Steven Cumming

The relationship between cognitive function and clinical and functional outcomes in major depressive disorder

BACKGROUND Although cognitive variables have been shown to be useful in predicting outcomes in late-life depression, there has not yet been a comprehensive study in younger persons with depression. METHOD The clinical symptoms and cognitive performance of participants were evaluated at admission to one of two university teaching hospitals and again at 3 months after remission and discharge. A total of 52 participants with a DSM-IV diagnosis of major depressive disorder, aged between 20 and 60 years and with a Hamilton Depression Rating Scale score 17 > or = entered the study. The sample for this paper comprises the 48 subjects (mean age 37.9 years, s.d.=10.7) who received admission and follow-up assessments; an attrition rate of 7.7%. RESULTS More perseverative errors on the shortened Wisconsin Card Sorting Test at admission predicted a worse clinical outcome at follow-up. Poor event-based prospective memory and more perseverative errors on the shortened Wisconsin Card Sorting Test at admission predicted worse social and occupational outcome at follow-up. CONCLUSIONS These results suggest that a brief cognitive screen at hospital admission, focusing on executive function, would have a useful prognostic value in depression. Determining early predictors of individuals at risk of poorer outcomes is important for identifying those who may need altered or additional treatment approaches.

An Examination of the Relationship Between Anxiety and Performance on Prospective and Retrospective Memory Tasks

The present study investigated the association between self-reported state anxiety, trait anxiety and performance on losely matched prospective and retrospective memory tasks and on a working memory (reading span) task. Eysenck and alvos (1992) processing efficiency theory suggests that the deleterious effects of anxiety on cognitive task erformance are mediated by worry occupying working memory. They suggest that the adverse effects of anxiety would be ost marked when people are experiencing acute anxiety states on tasks that place high demands on working memory apacity and are treated as secondary tasks, conditions that typically occur for prospective remembering. Sixty-three ndergraduate students were allocated to high, medium and low anxiety conditions using tertile splits of ranked state nd trait anxiety scores. It was found that people with elevated levels of state anxiety performed more poorly on a rospective memory test than people with lower levels of state anxiety. No difference between these g...

A longitudinal study of cognitive function in melancholic and non-melancholic subtypes of Major Depressive Disorder

BACKGROUND Research concerning cognition in depression has often yielded inconsistent findings. The presence of mixed melancholic and non-melancholic subtypes of major depressive disorder (MDD) in most previous research may explain some of the contradictory results (Hickie, 1996). METHODS This longitudinal study compared the cognitive performance of people with melancholic (n=17) and non-melancholic (n=17) MDD admitted to one of two university hospitals. Participants received an extensive clinical and cognitive assessment at admission and again 3 months after recovery and discharge. RESULTS Overall, participants with melancholia had selective memory deficits with broader impairment of executive control skills. Specifically, after correcting for depression severity, they performed more poorly on tests requiring memory acquisition, mental flexibility, set-shifting, selective attention, concept-formation and multi-tasking compared to those with non-melancholic depression. These deficits were present at both assessments suggesting that the increased initial severity of cognitive deficits for those with melancholia mean that they require a longer time to recovery. LIMITATIONS The clinical homogeneity of the study sample may underestimate the extent of cognitive impairment for those presenting with comorbid illness and/or significant drug/alcohol histories. CONCLUSIONS These findings indicate that the depressed group with melancholia have a distinctly different and more impaired cognitive profile to those without melancholic features and suggest that these clinical subtypes should be considered separately in future research concerning MDD. Furthermore, the melancholic group appears to require longer periods for cognitive recovery and this has implications for return to work and daily functioning following clinical discharge.

Psychometric analysis of the Self-Harm Inventory using Rasch modelling

BackgroundDeliberate Self-Harm (DSH) is the intentional destruction of healthy body tissue without suicidal intent. DSH behaviours in non-clinical populations vary, and instruments containing a range of behaviours may be more informative than ones with restricted content. The Self-Harm Inventory (SHI) is a widely used measure of DSH in clinical populations (mental and physical health) and covers a broad range of behaviours (self-injury, risk taking and self-defeating acts). The test authors recommend the SHI to screen for Borderline Personality Disorder (BPD) using a cut-off score of five or more. The aim of this study was to investigate the psychometric characteristics of the SHI in non-clinical samples.MethodsThe SHI was administered to a sample of 423 non-clinical participants (university students, age range 17 to 30). External validation was informed by the administration of the Depression Anxiety Stress Scales 21 (DASS-21) to a sub-sample (n = 221). Rasch analysis of the SHI was conducted to provide a stringent test of unidimensionality and to identify the DSH behaviours most likely to be endorsed at each total score.ResultsThe SHI showed adequate fit to the Rasch model and no modifications were required following checks of local response dependency, differential item functioning and unidimensionality. The scale identified gender and age differences in scores, with females and older participants reporting higher levels of DSH. SHI scores and DASS-21 scores were related.ConclusionThe recommended cut-off point of five is likely to comprise mild forms of DSH and may not be indicative of psychopathology in a non-clinical population. Rather it may be more indicative of developmentally related risk taking behaviours while a higher cut-off point may be more suggestive of psychopathology as indicated by higher levels of depression, stress and anxiety.

