A prospective study of bipolar disorder vulnerability in relation to behavioural activation, behavioural inhibition and dysregulation of the Behavioural Activation System.

BACKGROUND: The weak regulation, or "dysregulation", of the Behavioural Activation System (BAS) is implicated in the development and recurrence of bipolar disorder. However, there has been a lack of prospective studies investigating the predictive role of BAS dysregulation in relation to bipolar-vulnerability. Furthermore, no studies have tested the prospective predictive utility of the DYS self-report measure of BAS dysregulation in an analogue sample. The goal of the current study was to redress this gap. METHODS: Participants (n=127) completed baseline self-report measures of mood symptoms (Internal States Scale [ISS]), the Hypomanic Personality Scale (HPS), behavioural activation, inhibition and dysregulation of BAS (BIS/BAS and DYS), and at six months, the Mood Disorders Questionnaire (MDQ). RESULTS: Linear regression analysis indicated a significant main effect of BAS Dysregulation, and a significant interaction between BIS and BAS Fun Seeking, on prospective MDQ scores whilst controlling for baseline mood symptoms and HPS scores. The interaction effect indicated that the relationship between high BAS Fun Seeking and follow-up MDQ scores was strongest when BIS scores were high, whilst the lowest MDQ scores were observed for a combination of low BAS Fun Seeking and high BIS. However, DYS scores were the stronger predictor of MDQ scores compared to the BAS Fun Seeking and BIS interaction. CONCLUSIONS: Bipolar-vulnerability is prospectively associated with heightened BAS Dysregulation, as measured by the DYS subscale, similar to prior findings in clinical samples. Further research investigating the longer-term associations between BAS Dysregulation with the development of clinically significant bipolar mood symptoms is required.

Perceived social support buffers the impact of PTSD symptoms on suicidal behavior: implications into suicide resilience research.

BACKGROUND: A growing body of research has highlighted the importance of identifying resilience factors against suicidal behavior. However, no previous study has investigated potential resilience factors among individuals with Posttraumatic Stress Disorder (PTSD). The aim of this study was to examine whether perceived social support buffered the impact of PTSD symptoms on suicidal behavior. METHODS: Fifty-six individuals who had previously been exposed to a traumatic event and reported PTSD symptoms in the past month (n = 34, 60.7% participants met the full criteria for a current PTSD diagnosis) completed a range of self-report measures assessing PTSD symptoms, perceived social support and suicidal behavior. Hierarchical regression analyses were conducted to examine whether perceived social support moderates the effects of PTSD symptoms on suicidal behavior. RESULTS: The results showed that perceived social support moderated the impact of the number and severity of PTSD symptoms on suicidal behavior. For those who perceived themselves as having high levels of social support, an increased number and severity of PTSD symptoms were less likely to lead to suicidal behavior. CONCLUSIONS: The current findings suggest that perceived social support might confer resilience to individuals with PTSD and counter the development of suicidal thoughts and behaviors. The milieu of social support potentially provides an area of further research and an important aspect to incorporate into clinical interventions for suicidal behavior in PTSD or trauma populations.

Perceived stops to suicidal thoughts, plans, and actions in persons experiencing psychosis.

BACKGROUND: Suicide has been conceived as involving a continuum, whereby suicidal plans and acts emerge from thoughts about suicide. Suicide prevention strategies need to determine whether different responses are needed at these points on the continuum. AIMS: This study investigates factors that were perceived to counter suicidal ideation, plans, and acts. METHOD: The 36 participants, all of whom had had experiences of psychosis and some level of suicidality, were presented with a vignette describing a protagonist with psychotic symptoms. They were asked to indicate what would counter the suicidal thoughts, plans, and acts of the protagonist described in the vignette. Qualitative techniques were first used to code these free responses into themes/categories. Correspondence analysis was then applied to the frequency of responses in each of these categories. RESULTS: Social support was identified as a strong counter to suicidal ideation but not as a counter to suicidal plans or acts. Help from health professionals was strongly related to the cessation of suicidal plans as were the opinions of the protagonist's children. Changing cognitions and strengthening psychological resources were more weakly associated with the cessation of suicidal ideation and plans. The protagonist's children were considered potentially helpful in addressing suicidal acts. CONCLUSION: These results suggest that both overlapping and nonoverlapping factors need to be considered in understanding suicide prevention, dependent on whether individuals are thinking about, planning, or attempting suicide.

An empirical investigation of the effectiveness of the broad-minded affective coping procedure (BMAC) to boost mood among individuals with posttraumatic stress disorder (PTSD).

The broaden-and-build theory postulates that positive emotions broaden people's cognitions and actions, and facilitate the building of personal and social resources which enhance resilience in a range of clinical populations. The Broad-Minded Affective Coping procedure (BMAC) is a recently developed clinical technique which utilizes the recall of positive autobiographical memories and mental imagery to elicit positive affect. This study aims to investigate the ability of the BMAC to boost mood among 50 individuals diagnosed currently (n = 31) or previously (n = 19) with Posttraumatic Stress Disorder (PTSD). To assess mood, a series of Visual Analog Scales (VASs) and Likert scales measuring feelings of sadness, calmness, happiness, hopelessness, defeat and frustration were administrated at baseline, immediately following the completion of the BMAC and two hours and two days afterwards. Participants in the BMAC condition demonstrated greater increases in self-reported levels of positive emotions and greater reductions in self-reported levels of negative emotions following the BMAC technique compared to those in the control condition. The results suggest that the BMAC is a useful clinical technique which can be incorporated into other clinical interventions such as cognitive behavioral therapy to elicit positive affect and promote resilience.

