Eric Constant

Major depression is associated with impaired processing of emotion in music as well as in facial and vocal stimuli

BACKGROUNDnThe processing of emotional stimuli is thought to be negatively biased in major depression. This study investigates this issue using musical, vocal and facial affective stimuli.nnnMETHODSn23 depressed in-patients and 23 matched healthy controls were recruited. Affective information processing was assessed through musical, vocal and facial emotion recognition tasks. Depression, anxiety level and attention capacity were controlled.nnnRESULTSnThe depressed participants demonstrated less accurate identification of emotions than the control group in all three sorts of emotion-recognition tasks. The depressed group also gave higher intensity ratings than the controls when scoring negative emotions, and they were more likely to attribute negative emotions to neutral voices and faces.nnnLIMITATIONSnOur in-patient group might differ from the more general population of depressed adults. They were all taking anti-depressant medication, which may have had an influence on their emotional information processing.nnnCONCLUSIONSnMajor depression is associated with a general negative bias in the processing of emotional stimuli. Emotional processing impairment in depression is not confined to interpersonal stimuli (faces and voices), being also present in the ability to feel music accurately.

Second generation antipsychotics in the treatment of bipolar depression: a systematic review and meta-analysis

Depressive symptoms and episodes dominate the course of bipolar disorder. However, the therapeutic armamentarium for bipolar depression is limited. Recent evidence points to the efficacy of second generation antipsychotics (SGAs) for the treatment of bipolar depression. We conducted a systematic review and meta-analysis of the efficacy and safety of SGAs (randomized, double-blind, placebo-controlled trials; used in monotherapy) in the treatment of adult patients with bipolar depression. Publication bias was corrected for by performing similar searches using the clinical trials register of the respective pharmaceutical companies, the Cochrane Database and ClinicalTrials.gov. Seven published papers were identified on the use of aripiprazole, olanzapine and quetiapine. Internal validity of the trials was fairly good, external validity only moderate. Different outcome measures of efficacy and safety were assessed. When the individual trials were looked at, quetiapine and to a lesser extent olanzapine demonstrated significant improvement in MADRS (Montgomery–Åsberg Depression Rating Scale) total scores. This was not demonstrated for aripiprazole. Efficacy was hampered by adverse events, such as weight gain, akathisia and somnolence/sedation. Both clinical heterogeneity of the included trials and statistical heterogeneity of the meta-analytic data were considerable. The number of quetiapine trials was disproportionate to the number of trials of aripiprazole and olanzapine. Further research is needed to assess differential efficacy of the different SGAs and their use in clinical practice.

Fighting stigma of mental illness in midsize European countries.

PurposeStigma is the most powerful obstacle to the development of mental health care. Numerous activities aiming to reduce the stigma of mental illness and the consequent negative discrimination of the mentally ill and their families have been conducted in Europe. Descriptions of many of these activities are not easily available, either because there are no publications that describe them, or because descriptions exist only in local languages. This supplement aims to help in overcoming this imbalance by providing a description of anti-stigma activities in 14 countries in Europe regardless of the language in which they were published and regardless whether they were previously published.MethodsThe review was undertaken by experts who were invited to describe anti-stigma activities in the countries in which they reside. It was suggested that they use all the available evidence and that they consult others in their country to obtain a description of anti-stigma activities that is as complete as possible.ResultsThe anti-stigma activities undertaken in the countries involved are presented in a tabular form. The texts contributed by the authors focus on their perception of the stigma of mental illness and of activities undertaken to combat it in their country.ConclusionsAlthough much has been done against the stigmatization and discrimination of the mentally ill, fighting stigma remains an essential task for mental health programs and for society. The descriptions summarized in this volume might serve as an inspiration for anti-stigma work and as an indication of potential collaborators in anti-stigma programs.

Anxiety and depression, attention, and executive functions in hypothyroidism.

