety. Studies found neurofeedback reduced anxiety scores more than relaxation training or no treatment. Clinical reports also suggest neurofeedback may effectively treat mild to severe depression. It has produced significant, enduring changes in mood and depression symptoms in approximately 80% of patients. Neurofeedback also seems to have minimal risks and be less invasive than other treatments like antidepressants. More research is still needed, but it qualifies as an evidence-based treatment for certain anxiety disorders and could be an effective alternative treatment for modifying dysfunctional brain patterns associated with psychiatric conditions.
Acceptance and Commitment Therapy (ACT) is a form of cognitive behavioral therapy that uses mindfulness and behavioral activation to increase psychological flexibility. ACT has been shown to effectively treat a broad range of mental health issues by focusing on six core processes: acceptance, defusion, presence, self-awareness, values identification, and committed action. ACT reduces dysfunctional thoughts and behaviors while increasing effective action and alleviating distress. Studies have found ACT reduces OCD and depression symptoms, prevents psychosis rehospitalization, and improves general mental health and workplace stress coping. ACT is delivered flexibly in individual sessions, groups, or self-help formats.
1PAGE 21. What is the question the authors are asking .docxfelicidaddinwoodie
1
PAGE
2
1. What is the question the authors are asking?
They asked about a reduction in judgmental biases regarding the cost and probability associated with adverse social events as they are presumed as being mechanisms for the treatment of Social Anxiety Disorder (SAD). Also, the authors poised on the changes in judgmental biases as mechanisms to explain cognitive-behavioral therapy for social anxiety disorder. On top of that, they stated that methodological limitations extant studies highlight the possibility that rather than causing symptom relief, a significant reduction in judgmental biases tends to be consequences of it or correlate. Considerably, they expected cost bias at mid-treatment to be a predictor of the treatment outcome.
2. Why do the authors believe this question is important?
According to the authors, this question was relevant as methodological limitations of present studies reflect on the possibility that instead of causing symptom belief, a significant reduction in judgmental biases can be consequences or correlated to it. Additionally, they ought to ascertain the judgment bias between treated and non-treated participants. Significantly, this was important as they had to determine the impact of pre and post changes in cost and probability of the treatment outcomes. But, probability bias at mid-treatment was a predictor of the treatment outcome contrary to the cost bias at mid-treatment that could not be identified as a significant predictor of the treatment outcome.
3. How do they try to answer this question?
They conducted a study to evaluate the significant changes in judgmental bias as aspects of cognitive-behavioral therapy for social anxiety disorders. To do this, they conducted a study using information from two treatment studies; an uncontrolled trial observing amygdala activity as a response to VRE (Virtual Reality Exposure Therapy) with the use of functional magnetic resonance imaging and a randomized control trial that compared Virtual Reality Exposure Therapy with Exposure Group Therapy for SAD. A total of 86 individuals who met the DSM-IV-TR criteria for the diagnosis of non-generalized (n=46) and generalized (n=40) SAD participated. After completing eight weeks of the treatment protocol, the participants who identified public speaking as their most fearsome social situation were included. The SCID (Structured clinical interview for the DSM-IV) was used to ascertain diagnostic and eligibility status on Axis 1 conditions within substance abuse, mood and anxiety disorder modules. The social anxiety measures were measured with the use of BFNE (Brief Fear of Negative Evaluation), a self-reporting questioner that examined the degree to which persons fear to be assessed by other across different social settings. Additionally, the OPQ (Outcome Probability Questionnaire) self-reporting questionnaire was used to evaluate individual’s estimate on the probability that adverse, threatening events will occur at t ...
Cognitive behavioural therapy (CBT) leads to significant improvements in functioning and quality of life for chronic pain conditions like low back pain. Several studies show CBT is as effective or more effective than other therapies or medications for issues like reducing catastrophizing thoughts, pain levels, and disability. While evidence is limited, online CBT and web-based interventions show promise in improving outcomes for chronic low back pain. Overall, CBT aims to help patients better manage their pain by changing maladaptive thoughts and behaviors.
Expanding the Lens of EBP: A Common Factors in AgreementScott Miller
The authors explore the limitations of the traditional view of evidence-based practice with its emphasis on specific methods and diagnosis. An alternative is proposed based on the common factors.
Treating Insomnia in Depression Insomnia Related Factors Pred.docxturveycharlyn
Treating Insomnia in Depression: Insomnia Related Factors Predict
Long-Term Depression Trajectories
Bei Bei
Monash University and Royal Women’s Hospital, University of
Melbourne
Lauren D. Asarnow
Stanford University
Andrew Krystal
University of California, San Francisco
Jack D. Edinger
National Jewish Health, Denver, Colorado, and Duke University
Medical Center
Daniel J. Buysse
University of Pittsburgh
Rachel Manber
Stanford University
Objective: Insomnia and major depressive disorders (MDD) often co-occur, and such comorbidity has
been associated with poorer outcomes for both conditions. However, individual differences in depressive
symptom trajectories during and after treatment are poorly understood in comorbid insomnia and
depression. This study explored the heterogeneity in long-term depression change trajectories, and
examined their correlates, particularly insomnia-related characteristics. Method: Participants were 148
adults (age M � SD � 46.6 � 12.6, 73.0% female) with insomnia and MDD who received antidepressant
pharmacotherapy, and were randomized to 7-session Cognitive Behavioral Therapy for Insomnia or
control conditions over 16 weeks with 2-year follow-ups. Depression and insomnia severity were
assessed at baseline, biweekly during treatment, and every 4 months thereafter. Sleep effort and beliefs
about sleep were also assessed. Results: Growth mixture modeling revealed three trajectories: (a)
Partial-Responders (68.9%) had moderate symptom reduction during early treatment (p value � .001)
and maintained mild depression during follow-ups. (b) Initial-Responders (17.6%) had marked symptom
reduction during treatment (p values � .001) and low depression severity at posttreatment, but increased
severity over follow-up (p value � .001). (c) Optimal-Responders (13.5%) achieved most gains during
early treatment (p value � .001), continued to improve (p value � .01) and maintained minimal
depression during follow-ups. The classes did not differ significantly on baseline measures or treatment
received, but differed on insomnia-related measures after treatment began (p values � .05): Optimal-
Responders consistently endorsed the lowest insomnia severity, sleep effort, and unhelpful beliefs about
sleep. Conclusions: Three depression symptom trajectories were observed among patients with comorbid
insomnia and MDD. These trajectories were associated with insomnia-related constructs after commenc-
ing treatment. Early changes in insomnia characteristics may predict long-term depression outcomes.
What is the public health significance of this article?
This study identified three distinct depression trajectories in patients with comorbid major depression
and insomnia disorders during treatment and 2-year follow-up. Those with the largest and most
sustained improvements in depression consistently scored the lowest on postbaseline insomnia and
insomnia-related cognitions. Early changes in insomnia symptoms and insomnia-related character ...
1) Schizophrenia and psychosis greatly impact normal brain processes and functioning, making it difficult for clients to think clearly and function in daily life.
2) Proper diagnosis and treatment under close supervision from a mental health practitioner can help clients thrive.
3) Assessing client history and factors is important to develop personalized treatment plans, considering how medications may impact each client differently based on pharmacokinetic and pharmacodynamic processes.
Cognitive-Behavioural Exposure Therapy for Multiple Chemical Sensitivity: A C...CrimsonpublishersPPrs
A case report of a woman treated with a multi-faceted cognitive-behavioral exposure therapy (CBET) for multiple chemical sensitivity (MCS) is presented. The patient reported substantial improvements in the severity of her somatic symptoms, catastrophic thinking about symptoms, and functioning. Improvements were maintained six months after treatment ended. It is hypothesized that CBET reduces symptoms by reducing central sympathetic activation, maladaptive thinking and avoidant behavior. Long-term efficacy of CBET for MCS should be examined in large clinical trials.
