Rodrigo Becerra

Executive functioning deficits among adults with Bipolar Disorder (types I and II): A systematic review and meta-analysis.

BACKGROUND Executive functioning (EF) deficits contribute to a significant proportion of the burden of disease associated with bipolar disorder (BD). Yet, there is still debate in the literature regarding the exact profile of executive functioning in BD. The purpose of the present project was to assess whether EF deficits exist among adults suffering BD, and whether these deficits (if apparent) differ by BD subtype. METHODS A systematic search identified relevant literature. Randomised controlled trials that used neuropsychological assessment to investigate EF among adults 16-65 years) with a remitted DSM diagnosis of BD (type I or II) were included. Studies were published between 1994 and 2015. A systematic review and meta-analysis were undertaken. For individual studies, standardised mean differences (Cohens d) and 95% confidence intervals were calculated and represented in forest plots to illustrate differences in executive performance between groups. Summary effects were produced and tests of heterogeneity employed to assess the dispersion and generalisability of results. RESULTS Thirty-six studies met criteria for inclusion. Six domains of EF were identified: Set-shifting (SS), inhibition (INH), planning (PLA), verbal fluency (VF), working memory (WM), and attention (ATT). BD1s performed worse than HCs in all domains. BD2s demonstrated impairment in VF, WM, SS, and ATT. The results were mixed for comparisons between BD1s and BD2s, but revealed that BD2s can experience similar (or sometimes greater) EF impairment. LIMITATIONS Only a limited number of studies that included BD2 samples were available for inclusion in the current study. Subgroup analysis to elucidate potential moderators of within-study variance was not undertaken. CONCLUSION This is the first systematic review and meta-analysis to have compared the EF of remitted BD1s, BD2s, and HCs. The results provided useful insight into the EF profile of patients with BD, and offered commentary as to some of the contradictory results reported in the literature. A standardised methodological protocol for assessment of EF in BD was proposed. The information in this review could enhance our understanding of EF impairment inherent in BD, and the methods and efficacy with which clinicians assess and treat this population.

The Relationship Between Neurocognitive Functioning and Occupational Functioning in Bipolar Disorder: A Literature Review

Neurocognitive impairment in Bipolar Disorder (BD) has been widely reported, even during remission. Neurocognitive impairment has been identified as a contributing factor towards unfavourable psychosocial functioning within this population. The objective of this review was to investigate the association between neurocognitive impairment and occupational functioning in BD. A literature review of English-language journal articles from January 1990 to November 2013 was undertaken utilising the PsychINFO, Scopus and Web of Knowledge databases. Studies that made specific reference to occupational outcomes were included, and those that reported on global psychosocial measures were excluded. Majority of the papers reviewed (20 out of 23) identified an association between neurocognitive impairment (particularly in executive functioning, verbal learning and memory, processing speed and attention) and occupational functioning. Several methodological issues were identified. There was a discrepancy in the measures used to assess neurocognitive function across studies and also the definition and measurement of occupational functioning. The clinical features of the samples varied across studies, and confounding variables were intermittently controlled. The review focused on English-language papers only and hence there is a bias toward the Western labour market. These limitations therefore influence the generalizability of the interpreted findings and the reliability of comparisons across studies. Neurocognitive impairment in BD appears to play a role in occupational outcomes. The findings of this review highlight the challenges for future research in this area, particularly in the measurement of neurocognitive and occupational functioning. Incorporating neurocognitive interventions in the treatment of BD, which has traditionally focussed solely on symptomatic recovery, may advance the vocational rehabilitation of these patients.

Prevalence and Demographic Correlates of Alexithymia: A Comparison Between Australian Psychiatric and Community Samples

OBJECTIVES A cross-sectional empirical design was used to compare differences in alexithymia between Australian psychiatric and community samples and examine the influence of sample type on the relation between alexithymia and psychological distress. METHOD Psychiatric outpatients (N = 151) and a convenience sample of the general community (N = 216) completed questionnaires measuring alexithymia and psychological distress. RESULTS Alexithymia was several times more prevalent in the psychiatric sample than the community sample. While the psychiatric sample reported greater psychological distress, no difference was found in the strength of the association between alexithymia and psychological distress between the study samples. CONCLUSION These findings emphasize the pervasive problem alexithymia presents within the Australian psychiatric population and the importance of increasing recognition of alexithymia for the future research about and treatment of psychiatric patients.

