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Biomedical subjects

Zindel V Segal

Publications and source records attributed to Zindel V Segal.

11 recordsLinked to original sources
PubMed2007

Changes in regional cerebral blood flow following mood challenge in drug-free, remitted patients with unipolar depression.

Studies of mood provocation in remitted patients with depression have enabled the description of specific brain changes relevant to depression relapse vulnerability. Because patients in these studies were also receiving maintenance pharmacotherapy, the ability to subtract out the drug effect from the changes observed is reduced. Our study addresses this concern. Changes in regional cerebral blood flow (rCBF) among 11 medication-free, remitted patients with unipolar depression relative to baseline state were assessed with [(15)O]H(2)O positron emission tomography (PET) following provocation of sadness. Participants showed decreased activation in prefrontal cortex similar to those reported for remitted, medicated patients undergoing mood challenge, as well as for acutely depressed patients who were medication free. Previously reported mediofrontal changes in remitted patients are unlikely to be a consequence of maintenance medication and more likely are evidence of relapse vulnerability.

Adult↗
PubMed2006

Cognitive reactivity to sad mood provocation and the prediction of depressive relapse.

CONTEXT: Episode remission in unipolar major depression, while distinguished by minimal symptom burden, can also be a period of marked sensitivity to emotional stress as well as an increased risk of relapse. OBJECTIVE: To examine whether mood-linked changes in dysfunctional thinking predict relapse in recovered patients who were depressed. DESIGN: In phase 1 of this study, patients with major depressive disorder were randomly assigned to receive either antidepressant medication or cognitive behavior therapy. In phase 2, patients who achieved clinical remission underwent sad mood provocation and were then observed with regular clinical assessments for 18 months. SETTING: Outpatient psychiatric clinics at the Centre for Addiction and Mental Health, Toronto, Ontario. PARTICIPANTS: A total of 301 outpatients with major depressive disorder, aged 18 to 65 years, participated in phase 1 of this study and 99 outpatients with major depressive disorder in remission, aged 18 to 65 years, participated in phase 2. MAIN OUTCOME MEASURE: Occurrence of a relapse meeting DSM-IV criteria for a major depressive episode as assessed by the longitudinal interval follow-up evaluation and a Hamilton Depression Rating Scale score of 16 or greater. RESULTS: Patients who recovered through antidepressant medication showed greater cognitive reactivity following the mood provocation than those who received cognitive behavior therapy. Regardless of type of prior treatment, the magnitude of mood-linked cognitive reactivity was a significant predictor of relapse over the subsequent 18 months. Patients whose mood-linked endorsement of dysfunctional attitudes increased by a minimum of 8 points had a significantly shorter time to relapse than those whose scores were not as elevated. CONCLUSIONS: The vulnerability of remitted depressed patients for illness relapse may be related to the (re)activation of depressive thinking styles triggered by temporary dysphoric states. This is the first study to link such differences to prognosis following successful treatment for depression. Further understanding of factors predisposing to relapse/recurrence in recovered patients may help to shorten the potentially lifelong course of depression.

Acoustic Stimulation↗
PubMed2006

The Toronto Mindfulness Scale: development and validation.

In this study, the authors both developed and validated a self-report mindfulness measure, the Toronto Mindfulness Scale (TMS). In Study 1, participants were individuals with and without meditation experience. Results showed good internal consistency and two factors, Curiosity and Decentering. Most of the expected relationships with other constructs were as expected. The TMS scores increased with increasing mindfulness meditation experience. In Study 2, criterion and incremental validity of the TMS were investigated on a group of individuals participating in 8-week mindfulness-based stress reduction programs. Results showed that TMS scores increased following treatment, and Decentering scores predicted improvements in clinical outcome. Thus, the TMS is a promising measure of the mindfulness state with good psychometric properties and predictive of treatment outcome.

Adult↗
PubMed2005

Cognitive reactivity and vulnerability: empirical evaluation of construct activation and cognitive diatheses in unipolar depression.

Cognitive vulnerability is a central concept in cognitive theories of unipolar depression. This idea suggests that negative cognitive factors emerge during stressful situations, and that this cognitive reactivity is critical for the onset, relapse, and recurrence of depression. The number of empirical investigations that model the diathesis-stress nature of cognitive reactivity has substantially increased within the last decade. This review examines this literature, with a focus on priming and longitudinal designs. Extant research supports the concept of cognitive vulnerability to depression among adults, and support is accruing for the validity of this concept among children. Research that examines direct links between cognitive vulnerability and depression onset, relapse, and recurrence and the attachment origins of cognitive vulnerability is also accruing, although at a slower pace.

Cognition Disorders↗
PubMed2004

Teasdale's differential activation hypothesis: implications for mechanisms of depressive relapse and suicidal behaviour.

Teasdale's differential activation hypothesis (DAH) has been proposed as one account of cognitive vulnerability to depression. This view holds that important factors determining whether one's initial depression becomes more severe or persistent are the degree of activation, and content, of negative thinking patterns that become accessible in the depressed state. This phenomenon has been referred to as cognitive reactivity. Empirical support for the predictions of this model derives from a combination of cross-sectional and prospective studies. In this article, we evaluate this evidence with the goal of determining whether mood-induced cognitive reactivity can be considered a risk factor for depressive relapse/recurrence. Our review demonstrates sufficient evidence to consider cognitive reactivity as a potential causal risk factor for depressive relapse/recurrence. Furthermore, we extend the application of this model to the problem of suicidal relapse/recurrence including a review of preliminary support for this approach.