Integrated Psychological Therapy (IPT) and Wellness Self-Management (WSM) are two multimodal workbook-based treatments for individuals with schizophrenia. IPT was developed in 1994 and focuses on remediating cognitive deficits through group exercises before building social skills. Research shows IPT improves neurocognition, symptoms, and functioning. WSM was developed in 2001 from Illness Management and Recovery and uses a personal workbook to build competencies like medication management. Over 80% of facilities using WSM continued ten months later. Both treatments aim to improve functioning through cognitive and social rehabilitation, though IPT has more extensive research support currently.
This study examined the effectiveness of brief emotion-focused therapy (EFT) for students presenting with worry and anxiety issues. Nine students received up to 12 sessions of EFT. Quantitative measures found significant reductions in generalized anxiety and worry symptoms. Qualitatively, clients reported increased resilience, self-acceptance, and decreased anxiety. Helpful aspects included the therapeutic relationship and experiential work. While more research is needed, brief EFT showed promise in reducing anxiety symptoms for students.
Hyland2007 dispositional predictors of placebo respondingbenwhalley
This study aimed to test a motivational interpretation of placebo effects using two different placebo therapies: flower essences and gratitude therapy. The motivational interpretation is that rituals consistent with self-actualizing goals have a nonspecific therapeutic benefit beyond expectations. Study 1 found that trait spirituality predicted perceived improvement from flower essences, independently of optimism and expectations. Study 2 found that trait gratitude predicted perceived sleep improvement from gratitude therapy, independently of expectations. These findings suggest that engagement with positive, therapeutic rituals, beyond expectations, determines the extent of the placebo response.
Relationship between cortisol, perceived stress, and mindfulness meditationRachael Blais
The study examined the effects of a 30-minute mindfulness meditation session on perceived stress levels and cortisol levels in college students. 39 undergraduate students were randomly assigned to either a meditation group or a control group. Personality traits, health behaviors, perceived stress scales, and cortisol samples were measured. Results found no significant differences in perceived stress or cortisol levels between the meditation and control groups, suggesting a brief mindfulness meditation did not reduce stress. However, emotional stability was found to negatively correlate with perceived stress levels.
CBT is a for of psychological therapy used to alter subjects thoughts to improve behaviors and or feelings. it is great tool to be used for psychological disease or chronic diseases. this presentation cover the basics aspects of CBT with some studies about use of CBT in pulmonary diseases.
Week 4 Assignment - Strategic Plan, Part 3 Strategic Evaluation.docxjessiehampson
This document provides instructions for a strategic evaluation assignment. Students are asked to evaluate potential business, corporate, and global strategies for an organization and recommend a strategy or combination of strategies. They are to insert their assessment and evaluation into tables provided in an attached document and include these tables in their paper. The paper must be at least 1,050 words.
This document summarizes a meta-analysis of cognitive-behavioral therapy (CBT) for symptoms of schizophrenia. The meta-analysis included 34 studies examining overall symptoms, 33 examining positive symptoms, and 34 examining negative symptoms. It found small effect sizes favoring CBT across symptoms. However, effect sizes were larger in studies that masked outcome assessments, indicating masking reduced bias. The analysis also examined potential biases from randomization, incomplete data, and type of control group, but found little effect of these factors on results. While meta-analyses have found CBT effective for schizophrenia, biases like lack of masking in some studies may inflate apparent benefits.
The document summarizes a study that examined the impact of gender and age on the efficacy of electroconvulsive therapy (ECT) for treating major depressive disorder (MDD). The study analyzed data from 157 patients who received ECT and found that neither gender nor age significantly influenced treatment outcomes. Specifically, gender did not affect the rate of response to ECT or patient receptivity to treatment, and age was also not related to these measures of efficacy. The study had some limitations but provides initial evidence that gender and age may not be determinants of ECT effectiveness for MDD.
The Effects of ADHD Symptomology on Sleep draft.final-2Leah Doghramji
This study examined the relationship between ADHD symptomology and sleep problems. The results showed that:
1) Both hyperactive/impulsive and inattentive ADHD symptoms were significantly related to poor sleep quality and efficiency.
2) Inattentive symptoms were also positively correlated with sleep disturbance and insomnia.
3) Hyperactive/impulsive symptoms at Time 1 were related to insomnia at Time 2, but this relationship was accounted for by depressive symptoms, suggesting depression partially mediates this relationship.
4) The findings indicate ADHD symptoms negatively impact sleep, and addressing sleep problems may help manage ADHD symptoms and related depression.
The document summarizes a study that aimed to map the underlying structure of the at-risk mental state (ARMS) by defining dimensions of subclinical psychopathology in ARMS subjects. 316 participants meeting criteria for ARMS were assessed using the CAARMS interview and other measures. Principal component analysis of the CAARMS items yielded five interpretable components ("Depression", "Disorganization", "Bodily-impairment", "Manic", and "Schizo-affective"). The "Depression" component was most strongly related to worse functioning and increased depressive symptoms. The identified components could provide a step towards a dimensional approach to assessing ARMS.
Acceptance and Commitment Therapy as a Web-based Intervention for Depressive ...Tejas Shah
To compare the efficacy of a guided web-based intervention based on acceptance and commitment therapy (ACT) with an active control (expressive writing) and a waiting-list control
condition.
Similar to Scientific Journal of Depression & Anxiety (20)
A 5-year old boy, with an established diagnosis of a topic
dermatitis, previously treated by topical corticosteroids and emollient cream with a good improvement, developed widespread papules on his legs, hands and forearm that appeared 5 months ago.
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
Introduction: Laparoscopic surgery has been performed in Mexico since 1989, but no reports about training tendencies exist. We conducted a national survey in 2015, and here we report the results concerning training characteristics during the surgical residence of the respondents. Materials and Methods: A prospective study was conducted through a survey questioning demographic data, laparoscopic training during pre and post surgical residency and other of areas of laparoscopic practice. The sample was calculated and survey piloted before
application. Special interest in this report was placed on type and quality of training received. Data are reported in percentages.
Heterotopic Ossification (HO) is defined as pathological bone formation at locations where bone normally does not exist. The
presence of HO has been found to be a rare complication after stroke in several studies, whereas there are only sporadic references relating HO to Cerebral Palsy (CP) and few for CP and stroke. No effective treatment for HO has yet been found, whereas the cellular and molecular mechanisms have not been completely understood. Therefore, increased awareness among physicians is required, as a challenge for early diagnosis and treatment. A case of a male patient with CP, who developed HO on the paretichip joint following an ischemic stroke is presented.
Objectives: To assess the practice of food hygiene and safety, and its associated factors among street food vendors in urban areas of Shashemane, West Arsi Zone, Oromia Ethiopia, 2019.
Methods: Cross-sectional study design was applied from December 28, 2019 to January 27, 2020. Data was collected from 120 food handlers, which were selected by purposive sampling techniques. Information was gathered from interview and field observation by conducting food safety survey and using questionnaires via face to face interview. The collected data was entered using Epi Data 3.1 and finally, it was analyzed using SPSS VERSION 20.
A Division I football player experienced acute posterior leg pain while playing. An ultrasound examination revealed an unusual injury - a complete rupture of the plantaris tendon mid-substance. This type of isolated plantaris tendon injury has rarely been reported. Ultrasound was useful for diagnosis and guided rehabilitation by monitoring healing over time. The athlete was able to return to full competition within 3 weeks through a progressive rehabilitation program focused on restoring range of motion and strength. This case suggests isolated plantaris tendon injuries may allow for faster return to play than other potential causes of posterior leg pain.
