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Cognitive vulnerability to depression: a dual process model.

Dual process models offer powerful accounts of cognitive phenomena in social and personality psychology but they have not been widely adapted to clinical phenomena. This review presents a dual process model of cognitive vulnerability to unipolar depression. According to dual process theories, humans possess two modes of information processing. An associative mode involves quick, effortless processing that rests on well-learned associations. A reflective mode involves slow, effortful processing that rests on symbolic rule-based inferences. Whereas the associative mode occurs automatically, the reflective mode operates when expectancies are violated and sufficient cognitive resources are available to respond. A cognitive vulnerability to depression is observed when negatively biased associative processing is uncorrected by reflective processing. The circumstances when this is likely to occur are reviewed. New insights and implications for assessment, etiology, and treatment of cognitive vulnerability to depression are discussed.

Association↗

Depression and bulimia: the link between depression and bulimic cognitions.

This study assessed the link between bulimic and depressive cognitions. Twenty-nine bulimics and 16 controls from the general population were first assessed on levels of depression using the Schedule for Affective Disorders and Schizophrenia-Change Version and the Beck Depression Inventory (BDI). Bulimics were significantly more depressed than controls. Bulimics differed significantly from controls on all cognitive measures associated with depression (Automatic Thoughts Questionnaire, Dysfunctional Attitude Scale, and Attributional Style Questionnaire), but differences on these measures were nonsignificant when depression, as measured by the BDI, was controlled. Bulimics differed from controls regardless of level of depression on the three scales of the Restraint Inventory, the Rationalization and All-or-None scales of the Thoughts About Eating Inventory, and most of the eight scales of the Eating Disorders Inventory. Bulimics showed more maladaptive thinking associated with depression, but these differences likely reflect the levels of depression for each group. The differences on the measures of cognitive and behavioral symptoms of bulimia remained when the level of depression was controlled statistically. This suggests that although depression can be frequently diagnosed in a bulimic sample, specific maladaptive cognitions and behaviors reflect a distinct disorder (bulimia) and are not simply the expression of an affective disorder.

Adolescent↗

A model of group treatment to facilitate recovery from chemical dependence.

In this article, a model of group treatment is proposed that incorporates four different group approaches (i.e., experiential, physiological-cognitive-behavioral, mutual support, advocacy) sequentially to achieve recovery outcomes among people coping with chemical dependence. The model identifies two strategies (i.e., reflection and restoration, action and support) as overarching frameworks guiding the use of these four treatment approaches. The first strategy of reflection and restoration incorporates experiential and physiological-cognitive-behavioral group approaches to promote precontemplation, contemplation, preparation, and tentative action among group members. The second strategy of action and support uses mutual support and advocacy approaches to help group members achieve and maintain treatment gains, learn from setbacks, and adopt new personal and social roles.

Adaptation, Psychological↗

Effects of night work on the cognitive function in young and elderly subjects with specific reference to the auditory P300.

To estimate the effects of night work on the human cognitive function, P300 event related potentials (ERPs) evoked with an auditory "oddball" paradigm were recorded for 17 nurses (mean age 27.4 +/- 6.1 years; range 21-41 years) for 3 epochs; after a night of work, after a day of work and on a holiday, and for 12 elderly security guards (mean age 62.8 +/- 2.2 years; range 60-67 years) for 2 epochs; after a night of work and on a holiday. The Stress Arousal Check List (SACL) was used for all the subjects just prior to the P300 ERP recording to determine the extent of stress and the arousal grades. Fourteen of the nurses were in their twenties (mean age 24.9 +/- 2.6 years; range 21-29 years), and 3 (39.0 +/- 2.6) were older (36, 40 and 41 years). The 14 nurses were classed as the young group. All the security guards were classed as the elderly group. In the young group, the stress grade scores increased significantly (P < 0.05) and the arousal grades decreased significantly (P < 0.01) after night work as compared to the holiday values. Although statistically not significant, the amplitude of the P300 component tended to decrease after night work, whereas the latency was very stable for these 2 epochs. The P300 latencies of the 3 older nurses were as stable as those of the young group, but their amplitudes were significantly reduced after night work as compared with the holiday amplitudes (P < 0.05). In contrast, the 12 elderly security guards showed no statistically significant changes in the scores for the stress and arousal grades between the 2 epochs, after night work and holiday. Latency prolongation however, was statistically significant (P < 0.01) after night work. The P300 amplitudes for many of the elderly security guards also tended to decrease after night work, but were not statistically significant. The P300 amplitude is considered to reflect the amount of attentional resources and the latency to reflect the time needed for the cognitive process, indicating that the elderly security guards experiences slowing of the cognitive process in night work. Our results suggest that the effect of night work on the cognitive function is greater for elderly than for young workers. We conclude that P300 can be used to evaluate changes in the human cognitive function produced by night or rotating shift work and that the results provide useful information with which to plan shift schedules on the basis of worker age.

