Attachment mediates the link between childhood maltreatment and loneliness in persistent depressive disorder.

BACKGROUND: A central concept of attachment theory is that early experiences with close attachment figures shape the way we interact with and relate to other social partners throughout life. As such, early experiences of childhood maltreatment (CM) have been suggested as a key precursor of adult insecure attachment representations. As CM has been linked to feelings of loneliness in adulthood, this study examines whether insecure attachment could explain the relationship between CM and loneliness. Also, the moderating role of a diagnosis of persistent depressive disorder (PDD) is investigated, a disorder characterized by high levels of CM and loneliness. METHOD: 60 patients with PDD (DSM-5) and 60 gender- and age-matched non-clinical control participants (NC) completed self-report questionnaires measuring attachment, loneliness, and CM. Mediation analyses (PDD as a moderator) were performed. RESULTS: PDD patients reported higher levels of CM, attachment anxiety, attachment avoidance, and loneliness than NC. CM was positively associated with loneliness in both groups. Mediation analyses demonstrated that the relationship between CM and loneliness was mediated by avoidant, but not anxious attachment, regardless of a diagnosis of PDD. LIMITATIONS: Caution when interpreting these results is crucial as the study lacked a clinical control group, relied on self-report measures, and the cross-sectional design limits the ability to draw causal inferences. CONCLUSIONS: All constructs studied were present to a greater degree in PDD. Above, findings provide initial evidence that avoidant attachment may explain the relationship between CM and loneliness. Potentially, adult avoidant attachment may lead to and maintain feelings of loneliness, regardless of PDD.

Dynamics of the immediate behavioral response to partial social exclusion.

Social rejection and exclusion (ostracism) represent main stressors in daily life and even threaten mental and physical health. Abundant data from subjective measures in social exclusion paradigms are available, but the dynamic behavioral response is largely unexplored. Here, we applied modified variants of the Cyberball paradigm in two consecutive experiments to investigate the adaptive behavioral and emotional reactions to partial social exclusion. In experiment 1, 68 healthy participants (females, mean age 24.76 ± 4.05 years) played 2 min inclusion, 5 min partial exclusion and 2 min total exclusion. In experiment 2, 94 healthy participants (48 females, mean age 34.50 ± 12.08 years) underwent an experimental condition (2 min inclusion, 10 min partial exclusion) and a control condition (12 min inclusion only) in randomized order. In experiment 1, behavioral responses to partial exclusion showed two characteristics: (1) an immediate increase in ball passes to the excluding player followed (2) by a later return of participants' behavior to baseline. This finding was replicated for both genders and in comparison to a control condition in experiment 2. The dynamic behavioral response observed here may point to overlapping principles of cooperation in this ball tossing paradigm and serves as a novel experimental proxy.

Oxytocin plasma levels predict the outcome of psychotherapy: A pilot study in chronic depression.

BACKGROUND: Oxytocin is associated with bonding and social deficits in psychiatric disorders and has also been discussed as a potential therapeutic intervention to augment psychotherapy. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is a specific form of psychotherapy for chronic depression, an illness in which interpersonal deficits play a major role. In this pilot study, we investigated whether Oxytocin plasma levels predict the clinical outcome of chronic depressive patients after CBASP. METHODS: Sixteen patients with chronic depression participated in a 10-week CBASP inpatient program. Oxytocin plasma levels were measured before and after participants played a virtual ball-tossing game (Cyberball) that mimics social exclusion. Clinical outcome after CBASP was evaluated with the Beck Depression Inventory-II (BDI-II) and the 24-item Hamilton Depression Rating Scale (HAMD-24). RESULTS: After CBASP, depressive symptoms decreased significantly: the response rates were 44% (BDI-II) and 50% (HAMD-24); and the remission rates, 38% (BDI-II) and 44% (HAMD-24). Lower oxytocin plasma levels at baseline correlated with smaller changes in BDI-II scores, but not with the change in HAMD-24 scores. LIMITATIONS: The limitations of our study were the small sample size, concomitant and non-standardized pharmacotherapy, and lack of a controlled design and a follow-up period. CONCLUSIONS: Our study provides first evidence that oxytocin plasma levels may predict the outcome of psychotherapy in chronic depression. These findings need to be replicated in larger randomized, controlled trials.

Attachment representations, patterns of emotion regulation, and social exclusion in patients with chronic and episodic depression and healthy controls.