Type 1 Diabetes (T1D), is a severe disease, representing 5-10% of all reported cases of diabetes worldwide. Fulminant Type 1 Diabetes Mellitus (FT1D) is a subtype of type 1 diabetes mellitus that is largely characterized by the abrupt onset of Diabetic Ketoacidosis (DKA) and severe hyperglycemia without insulin defi ciency. Viral infections have been hypothesized to play a major role in the pathogenesis of Fulminant Type 1 Diabetes Mellitus (FT1D) through the complete and rapid destruction of pancreatic beta cells. Coxsackie viral infection has been detected in islets of 50% of the pancreatic tissue recovered from recent-onset Type 1 Diabetes (T1D) patients. In this report we have highlighted a case where the patient developed a Group B Coxsackie virus infection culminating in the development of Fulminant Type 1 Diabetes Mellitus (FT1D).
Methods: Cercariae are released by infected water snails. To determine the occurrence of cercariae-emitting snails in SchleswigHolstein, 155 public bathing places were visited and searched for fresh water snails. Family and genus of the collected snails were determined and the snails were examined for the shedding of cercariae, using a standard method and a newly developed method.
Objective: To generate preliminary information about of enteroviruses and Enterovirus 71 (EV71) in patients with aseptic meningitis in Khartoum State, Sudan.
Method: Cerebrospinal fluid specimens were collected from 89 aseptic meningitis patients from different Khartoum Hospitals
(Mohammed Alamin Hamid Hospital, Soba Teaching Hospital, Omdurman Military Hospital, Alban Gadeed Teaching Hospital and Police Hospital) within February to May 2015. Among these 89 patients, 43 (48%) were males and 46 (52%) were females. The patient’s age ranged between 1 day and 30 years old. The collected specimens were assayed to detect enteroviruses and EV71 RNA using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) technique
Femoral hernias, comprise 2% to 4% of all hernias in the inguinal region, and occur most commonly in women. Th ey present typically with a mass below the level of the inguinal ligament. The sac may contain preperitoneal fat, omentum, small bowel, or other structures and have a high rate of incarceration and strangulation due to the small size of the hernia neck orifice, requiring emergency surgery. We present the case of a 54-year-old female patient with intestinal occlusion due to incarcerated femoral hernia, repaired by laparoscopic approach, that gave the patient the opportunity to attend her daughter’s wedding the same day.
Small Supernumerary Marker Chromosome (sSMC) is a rare genetic condition marked by the presence of an extra chromosome to the 46 human chromosomes. This case report describes a 4 year old child with SSMC on the 46th chromosome. The child presented with delayed speech and language development, seizures and mild developmental delay. Speech and Language evaluation was carried out and management options are discussed.
A catheter is a thin tube made from medical grade materials that serve a broad range of functions, but mainly catheters are medical devices that can be inserted in the body to treat disease or perform surgical procedures. Catheters have been inserted into body cavities, ducts, or vessels to allow for drainage, administration of therapeutic fluids or gases, operational access for surgery. Catheters help perform tasks in various systems such as cardiovascular, urological, gastrointestinal, neurovascular, and ophthalmic systems. A dataset of 12 patients with varying “weights” and “heights” was recorded along with the lengths of their catheter tubes. This data set was found from two revered statistical textbooks on linear regression and the Department of Scientific Computing at Florida State University. This data set was not able to be linked to any particular clinical or experimental research studies, but the data set can be used to help catheter manufacturers and medical professionals better decide on what particular catheter lengths to use for patients knowing only their height & weight. These research insights could be helpful to healthcare professionals that have patients with incomplete or no healthcare records
to decide what catheter length to use. The main investigative inquiry that needed to be answered was how does patient weight & height influence catheter length together and separately? We conducted linear regression and other statistical analysis procedures in R program & Microsoft Excel and discovered that this data exhibited a quality called multi collinearity. With multi collinearity, all predictors (2 or more
independent variables) are not significant in an all encompassing linear aggression, but the predictors might be significant in their own individual linear regressions. Individual linear regression analyses were conducted for both patient height & weight to see how much they both contribute to varying catheter length. Patient weight was found to be more impatful than patient height in relationship to catheter length, even though height and weight are a classical example of multi collinearity predictors.
Bovine mastitis has a negative impact through economic losses in the dairy sector across the globe. A cross sectional study was carried out from September 2015 to July 2016 to determine the prevalence of bovine mastitis, associated risk factors and isolation of major causative bacteria in lactating dairy cows in selected districts of central highland of Ethiopia. A total of 304 lactating cows selected randomly from five districts were screened by California Mastitis Test (CMT) for subclinical mastitis. Based on CMT result and clinical examination, over all prevalence of mastitis at cow level was 70.62% (214/304).
Two hundred fourteen milk samples collected from CMT positive cows were cultured for isolation of major causative bacteria. From 214 milk samples,187 were culture positive and the most prevalent isolates were Staphylococcus aureus 42.25% (79/187) followed by Streptococcus agalactiae 14.43%
(27/187). Other bacterial isolates were included Coagulase Negative Staphylococcus species 12.83% (24/187), Streptococcus dysgalactiae 5.88% (11/187), Escherichia coli 13.38% (25/187) and Entrococcus feacalis 11.23% (21/187) were also isolated. Moreover, age, parity number, visible teat abnormalities,husbandry practice, barn fl oor status and milking hygiene were considered as risk factors for the occurrence of bovine mastitis and they were found significantly associated with the occurrence of mastitis (p < 0.05). The findings of this study warrants the need for strategic approach including dairy extension that focus on enhancing dairy farmers’ awareness and practice of hygienic milking, regular screening for subclinical mastitis, dry cow therapy and culling of chronically infected cows.
A 36-year-old female developed right upper quadrant pain and nausea after taking the herbal supplement kratom for two weeks to manage back pain. Laboratory tests showed elevated liver enzymes. A liver biopsy ruled out other causes and determined she had drug-induced liver injury from kratom use. Her symptoms and liver enzymes gradually returned to normal over six weeks after stopping kratom. The case report discusses kratom's potential for hepatotoxicity and advises clinicians to consider its effects on patient health.
The assessment, diagnosis and treatment of critically ill patients is extremely challenging. Patients often deteriorate whilst being
reviewed and their rapidly changing pathophysiology barrages healthcare professionals with new data. Furthermore, comprehensive assessments must be postponed until the patient has been stabilised. So, important data and interventions are often missed in the heat of the moment. In emergency situations, suboptimal management decisions may cause signifi cant morbidity and mortality. Fortunately, standardisation and careful design of documentation (i.e. proformas and checklists) can enhance patient safety. So, I have developed a series of checklist proformas to guide the assessment of critically ill patients. These proformas also promote the systematic recording and presentation of information to facilitate the retrieval of the precise data required for the management for critically ill patients. The proformas have been modifi ed extensively over the last twenty years based on my personal experience and extensive consultation with colleagues in several world-renowned centres of excellence. The proformas were originally developed for use in the intensive therapy unit
or high dependency unit. However, they have been adapted for use by outreach teams reviewing patients admitted outside of critical care areas. The use of these tools can direct eff orts to provide appropriate organ support and provides a framework for diagnostic reasoning.
This review article discusses microvascular and macrovascular disease in systemic hypertension. It summarizes that:
1) Cardiac imaging plays a crucial role in risk stratifying hypertensive patients and identifying management strategies by properly diagnosing microvascular and coronary artery disease.
2) The nitric oxide synthase (eNOS) G298 gene allele may be a marker for microvascular angina in hypertensive patients, as studies have found it to be more prevalent in hypertensive patients with chest pain and reversible myocardial defects but normal coronary arteries.
3) Both structural changes like capillary rarefaction and functional changes like endothelial dysfunction can cause microvascular dysfunction and angina in hypertensive individuals in the absence of
This study characterized dengue infections in Pakistan by analyzing hematological and serological markers in 154 suspected dengue cases and 146 control patients with other febrile illnesses. NS1 antigen was detected in 55% of dengue cases, IgM antibodies in 30%, and both in 15%. Control groups primarily had malaria (71%) and enteric fever (20%). Hematological markers (platelet count, hematocrit, WBC) measured before and after treatment showed significant differences for platelet count and hematocrit but not WBC count between the groups. Analysis of clinical symptoms and serological/hematological markers helps diagnose dengue, assess prognosis, and inform prevention efforts to reduce morbidity, mortality and spread of the disease.
