Denada Hoxha

How do depressed and healthy adults interpret nuanced facial expressions

This study investigates the discrimination accuracy of emotional stimuli in subjects with major depression compared with healthy controls using photographs of facial expressions of varying emotional intensities. The sample included 88 unmedicated male and female subjects, aged 18-56 years, with major depressive disorder (n = 44) or no psychiatric illness (n = 44), who judged the emotion of 200 facial pictures displaying an expression between 10% (90% neutral) and 80% (nuanced) emotion. Stimuli were presented in 10% increments to generate a range of intensities, each presented for a 500-ms duration. Compared with healthy volunteers, depressed subjects showed very good recognition accuracy for sad faces but impaired recognition accuracy for other emotions (e.g., harsh, surprise, and sad expressions) of subtle emotional intensity. Recognition accuracy improved for both groups as a function of increased intensity on all emotions. Finally, as depressive symptoms increased, recognition accuracy increased for sad faces, but decreased for surprised faces. Moreover, depressed subjects showed an impaired ability to accurately identify subtle facial expressions, indicating that depressive symptoms influence accuracy of emotional recognition.

Frontal alpha EEG asymmetry before and after behavioral activation treatment for depression.

BACKGROUND Mid-frontal and mid-lateral (F3/F4 and F7/F8) EEG asymmetry has been associated with motivation and affect. We examined alpha EEG asymmetry in depressed and healthy participants before and after Behavioral Activation treatment for depression; examined the association between alpha EEG asymmetry and motivational systems and affect; and evaluated the utility of alpha EEG asymmetry in predicting remission. METHODS Depressed (n=37) and healthy participants (n=35) were assessed before and after treatment using a clinical interview, a task to measure baseline EEG, and questionnaires of behavioral activation and inhibition, avoidance, and affect. RESULTS Alpha EEG asymmetry was significantly higher in depressed than healthy participants at pre-treatment, positively correlated with negative affect and behavioral inhibition, and inversely correlated with lower behavioral activation sensitivity. CONCLUSIONS Heightened alpha EEG asymmetry in depressed participants was significantly associated with increased behavioral inhibition and negative emotion and was independent of clinical remission.

Exploring sudden gains in behavioral activation therapy for Major Depressive Disorder.

Understanding the onset and course of sudden gains in treatment provides clinical information to the patient and clinician, and encourages clinicians to strive for these sudden clinical gains with their patients. This study characterizes the occurrence of sudden gains with Behavioral Activation (BA; Martell, Addis, & Jacobson, 2001), and the extent to which pre-treatment dysfunctional depressive thinking predicts sudden gains during treatment. We enrolled a sample of adults (n = 42) between ages 18-65 diagnosed with primary Major Depressive Disorder. All participants completed a 16-week course of BA, with clinical and self-report assessments at pre-, mid- and post-treatment. Results indicated that sudden gain and non-sudden gain participants showed differential improvement across treatment. No significant effects emerged for the dysfunctional cognitive style as a predictor of sudden gain status. Sudden gains may result from interaction of non-specific factors with the BA techniques implemented during early phases of therapy.

Neural substrates of negativity bias in women with and without major depression

BACKGROUND The functional localization of negativity bias, an influential index of emotion information processing, has yet to be identified. METHOD Depressed (n=47) and healthy participants (n=58) completed a clinical interview for DSM-IV Axis I disorders, symptom checklists, a behavioral task to measure negativity bias, and then viewed positive and negative images of social and nonsocial scenes during an event-related fMRI task. Two subsamples of participants with high (i.e., 75%; n=26) and low (i.e., 25%; n=26) negativity bias scores were as included in subsequent analyses to examine neural differences. RESULTS Depressed participants with a higher, relative to lower, negative bias showed significantly greater neural activation in the left inferior frontal gyrus. CONCLUSION High negativity bias evokes a distinctive pattern of brain activation in the frontal cortex of depressed participants. Increased activation occurred in the left inferior frontal gyrus, related to Brodmann area 44, which is associated with language and semantic processing, response inhibition, and cognitive reappraisal. This finding may reflect an abnormality in integrative emotional processing rather than processing of individual emotional dimensions in depressed participants with negativity bias.

A comparison of a milieu-based Behavioural Activation Communication with treatment as usual for acute psychiatric inpatients

Aim Patient emotion, behaviour, and symptoms may explain avoidance of the daily programming on an acute psychiatric inpatient treatment milieu. We compared changes of emotion, behaviour, and symptoms among acutely ill psychiatric inpatients assigned to Behavioural Activation Communication (BAC), a newly designed milieu program, and those assigned to a unit representing treatment as usual (TAU). Method Participants included 144 adult inpatients treated between January 2011 and July 2011 at two similar psychiatric units at a medical centre. Psychiatric patients were assigned to either the BAC or the TAU unit based bed availability. At admission and discharge, patients completed the Brief Symptom Inventory, Positive Affect and Negative Affect Scale, and the Checklist of Unit Behaviors. Results A comparison of BAC and TAU patients showed greater relative change on positive affect and of behavioural activation with the daily programming. Conclusion The BAC program is associated with a significant increase of positive emotion and activation of inpatients.