BACKGROUND: The experience of social exclusion (ostracism) is linked to the etiology and maintenance of depression. Most individuals experience emotional stress in states of social exclusion. Insecurely attached individuals, especially with an unresolved trauma, show maladaptive coping in response to social stress. The present study examines (a) the differences with regards to attachment representations in episodic (ED) and chronic depressive (CD) inpatients and (b) how ostracism affects their emotional reactions. METHODS: Patients with CD (n=29) and ED (n=23) and healthy control subjects (n=29) were interviewed using the Adult Attachment Projective Picture System (AAP), a valid measure to assess attachment representation; and played a virtual ball tossing game simulating social exclusion (Cyberball). Multiple depression-related risk and protective factors were considered. We hypothesized that CD patients show the most severe attachment disorganization and are emotionally most affected by the social exclusion situation. Moreover, we explored the interaction between ostracism and attachment. RESULTS: Contradicting our hypotheses, ED and CD individuals were almost akin with regards to their attachment insecurity/disorganization and reactions to Cyberball. An emotionally altered reaction to social exclusion was identified in the insecure-disorganized depressive subgroup. LIMITATIONS: Small sample size hampering further subgroup analyses. The ED sample may include single CD subjects with recent manifestation. CONCLUSIONS: The pattern of emotion regulation in the depressive groups matches with findings from clinical studies, including attachment research. The relationship between attachment representations and ostracism should be further investigated in larger samples of depressive individuals.

European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe.

PURPOSE: Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given. METHODS: We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders. RESULTS: We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences. DISCUSSION: The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD. CONCLUSION: Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.

Structural basis for the phase transitions of Cs2HgCl4.

The a(0) x b(0) x 2c(0) twofold superstructure of dicaesium mercury tetrachloride, Cs(2)HgCl(4), at T = 120 K has been determined by single-crystal X-ray diffraction using synchrotron radiation. Lattice parameters were found as a = 9.7105 (2), b = 7.4691 (1), c = 26.8992 (4) A, and beta = 90.368 (1) degrees with the supercell space group P2(1)/c. Refinements on 1828 observed unique reflections converged to R = 0.053 (wR = 0.057) using anisotropic temperature factors for all atoms. This phase is the stable phase of Cs(2)HgCl(4) below 163 K. A quantitative comparison is made of the distortions of the 2c(0) superstructure with the undistorted phase that is stable at room temperature, and with the 3c(0) and 5a(0) superstructures that are stable at temperatures between 163 K and room temperature. The principal difference between the 2c(0) superstructure and all other phases of Cs(2)HgCl(4) is that the Cs cations are displaced away from the centers of their coordination polyhedra in the 2c(0) superstructure. The structural basis for the driving force of the series of phase transitions in this compound is found in the variations of the environments of Cs atoms and in the variations of the distortions of the HgCl(4) tetrahedra.

[Medical publications in the Scientific Thesaurus]. / A Tudományos Gyújtemény orvosi vonatkozásai.

As a result of the increased public interest the first academic journals in sciences, providing anyone with easily accessible information, appeared from the 17th-18th century in Europe. These early journals were encyclopaedic and involved all branches of sciences. This was partly due to the few number of scientists but to the systematising methods of the Enlightenment as well. The first such paper in Hungarian came out only in 1814 (edited by Gábor Döbrentei) but owing to the little interest it had not lasted longer than four years. The next one, the Scientific Thesaurus, was the longest surviving journal in the first half of 19th century Hungary, published also in Hungarian. The Scientific Thesaurus was also characterised by the publication of a wide range of academic subjects, and though only in supplements, even literature. Dr. Jobst's paper investigated all the fifty medical publications of the Scientific Thesaurus. She concludes that it fulfilled the expectations academic journals were faced with. Through its publications it played an especially important role in distributing newly invented Hungarian terms for anatomy, medicine, and surgery (and for all other fields of natural sciences alike) which was indispensable for creating an independent Hungarian scientific language that could replace Latin and German, the two main lingue franca in Hungarian science so far. the Scientific Thesaurus gave way for special registers of invented scientific terms and also for the disputes that usually followed them. Another field was the presentation of the principles of recent medical schools into Hungarian academic life, such as homeopathy, Mesmerism, Brownism, balneology and traditional medicine. The editors equally stood for the publication of theoretical papers and those reciting the counter measures taken during cholera and small pox epidemics, the development of health organisations, hospital work, etc. In the field of medicine the Scientific Thesaurus carried out its mission in informing not only the Hungarian physician, pharmacist or scientist but the general public as well, about new schools, achievements, and breakthroughs of healing.