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Predictors of functioning in major depression
- M. Serra-Blasco, E. Aguilar, M. Vicent, G. Navarra, M.J. Portella, A. Sánchez, L. Ros, S. Acebillo, G. Lahera, D. Palao, N. Cardoner
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S325
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Introduction
Life functioning difficulties are a relevant but undervalued consequence of major depression. Mood symptoms and cognitive deficits have a significant, and somehow independent, impact on them. Therefore, cognitive difficulties should be considered a potential target to improve patients’ functioning.
AimsTo examine the degree in which objective and subjective cognition explain functional outcome.
ObjectivesTo assess objective cognitive function (CF) with a neuropsychological battery and to measure subjective CF using measures of cognitive perception.
MethodsNinety-nine patients with depression were assessed by age, sex and level of schooling. Depressive symptoms severity was measured by Hamilton Depression Rating Scale (HDRS-17). Objective CF consisted in the following cognitive domains: memory, attention, executive functioning and processing speed. Subjective CF was assessed with Perceived Deficit Questionnaire-Depression (PDQ-D). Functioning Assessment Short Test (FAST) was used to evaluate life functioning, excluding the cognitive domain. All the listed measures were included in a multiple regression analysis with FAST scores as dependent variable.
ResultsThe regression model was significant (F1,98 = 67.484, P < 0.001) with an R of 0.825. The variables showing statistical power included (from higher to lower β-coefficient) HDRS-17 (β = 0.545, t = 8.453, P < 0.001), PDQ-D (β = 0.383, t = 6.047, P < 0.001) and DSST (β = −0.123, t = −1.998, P = 0.049).
ConclusionsThe severity of depressive symptoms is the variable that best explains life functioning. Surprisingly, the second factor hindering it is the patients’ perception of their cognition. Current findings highlight the importance of correcting cognitive bias in order to improve functionality. However, results have to be taken cautiously as mood symptoms could partly explain the bias.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Neuropersonaltrainer-mh: A New Computerized Platform for the Cognitive Remediation in Schizophrenia and Bipolar Disorders
- N. Cardoner, A. Cebria, C. Lopez-Sola, M. Serra-Blasco, C. Massons, V. Muriel, G. Navarra, E. Via, J. Cobo, X. Golberg
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S23
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Schizophrenia and mood disorders -including unipolar depression and bipolar disorder-, are severe mental diseases with a highly heterogeneous symptomatology, among which cognitive dysfunction has progressively emerged as a key cornerstone. Patients suffering from these illnesses show significant deficits in different neurocognitive and social cognition domains. These deficits are evident during acute episodes, and in a high percentage of patients persist in periods of recovery, playing a decisive role on functional and clinical outcome. Nowadays, different pharmacological therapies have been tested, obtaining non-conclusive results. In this context, non-pharmacological strategies, such as neurocognitive remediation, have emerged as promising therapeutic intervention. Neurocognitive remediation comprises a program to rehabilitate cognitively impaired subjects, aiming either to restore their cognitive functioning or to compensate them in specific cognitive domains. One evolving approach, beginning to receive attention for its initial promising results, is computerized cognitive training. This technique employs tasks or games that exercise a particular brain function which target specific neural networks in order to improve cognitive functioning through neuroplasticity in a given neural circuit. In this scenario, we report our recent results with neuropersonaltrainer®-MH; a module for neurocognitive remediation consisting in a computerized telerehabilitation platform that enables cognitive remediation programs to be carried out in an intensive and personalized manner. Our group has applied NPTMH® in a pilot study treating patients with early onset psychotic disorder with positive and promising results, involving an improvement in functionality, neurocognition, and social cognition performance. Furthermore, new trials in bipolar disorder and major depressive disorder have been recently started.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Cognitive dysfunction in depression. Is it well detected?
- M. Serra-Blasco, E. Aguilar, M. Vicent, G. Navarra, M.J. Portella, I. Figuereo, S. Crivillés, E. Martínez-Amorós, G. Lahera, J.A. Monreal, N. Cardoner
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- Journal:
- European Psychiatry / Volume 41 / Issue S1 / April 2017
- Published online by Cambridge University Press:
- 23 March 2020, p. S325
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- Article
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Introduction
Major depression cognitive impairments lasts in remission periods, have an impact on treatment outcome and hamper psychosocial functioning. Thus, its accurate detection and specific treatment has become a crucial step.