Implementing curriculum evaluation: case study of a generic undergraduate degree in health sciences

This case study presents a longitudinal, evidence‐based approach to health science curriculum reform and evaluation. Curriculum in higher education must meet the needs of diverse stakeholders and must respond to dynamic local, national and international contexts, and this creates challenges for evaluation. The long lead time prior to the introduction of new or revised university curriculum (at least two years), the length of degree programmes (three to five years) and the lag time in the availability of objective indicators of degree outcomes (at least one year post‐graduation) mean that findings may be obsolete before an evaluation can be completed. Few would argue that evaluation is important and methods and approaches for conducting curriculum evaluation are proposed in the literature, although few published reports of the outcomes of comprehensive evaluations are evident. This paper discusses potential for evaluation to establish responsive communication between students, teaching staff and programme administrators, ensuring a match between the intended, implemented and attained curriculum.

Trauma-related appraisals and coping styles of injured adults with and without symptoms of PTSD and their relationship to work potential

Purpose. This study aimed to document the self-reported trauma-related appraisals and coping strategies of injured workers with and without symptoms of posttraumatic stress disorder (PTSD) and to explore relationships between these cognitive variables and work potential. Method. Sixty-nine (55% males) respondents previously admitted to a teaching hospital following accidental injury completed a self-report survey which included measures for PTSD, trauma-related appraisals, coping strategies and work potential approximately 8 months post-accident. Results. Nineteen percent of the sample reported symptoms consistent with a PTSD diagnosis, and these participants reported more negative appraisals about the self and the world, greater use of avoidant coping and poorer work outcomes than those without clinically significant PTSD symptoms. After partialing out the influence of PTSD symptom severity, active cognitive coping was associated with increased work potential and negative appraisals of the world was associated with reduced work potential. Conclusions. Trauma-related appraisals and coping strategies are associated with work potential following accidental injury. Although the role of negative appraisals in the maintenance of PTSD is well documented, this study identified negative appraisals of the world as being associated with work potential after controlling for PTSD symptoms. Reducing negative appraisals of the world and increasing active coping may influence work potential, however, longitudinal studies that substantiate the direction of the associations are required.

Cognitive Impairment in Rheumatoid Arthritis: A Systematic Review

Rheumatoid arthritis (RA) is not commonly associated with central nervous system and brain changes. However, a number of studies have reported high rates of cognitive impairment in adults with RA. The objective of this systematic review was to identify and explore the rates and types of cognitive impairment in RA.

The role of speech-language pathologists in palliative care: Where are we now? A review of the literature

Introduction: Dysphagia and communication changes are common in life-limiting conditions and Speech-Language Pathology (SLP) involvement to facilitate effective communication, eating and drinking contributes to the goals of comprehensive palliative care. Aim: To examine the existing literature around the role of SLPs in palliative care to define the best practice role for SLPs in this area, identify current services and interventions provided by SLPs to patients with life-limiting conditions, assess for potential gaps between best practice in the literature and everyday SLP practice and opportunities for improvement. Methods: The methods used were electronic literature searches within MEDLINE, EMBASE and CINAHL, and manual searching. Papers were classified according to type. Meta-analysis was not appropriate due to the nature of the papers, and so a narrative exploration of themes was conducted. Results: Thirty-two papers were included (eight research, twenty-four non-research). Discussion: Specific roles for SLPs in dysphagia, communication, and holistic professional practice were identified. There is insufficient research to determine whether this is reflected in everyday SLP practice. Potential challenges to providing services include the impact of working with people who are dying, limited professional preparation, ongoing education constraints, and legal and ethical considerations. Further research into SLP activities with patients with life-limiting conditions is required to explore the valuable contributions already being made by SLPs to the care of patients with life-limiting illnesses and to identify opportunities to develop and improve evidence-based services in this area.

Predictors of self-harm in male inmates

Purpose – The purpose of this paper is to examine the predictors of self-harm in male inmates. Design/methodology/approach – Male inmates with and without a background of self-harm (i.e. suicidal and non-suicidal) were compared across two distal (static and trait) and two proximal (environmental and current/state psychological) domains. The factors from the four domains which may accurately classify self-harm history were also examined. Findings – The two groups were significantly different across the four domains, particularly on psychological characteristics. The self-harm group was associated with childhood trauma, violent offences, institutional misconducts and lower levels of social support significantly more than the non-self-harm group. Being single, childhood abuse, impulsivity, antisocial personality disorder and global psychopathology were the five key predictors that contributed to 87.4 per cent of all cases being correctly classified. Practical implications – The high levels of psychiatric mor...

Semantic priming of expectancies among high and low restraint non-problem drinkers

Abstract This report presents a cognitive measure of drinking expectancies based on semantic priming methodologies, and it investigates differences between high and low drinking restraint undergraduates. Reaction time to an emotion name (e.g., sociable) was measured when that word was preceded by a drinking-related word (e.g., beer) and when preceded by a neutral word (e.g., book). One hundred and four undergraduate students were administered the “differentiated” Restrained Drinking Scale (Ruderman & McKiman, 1984; Collins, George, & Lapp, 1989), a drinking behaviour questionnaire, and completed the priming task. High and low-restraint drinkers were found to differ significantly in the extent and direction of priming to positive and negative emotional-word targets, with the high-restraint drinkers taking longer to recognise positive words. The results suggest that, in the absence of an alcohol pre-load, highly restrained drinkers have weaker positive drinking expectancies than their less restrained peers....