Overgeneral Memory Retrieval and Ineffective Problem-Solving in Depressed Patients with Suicidal Ideation: Implications for Therapy

The present study was designed to extend our knowledge around cognitive aspects of memory retrieval and problem-solving in two groups of clinically depressed patients. We administered an autobiographical memory test, a means-ends problem-solving task, Beck Depression Inventory, and Beck Hopelessness Scale to measure respectively level of specificity in memory retrieval, problem-solving effectiveness, depression and hopelessness in clinically depressed patients with suicidal ideation and in a matched control group of depressed patients without suicide ideation. Both groups met DSM-IV criteria for major depression disorder without psychotic features. The depressed suicide-ideators were significantly more hopeless than their non-ideator counterparts. Also an overall tendency was found for the ideator group to retrieve less specific memories compared to the non-ideator group. Depressed patients’ bias toward negative memory retrieval is broadly documented. Access to non-specific memories in depressed people can lead to ineffective problem solutions and subsequently hopelessness. By this account, this very vicious cycle continues over time to resonate powerfully, perhaps leading to suicidal attempt. An emergence of suicidal ideation when assessing helps clinicians identify those who are most at risk for suicide. They can be targeted then for intensive therapy designed to lower the risk (AU)

El presente estudio se diseñó con el propósito de ampliar el conocimiento acerca de los aspectos cognifivos de la recuperación de memoria y la solución de problemas en dos grupos de pacientes con depresión: pacientes con ideación suicida y pacientes sin idea- ción suicida. Ambos grupos cumplían los criterios DSM-IV para el trastorno de depresión mayor sin características psicóticas. Se administraron a los participantes una prueba de memoria autobiográfica, una tarea de solución de problemas, el Inventario de Depresión y la Escala de Desesperanza de Beck, para medir el nivel de especificidad en la recupera- ción de recuerdos, la efectividad en solución de problemas, depression and hopelessness. Los ideadores suicidas puntuaron significativamente más alto en desesperanza que los no ideadores. Se encontró una tendencia global en el grupo de ideadores a recuperar menos memorias específicas en comparación con los no ideadores. Se discuten los resultados de acuerdo al conocido sesgo en la recuperación de memorias negativas en pacientes depresivos y la emergencia de la ideación suicida como identificador de riesgo para el suicidio (AU)

Impact of depression and disability on quality of life in Iranian patients with multiple sclerosis.

Multiple sclerosis (MS) can influence all aspects of a patient's health. This study determines the main factors affecting quality of life (QoL) in Iranian MS patients. QoL (Multiple Sclerosis Impact Scale; MSIS-29), disability (Expanded Disability Status Scale; EDSS) and depression (Beck Depression Inventory; BDI) were assessed in 106 MS patients. EDSS, clinical course and MS duration significantly correlated with physical MSIS-29. Depression highly correlated with both physical and psychological MSIS-29. Regression analyses showed that depression and EDSS predicted physical health. Psychological health was predicted by depression. These findings highlight that depression and physical disability strongly influence QoL in Iranian MS patients.

Affective modulation of the startle response in depression: influence of the severity of depression, anhedonia, and anxiety.

BACKGROUND: The amplitude of the startle reflex response is known to be influenced by the concomitant presentation of affect-toned material--if it is positive affect-toned, the reflex is inhibited, and if it is negative affect-toned, the reflex is augmented. Abundant evidence demonstrates the utility of the affect-startle paradigm as a significant tool for measuring both positive and negative emotions. We applied this paradigm to study emotional reactivity in depression, particularly in relation to symptoms of depression, anhedonia, and anxiety. METHODS: Depressed patients (22) and controls (22) were shown a series of film clips, consisting of two clips with positive valence, two with negative valence, and two with relatively neutral valence. The startle response was measured in reaction to the acoustic startle-eliciting stimuli presented three times binaurally during each clip. RESULTS: Highly depressed and anhedonic patients, relative to controls, showed a reduced mood (self-ratings) and a lack of startle modulation in response to affective film clips whereas patients relatively low on depression/anhedonia displayed a reduced mood only with pleasant clips and a normal pattern of affective startle modulation. Anhedonia and depression were highly positively correlated but neither correlated with anxiety. Anxious patients displayed larger reflexes across all clips and showed a reduced mood modulation with pleasant, but not unpleasant, clips. LIMITATIONS: The large majority of patients was medicated with antidepressants which may have influenced the results. CONCLUSIONS. Reactivity to pleasant stimuli is diminished in patients suffering from low levels of depression and/or anhedonia, but reactivity even to unpleasant stimuli seems compromised at high levels of depression and/or anhedonia. Anxiety is associated with hyperstartle responding.

Enhanced startle reactions to acoustic stimuli in patients with obsessive-compulsive disorder.

OBJECTIVE: Anxiety states induced experimentally or occurring naturally potentiate the startle reflex elicited by sudden sensory stimuli in both animals and human beings. The authors investigated whether patients with obsessive-compulsive disorder (OCD) show exaggerated startle reactions to acoustic probes, especially during negative-affect-toned stimuli, compared with healthy subjects. METHOD: Ten patients with OCD and 10 age- and sex-matched comparison subjects were shown a series of film clips. Two of the film clips had positive valence, two had negative valence, and two had relatively neutral valence. The subjects' eyeblink startle response was measured in reaction to startle-eliciting stimuli presented three times binaurally during each film clip. RESULTS: Patients with OCD produced larger startle reflexes and shorter latencies to onset of startle response than the comparison subjects over the entire session. CONCLUSIONS: Patients with OCD were excessively responsive to startle-eliciting stimuli. This effect may be associated with the development or maintenance of OCD.

Modulation of the acoustic startle reflex by emotionally-toned film-clips.

It has been widely reported that the eyeblink component of the acoustic startle reflex can be modulated by emotionally-toned slide stimuli; pleasant slides reduce eyeblink amplitudes whereas unpleasant slides enhance them. The present study examines the modulation of the acoustic startle reflex by short (2-min) film-clips classified as pleasant, unpleasant or neutral, on the basis of subjective ratings. These film-clips were also evaluated with respect to their test-retest reliability in producing affective states as well as modulating startle reflexes. Overall, results showed significant reduction of startle during pleasant clips and augmentation during unpleasant clips. However, on first showing, one of the two unpleasant clips (a medical demonstration film depicting details of toe surgery) actually inhibited the startle reflex rather than augmented it. This is discussed in terms of the proposition that only stimuli which arouse fear can be guaranteed to augment startle; stimuli that are repulsive may produce perceptual and emotional 'blunting' that reduces startle amplitude.