ObjectivesIn order to assess objective cognitive functioning (OCF), a neuropsychological battery was administered. For subjective cognitive functioning (SCF), cognitive perception was evaluated by clinicians and patients.
AimsTo determine the concordance between OCF and SCF.
MethodsOne hundred and two patients were grouped according to Hamilton Depressive Rating Scale (HDRS−17): 18 remitters (RE < 7), 40 partly remitters (PR, 7–18) and 44 acutely depressed (AD > 18). OCF was computed combining T-scores of digit symbol substitution test (WAIS-IV) with two RAVLT subtests (learning and memory). SCF was assessed with a CGI adaptation for cognitive disturbances severity.
ResultsThe OFC was 41.21(8.49) for all patients and 45.54(6.8), 41.93(6.8) and 38.7 (9.7) for RE, PR, and AD, respectively. Psychiatrist and patients’ SCF had a poor agreement (α=0.518), with Cronbach's alpha for RE, PR and AD of −0.607, 0.518 and 0.404. Concordance between OCF and SCF was calculated for all patients (psychiatrist, r = −0.317, P = 0.002; patient, r = −0.310, P = 0.002), for RE (r = −0.535, P = 0.022; r = 0.395, P = 0.105) for PR (r = −0.013, P = 0.94; r = −0.328, P = 0.045) and for AD (r = −0.252, P = 0.122; r = −0.333, P = 0.033). Patients rated their SFC as more impaired than did clinicians.
ConclusionsConcordance between clinicians and patients regarding SCF is very poor, worsening in AD group and being null in remission. This study also points out that CF is best detected by patients in acute episodes and by psychiatrists when patients are in clinical remission.
Disclosure of interestThe authors have not supplied their declaration of competing interest.
Microstructural white-matter abnormalities associated with treatment resistance, severity and duration of illness in major depression
- J. de Diego-Adeliño, P. Pires, B. Gómez-Ansón, M. Serra-Blasco, Y. Vives-Gilabert, D. Puigdemont, A. Martín-Blanco, E. Álvarez, V. Pérez, M. J. Portella
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- Journal:
- Psychological Medicine / Volume 44 / Issue 6 / April 2014
- Published online by Cambridge University Press:
- 21 August 2013, pp. 1171-1182
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Background
Although white-matter abnormalities have been reported in middle-aged patients with major depressive disorder (MDD), few data are available on treatment-resistant MDD and the influence of relevant variables related to clinical burden of illness is far from being well established.
MethodThe present study examined white-matter microstructure in a sample of 52 patients with MDD in different stages (treatment-resistant/chronic MDD, n = 18; remitted-recurrent MDD, n = 15; first-episode MDD, n = 19) and 17 healthy controls, using diffusion tensor imaging with a tract-based spatial statistics approach. Groups were comparable in age and gender distribution, and results were corrected for familywise error (FWE) rate.
ResultsWidespread significant reductions of fractional anisotropy (FA) – including the cingulum, corpus callosum, superior and inferior longitudinal fascicule – were evident in treatment-resistant/chronic MDD compared with first-episode MDD and controls (p < 0.05, FWE-corrected). Decreased FA was observed within the ventromedial prefrontal region in treatment-resistant/chronic MDD even when compared with the remitted-recurrent MDD group (p < 0.05, FWE-corrected). Longer duration of illness (β = –0.49, p = 0.04) and higher depression severity (at a trend level: β = –0.26, p = 0.06) predicted lower FA in linear multiple regression analysis at the whole-brain level. The number of previous episodes and severity of symptoms were significant predictors when focused on the ventromedial prefrontal area (β = −0.28, p = 0.04; and β = −0.29, p = 0.03, respectively). Medication effects were controlled for in the analyses and results remained unaltered.
ConclusionsOur findings support the notion that disruptions of white-matter microstructure, particularly in fronto-limbic networks, are associated with resistance to treatment and higher current and past burden of depression.