Attachment Status Affects Heart Rate Responses to Experimental Ostracism in Inpatients with Depression.

Depression is assumed to be both a risk factor for rejection and a result of it, and as such constitutes an important factor in rejection research. Attachment theory has been applied to understand psychological disorders, such as depression, and can explain individual differences in responses to rejection. Research on autonomic nervous system activity to rejection experiences has been contradictory, with opposing strings of argumentation (activating vs. numbing). We investigated autonomic nervous system-mediated peripheral physiological responses (heart rate) to experimentally manipulated ostracism (Cyberball) in 97 depressed patients with organized (n = 52) and disorganized attachment status (n = 45). Controlling for baseline mean heart rate levels, depressed patients with disorganized attachment status responded to ostracism with significantly higher increases in heart rate than depressed patients with organized attachment status (p = .029; ηp2 = .051). These results suggest that attachment status may be a useful indicator of autonomic responses to perceived social threat, which in turn may affect the therapeutic process and the patient-therapist relationship.

Contrasting chronic with episodic depression: an analysis of distorted socio-emotional information processing in chronic depression.

BACKGROUND: The specific features that differentiate chronic and episodic depression are widely unknown. This study compares the chronic and episodic form of depression with regard to two domains of socio-emotional information processing: Decoding of other people's emotional states (Theory of Mind) and the perception of own emotions (alexithymia). METHOD: This study compares 30 chronically and 29 episodically depressed patients by tapping into Theory of Mind deficits with a multi-method approach and by assessing alexithymic deficits. Furthermore, a retrospective assessment of adverse relational childhood experiences is administered. RESULTS: The observed results reveal distorted information processing in only one of the two domains: Chronically depressed patients scored higher in alexithymia than episodically depressed patients, while no group differences in the domain of Theory of Mind were found. Moreover, alexithymia was found to mediate the influence of adverse relational childhood experiences on depression type (chronic vs. episodic). LIMITATIONS: Due to the reliance on retrospective and self-report data, results should be interpreted with due caution. In addition, the cross-sectional design limits causal conclusions. CONCLUSIONS: These results suggest a potentially central role of the deficient perception of own emotions in causing or maintaining chronic depression. Derived practical implications include a focus on the perception of own emotions in the psychotherapy of chronic depression. If future research continues to uncover systematic differences in the psychopathology of chronic and episodic depression, chronicity should be more strongly considered when classifying unipolar depressive disorders.

Quality of marital relationship and depression: results of a 10-year prospective follow-up study.

BACKGROUND: Although the long-term course of depression has been intensively examined, there are only few studies on the long-term development of depressed patients' spousal relationships. The aim of the study was to assess the quality and stability of depressed patients' spousal relationships in the long-term course of depression and to identify predictors of relationship outcome. METHODS: In the study, 50 inpatients with Major Depression were followed-up one, two and ten years after discharge from hospital and compared to a healthy control group matched by age and sex. Marital satisfaction was measured by the Terman item. Expressed Emotion (EE) was assessed with the Five-Minute Speech Sample (FMSS) and the Perceived Criticism Index (PC). RESULTS: In the follow-up period of ten years, 26 patients (56.5%) had a recurrence. Ten years after discharge from hospital 8 couples were separated, 11 were unhappy and 26 couples were happy with their spousal relationship. The quality of marital relationship decreased over the follow-up period. In comparison to a healthy control group, patients showed a significantly worse quality of marital relationship at follow-up. Besides age and course of depression, the spousal EE status was a prognostic factor for the quality of the relationship after 10 years. CONCLUSIONS: The results confirm the decrease of marital satisfaction over time in the long-term course of depression. Identified interpersonal predictors of the quality of spousal relationship in major depression could be used as indication criteria for couple therapy.

Hippocampal volume in first episode and recurrent depression.

Abnormalities in limbic-thalamic-cortical networks are hypothesized to modulate human mood states. In the present study differences in hippocampal volumes of patients with a first episode of depression, recurrent major depression and healthy control subjects were examined with high-resolution magnetic resonance imaging (MRI). Male patients with a first episode of major depression had a significantly smaller left hippocampal volume than male control subjects. Also, these patients had a significant left-right asymmetry in hippocampal volume. Female patients showed no significant alterations in hippocampal volumes. The results support the hypothesis that the hippocampus plays an important role in the pathophysiology of the early phase of major depression, especially for male patients. Implications for the neurodevelopmental and the neurodegenerative model of hippocampal change are discussed.