Adult↗

Cognitive dysfunction and chemotherapy: neuropsychological findings in perspective.

Currently, the interest in cognitive functioning following chemotherapy is rapidly expanding as is reflected in a growing number of published studies on this topic. Although most studies are indicative of cognitive deficits after chemotherapy, definite conclusions on the role of chemotherapy on cognitive function can often not be drawn due to methodological problems. On the basis of the studies on cognitive functioning after chemotherapy that are conducted in The Netherlands Cancer Institute, the current article describes a number of such methodological topics that obscure straightforward interpretation of neuropsychological findings in toxicity research. Measurement issues that diverge from usual assessment issues encountered in psychosocial oncology will be described, and factors that might play a role in the cause of cognitive impairment will be evaluated. Also, future developments necessary to gain more insight into the prevalence, the pattern, and the impact of cognitive problems following chemotherapy are discussed

Antineoplastic Combined Chemotherapy Protocols↗

[Concept analysis of reflective thinking].

The nursing practice is described as a scientific practice, but also as a practice where caring is important. The purpose of nursing education is to provide competent nursing practitioners. This implies that future practitioners must have both critical analytical thinking abilities, as well as empathy and moral values. Reflective thinking could probably accommodate these thinking skills. It seems that the facilitation of reflective thinking skills is essential in nursing education. The research question that is relevant in this context is: "What is reflective thinking?" The purpose of this article is to report on the concept analysis of reflective thinking and in particular on the connotative meaning (critical attributes) thereof. The method used to perform the concept analysis is based on the original method of Wilson (1987) as described by Walker & Avant (1995). As part of the concept analysis the connotations (critical attributes) are identified, reduced and organized into three categories, namely pre-requisites, processes and outcomes. A model case is described which confirms the essential critical attributes of reflective thinking. Finally a theoretical definition of reflective thinking is derived and reads as follows: Reflective thinking is a cyclic, hierarchical and interactive construction process. It is initiated, extended and continued because of personal cognitive-affective interaction (individual dimension) as well as interaction with the social environment (social dimension). to realize reflective thinking, a level of internalization on the cognitive and affective domain is required. The result of reflective thinking is a integrated framework of knowledge (meaningful learning) and a internalized value system providing a new perspective on and better understanding of a problem. Reflective thinking further leads to more effective decision making- and problem solving skills.

Decision Making↗

Interrelations of age, visual acuity, and cognitive functioning.

It has recently been suggested that a large proportion of the age-related influences on many measures of cognitive functioning is mediated through a single common factor. This hypothesis has been supported by the discovery that much of the age-related variance in different cognitive measures is shared, and is not distinct or independent. These earlier results were replicated in this project, and it was also discovered that measures of corrected visual acuity and processing speed share a very large proportion of the age-related variance in measures of working memory, associative learning, and concept identification. The apparent implication is that the common factor that appears to contribute to age-related differences in many cognitive measures is quite broad and may reflect a relatively general reduction in central nervous system functioning.

Adult↗

Recent cognitive perspectives on learning--implications for nurse education.

Nurse educators must keep abreast of contemporary learning theory so that their teaching reflects current ideas of best practice. In view of this, it is important to report on recent developments in the field of learning. Of particular significance is the fact that behaviouristic explanations of learning have largely been replaced with cognitive perspectives which emphasise the complexity of the learning process. Memory, learning, problem solving and expertise have all been investigated from a cognitive stance. The highlights of this work include, firstly, the portrayal of learning as an active, constructivist, cumulative and self-regulated process leading to the development of understanding and complex, skilled performance. Secondly, the highly important role played by knowledge in learning has been identified and described. Lastly, novice-expert differences in problem solving and academic and practical performance more generally, are well understood as a result of investigations of expertise in many domains. In this paper, these three significant perspectives from cognitive psychology will be examined and their implications for the education of undergraduate nurses described. Developments in the field of nursing that reflect or challenge a cognitive outlook are also identified.