Researchers from Utrecht recently published yet another paper on the use of Magnetic Resonance Imaging (MRI)demonstrating an additional failed attempt to understand the importance of qualitative versus quantitative imaging, and anatomic versus physiologic imaging. Th e implications of this failure here cannot be overstated.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Background: This report describes a unique case of a patient that developed psychotic symptoms believed to be secondary
to a tentorial meningioma with associated hydrocephalus. These psychotic symptoms subsequently abated with placement of a
ventriculoperitoneal shunt. Case description: 60-year-old female was admitted to an inpatient psychiatric facility on a psychiatric involuntary commitment petition due to progressive paranoia, homicidal ideation and psychosis. The work up showed a calcified six cm tentorial meningioma with associated hydrocephalus. The patient initially rejected treatment but later became amenable to placement of Ventriculoperitoneal Shunt
(VPS).
More from SciRes Literature LLC. | Open Access Journals (20)
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
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TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. Scientific Journal of Depression & Anxiety
SCIRES Literature - Volume 2 Issue 1 - www.scireslit.com Page -002
INTRODUCTION
Executive Function (EF) is the higher order, self-regulatory,
cognitive processes for monitoring and control of thought and
behaviour, associated with the frontal lobes [1,2]. Executive deficits
could result from damage to the frontal lobe, or disruptions to the
connective pathways mediated by the frontal lobes [3]. Over the past
two decades, research has investigated apparent similarities between
symptoms of executive dysfunction and symptoms of clinical anxiety
and depression. According to the Diagnostic and Statistical Manual
of Mental Disorders 5th
Edition [4], individuals with depression and
anxiety typically present with deficits in motivation/volition, problem
solving, planning, concentration, emotional stability, psychomotor
disturbances and perseverative thoughts; all of these are fundamental
deficits in EF [5,6]. Depressed individuals frequently exhibit
hypoactivity in cortical regions of the frontal lobes and prefrontal and
anterior cingulate, which has been linked with the lack of volition (or
planned decisive action) that frequently accompanies depression
[7]. Anxiety disorders have sometimes been characterized by
problems with inhibition which is defined as the inability to inhibit a
prepotent response [8]. For example, panic disorder is characterized
by problems with ignoring stimuli [9], as is Obsessive Compulsive
Disorder (OCD). Recent meta-analyses have confirmed that both
anxiety and depression are associated with a wide range of significant
deficits in EF.
A large meta-analysis [10] compared participants with major
depressive disorder with healthy controls on neuropsychological
measures of EF. Depression was reliably associated with significant
impairments in all domains of EF measured (d = 0.45–0.58),
including inhibition (of a habitual response), shifting (adapting to
different sets of rules), updating (of relevant information in working
memory), verbal working memory, visuospatial working memory,
planning, and verbal fluency. Associations could not be accounted
for by processing speed. Deficits were greater in patients with more
severe depression, and those taking psychotropic medications. Some
evidence suggested there were greater impairments in tasks requiring
inhibition than other domains. Other meta-analyses have confirmed
that major depression is associated with deficits across numerous
domains of EF [11,12].
Recent meta-analyses have examined the relationship of EF with
specific anxiety disorders. Snyder, Raiser and Heller [13] found that,
compared with healthy controls, a diagnosis of OCD was associated
with broad range of EF impairments including inhibition, shifting,
updating, verbal and visuospatial working memory or planning (with
most effect sizes d between 0.3 and 0.5). None of these associations
could be accounted for by general motor slowness or by comorbid
depression. Depression was a significant moderator on one task
measure, the Stroop interference task; samples with comorbid
depression had less severe problems inhibiting an established
response on this task. Another meta-analysis [14] found that patients
with OCD were significantly impaired in EF and a wide range of other
cognitive domains, independent of symptom severity, medication
status or co-morbid disorders. There seemed to be a larger deficit in
planning ability than other domains.
Scott et al. [15] conducted a meta-analysis of 60 studies on
neurocognitive deficits associated with Post-Traumatic Stress
Disorder (PTSD). Compared to healthy controls, patients with PTSD
had significant deficits in a wide range of cognitive abilities including
EF (d = .45). A systematic review [16] of the role of EF in PTSD and,
across 18 studies, found that, in comparison with trauma-exposed
controls and healthy controls, participants with PTSD showed
significantly impaired EF. There were greater impairments in EF for
participants with comorbid depression.
A systematic review of studies of panic disorder [17] did not find
support for the presence of an impairment in EF, nor other areas
of cognitive functioning; however, the findings were inconclusive
due to small sample sizes in studies. Isolated studies investigating
EF deficits associated with other anxiety disorders report mixed
results. For instance, one study of Generalized Anxiety Disorder
in later life [18], reported no deficits in EF associated with anxiety
unless there was comorbid depression. Another study [19] reported
deficits in EF associated with generalized social anxiety disorder. In
summary, despite some mixed results, recent large meta-analyses
confirm significant deficits in executive deficits associated with
major depression and anxiety diagnoses of OCD and PTSD. Given
its relationship with anxiety and depression, attention has turned
to the role of executive dysfunction in predicting responsiveness to
treatment.
Both pharmacological and psychological interventions have
been demonstrated to be effective in treating depression [20-22]
and anxiety disorders [23]. There have been two meta-analyses of
ABSTRACT
Previous research shows deficits in Executive Function (EF) in patients with anxiety and depression. Recent studies have shown that
EF measured by neuro-imaging and neuropsychological tests predicts treatment outcomes for depression, but it is unclear whether they
predict outcomes for anxiety. Neuro-imaging and neuropsychological tests are effective but intensive procedures that may not always be
accessible to clinicians. Previous research has explored the viability of questionnaire measures of EF. A previous study suggests that
the Revised Dysexecutive Questionnaire (DEX-R) predicts concurrent depression and anxiety; however, it is unclear how comorbidity
influenced these results. The purpose of the current study was to investigate whether a questionnaire measure of EF could predict
concurrent depression and anxiety and well as outcomes following treatment. A total of 206 psychiatric outpatients with major depression
or anxiety disorders completed the DEX-R prior to Group Cognitive Behavioral Therapy (GCBT). They also completed anxiety and
depression scales at pre-and post-treatment. Executive dysfunction predicted symptom severity for pre-treatment anxiety after controlling
for comorbid depression, and for pre-treatment depression after controlling for comorbid anxiety. Symptom severity in anxiety was
predicted by specific executive deficits in inhibition; symptom severity in depression was predicted by executive problems with volition
and social regulation. DEX-R significantly predicted post-treatment symptoms of anxiety but not depression following treatment in GCBT.
It was concluded that EF deficits are associated with both anxiety and depressive disorders and predict responsiveness to treatment for
anxiety patients. Screening of psychiatric patients for EF and, where indicated, incorporation of neurocognitive training strategies into
therapy, may improve treatment outcomes.
Keywords: Executive Function; Depression; Mood Disorders; Anxiety Disorders; CBT
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predictors of treatment response for depression. A meta-analysis
of predictors of treatment outcomes (including pharmacological,
psychological and care management) for depression [24], found
that poor treatment outcomes were predicted by severity of baseline
depression, EF deficits and presence of co-morbid anxiety. There were
mixed results about whether the domain of response inhibition was a
significant predictor. Another meta-analysis [25] examined whether
six domains of EF extracted from eight studies predicted short-term
effectiveness of pharmacological interventions. Only performance
related to the planning and organisation tasks predicted treatment
response; other domains including response inhibition did not. This
is consistent with early research linking depression with problems
in volition [7]. Using positron emission tomography with inpatients
with major depression, Mayberg et al. [26] found that responsiveness
to antidepressant medication was predicted by metabolism in the
rostral anterior cingulate area of the brain which is deeply involved
in action regulation [27]. Gyurak et al. [28] used magnetic resonance
imaging to monitor frontoparietal activation in patients with major
depression, and found that frontoparietal activation, during the
response inhibition task (but not selective attention or working
memory tasks) predicted later remission with antidepressant
treatment. Overall these studies suggest that inhibition may be central
in predicting treatment effectiveness for depression, and that volition
(planning and organisation) may also play a role.