[Assessment of shame and guilt validation of the test of self-conscious affect for children and adolescents (TOSCA-C/A)]. / Zur Erfassung von Schuld und Scham bei Kindern und Jugendlichen Validierung der deutschen Fassung des Tests of Self-Conscious Affect for Children and Adolescents (TOSCA-C/A)

Shame and guilt feelings play a pivotal role in the aetiology and maintenance of a number of psychological disorders as well as in the development and regulation of moral behaviour. Despite intensive theoretical treatments of this topic, there have been few empirical studies to date, chiefly because of the lack of appropriate measuring instruments. The purpose of this study was the psychometric evaluation of the German version of the Test of Self-Conscious Affect for Children and Adolescents (TOSCA-C/A). The psychometric properties of this instrument were evaluated using a non-clinical sample of N = 505 children and adolescents aged between 8 and 18 years and a clinical sample of N = 50 children and adolescents. The individual scales proved reliable. There were many indications of the validity of the scales. We conclude that the German version of the TOSCA-C/A is the basis for the further investigation of self-conscious affects such as guilt and shame in children and adolescents.

Hippocampal volume and 2-year outcome in depression.

Although the hippocampus has been found to be smaller in people with depression, the clinical relevance of this is unclear. We investigated hippocampal volume (using high-resolution magnetic resonance imaging) and 2-year outcome in 57 patients with major depression. The left and right hippocampal volumes of patients with a depression relapse were significantly smaller than those of healthy controls. Our results support the hypothesis that the hippocampus is crucial in the outcome of depression.

Expressed emotion, perceived criticism and 10-year outcome of depression.

Outcome studies of patients suffering from depression indicate a high relapse rate and a tendency towards chronicity. A family atmosphere characterised by expressed emotion (EE) and perceived criticism (PC) was reported to be a robust predictor of outcome in affective disorders. The aim of the study was to analyze the association between EE, PC and long-term outcome of depression. Fifty inpatients with major depression were followed up 1, 2 and 10 years after discharge from the hospital. After 10 years, 26 patients (56.5%) had at least one recurrence. Spousal EE, assessed with the Five-Minute Speech Sample (FMSS), and the Perceived Criticism Index (PCI) were not significant prognostic factors for depression outcome. The significance of EE and PC for the long-term course of depression has to be questioned. The findings indicate a need to examine factors that may partly mediate the effect of EE and PC on the outcome of depression.

Life events and hippocampal volume in first-episode major depression.

BACKGROUND: There are many studies on life events in depression and also several studies examining brain structural changes in the hippocampus of depressed patients. However, only few studies have focused on the association of life events and hippocampal volume in depression. The hypothesis of a significant negative association between life events and hippocampal volumes in first episode depression was examined. METHODS: 28 in-patients with a first episode of major depression were examined with high-resolution magnetic resonance imaging measuring hippocampal volumes. The precourse of depression was assessed with the Interview for the Retrospective Assessment of the Onset and Course of Schizophrenia and Other Psychoses (IRAOS) and life events by using the Munich Interview for the Assessment of Life Events and Conditions (MEL). RESULTS: A significant negative correlation between major life events three month before the onset of depression and the left hippocampal volume was found for male patients. In female patients no significant association between major life events and hippocampal volumes could be found. CONCLUSIONS: The results support the hypothesis that the hippocampus plays a crucial role in the pathogenesis of major depression in the early phase of the disorder particularly for male patients.

Knowledge about affective disorders and outcome of depression.