The assessment of emotional reactivity across negative and positive emotions

The Perth Emotional Reactivity Scale (PERS) is a newly developed 30-item self-report measure of emotional reactivity (affective style). The PERS measures the typical ease of activation, intensity, and duration of one’s emotional responses, and importantly does so for negative and positive emotions separately. We examined the psychometric properties of the PERS in an adult community sample (N = 183). Confirmatory and exploratory factor analyses supported the capacity of the PERS to measure separate negative and positive reactivity factors, and to distinguish between the activation, intensity, and duration aspects of reactivity. All items of the PERS had strong loadings on their intended factor. Concurrent validity was supported via congruent correlations with other emotion measures, and internal reliability was good to excellent for all PERS scales and subscales. Overall, the PERS appears to have good psychometric properties, and thus has promising utility for research and clinical settings.

Alexithymia and problematic alcohol use: A critical update

There has been a substantial growth in empirical research aimed at examining the co-occurrence of alexithymia and problematic alcohol use and alcohol use disorder (AUD) since Thorberg, Young, Sullivan, and Lyvers (2009) original review article. The objective of the present paper is therefore to provide a critical update review of research on alexithymia and problematic alcohol use published since 2009. A systematic search was conducted through PsychINFO, Medline, and ProQuest databases to obtain relevant literature published between 2009 and 2016. Studies that involved measures of alexithymia and problematic alcohol use among clinical and non-clinical samples were included. Prevalence rates of alexithymia among Alcohol Dependent (AD) samples were identified between 30 and 49%, and were therefore much lower than originally reported. The findings of this update review highlight an indirect relationship between alexithymia and alcohol problem severity that is mediated by a number of psychological drinking constructs (e.g., alcohol expectancy, drinking motives, craving and alcohol related intrusive thoughts) and psychological risk factors for the development of alcohol related problems (e.g., mood and emotion dysregulation, attachment, trauma, and cognitive function). In addition, this review provides reasonable evidence to support alexithymia as an independent risk factor for alcohol related problems among clinical samples only. In conclusion, alexithymia is a multifaceted construct that has a complex relationship with various risk factors and psychological drinking constructs. The growing body of research highlights the demand for understanding the interrelationships between alexithymia, psychosocial risk factors, and problematic alcohol use in order to tailor and target therapeutic interventions.

Mindfulness-Based Treatment for Bipolar Disorder: A Systematic Review of the Literature

Despite the increasing number of studies examining the effects of mindfulness interventions on symptoms associated with Bipolar Disorder (BD), the effectiveness of this type of interventions remains unclear. The aim of the present systematic review was to (i) critically review all available evidence on Mindfulness Based Cognitive Therapy (MBCT) as a form of intervention for BD; (ii) discuss clinical implications of MBCT in treating patients with BD; and (iii) provide a direction for future research. The review presents findings from 13 studies (N = 429) that fulfilled the following selection criteria: (i) included BD patients; (ii) presented results separately for BD patients and control groups (where a control group was available); (iii) implemented MBCT intervention; (iv) were published in English; (v) were published in a peer reviewed journal; and (vi) reported results for adult participants. Although derived from a relatively small number of studies, results from the present review suggest that MBCT is a promising treatment in BD in conjunction with pharmacotherapy. MBCT in BD is associated with improvements in cognitive functioning and emotional regulation, reduction in symptoms of anxiety depression and mania symptoms (when participants had residual manic symptoms prior to MBCT). These, treatment gains were maintained at 12 month follow up when mindfulness was practiced for at least 3 days per week or booster sessions were included. Additionally, the present review outlined some limitations of the current literature on MBCT interventions in BD, including small study sample sizes, lack of active control groups and idiosyncratic modifications to the MBCT intervention across studies. Suggestions for future research included focusing on factors underlying treatment adherence and understanding possible adverse effects of MBCT, which could be of crucial clinical importance.

Assessing Emotional Reactivity: Psychometric Properties of the Perth Emotional Reactivity Scale and the Development of a Short Form

ABSTRACT The Perth Emotional Reactivity Scale (PERS) is a 30-item self-report measure of trait levels of emotional reactivity. In this article, we examine the psychometric properties of the PERS subscale and composite scores in an adult community sample (N = 428), and develop an 18-item short form of the measure (PERS–S). The PERS and PERS–S are designed to assess the typical ease of activation, intensity, and duration of ones emotional responses, and do so for positive and negative emotions separately. Our confirmatory factor analyses supported that the PERS and PERS–S both had the same theoretically congruent factor structure, and that all subscale and composite scores displayed high internal consistency reliability. Correlations with scores from established measures of psychopathology and emotion regulation also supported the validity of PERS and PERS–S scores. Our data therefore suggest that the PERS–S subscale and composite scores retain the psychometric strengths of their longer PERS counterparts. We conclude that both forms of the measure have good utility. Clinical and research applications are discussed.