Clinical Competence↗

Environmental hypotheses of hominin evolution.

The study of human evolution has long sought to explain major adaptations and trends that led to the origin of Homo sapiens. Environmental scenarios have played a pivotal role in this endeavor. They represent statements or, more commonly, assumptions concerning the adaptive context in which key hominin traits emerged. In many cases, however, these scenarios are based on very little if any data about the past settings in which early hominins lived. Several environmental hypotheses of human evolution are presented in this paper. Explicit test expectations are laid out, and a preliminary assessment of the hypotheses is made by examining the environmental records of Olduvai, Turkana, Olorgesailie, Zhoukoudian, Combe Grenal, and other hominin localities. Habitat-specific hypotheses have prevailed in almost all previous accounts of human adaptive history. The rise of African dry savanna is often cited as the critical event behind the development of terrestrial bipedality, stone toolmaking, and encephalized brains, among other traits. This savanna hypothesis has been countered recently by the woodland/forest hypothesis, which claims that Pliocene hominins had evolved in and were primarily attracted to closed habitats. The ideas that human evolution was fostered by cold habitats in higher latitudes or by seasonal variations in tropical and temperate zones also have their proponents. An alternative view, the variability selection hypothesis, states that large disparities in environmental conditions were responsible for important episodes of adaptive evolution. The resulting adaptations enhanced behavioral versatility and ultimately ecological diversity in the human lineage. Global environmental records for the late Cenozoic and specific records at hominin sites show the following: 1) early human habitats were subject to large-scale remodeling over time; 2) the evidence for environmental instability does not support habitat-specific explanations of key adaptive changes; 3) the range of environmental change over time was more extensive and the tempo far more prolonged than allowed by the seasonality hypothesis; and 4) the variability selection hypothesis is strongly supported by the persistence of hominins through long sequences of environmental remodeling and the origin of important adaptations in periods of wide habitat diversity. Early bipedality, stone transport, diversification of artifact contexts, encephalization, and enhanced cognitive and social functioning all may reflect adaptations to environmental novelty and highly varying selective contexts.

Adaptation, Physiological↗

Neuropsychological markers of dementia in patients with memory complaints.

OBJECTIVES: To identify neuropsychological markers able to predict evolution towards dementia, through the detection of differential neuropsychological characteristics in a group of subjects complaining of memory loss, in a longitudinal, two-year follow-up study. METHODS: Longitudinal and retrospective comparisons of neuropsychological performance in: (a) subjects complaining of memory loss who, after a two-year period, met neurological and clinical diagnostic criteria for probable AD, and (b) subjects from the same group who did not progress towards dementia. A sample of 43 subjects were administered a comprehensive neuropsychological battery evaluating orientation, logical-verbal and visuoperceptive reasoning, immediate and delayed verbal and visual memory, attention, learning, executive functions and semantic and phonemic verbal fluency. RESULTS: Of the 43 subjects evaluated and then re-evaluated two years later, ten (23%) progressed to dementia according to the NINCS-ADRDA criteria for probable Alzheimer's disease. The neuropsychological performance of the rest of the subjects (n=33) over the two examinations was stable. In the retrospective analysis the principal differences between the two groups were found in the intensity of the initial memory deficits (WMS-R) and in the impairment of other cognitive areas in the dementia group: formation of concepts, vocabulary and similarities (WAIS), learning (WMS-R) and several executive functions. CONCLUSIONS: The deficits in cognitive areas other than memory are significant in subjects with memory complaints who progress towards dementia within two years. Memory complaints represent a risk factor that is at least as important as actual memory loss. Recent proposals for adding descriptive labels to the diagnosis of Mild Cognitive Impairment (MCI) in order to reflect the neuropsychological functions impaired in addition to memory (Petersen, 2001a), may be decisive from the prognostic viewpoint.

Aged↗

Meta-analysis of neuroimaging studies of the Wisconsin card-sorting task and component processes.