BACKGROUNDnDivergences in cognitive disturbances in hypothyroidism reported in the literature are a result of a methodological bias.nnnMETHODSnBy using a precise methodology, we examined attention and executive functions in hypothyroidism, verified the presence of anxiety and depressive symptoms in hypothyroidism, and examined the possible link between these symptoms and the cognitive disturbances (searching for attentional bias for words with a negative emotional valence). We administered a battery of cognitive tests to 23 participants who had undergone thyroidectomy for thyroid carcinoma: for the first time in an euthyroid state, then 3 weeks later (still in the euthyroid state) to assess the test/retest effect, and finally 4 weeks later in an hypothyroid state. We compared their performance with that of a group of 26 control participants who were also administered the same cognitive tests, also 3 times.nnnRESULTSnIn hypothyroidism, the thyroid participants were more anxious and depressed than the controls and presented attentional and executive disturbances that reflected general slowing and difficulties in using their capacities of inhibition. However, they did not exhibit an attentional bias for words with a negative emotional valence.nnnCONCLUSIONSnContrary to what was expected, symptoms of anxiety and not symptoms of depression interfered with the cognitive performance of participants in hypothyroidism.

Impaired processing of emotion in music, faces and voices supports a generalized emotional decoding deficit in alcoholism

AIMnTo test the generalized emotional decoding impairment hypothesis in alcoholism.nnnDESIGNnCross-sectional behavioural study comparing emotion recognition conveyed by faces, voices and musical excerpts.nnnSETTINGnAlcohol detoxification unit of Brugmann University Hospital.nnnPARTICIPANTSnTwenty-five recently detoxified alcohol-dependent patients were compared to 25 normal controls matched for sex, age and educational level.nnnMEASUREMENTSnFrom faces, voices and musical excerpts, participants were instructed to rate the intensity of several emotions on a scale from 0 for absent to 9 for highly present. Depression, anxiety and sustained/selective attention capacities were controlled for.nnnFINDINGSnAlcohol-dependent patients were less accurate than controls in identifying the target emotion in faces (P < 0.001), voices (P < 0.001) and musical excerpts (P < 0.001).nnnCONCLUSIONSnAlcohol-dependent patients who are completing detoxification are impaired in recognizing emotions conveyed by faces, voices and music; these results suggest a generalized emotional decoding impairment. Hypothetically, deficits in the fronto-parietal mirror neurone system could link all these disturbances together.

Distinct effects of protracted withdrawal on affect, craving, selective attention and executive functions among alcohol-dependent patients

AIMSnThe present study examined the effects of protracted alcohol withdrawal on affectivity, craving, selective attention and executive functions (EFs) in alcohol-dependent patients.nnnMETHODSnSelective attention (The D2 Cancellation Test), flexibility (Trail Making Test), inhibition (Stroop Task), decision making (Iowa Gambling Task), craving (Obsessive-Compulsive Drinking Scale) and state affectivity (Positive and Negative Affectivity Schedule) were assessed in alcohol-dependent patients (DSM-IV, n = 35) matched to non-alcohol-dependent participants (n = 22) at the onset (T1: day 1 or 2) and at the end (T2: days 14-18) of protracted withdrawal during rehab.nnnRESULTSnAlcohol-dependent patients abilities to focus their attention on relevant information, to switch from one pattern to another, to inhibit irrelevant information and to make advantageous choices were lower than those of control participants during both times of a withdrawal cure. No effect of time emerged from analyses for selective attention and EF deficits. Conversely, significant differences between T1 and T2 were observed for craving and affect scores indicating a weakening of alcohol craving and negative affect as well as an improvement of positive affect among patients from onset to the end of cure.nnnCONCLUSIONnControl functions of the Supervisory Attentional System (Norman and Shallice, 1986) were impaired and did not improve during a 3-week withdrawal cure, whereas alcohol craving and negative state affectivity significantly improved in parallel during this period. Implications for understanding the clinical processes of withdrawal are discussed.