At present, research results are inconclusive regarding whether
EF predicts treatment outcomes for anxiety disorders. Two studies of
generalized anxiety disorder in later life found that pre-treatment EF
did not predict treatment outcome, although changes over time in EF
were associated with reductions in anxiety [29,30]. Johnco, Wuthrich
and Rapee [31] found that pre-treatment cognitive flexibility did
not predict outcomes in anxiety or depression following CBT for
older participants. Similarly, EF did not predict treatment outcomes
following CBT for participants with OCD [32], although non-
recovered patients had lower pre-treatment social functioning than
recovered patients. In summary, research has not been successful at
predicting treatment outcomes for anxiety from pre-treatment EF.
The present study investigates whether EF predicts treatment
outcomes following CBT for outpatients with diagnoses of depression
and anxiety. Most studies of EF to date have used neurological
imaging or neuropsychological tests of EF. Although highly
effective, these intensive assessments may not always be available
to clinicians in all settings. Previous research has investigated the
utility of psychometric questionnaires including The Dysexecutive
Questionnaire (DEX) [33,34] to measure executive dysfunction.
Shaw, Oei and Sawang [35] investigated the factor structure of
the DEX with community, depressed, anxious, and neurologically
impaired samples and found that that a factor structure including
factors of Inhibition, Volition, and Social Regulation, was superior to
other factor models (DEX-R). Volition is the formation of intention
and self-awareness [2]. Inhibition is the ability to inhibit a prepotent
response in order to make a less automatic but task-relevant response
[37]. Social regulation reflects awareness and concern for social rules
[35]. Oei, Shaw and Healy [34] compared EF using the DEX-R in
neurological, psychiatric patients and general community members.
They found that patients with anxiety had greater EF deficits than all
other groups and greater deficits in inhibition and volition; patients
with depression reported greater executive dysfunction in volition
than the community group. However, given the high co-morbidity
between depression and anxiety disorders (50 to 60%) [36], it is
unclear how comorbidity influenced results reported by Oei et al.
[34].
The current study investigates whether EF, measured by DEX-R,
predicts treatment outcomes for anxiety and depression following
CBT for outpatient with diagnoses of major depression or an anxiety
disorder. A further aim is to investigate whether EF concurrently
predicts symptom severity in depression and anxiety after controlling
for comorbidity. We hypothesized that 1) after controlling for
comorbidity, that executive dysfunction, would concurrently predict
bothanxietyanddepression;2)lowerlevelsofpre-treatmentexecutive
dysfunction would predict better treatment outcomes for both
anxiety and depression 3) that deficits in pre-treatment inhibition
would predict both concurrent and post-treatment outcomes for
anxiety and 4) that deficits in pre-treatment volition would predict
both concurrent and post-treatment outcomes for user.
METHOD
Participants
The sample consisted of 206 outpatients with a primary diagnosis
of either anxiety (71.4%) or major depression (28.6%) referred to a
private psychiatric hospital for Group Cognitive Behavioral Therapy
(GCBT). Inclusion criteria were a single primary diagnosis of either
anxiety or depression. No patients with a diagnosis of psychosis
were included. All diagnoses were made by psychiatrists according
to the DSM-IV-TR [38] prior to referral. No psychiatric patient
was excluded on the basis of medication status. Anxiety diagnoses
included panic disorder (39.3%), generalized anxiety disorder
(20.9%), Post-Traumatic Stress Disorder (PTSD) (10.1%), and other
anxiety disorders (1%). They were 64.5% female and 35.5% male
with an average age of 43.5 years. For 94.9% of participants, English
was the primary language. Post-treatment data was available for 144
outpatients who attended the final CBT session (69.9%). There were
no significant differences between completers and non-completers
on age (F [1, 204] = 1.97, p = .162), gender (F [1, 204] = 0.79, p =
.376) educational level (F [1, 204] = 0.27, p = .602), nor pre-treatment
anxiety (F [1, 204] = 1.59, p = .209), depression (F [1, 204] = 0.94, p =
.335 or EF DEX-R (F [1, 204] = 2.37, p = .125).
Measures
All measures were written in English.
Dysexecutive functioning: EF was assessed pre-treatment using
the 15-item revised Dysexecutive Questionnaire (DEX-R) [35]. Item
responses range from 0 (never) to 4 (very often) with higher scores
indicating greater dysfunction. Total DEX-R had a Cronbach’s
of .87. EF subscales of Inhibition (e.g. ability to inhibit responses,
confabulation, impulsivity), Volition (e.g. planning problems, apathy
and lack of drive) and Social Regulation (e.g. lack of concern for social
rules) were calculated after Shaw et al. [35]. Internal consistency
was good for Inhibition ( = .79) and Volition ( = .81). Internal
consistency as measured by Cronbach’s alpha was low for Social
Regulation ( = .56). However, given low scores on Cronbach’s alpha
are common for scales with few items, we also calculated mean inter-
item correlation for Social Regulation (r = .39); this was within the
recommended range [39].
Depression and anxiety symptomatology: Two well established
and validated scales were utilized: the Zung Self-Rating Depression
Scale (SDS) [40] and the Beck Anxiety Inventory (BAI) [41]. The
Zung SDS has demonstrated acceptable reliability, and predictive
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validity as a screening measure for diagnosis of depression [42]. It,
correlates well (0.69) with the treating physician’s global ratings
of depressed outpatients during treatment [43]. The BAI is a well-
established measure demonstrated to have sound psychometric
properties including reliability, concurrent and construct validity
[41]. For the current sample, the SDS had a Cronbach’s α of .84 for the
pre-treatment scores and .90 for post-treatment scores; Cronbach’s α
for the BAI was .94 for both pre-treatment scores and post-treatment
scores.
Procedure: Ethical clearance was received from The University of
Queensland and Toowong Private Hospital. As in our previous papers
[34,35],participantswererecruitedfromanoutpatientpsychiatricunit
at the Toowong Private Hospital. All patients were referred to the CBT
Unit for GCBT and gave informed written consent to participation in
the study prior to their involvement. The GCBT programs have been
described in previous publications [44-46]. Each group involved, on
average, eight patients. Treatment consisted of eight 3.5-hour sessions
over 4 weeks. The manualized GCBT program for anxiety comprised
psycho-education, self-monitoring, relaxation exercises, cognitive
restructuring, interoceptive and in vivo exposure, problem solving,
maintenance and relapse prevention. The manualized GCBT program
fordepressioncoveredpsycho-education,self-monitoring,relaxation,
behavioral activation, cognitive monitoring and restructuring,
problem solving, maintenance and relapse prevention. The anxiety
and depression programs are documented in unpublished workbooks
by Oei at Toowong Private Hospital. All groups were facilitated by
a clinical psychologist with over 20 years of GCBT experience and
a psychiatric nurse with extensive experience in GCBT. Participants
completed DEX-R, anxiety and depression scales prior to treatment
and anxiety and depression scales after GCBT.
Statistical Analyses
We first conducted a MANOVA to compare pre-treatment
differences on anxiety, depression and DEX-R scores for patients
with an anxiety diagnosis compared with patients with a depression
diagnosis; this was then repeated substituting DEX-R subscales. To
determine whether executive dysfunction could predict symptom
severity in anxiety and depression after taking into account
comorbidity, we conducted a series of stepwise Hierarchical
Multiple Regression Analyses (HMR) through SPSS, using either
pre-treatment anxiety or pre-treatment depression as the outcome
variable, as described by Tabachnick and Fidell [47]. When pre-
treatment anxiety was the outcome variable, the order of entry of
predictor variables was as follows: Step 1 pre-treatment depression;
Step 2 primary diagnostic category (anxiety versus depression); Step
3 executive dysfunction; Step 4 two-way product terms involving
executive dysfunction and diagnostic category. When pre-treatment
depression was the outcome variable, pre-treatment depression was
substituted at Step 1, and pre-treatment anxiety was substituted at
Step 2. We centred each variable before calculating product terms to
avoid problems of multicollinearity associated with utilizing product
terms in regression [48].