Psychological resilience in young and older adults.

BACKGROUND: The goal of the current study was to investigate psychological resilience in the older adults (>64 years) compared with that of the young ones (<26 years). METHODS: Questionnaire measures of depression, hopelessness, general health and resilience were administered to the participants. The resilience measure comprised three sub-scales of social support, emotional regulation and problem solving. RESULTS: The older adults were the more resilient group especially with respect to emotional regulation ability and problem solving. The young ones had more resilience related to social support. Poor perceptions of general health and low energy levels predicted low levels of resilience regardless of age. Low hopelessness scores also predicted greater resilience in both groups. Experiencing higher levels of mental illness and physical dysfunction predicted high resilience scores especially for the social support resilience scale in the older adults. The negative effects of depression on resilience related to emotional regulation were countered by low hopelessness but only in the young adults. CONCLUSIONS: These results highlight the importance of maintaining resilience-related coping skills in both young and older adults but indicate that different psychological processes underlie resilience across the lifespan.

Resilience to suicidal ideation in psychosis: Positive self-appraisals buffer the impact of hopelessness.

Recent years have seen growing interest into concepts of resilience, but minimal research has explored resilience to suicide and none has investigated resilience to suicide amongst clinical groups. The current study aimed to examine whether a proposed resilience factor, positive self-appraisals of the ability to cope with emotions, difficult situations and the ability to gain social support, could buffer against the negative impact of hopelessness amongst individuals with psychosis-spectrum disorders when measured cross-sectionally. Seventy-seven participants with schizophrenia-spectrum disorders completed self-report measures of suicidal ideation, hopelessness and positive self-appraisals. Positive self-appraisals were found to moderate the association between hopelessness and suicidal ideation. For those reporting high levels of positive self-appraisals, increased levels of hopelessness were significantly less likely to lead to suicidality. These results provide cross-sectional evidence suggest that positive self-appraisals may buffer individuals with psychosis against the pernicious impact of a well known clinical risk factor, hopelessness. Accounting for positive self-appraisals may improve identification of individuals at high risk of suicidality, and may be an important area to target for suicide interventions.

Resilience as positive coping appraisals: Testing the schematic appraisals model of suicide (SAMS).

AIMS: The Schematic Appraisals Model of Suicide (SAMS) suggests that positive self-appraisals may be important for buffering suicidal thoughts and behaviours, potentially providing a key source of resilience. The current study aimed to explore whether positive self-appraisals buffered individuals from suicidality in the face of stressful life events. METHOD: 78 participants who reported experiencing some degree of suicidality were recruited from a student population. They completed a battery of questionnaires including measures of suicidality, stressful life events and positive self-appraisals. RESULTS: Positive self-appraisals moderated the association between stressful life events and suicidality. For those reporting moderate or high levels of positive self-appraisals, raised incidence of stressful life events did not lead to increases in suicidality. DISCUSSION: These results support the SAMS framework, and suggest that positive self-appraisals may confer resilience to suicide. Positive self-appraisals may be a promising avenue for further resilience research, and an important area to target for suicide interventions.

Prose recall and amnesia: more implications for the episodic buffer.

Baddeley and Wilson [Baddeley, A. D., & Wilson, F. B. (2002). Prose recall and amnesia: implications for the structure of working memory. Neuropsychologia 40, 1737-1743.] have argued that their finding of a positive association between amnesics' immediate prose recall scores and their scores on measures of executive function and fluid intelligence supports the view that an episodic buffer exists. However, the pattern of data from amnesics tested in our laboratory presented some problems for this conceptualisation of the episodic buffer.

A meta-analysis of indirect memory tests for novel material in organic amnesics.

A meta-analysis was conducted on studies of implicit memory for novel and familiar information in organic amnesic patients and healthy controls. Across studies, the amnesics performed equivalently to the controls on indirect memory tests for familiar information. However, the controls performed better than amnesics for indirect memory tests for novel item and novel associative information. This is in accord with memory theories which suggest that medial temporal lobe structures are essential for encoding and storing arbitrary associations between items or events.

Shattered illusions: the effect of explicit memory mediation on an indirect memory test.

Four experiments were conducted to explore the possible involvement of explicit memory in an indirect memory test in which white noise accompanying old sentences was judged to be quieter than white noise accompanying new sentences (Jacoby, Allan, Collins & Larwill, 1988). Experiment 1 established that this effect lasted up to 1 week. Experiment 2 found that a group of amnesic patients showed a noise effect that was marginally above chance and not significantly less that that of their matched controls after a delay of one day. Effect of time pressure at test (Experiment 3) and divided attention at study (Experiment 4) suggested that the memory processes mediating the noise effect were not automatic, although the possibility that the processes involve enhanced fluency is also discussed.