A quantitative meta-analysis using the activation likelihood estimation (ALE) method was used to investigate the brain basis of the Wisconsin Card-Sorting Task (WCST) and two hypothesized component processes, task switching and response suppression. All three meta-analyses revealed distributed frontoparietal activation patterns consistent with the status of the WCST as an attention-demanding executive task. The WCST was associated with extensive bilateral clusters of reliable cross-study activity in the lateral prefrontal cortex, anterior cingulate cortex, and inferior parietal lobule. Task switching revealed a similar, although less robust, frontoparietal pattern with additional clusters of activity in the opercular region of the ventral prefrontal cortex, bilaterally. Response-suppression tasks, represented by studies of the go/no-go paradigm, showed a large and highly right-lateralized region of activity in the right prefrontal cortex. The activation patterns are interpreted as reflecting a neural fractionation of the cognitive components that must be integrated during the performance of the WCST.

Brain↗

Permanent neuropsychological impairment after recurrent episodes of severe hypoglycaemia in man.

Seventeen Type 1 (insulin-dependent) diabetic patients with a history of recurrent and severe hypoglycaemia and Type 1 diabetic patients with no severe hypoglycaemia were compared as regarded performances in tests of neuropsychological functioning. To test the hypothesis that recurrent severe hypoglycaemia gives rise to permanent cognitive impairment, the study group was selected among those patients who had met with repeated attacks over the last three years or more as identified by a questionnaire among almost 600 insulin-treated diabetic patients. The comparison group without known severe reactions were comparable to the study group with respect to type of diabetes, sex, age, age at onset, duration of diabetes, socio-economic parameters, and prevalence of neuropathy and retinopathy. The results indicate that Type 1 diabetic patients with recurrent severe hypoglycaemia scored lower than those without severe hypoglycaemia in tests of motor ability, short-term and associative memory and visuospatial tasks assessing ability in general problem-solving. Type 1 diabetic patients with severe hypoglycaemia also displayed a higher frequency of perspective reversals suggesting frontal-lobe involvement. These data can be interpreted in two ways. One interpretation implies that the cognitive impairment of Type 1 diabetic patients with severe hypoglycaemia reflects a selection factor, the other that recurrent episodes of severe hypoglycaemia result in permanent cognitive impairment.

Cognition↗

Independent biofeedback self-regulation of EEG alpha and skin resistance.

Skin resistance and EEG alpha were recorded concurrently during alpha biofeedback, in which the participant attempted to control alpha, and during skin resistance biofeedback, in which the participant attempted to control skin resistance. Alpha production changed significantly (p less than .001) during alpha biofeedback, indicating successful self-regulation of alpha, but did not change significantly during skin resistance biofeedback. Similarly, skin resistance changed significantly (p less than .001) during skin resistance biofeedback but did not change significantly during alpha biofeedback. The results show independent control of alpha and skin resistance, and may reflect independent self-regulation of cognitive and somatic tension-relaxation systems.

Adolescent↗

5HT drugs in animal models of anxiety.

It has been widely accepted that 5HT neurones promote anxiety, in humans as well as in animal models. This could be termed the "classic" hypothesis and it has led to a determined search for drugs which reduce 5HT function, especially agents which have selective actions at 5HT receptor subtypes. However, these novel agents tend to have weak and/or variable effects in animal models and more detailed examination of their actions suggests that not all findings are accounted for by the classic hypothesis. There appear to be circumstances in which increased 5HT activity can reduce anxious behaviour. There is increasing evidence for multiple anxiety mechanisms, which may be able to explain differential patterns of drug effects within and between models. Animal models of anxiety may also detect non-anxiety factors: effects on cognition or on impulsivity could be reflected in some models. This could be important in the light of recent evidence that 5HT-selective reuptake inhibitors are effective in impulsivity disorders. The classic hypothesis of 5HT function in anxiety may be only one part of an increasingly complex story. Unravelling the rest of this story is likely to lead to new insights in our understanding of anxiety and related disorders.

Animals↗

A double-blind placebo-controlled experimental study of nicotine: II--Effects on response inhibition and executive functioning.