We used a parallel procedure to test if pre-treatment DEX-R scales
predicted treatment outcomes in depression and anxiety following
GCBT. We first checked for change in depression and anxiety scores
between pre and post-treatment using ANOVAs. We used HMR to
test whether DEX-R scales would predict post-treatment anxiety after
controlling for pre-treatment anxiety and primary diagnosis, and
whether DEX-R scales would predict post-treatment depression after
controlling for pre-treatment depression and primary diagnosis.
RESULTS
Preliminary Analyses
Missing values (< 5% for each variable) were scattered randomly
throughout the data so did not pose any methodological problems
[49]. Several DEX-R scales, depression and anxiety scales had a
significant positively skew (Z > 1.96) and were kurtosed, which is
not uncommon with clinical data [50]. However multiple regression
assumes normality [47], so we transformed the data. Analyses
of transformed data yielded the same pattern of results as the
untransformed data, so the untransformed analyses were reported.
Comparison of Anxious and Depressed Groups on
Clinical Measures
We conducted MANOVAs to check differences in pre-treatment
scores for patients with an anxiety diagnosis compared with patients
with depression. The anxious group had higher scores than the
depressed group on anxiety (F [1, 203] = 58.20, p < .001), depression
(F [1, 203] = 24.70, p < .001), total DEX-R (F [1, 203] = 25.05, p <
.001) and DEX-R subscales of Inhibition (F [1, 203] = 17.46, p < .001),
Volition (F [1, 203] = 27.37, p < .001), but not Social Regulation (F [1,
203] = 0.70, p = .405).
Executive Dysfunction as a Predictor of Pre-Treatment
Anxiety
Table 1: Means, Standard Deviations and Inter-correlations between variable.
Variables Mean (SD) n 1. 2. 3. 4. 5. 6. 7.
1. Pre-treatment
anxiety
23.49 (13.25) 206 -
2. Post-treatment
anxiety
15.79 (12.21) 143
.62
***
-
3. Pre-treatment
depression
52.73 (9.48) 206
.61
***
.56
***
-
4. Post-treatment
depression
46.17 (11.05) 144
.45
***
.70
***
.69
***
-
5. DEX-R total
score
24.39 (10.30) 206
.52
***
.45
***
.54
***
.48
***
-
6. DEX-R
Inhibition
8.18 (4.61) 206
.47
***
.28
**
.36
***
.27
**
.85
***
-
7. DEX-R
Volition
13.76 (5.82) 206
.50
***
.47
***
.64
***
.55
***
.91
***
.59
***
-
8. DEX-R Social
Regulation
2.46 (1.97) 205
.15
*
.23
**
.09 .20
**
.57
***
.36
***
.40
***
* p < .05 ** p < .01 *** p < .001
Table 1 shows means, standard deviations and bivariate correlations. There
were significant correlations between DEX-R scales, anxiety and depression
measures.
Table 2: DEX-R as a Predictor of Concurrent Anxiety.
Step
Predictor
Variables
Added
Anxiety Score
B [95% CI] SEB
R2
(adj)
∆ R2
F
Change
1.
Depression
Score
0.57 [0.41; 0.74] 0.08
.41
***
.37
***
.38
123.08
***
2.
Diagnostic
Group
-9.49 [-12.82; -6.16] 1.69
-.32
***
.45
***
.08
30.87
***
3. DEX-R 0.24 [0.09; 0.39] 0.08
.19
**
.48
***
.03 11.59
**
4.
DEX-R x
Diagnosis
-0.43 [-0.75; -0.11] .16
-.14
*
.50 .02
6.85
*
* p < .05 ** p < .01 *** p < .001
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Tables 2 and 3 show HMR, using total DEX-R to predict
concurrent anxiety, after controlling for depression. Pre-treatment
depression scores at Step 1 and diagnostic category at Step 2 both
predicted pre-treatment anxiety scores (p < .001). At Step 3, inclusion
of the DEX-R total scores improved prediction of pre-treatment
anxiety scores (p = .001). There were further improvements to the
model with inclusion of 2-way product terms at Step 4 (p = .010).
The variables which accounted for unique variance in anxiety scores
were depression scores ( p < .001), diagnostic category (
p < .001), DEX-R total scores ( p = .002) and DEX-R
X Diagnosis ( p = .010). So, higher anxiety scores were
predicted by an anxiety diagnosis, higher scores on DEX-R and the
interaction term. Figure 1 graphs the significant two-way interaction.
There is a steeper gradient for the relationship between DEX-R and
anxiety for patients with an anxiety diagnosis than for patients with
a depression diagnosis, meaning that higher levels of DEX-R predict
proportionately higher levels of anxiety for anxiety patients than for
depression patients.
Table 3 shows that when DEX-R sub-scales (instead of total
DEX-R) were entered at Step 3, this still significantly improved
prediction of concurrent anxiety (F [3, 199] = 6.42, p < .001) but
inclusion of product terms at Step 4 made no further improvement
(F [3, 196] = 2.10, p = .102). The variables accounting for unique
variance in pre-treatment anxiety scores were depression scores (
p < .001), diagnostic category (p < .001) and DEX-R
Inhibition (p = .001). So, higher pre-treatment anxiety scores
were predicted by an anxiety diagnosis and higher scores on DEX-R
Inhibition.
Executive Dysfunction as a Predictor of Pre-Treatment
Depression
Table 4 shows the HMR using total DEX-R to predict depression
scores after controlling for anxiety scores. At Step 1, anxiety scores
predicted pre-treatment depression (p < .001) but diagnostic category
at Step 2 did not (p = .417). Inclusion of whole-scale DEX-R at Step
3 improved the model (p < .001) but inclusion of product terms at
Step 4 made no further improvement (p = .358). The variables which
accounted for unique variance in depression scores were anxiety
scores ( p < .001) and DEX-R total score ( p < .001).
So, higher pre-treatment depression scores were predicted by higher
scores on DEX-R.
Table 5 shows the HMR for depression scores using the DEX-R
subscales. Inclusion of DEX-R subscales at Step 3 significantly
improved prediction of pre-treatment depression (p < .001), but
inclusion of the product terms at Step 4 made no further improvement
(p =.176). The variables which accounted for unique variance in
depression scores were DEX-R Volition (p < .001), anxiety
score (p < .001), and DEX-R Social Regulation (p =
.014). So, higher depression scores were predicted by higher scores in
DEX-R Volition, and lower scores on DEX-R Social Regulation.
Evaluation of GCBT Treatment Outcomes
We tested for reductions in depression and anxiety
symptomatology following GCBT. Means and standard deviations
for pre and post measures for anxiety and depression are displayed
in Table 1. There were significant reductions in anxiety (t [142] =
8.66, p < .001), and depression (t (143) = 7.60, p < .001). As there
was no control group in the clinical setting, we used a pre-post bias
correction to calculate effect size recommended by Morris and De
Shon [51], resulting in medium effect sizes for anxiety (d = 0.53) and
depression, (d = 0.43).
DEX-R Scales as Predictors of Treatment Outcomes for
Anxiety
Table 6 and 7 show HMR using DEX-R scales to predict post-
treatment anxiety, after controlling for pre-treatment anxiety.
Table 3: DEX-R Subscales as Predictors of Concurrent Anxiety.
Step
Predictor
Variables Added
Anxiety Score
B [95% CI] SEB
R2
(adj)
∆
R2
F
Change
1. Depression Score 0.62 [0.43; 0.81] 0.10
.45
***
.37
***
.38
122.34
***
2. Diagnostic Group -9.98 [-12.39; -5.58] 1.73
-.31
***
.45
***
.08
30.48
***
3.