“Atmosphere”, a Precursor of “Cognitive Schemas”: Tracing Tacit Phenomenological Influences on Cognitive Behaviour Therapy

Whilst individuals deal with divergent sorts of stimuli from the environment, they also tend to display some regularity in the way they respond to related patterns. These consistent responses can be conceptualised as cognitive schemas. A paramount component of Cognitive Behaviour Therapy (CBT) is the notion of cognitive schemas as they are a favoured point of therapeutic intervention. CBT as articulated by Beck in the 1960s owes intellectual acknowledgment to Merleau-Ponty and Heidegger and their notions of “atmosphere” and “clearing” respectively. This essay explores the notion of cognitive schema and atmosphere as applied to emotional pathology. It suggests that the well-known influence that phenomenology had on existential psychology could be extended to empirical clinical psychology, like CBT. The strategy adopted in this paper is to use Dreyfus’ ontological and epistemological distinction in psychopathology and then make a similar distinction, albeit using different terminology, in the CBT tradition. Some empirical findings from the literature are examined which render support to the existence of cognitive schemas and their crucial contributory role in the aetiology and maintenance of emotional disorders. It is noted that some of the features of these cognitive schemas were espoused well before Beck by Merleau-Ponty and the phenomenological-existential tradition.

Alexithymia stability and therapeutic outcome in an Australian psychiatric outpatient sample: Alexithymia stability and therapeutic outcome

Background: The aim was to examine the role of alexithymia on therapeutic outcome in a naturalistic group therapy setting, as well as the effectiveness of cognitive-behavioural group therapy in reducing alexithymia. Methods: A pre-test/post-test research design was used to examine alexithymia before and after treatment. Preand post-alexithymia and psychological distress scores from routinely administered measures were retrieved for 61 psychiatric outpatients referred for group therapy at a mental health facility. Correlation, repeated measures t-test, and regression analyses were conducted to explore the data. Results: Baseline alexithymia was not a significant predictor of group therapy outcome (change in psychological distress) once baseline psychological distress was controlled for. There was a small but significant reduction in mean-level alexithymia scores over the course of therapy. A high level of relative stability was observed in alexithymia scores, independent of change in psychological distress severity. A reduction in alexithymia during treatment was a significant predictor of a reduction in psychological distress over the course of therapy. Conclusions: High baseline alexithymia does not present a therapeutic disadvantage for patients receiving cognitive-behavioural group therapy. However, cognitive-behavioural group therapy is somewhat effective at improving alexithymic features, and this improvement can provide symptom relief by the end of treatment. Thus, it may advantageous for clinicians to treat alexithymia in order to enhance therapeutic intervention.

A case study of the neuropsychological outcomes following microsurgery, conventional radiotherapy and stereotactic radiotherapy for an adult’s recurrent craniopharyngioma

Abstract Objective: To examine the neuropsychological outcomes for an adult patient, 2 years after receiving microsurgery and conventional radiotherapy for a recurrent craniopharyngioma; and the impact of a further intervention, stereotactic radiotherapy, on this level of neuropsychological functioning. Participant: JD, a 30 year old male whose recurrent craniopharyngioma had 2 years earlier been treated with two operations and conventional radiotherapy. Design: JD was assessed (using standardized clinical tests) before and after a course of stereotactic radiotherapy. Results: Prior to stereotactic radiotherapy (and 2 years after microsurgery and conventional radiotherapy) JD’s IQ was intact, but considerable impairments were present in executive functioning, memory, theory of mind and processing speed. Fifteen months after stereotactic radiotherapy, all neuropsychological domains remained largely static or improved, supporting the utility of this treatment option in the neuropsychological domain. However, deficits in executive functioning, memory and processing speed remained. Conclusion: These findings suggest that, even after multiple treatments, substantial cognitive impairments can be present in an adult patient with a recurrent craniopharyngioma. This profile of deficits underlines the inadequacy of relying purely on IQ as a marker for cognitive health in this population and emphasizes the need to include neuropsychological impairments as a focus of rehabilitation with these patients.