BACKGROUND: For affective disorders, imparting information about the illness has become standard treatment. Despite the great clinical relevance of knowledge about depression, few empirical studies on this subject have been carried out. The aim of the study was to identify the prognostic value of knowledge about affective disorders for the two year outcome of depression. METHODS: 62 first-hospitalised patients with major depression were recruited and tested with the Knowledge about Depression and Mania Inventory (KDMI). The patients were followed-up after 1 and 2 years. RESULTS: In the 2-year follow-up period, 28 patients (45.2%) had a recurrent or chronic course of depression. Patients with stable remission had significantly more knowledge about affective disorders compared to patients with recurrence or chronic depression. Knowledge about treatment was prognostically relevant whereas knowledge about symptoms and knowledge about coping were not. CONCLUSIONS: The results show that knowledge about affective disorders and especially knowledge about treatment is a predictor for the outcome of depression. This indicates the necessity of multidimensional assessment of knowledge about disorder. Future studies should examine the mechanisms underlying the prognostic effect in order to improve treatment of depression.

[The exploration of the depressive personality disorder]. / Zur Erfassung der depressiven Persönlichkeitsstörung -- Validierung einer deutschen Version des "Depressive-Persönlichkeitsstörungs-Inventars" (DPSI).

Lately the concept of the depressive personality disorder has been regarded more often again in the context of chronic and subthreshold forms of depression. The purpose of the present study was the psychometric evaluation of a German version of the "Depressive Personality Disorder Inventory" (DPDI), which is a questionnaire for the exploration of the depressive personality disorder. A total of 138 depressive patients and controls were included in the study. The inter-rater-reliability as well as the internal consistency and the test-retest-reliability of the DPDI revealed satisfactory and good results. A short version of the DPDI was developed by means of a factor analysis. Medium correlations were found between the DPDI and two interviews for the depressive personality disorder. These results are discussed and it is concluded that the DPDI as well as its short version are reliable, valid and economic self-rating instruments for the exploration of the depressive personality disorder.

[Psychometric evaluation of the German version of the temperament questionnaire TEMPS-A]. / Psychometrische Evaluation der deutschen Version des Temperamentsfragebogens TEMPS-A.

One aim of the present study was the psychometric evaluation of the German version of the questionnaire TEMPS-A of Akiskal, Mundt, Maier and Angst , which explores five affective temperaments. Another aim was to create a short version of the questionnaire. For that purpose the TEMPS-A was filled in by n = 62 in-patients who suffered from Major Depression. Then the relation between the five types of temperament and the big five personality factors was examined. The intercorrelations of the five temperament scales of the TEMPS-A showed mainly moderate associations. The correlations with the big five personality factors resulted in significant associations of all temperaments with neuroticism. By factor analyses, conducted for each scale of the TEMPS-A, we developed a short form of the TEMPS-A with 30 items. The evaluation of the TEMPS-A is just beginning. The TEMPS-A is an important basis for the further examination of the relationship between temperament and psychiatric disorders.

[Efficacy of psychodynamic short-term psychotherapy for children and adolescents with depression]. / Zur Wirksamkeit psychodynamischer Kurzzeit- psychotherapie bei Kindern und Jugendlichen mit Depressionen.

Depression is highly prevalent in children and adolescents. Psychodynamic therapies are only insufficiently evaluated in this field although many children and adolescents suffering from depression are treated using this approach. Therefore, the aim of our study was to evaluate the efficacy of psychodynamic short-term psychotherapy (PSTP) for the treatment of depression in children and adolescents. In a waiting-list controlled study, 20 children and adolescents fulfilling diagnosis of major depression or dysthymia were included. The treatment group received 25 sessions of psychodynamic psychotherapy. Main outcome criterion was the Impairment-Score for Children and Adolescents (IS-CA) as well as the Psychic and Social-Communicative Findings Sheet for Children and Adolescents (PSCFS-CA) and the Child Behavior Checklist (CBCL), which were assessed at the beginning and the end of treatment. The statistical and clinical significance of changes in these measures were evaluated. There was a significant advantage of the treatment group compared to the waiting group for the IS-CA. The effect size of the IS-CA total score was 1,3. In contrast to the treatment group, where 20% of the children showed clinically significant and reliable improvement, no subject in the waiting-list control group met this criterion. Comparable results were found for the PSCFS-CA and for the internalising score assessed with the CBCL. The results show that psychodynamic short-term psychotherapy (PSTP) is an effective treatment for depressed children and adolescents. Still, some of the children surely require more intensive treatment.