DEX-R Inhibition 0.65 [0.29; 1.00] 0.18
.23
***
.49
***
.05
6.42
***
DEX-R Volition -0.06 [-0.42; 0.30] 0.18 -.03
DEX-R Social
Regulation
0.09 [-0.66; 0.84] 0.38 .01
4.
DEX-R Inhibition x
Diagnosis
-0.23 [-1.09; 0.63] 0.44 -.03
.50
***
.02 2.10
DEX-R Volition x
Diagnosis
-0.35 [-1.03; 0.32] 0.34 -.07
DEX-R Social Reg
x Diagnosis
-0.98 [-2.67; 0.72] 0.86 -.06
* p < .05 ** p < .01 *** p < .001
Figure 1: Interaction of DEX-R and Diagnostic Category in Prediction of
Anxiety
Table 4: DEX-R as a Predictor of Concurrent Depression.
Step
Predictor
Variables Added
Depression Score
B [95% CI] SEB
R2
(adj)
∆ R2
F
Change
1. Anxiety Score 0.33 [0.23; 0.42] 0.05
.46
***
.37
***
.38
123.08
***
2. Diagnostic Group 0.15 [-2.57; 2.86] 1.38 .01
.37
***
.00 0.66
3. DEX-R 0.28 [0.17; 0.40] 0.06
.31
***
.44
***
.07
24.15
***
4. DEX-R x Diagnosis 0.12 [-0.13; 0.37] .13 .05 .44 .00 0.89
* p < .05 ** p < .01 *** p < .001
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For both regressions, inclusion of pre-treatment anxiety at Step 1
significantly contributed to the prediction of post-treatment anxiety
(p < .001) but inclusion of diagnostic group at Step 2 did not (p = .363).
Table 6 shows that inclusion of DEX-R total score at Step 3 improved
prediction of post-treatment anxiety (p = .011), but inclusion of the
interaction term at Step 4 did not (p = .993). At Step 4, pre-treatment
anxiety ( p < .001), and DEX-R total score ( p = .011),
accounted for significant unique variance in post-treatment anxiety.
That is, better treatment outcomes in anxiety were predicted by lower
levels of pre-treatment anxiety and lower DEX-R total score. Table
7 shows that when DEX-R subscales were used instead of DEX-R
total score at Step 3, DEX-R subscales improved prediction of pre-
treatment anxiety (p = .003), but inclusion of product terms at Step 4
did not. Variables accounting for unique variance in post-treatment
anxiety were pre-treatment anxiety ( p < .001), DEX-R
Volition ( p = .008) and DEX-R Social Regulation ( p
= .020). That is, better treatment outcomes for anxiety were predicted
by lower levels of pre-treatment anxiety, DEX-R Volition and DEX-R
Social Regulation.
DEX-R Scales as Predictors of Treatment Outcomes for
Depression
Tables 8 and 9 show HMR, using DEX-R scales, to predict post-
treatment outcomes for depression scores. For both regressions,
inclusion of pre-treatment depression at Step 1 significantly
contributed to prediction of post-treatment depression (p < .001) but
inclusion of diagnostic group at Step 2 did not (p = .322). Inclusion
of neither total DEX-R nor DEX-R subscales at Step 3 significantly
improved the model, nor did inclusion of the interaction terms at
Step 4. However, examination of -weights reveals that DEX-R Social
Regulation predicted significant unique variance in post-treatment
depression ( p = .034), as did pre-treatment depression (
p < .001). That is better treatment outcomes in depression were
Table 5: DEX-R Subscales as Predictor of Concurrent Depression.
Step
Predictor Variables
Added
Depression Score
B [95% CI] SEB
R2
(adj)
∆ R2
F
Change
1. Anxiety Score 0.29 [0.20; 0.38] 0.04
.40
***
.37
***
.38 122.34
***
2. Diagnostic Group 1.13 [-1.34; 3.60] 1.25 .05
.37
***
.00
0.67
3.
DEX-R Inhibition -0.19 [-0.44; 0.06] 0.13 -.09
.55
***
.18
26.95
***
DEX-R Volition 0.94 [0.74; 1.15] 0.11
.58
***
DEX-R Social
Regulation
-0.76 [-1.26;
-0.27]
0.25
-
0.16
**
4.
DEX-R Inhibition x
Diagnosis
0.48 [-0.10; 1.06] 0.30 .10
.55
***
1.6 1.67
DEX-R Volition x
Diagnosis
0.06 [-0.40; 0.53] 0.24 .02
DEX-R Social Reg x
Diagnosis
-0.97 [-2.12; 0.18] 0.58 -.09
* p < .05 ** p < .01 *** p < .001
Table 6: DEX-R as a Predictor of Post-Treatment Anxiety.
Step
Predictor
Variables Added
Post Treatment Anxiety Score
B [95% CI] SEB
R2
(adj)
∆
R2
F
Change
1.
Pre Treatment
Anxiety
0.49 [0.33; 0.65] 0.08
.50
***
.38
***
.38
81.80
***
2. Diagnostic Group -1.09 [-5.70; 3.52] 2.33
-.04 .38
***
.00
0.83
3. DEX-R 0.25 [0.06; 0.44] 0.10
.20
*
.40
***
.03 6.65
*
4.
DEX-R x
Diagnosis
0.00 [-0.43; 0.43] 0.22
.00 .40
***
.00
0.00
* p < .05 ** p < .01 *** p < .001
Table 7: DEX-R Subscales as Predictors of Post-Treatment Anxiety.
Step
Predictor
Variables Added
Post Treatment Anxiety Score
B [95% CI] SEB
R2
(adj)
∆
R2
F
Change
1.
Pre Treatment
Anxiety Score
0.47 [0.31; 0.63] 0.08
.48
***
.38
***
.38
81.80
***
2. Diagnostic Group -1.54 [-6.12; 3.05] 2.32
-.06 .38
***
.00
0.83
3.
DEX-R Inhibition -0.26 [-0.71; 0.20] 0.23
-.09
.43
***
.06
4.82
**DEX-R Volition 0.49 [0.13; 0.85] 0.18
.24
**
DEX-R Social
Regulation
1.11 [0.18; 2.04] 0.47
.16
*
4.
DEX-R Inhibition x
Diagnosis
0.84 [-0.21; 1.89] 0.53 .13
.43
***
.02 1.39
DEX-R Volition x
Diagnosis
-0.47 [-1.26; 0.33] 0.40 -.10
DEX-R Social Reg
x Diagnosis
-0.96 [-3.07; 1.15] 1.07 -.07
* p < .05 ** p < .01 *** p < .001
Table 8: DEX-R as a Predictor of Post-Treatment Depression.
Step
Predictor
Variables Added
Post Treatment Depression Score
B [95% CI] SEB
R2
(adj)
∆ R2
F
Change
1.
Pre-Treatment
Depression Score
0.71 [0.53; 0.88] 0.09
.61
***
.47
***
.48
122.53
***
2. Diagnostic Group -1.86 [-5.51; 1.79] 1.84 -.08
.47
***
.00 0.99
3. DEX-R 0.12 [-0.06; 0.29] 0.09
.10 .48
***
.01
2.14
4.
DEX-R x
Diagnosis
-0.16 [-0.52; 0.20] .18 -.06
.48
***
.00 0.74
* p < .05 ** p < .01 *** p < .001
Table 9: DEX-R Subscales as Predictors of Post-Treatment Depression.
Step
Predictor
Variables Added
Post Treatment Depression Score
B [95% CI] SEB β
R2
(adj)
∆
R2
F
Change
1.
Pre Treatment
Depression Score
0.71 [0.50; 0.92] 0.10
.61
***
.47
***
.48
122.53
***
2. Diagnostic Group -2.39 [-6.14; 1.35] 1.89
-.10 .47
***
.00
0.99
3.