The Checklist of Unit Behaviors (CUB): psychometric properties of a measure of patient milieu engagement on an acute inpatient psychiatric unit

Objective This paper presents the psychometric properties, including factor structure, internal reliability and relative validity of a 16-item questionnaire measuring patients’ relative activation with milieu activities while hospitalised in an acute psychiatric inpatient unit. Method 24 hours after admission, and before discharge, psychiatric inpatients (N = 132) completed a set of validated self-reports and the pilot questionnaire, the Checklist of Unit Behaviors (CUB). The CUB outlines items that reflect the extent to which the patient avoided or engaged with the treatment milieu within the previous 24 hours. Factor analysis, bivariate correlations and repeated-measures t-tests were used to analyse the data. Results Factor analysis identified two factors for the CUB: (1) Behavioural Approach; and (2) Behavioural Avoidance. Psychometric properties were satisfactory (Approach, Cronbachs α = 0.93; Avoidance, Cronbachs α = 0.79). Over the course of treatment, CUB-Approach increased (p Conclusions The CUB demonstrates strong psychometric properties, quantifying patients’ behavioural activation in the treatment milieu. Daily use of the CUB provides clinically useful information that has the potential to improve patient care and treatment planning.

Skin conductance and subjective arousal in anxiety, depression, and comorbidity: Implications for affective reactivity

Skin conductance (SC), an autonomic arousal measure of the sympathetic nervous system, is a sensitive and useful index of physiological arousal. However, SC data does not always align with self-reports of arousal. SC, self-reported arousal, and their association, known as emotion coherence, may be altered with the presence of major psychiatric illness. This study investigated group differences on SC reactivity and self-reported arousal while viewing positive, negative, neutral, and threat images between participants diagnosed with major depression with and without anxiety disorders relative to a healthy comparison group. Additionally, the strength and direction of association between SC reactivity and arousal ratings (emotion coherence) was examined within groups. Unmedicated participants were recruited via online and paper advertisements around Chicago and categorized into one of four groups (Depressed: n = 35, Anxious: n = 44, Comorbid: n = 38, Healthy: n = 29). SC and affect ratings were collected during and after a standardized emotional picture viewing task. SC reactivity was significantly higher during threat images, regardless of group. During threat image presentation, increased SC reactivity occurred during the last few seconds before picture offset; for all other stimulus types, SC reactivity decreased significantly after picture offset. Anxious and comorbid participants rated emotional images as more arousing than healthy participants; there were no observed differences in arousal ratings between depressed and healthy participants. Heightened reactivity in anxiety may manifest in arousal ratings without corresponding increased SC reactivity to emotional images. Results do not suggest underlying altered psychophysiology in this sample of depressed or anxious participants.

Obsessions and Compulsions in Postpartum Women Without Obsessive Compulsive Disorder

BACKGROUND To describe the prevalence of obsessions and compulsions and the specific symptoms present in postpartum women without obsessive compulsive disorder (OCD). METHODS In this prospective cohort, women were screened with the Yale Brown Obsessive Compulsive Scale at 2 weeks postpartum. Demographics and comorbid psychiatric symptoms were compared between women with screen-positive OCD, screen-negative OCD but with some endorsed symptoms (subclinical OCD), and no OCD symptoms. The prevalence of each specific set of obsessive and compulsive symptoms and the rate of impairment from those symptoms were compared. RESULTS Of the 461 women included, 52 (11.2%) screened positive for OCD, while 173 (37.5%) reported experiencing subclinical obsessions or compulsions. This subclinical OCD was associated with an increased rate of depression (24%) and state-trait anxiety (8%) compared with women who did not endorse experiencing any obsessions or compulsions. Aggressive, religious, and somatic obsessions as well as obsessions with symmetry, when present, were most likely to result in OCD screen positivity. CONCLUSIONS Nearly half of all women who screen negative for OCD experienced obsessions or compulsions that did not result in OCD screen positivity. However, the presence of these subclinical obsessions and compulsions is associated with an increased rate of depression or anxiety.

Affective information processing in pregnancy and postpartum with and without major depression

Adults with clinical depression exhibit systematic errors in their recognition and interpretation of affective stimuli. This study investigated the extent to which depression and phases of pregnancy and postpartum influence affective processing of positive and negative information, and the extent to which affective information processing in pregnancy predicts depressive symptoms in postpartum. Data were collected from 80 unmedicated women, diagnosed with major depressive disorder (MDD) or with no psychiatric disorder and between ages 18 and 44 years, during 32-36 weeks of pregnancy and during 6-8 weeks postpartum. All completed a Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) Axis I review, symptom reports, and a computer task measuring affective information processing. Significant group differences were found in which postpartum women with major depression were less responsive to negative stimuli, with lower ratings of intensity and reactions to negative pictorial stimuli, compared with postpartum healthy women. Also, lower ratings of the intensity and reactions to negative stimuli during pregnancy among depressed women predicted postpartum depression severity, even after controlling for depressive severity and affect ratings in pregnancy. Blunted affective reactivity to negative stimuli is a characteristic of depression that was observed among depressed women during pregnancy and postpartum in our study.

Twice The Negativity Bias And Half The Positivity Offset: Evaluative Responses To Emotional Information In Depression

BACKGROUND AND OBJECTIVES Humans have the dual capacity to assign a slightly pleasant valence to neutral stimuli (the positivity offset) to encourage approach behaviors, as well as to assign a higher negative valence to unpleasant images relative to the positive valence to equally arousing and extreme pleasant images (the negativity bias) to facilitate defensive strategies. We conducted an experimental psychopathology study to examine the extent to which the negativity bias and the positivity offset differ in participants with and without major depression.. METHOD Forty-one depressed and thirty-six healthy participants were evaluated using a structured clinical interview for DSM-IV Axis I disorders, questionnaires, and a computerized task designed to measure implicit affective responses to unpleasant, neutral, and pleasant stimuli. RESULTS The negativity bias was significantly higher and the positivity offset was significantly lower in depressed relative to healthy participants.. LIMITATIONS Entry criteria enrolling medication-free participants with minimal DSM-IV comorbidity may limit generalizability of the findings. CONCLUSIONS This study advances our understanding of the positive and negative valence systems in depression, highlighting the irregularities in the positive valence system..