Cognitive deficits in patients with chronic fatigue syndrome compared to those with major depressive disorder and healthy controls

OBJECTnChronic fatigue syndrome (CFS) patients report usually cognitive complaints. They also have frequently comorbid depression that can be considered a possible explanation for their cognitive dysfunction. We evaluated the cognitive performance of patients with CFS in comparison with a control group of healthy volunteers and a group of patients with MDD.nnnPATIENTS AND METHODSnTwenty-five patients with CFS, 25 patients with major depressive disorder (MDD), and 25 healthy control subjects were given standardized tests of attention, working memory, and verbal and visual episodic memory, and were also tested for effects related to lack of effort/simulation, suggestibility, and fatigue.nnnRESULTSnPatients with CFS had slower phasic alertness, and also had impaired working, visual and verbal episodic memory compared to controls. They were, however, no more sensitive than the other groups to suggestibility or to fatigue induced during the cognitive session. Cognitive impairments in MDD patients were strongly associated with depression and subjective fatigue; in patients with CFS, there was a weaker correlation between cognition and depression (and no correlation with fatigue).nnnCONCLUSIONSnThis study confirms the presence of an objective impairment in attention and memory in patients with CFS but with good mobilization of effort and without exaggerated suggestibility.

Electrophysiological correlates of the disrupted processing of anger in alcoholism.

OBJECTIVEnRecent studies have shown that alcoholism is characterized by a deficit in the processing of emotional facial expressions (EFE), and that this deficit could be emotion specific. The present study explored the hypothesis that there is a specific deficit for the EFE of anger compared to another negative emotion (disgust). Moreover, on the basis of event-related potentials (ERPs), this study aimed at determining the locus of this deficit in the information-processing stream.nnnMETHODSnFifteen patients suffering from alcoholism and fifteen matched healthy controls took part in the study, which used a modified emotional oddball paradigm. ERPs were recorded in response to repetitions of a particular facial expression (i.e. anger) and in response to two deviant (rare) stimuli obtained by a morphing procedure, one depicting the same emotion as the frequent stimulus, the other depicting a different emotion (i.e. disgust). The participants task was to press a key as soon as they spotted the deviant stimulus.nnnRESULTSnBehavioural data showed an absence of categorical perception effect for anger (but not for disgust) stimuli among alcoholic patients. Moreover, electrophysiological data revealed that alcoholism is associated with an impaired processing of anger at the attentional level (N2b/P3a complex), extending to the decisional level (P3b).nnnCONCLUSIONnThis study demonstrated disturbed processing of anger in alcoholism, at behavioural and electrophysiological levels. These preliminary results strengthen the proposition of a specific deficit for anger, and localize its possible origin to the attentional level (N2b/P3a complex) of the information processing stream. The clinical implications of these results are discussed.

Hypothyroidism and Major Depression: A Common Executive Dysfunction?

Little is known about the possible link between the cognitive disorders associated with hypothyroidism and those encountered in depression. This study examines attentional and executive functions as well as the intensity of anxiety and depressive symptoms in hypothyroidism and major depression and the possible link between these symptoms and cognitive disturbances. This study confirms the existence of psychomotor slowing associated with attentional and executive disturbance in major depression as well as in hypothyroidism. However, while depressed subjects manifested a conscious bias with material of negative emotional valence, no such bias was found in the hypothyroid subjects. While the hypothyroid state is accompanied by anxiety/depressive symptoms, it seems that the latter are too discrete for an attentional bias to be observed with material with a negative emotional valence.

Aripiprazole is effective in the treatment of Tourette's disorder

Tourettes disorder is a chronic neuropsychiatric disorder including multiple involuntary motor and vocal tics. We report the clinical case of a 23-yr-old girl with Tourettes disorder and a successful treatment of this condition with aripiprazole, a new antipsychotic drug with dopamine-2 (D2) receptor antagonism under hyperdopaminergic conditions and with D2 receptor agonism under hypodopaminergic conditions. After 3 wk treatment with 15 mg/d aripiprazole, both motor and vocal tics had almost completely disappeared. The treatment was well tolerated by the patient. The only reported side-effect was insomnia during the first 3 wk of treatment. This encouraging case report should justify long-term placebo-controlled trials to further establish the treatment of tics with aripiprazole in this life-long disorder with severe functional consequences.