DEX-R Inhibition -0.16 [-0.56; 0.23] 0.20
-.06
.49
***
.03
2.22
DEX-R Volition 0.15 [-0.25; 0.55] 0.20 .08
DEX-R Social
Regulation
0.88 [0.07; 1.69] 0.41
.15
*
4.
DEX-R Inhibition x
Diagnosis
-0.23 [-1.15; 0.69] 0.47 -.04
.48
***
.01 0.55
DEX-R Volition x
Diagnosis
-0.06 [-0.76; 0.63] 0.35 -.01
DEX-R Social Reg
x Diagnosis
-0.76 [-2.58; 1.06] 0.92 -.06
* p < .05 ** p < .01 *** p < .001
7. Scientific Journal of Depression & Anxiety
SCIRES Literature - Volume 2 Issue 1 - www.scireslit.com Page -007
predicted by lower pre-treatment scores in depression and social
regulation problems.
DISCUSSION
This study aimed to test whether EF, as measured by DEX-R, was
related to concurrent symptom severity of depression and anxiety
after controlling for comorbidity, and whether it could predict
treatment outcomes following GCBT for outpatients with depression
and anxiety disorders. Consistent with our hypothesis and previous
research [10,13], executive dysfunction predicted concurrent
symptom severity in anxiety after controlling for comorbid
depression, and concurrent depression after controlling for comorbid
anxiety. Analyses using subscales were consistent with hypotheses
that, after controlling for comorbidity, problems in inhibition would
be concurrently associated with anxiety, and problems with volition
associated with depression.
Consistent with our predictions, DEX-R significantly predicted
reductions in anxiety following participation in a GCBT. However,
contrary to predictions, DEX-R did not predict treatment outcomes
for depression. The prediction of outcomes from DEX-R subscales
also differed from hypotheses. We will first discuss the pattern DEX-R
of subscales in the prediction of concurrent anxiety and depression,
then in the prediction of treatment outcomes.
Consistent with our hypothesis and previous literature [9], after
controllingforcomorbiddepression,severityofpre-treatmentanxiety
was predicted by executive deficits in inhibition. Also, consistent with
our hypotheses, after controlling for comorbid anxiety, depression
scores were predicted by executive problems with volition; this is
consistent with previous reports that patients with depression have
difficulties in organization and initiating goal-directed activities [7].
This suggests that findings by Oei et al. [34] that patients with anxiety
had greater deficits in Volition as well as Inhibition may have been
due to comorbid depression. The current study shows that, after
controlling for comorbidity, problems with volition are associated
with depression but not anxiety.
Additional to our hypotheses, after controlling for comorbid
anxiety, severity of pre-treatment depression was also predicted
by lower scores on social regulation. Social Regulation reflects a
lack of concern in social situations. So, higher levels of depression
symptomatology were predicted by higher levels of social concern,
rather than indifference to social rules typical of executive
dysfunction. There is little previous literature examining the
relationship between concern for social rules and depression. Oei
et al. [34] reported no significant differences in Social Regulation
between depression patients and a community sample. Perhaps the
relationship between depression and high social concern in this study
reflects social discomfort. Zahn et al. [52] found that depression
patients in remission retrospectively reported high levels of self-
disgust, guilt and shame. Collazzoni et al. [53] found that humiliation
differentiated clinically depressed subjects, from a carefully matched
non-clinical sample. It is possible then that the relationship between
social regulation and depression in this study may reflect social
discomfort and embarrassment.
In this study higher pre-treatment anxiety scores were predicted,
not only by higher scores on DEX-R, but also by the interaction of
DEX-R and diagnosis. That is, higher levels of executive dysfunction
predicted proportionately higher levels of anxiety for anxiety
patients than for depression patients. This pattern of results can be
interpreted through considering differences in scores on clinical
measures for patients with a primary diagnosis of anxiety versus
depression. Patients with an anxiety diagnosis had higher scores than
depression patients, on anxiety, depression, DEX-R total score, and
problems with Inhibition. This suggests that patients with a primary
diagnosis of anxiety were more likely to have a secondary diagnosis of
depression than vice versa. This is consistent with previous findings
that depression can develop as a secondary issue to anxiety [54] and
to mild to moderate traumatic brain injury [55].
Analyses using DEX-R scales to predict treatment outcomes in
anxiety showed some departures from hypotheses. Consistent with
hypotheses, total DEX-R scores predicted treatment outcomes in
symptom severity for anxiety. However, contrary to predictions,
and previous literature linking inhibition problems with anxiety [9],
VolitionandSocialRegulationratherthanInhibitionpredictedpoorer
treatment outcomes in anxiety. Why might this be? Problems with
response inhibition are common for patients with anxiety. However,
CBT teaches patients with anxiety to better manage their automatic
responses. So perhaps GCBT helped treat problems with inhibiting
responses common to anxiety and executive dysfunction, by enabling
patients to respond in more flexible ways to aversive stimuli. In the
current sample, depression was higher for patients with an anxiety
diagnosis than for patients with a depression diagnosis. Perhaps
comorbid depression associated with volition problems predicted
poor outcomes1
. Patients with comorbid depression may not have
had issues related to depression addressed within the time frame
given that the GCBT program was intended primarily to address
issues associated with anxiety. Deficits in planning and initiating
associated with lower scores in in Volition may have been associated
with poorer participation in group activities and homework for these
outpatients, which affected treatment outcomes.
Regressions using DEX-R scales to predict treatment outcomes
in depression also showed some unexpected results. Contrary to
hypotheses, neither total DEX-R score, nor problems with Volition
predicted post-treatment depression scores. The sample for this study
included psychiatric outpatients with major depressive disorder. As
lack of volition is a key symptom of depression [7], patients would
have had major deficits in volition. Therefore, eight sessions of GCBT
over four weeks of GCBT may have been insufficient to produce
significant change, which may have effected prediction of treatment
outcomes by DEX-R. Although this explanation seems plausible,
further vigorous research is needed. The only DEX-R subscale which
predicted treatment outcomes in depression was Social Regulation,
with poorer treatment outcomes predicted by greater deficits in social
awareness characteristic of executive dysfunction. Perhaps a lack of
concern about group rules impeded participation in GCBT.
This study investigated executive dysfunction measured by
the DEX-R questionnaire with psychiatric outpatients diagnosed
with anxiety or depression. Executive dysfunction predicted both
concurrent anxiety and depression after controlling for comorbidity.
Problems in inhibiting responses predicted concurrent anxiety;
problems with Volition and Social Regulation predicted concurrent
depression. Greater EF problems in Volition and Social Regulation
predicted poorer treatment outcomes for anxiety. Strengths of the
study included a real-world sample and a longitudinal data set.
Weaknesses included reliance on self-report measures, which are
limited by individuals’ insight into their own abilities. A further
1 Indeed when regressions were repeated controlling for depression as well as
anxiety at Step 1, Volition no longer predicted treatment outcomes.
8. Scientific Journal of Depression & Anxiety
SCIRES Literature - Volume 2 Issue 1 - www.scireslit.com Page -008
limitation is that no control group was utilized.
The findings suggest that screening patients with anxiety for
executivedysfunctionmaypredictreceptivitytoCBT.Socialregulation
wasrelevantfortreatmentoutcomesforbothpatientswithdepression,
and patients for anxiety. Checking social regulation scores prior to
CBT may identify individuals who may have difficulty participating
in a group and may benefit more from individual therapy. Individuals
with executive dysfunction may benefit from incorporation of
neurocognitive training strategies along with traditional approaches
in order to improve therapeutic gains. Neurocognitive training has
been found to improve EF and social ability in brain injured samples
and schizophrenic patients [56,57]. Future research could test the
effectiveness of incorporating neurocognitive training into CBT for
individuals with anxiety diagnoses following pre-treatment screening
for EF deficits.
ACKNOWLEDGEMENTS
Dr. Oei is now an Emeritus Professor of UQ. We would like to
thank the participants of this study.
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