Cognition Disorders↗
PubMed2003

Cognitive therapy for schizophrenia: a preliminary randomized controlled trial.

BACKGROUND: The aim of the current study was to assess whether patients with a DSM-IV diagnosis of schizophrenia and experiencing persistent positive and negative symptoms improve with the addition of cognitive-behavioural therapy to enriched standard treatment. METHODS: A controlled study was completed with 42 patients randomized to either cognitive-behavioural therapy plus enriched treatment-as-usual (CBT-ETAU) (n = 24) or enriched treatment-as-usual only (ETAU) (n = 18). Enriched treatment-as-usual comprised comprehensive treatment within specialised schizophrenia treatment services. Cognitive-behavioural therapy was conducted on an individual basis for 6 months (20 sessions). Clinical assessments were done at pretreatment, posttreatment and at 6-month follow-up by raters blind to group allocation. RESULTS: Significant clinical effects were observed for positive, negative and overall symptom severity for patients treated in CBT-ETAU, although there were no statistically significant differences between the treatment groups at posttreatment. The most pronounced effect of CBT-ETAU in comparison to ETAU in this study was in the reduction of negative symptoms at follow-up. CONCLUSION: These results show promise for the impact of CBT on negative symptoms when explicitly targeted in treatment.

Adult↗
PubMed2003

Challenges in preventing relapse in major depression. Report of a National Institute of Mental Health Workshop on state of the science of relapse prevention in major depression.

On 21 and 22 May 2001, the National Institute of Mental Health convened a workshop to explore imminent scientific opportunities and encourage new research on preventing relapse in major depression, as a part of a larger effort to find treatments capable of producing durable long-term recovery from major depression. Participants considered definitional and developmental perspectives on depression relapse, the prophylactic potential of current treatments and their cost effectiveness and the neurobiological and psychological risk factors for episode return. It was recommended that the definition of the relapse construct be expanded to capture salient features of incomplete recovery or partial response to treatment that are associated with significant functional impairment. This information is often overlooked by the categorical criteria currently in use. With respect to interventions, there was support for sequencing pharmacological remission with psychological prophylaxis. Provision of focal, short-term treatments that embed relapse prevention skills augment the routes to effective prevention available to patients, beyond that afforded by continuation pharmacotherapy. The challenge will be to identify those subgroups of patients for whom each treatment algorithm is indicated. Finally, the link between basic science findings of biological and psychological markers of relapse vulnerability and treatment design needs to be strengthened. This could be accomplished by assessing patients in clinical prevention trials for the presence of, and changes in, relapse vulnerability markers, thereby providing direct, outcome-based data to gauge the protective value of different treatments that modify these markers.

Algorithms↗
PubMed2003

Lithium carbonate versus cognitive therapy as sequential combination treatment strategies in partial responders to antidepressant medication: an exploratory trial.

BACKGROUND: Partial antidepressant response is associated with increased rates of relapse. Despite increasing evidence that full symptomatic remission is the optimal goal of antidepressant therapy, there have been few comparisons between disparate treatment approaches to achieve this goal. METHOD: Forty-four patients with DSM-IV major depressive disorder (MDD) who had a partial response (17-item Hamilton Rating Scale for Depression [HAM-D-17] score of 8-15) during open-label antidepressant treatment for 8 to 14 weeks were randomly assigned to receive cognitive therapy (CT) or lithium augmentation (LA) for a further 8 weeks using a single-blind design. Antidepressant medication was continued throughout the study. Subjects were also reassessed 4 weeks after discontinuation of LA or CT. Patients were enrolled in this study beginning September 1996 and follow-up for all patients was completed in December 2000. RESULTS: Although LA or CT did not significantly decrease symptom severity during sequential combination therapy, there was a significant decrease in HAM-D-17 scores 4 weeks later in LA-treated subjects compared with CT-treated subjects (p =.04). This resulted in 32% of patients achieving remission status, although between-group differences were not significantly different (38% in the LA group compared with 26% in the CT group, p =.39). CONCLUSION: Despite methodological limitations, this preliminary study provides justification for both combination treatments. An adequately powered, randomized, controlled trial to evaluate the relative merits of combination psychotherapy and augmentation of pharmacotherapy in patients with partially remitted MDD is required.

Adolescent↗
PubMed2002

Metacognitive awareness and prevention of relapse in depression: empirical evidence.

Metacognitive awareness is a cognitive set in which negative thoughts/feelings are experienced as mental events, rather than as the self. The authors hypothesized that (a) reduced metacognitive awareness would be associated with vulnerability to depression and (b) cognitive therapy (CT) and mindfulness-based CT (MBCT) would reduce depressive relapse by increasing metacognitive awareness. They found (a) accessibility of metacognitive sets to depressive cues was less in a vulnerable group (residually depressed patients) than in nondepressed controls; (b) accessibility of metacognitive sets predicted relapse in residually depressed patients; (c) where CT reduced relapse in residually depressed patients, it increased accessibility of metacognitive sets; and (d) where MBCT reduced relapse in recovered depressed patients, it increased accessibility of metacognitive sets. CT and MBCT may reduce relapse by changing relationships to negative thoughts rather than by changing belief in thought content.

Adult↗