Do novel associative word stem completion and cued recall share the same memory retrieval processes?

The aim of this study was to determine whether word stem completion for novel associations between cue and target words was mediated by automatic unconscious memory processes or effortful memory processes under conscious control. This was done by applying full and divided attention conditions at test to stem completion, cued recall, and recognition, and by administering a questionnaire that probed the memory strategies used by subjects during the completion test. Divided attention had no effect on stem completion performance, but did reduce associative cued recall. Recognition performance was weakened overall by divided attention, but the associative effect was similar under both attention conditions. This suggested that novel associative word stem completion was mediated by automatic retrieval processes. However, the results of the questionnaire indicated that only subjects who attempted to remember the words from the study phase during the completion task showed any novel associative effect. It is concluded that novel association word stem completion and cued recall share automatic retrieval processes, which nevertheless give rise to the experience of remembering.

Reduced cortical excitability in depression. Impaired post-exercise motor facilitation with transcranial magnetic stimulation.

BACKGROUND: In healthy controls, preactivation of muscles by exercise results in enhanced motor-evoked potential (MEP) responses to transcranial magnetic stimulation (TMS). AIMS: We tested the hypothesis that medicated, depressed patients would show reduced post-exercise MEP facilitation compared with controls. METHOD: Ten patients with DSM-IV depression (two male, eight female) and ten controls (three male, seven female) participated. MEPs were elicited at rest, then after exercising the contralateral abductor pollicis brevis muscle, using TMS of the primary motor cortex. RESULTS: The mean MEP amplitude recorded after exercise (expressed as a percentage of baseline) was 210% in controls and 130% in patients. There was a significant difference in post-exercise MEP between patients and controls (P = 0.03). CONCLUSIONS: Post-exercise MEP facilitation was demonstrated in controls but not in patients. This supports the hypothesis that the modulation of cortical excitability may be impaired in depression.

Storage of verbal associations is sufficient to activate the left medial temporal lobe.

Neuroimaging studies have shown that memory encoding activates the medial temporal lobe (MTL). Many believe that these activations are related to novelty but it remains unproven which is critical - novelty detection or the rich associative encoding it triggers. We examined MTL activation during verbal associative encoding using functional magnetic resonance imaging. First, associative encoding activated left posterior MTL more than single word encoding even though novelty detection was matched, indicating not only that associative encoding activates the MTL particularly strongly, but also that activation does not require novelty detection. Moreover, it remains to be convincingly shown that novelty detection alone does produce such activation. Second, repetitive associative encoding produced less MTL activation than initial associative encoding, indicating that priming of associative information reduces MTL activation. Third, re-encoding familiar associations in a well-established way had a minimal effect on both memory and MTL activation, indicating that MTL activation reflects storage of associations, not merely their initial representation.

Long lasting indirect memory performance for abstract shapes in amnesics and matched controls.

The speed with which subjects copied complex geometrical shapes was used as an indirect memory measure in a group of 12 organic amnesics of several aetiologies and their matched controls, tested at two delays. Both subject groups were found to copy previous seen shapes faster than new foil shapes, and the magnitude of the speed up effect did not differ significantly between amnesics and matched controls when tested at two delays of 10 min and 24 hr, respectively. The size of the indirect memory effect did not decline across the delay in either group. In contrast to indirect memory performance, measured by two-choice recognition of the shapes, was impaired in the amnesic group and there was some suggestion that recognition performance declined across the delay in both subject groups.

Preserved pattern completion priming for novel, abstract geometric shapes in amnesics of several aetiologies.

Two experiments were conducted using a paradigm developed by Gabrieli et al., Neuropsychologia 28, 417-427, 1990, which assessed both indirect and direct memory performance in a completion task for novel abstract geometric patterns. The preferred method of scoring was the lines method, based on the number of correct and incorrect lines produced for each item. It was chosen because it is both the simplest and the most informative measure. Two methods of scoring were used in previous work, namely, the strict whole figure method and the lenient whole figure method (Gabrielli et al., 1990; Verfaelie et al., Brain Cognit. 18, 34-45, 1992). Therefore to facilitate comparisons between studies and to determine the characteristics of different scoring methods, results with all three measures were included. In Experiment 1, two different encoding strategies of naming and copying were used in order to explore the relationship between indirect and direct memory performance. Indirect memory performance in the naming condition was at baseline whereas in the copying condition it was significantly above baseline. Cued recall did not differ across encoding conditions but recognition was higher in the naming condition than the copying condition. In Experiment 2, an attempt was made to extend the findings of two studies, one with H.M. (Gabrielli et al., 1990) and one with nine Korsakoffs (Verfaelie et al., 1992), to a larger group of 14 amnesics of several aetiologies. Indirect memory performance was found to be equivalent for the amnesics and their matched controls, only when the lenient and the lines methods of scoring were used. Recognition and cued recall performance was impaired for the amnesics compared to the controls.