RATIONALE: Smokers may show abnormal functioning in prefrontal cortex during acute abstinence, reflecting deficient activity in mesocorticolimbic circuitry. Cognitive correlates of this putatively include impaired response inhibition and other aspects of executive functioning. OBJECTIVES: To investigate whether inhibitory control and other executive functions in smokers are impaired during acute abstinence relative to post-nicotine. METHODS: 145 smokers were tested twice after overnight abstinence-once after nicotine and once after placebo lozenges (order counterbalanced, double-blind)-on an antisaccade task, a continuous performance task (CPT), a delayed response spatial working memory task and a verbal fluency test. RESULTS: Compared with placebo, nicotine was associated with better inhibitory control on the antisaccade task and fewer impulsive responses to filler stimuli (motor errors) on the CPT; at the first assessment only, nicotine also reduced impulsive responses to 'catch' stimuli on the CPT. However, it did not affect CPT response bias (an index of impulsive vs cautious decision-making), spatial working memory, or verbal fluency. CONCLUSIONS: Smoking abstinence appears to be associated with a difficulty in inhibiting prepotent motor responses, and with nicotine to attenuate this difficulty. However, more 'cognitive' forms of inhibitory control (e.g. decision-making) and the other aspects of executive function tested here appear to be unaffected.

Adult↗

Transient phase-locking of 40 Hz electrical oscillations in prefrontal and parietal human cortex reflects the process of conscious somatic perception.

Electrical potential oscillations in the range of 35-45 Hz (gamma waves) have recently been shown to occur rather ubiquitously in the brain of awake humans. During selective somatic attention, we demonstrate a transient phase-locking of the gamma waves generated in the contralateral prefrontal and parietal cortical areas that we had previously shown to be involved in such selective attention tasks. In line with other microphysiological evidence obtained on mammalian visual cortex, this selective functional synchronization between critical human brain areas (as far as about 9 cm apart) is proposed to reflect the transient 'binding' of discrete cognitive features that are processed in distributed neuronal assemblies of the brain whereby the conscious perception of an object or event can be achieved. On this basis we emphasize that the conscious function of the brain is neither epiphenomenal nor delayed, but operates transiently to integrate relevant perceptual features at the time of target object identification and of conscious behavioural decision.

Adult↗

Event-related brain potentials to high incentive stimuli in abstinent alcoholics.

We have previously found that the P3 component of the event-related potential (ERP) is reduced in alcoholics in visual target-selection paradigms. P3 voltage depends on the "subjective significance" of the stimulus (e.g., task relevance, probability of occurrence, motivational factors). We were interested in assessing P3s in alcoholics to motivationally significant stimuli that did not differ with respect to other aspects of significance. Equiprobable, task-relevant visual stimuli with different acquired incentive values were presented to alcoholics under baseline and two incentive conditions. Alcoholics manifested similar lower P3 voltages without P3 latency delays to all stimuli, regardless of incentive values. Latency Corrected Averages indicated that these results were not due to latency jitter in the averages. These results suggest multiple system deficits in alcoholics, perhaps in involving frontal and/or medial temporal lobe, the brain sources implicated in the generation of P3. Our results perhaps reflect a deficit in motivational-cognitive systems in alcoholics, possibly affecting their ability to actively sustain information processing.

Adolescent↗

Reflection impulsivity in current and former substance users.

BACKGROUND: Chronic drug use is associated with increased impulsivity, risky decision making, and impaired behavioral control, but the underlying mechanisms of this neurocognitive profile remain unclear. We investigated impulsive responding in the context of decision making, using a novel behavioral measure of reflection impulsivity: the tendency to gather and evaluate information before making a decision. METHODS: The Information Sampling Task was administered to current substance users dependent on amphetamines (n = 24) or opiates (n = 40), former users of amphetamines or opiates abstinent for at least 1 year (n = 24), and non-drug-using control subjects (n = 26). RESULTS: Current users of amphetamines and opiates sampled less information than control subjects and responded at a lower probability of making a correct response. Amphetamine- and opiate-dependent subjects did not differ. Reduced reflection was also apparent in the former substance users, who did not differ from the current users. Questionnaire ratings of impulsivity (on the Barratt Impulsivity Scale, version 11) were also inflated in three groups of substance users but were not significantly correlated with performance on the behavioral task. CONCLUSIONS: Reduced reflection is suggested to represent a cognitive marker for substance dependence that does not recover with prolonged abstinence and is associated with multiple drugs of abuse.

Adult↗