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Background Pregnancy is a period of elevated risk for mental health difficulties, which are likely exacerbated by the COVID-19 pandemic. This study aims to understand the impact of COVID-19 on mental health and identify risk and protective factors during pregnancy. Methods Participants were 303 pregnant individuals from Ontario, Canada. Depression, anxiety and insomnia were measured using validated questionnaires. COVID-related experiences (i.e., financial difficulties, relationship conflict, social isolation) were assessed in relation to mental health. Social support and cognitive appraisal of the pandemic were examined as protective factors. Results 57% of the sample reported clinically elevated depression, >30% reported elevated worries, and 19% reported elevated insomnia. Depression (t = 25.14, p < .0001) and anxiety (t = 17.21, p < .0001) levels were higher than non-COVID pregnant samples. Social isolation, financial trouble, relationship difficulties and threat of COVID-19 were associated with mental health. Social support (rrange −.24 to −.38, p

Highlights • Global experts ranked biopsychosocial risk factors for adolescent depression • Risk factors include female sex, family history, physical illness, bullying • Mood changes and loss of interest are measurable early signs of adolescent depression • Culture influences the types and specificity of adolescent depression risk factors, Background Adolescence represents a vulnerable period for the onset of depression. Globally, there is a need to better understand risk factors for adolescent depression to inform policies for effective prevention initiatives. Methods A Delphi consensus study was conducted on risk factors, early signs, and detection strategies for adolescent depression in global settings. Over 3 survey rounds, global experts formulated and ranked these variables for (1) specificity for adolescent depression and (2) feasibility of measurement (round 1, n=21 participants; rounds 2 and 3, n=17). We calculated Smith's salience index as a measure of consensus. Interviews were conducted with 10 participants to elicit qualitative reflections on the ranking results, and on the influence of cultural and contextual factors on depression risks. Results Thirty-one risk factors for adolescent depression were generated. Panelists ranked three as highly specific and highly feasible to measure: family history of depression, exposure to bullying, and a negative family environment. Six were ranked as modestly specific and highly feasible: physical illness or disability, female sex, bereavement, trauma exposure, substance abuse, and low self-esteem. An additional 5 items were modestly specific and modestly feasible: social difficulties, academic stress, poverty, loss of family, and cognitive distortions. Five symptoms were at least modestly specific and feasible to measure: mood changes, loss of interest, social isolation, suicidality, and sleep changes. Schools were considered the most feasible place for screening. Limitations The participants were not representative of all countries and cultural regions. Conclusions This study offers a profile of risk factors developed and prioritized by experts to inform a research agenda for risk, identification and prevention of adolescent depression across global settings.

BACKGROUND: It is unclear how those with bipolar disorder (BD) have been affected by the coronavirus (COVID-19) pandemic. This study aimed to obtain a more detailed understanding of the current mental health needs of these individuals, which is important for both the development of intervention strategies to better manage patient distress and to better prepare for similar circumstances in future. METHODS: The sample comprised 43 individuals with a verified diagnosis of BD and 24 healthy controls. Data about pandemic-related mental health support use, socio-demographics, mood, lifestyle, social rhythm and subjective cognitive dysfunction data were collected and compared between groups. Inter-relationships between scores were also examined. RESULTS: No between-group differences were found in terms of age, sex, living situation, job loss or reduced work hours due to COVID-19. Most patients with BD reported a history of ongoing formal psychological support (68.3%), with most continuing this support throughout the pandemic (82.1%). A large, statistically significant pandemic-related increase in subjective cognitive dysfunction was evident in the BD group. Subjective cognitive dysfunction was significantly associated with negative symptomology, suicidal thoughts, and quality of life ratings. LIMITATIONS: Data was collected in self-report format in an online survey and objective symptom measures were not used at this time CONCLUSION: The absenceof substantial differences between patients and controls in terms of mood symptoms, COVID-19 fear or lifestyle factors and social rhythms suggests a degree of resilience in BD patients; despite large pandemic related increases in subjective cognitive dysfunction.

Background Qualitative review papers have indicated that verbal memory impairment is found to be the most consistent cognitive impairment related to PTSD. These review papers have used qualitative methods to describe the effects, and consequently they have not been able to estimate the strength of the memory-PTSD association. Methods This meta-analysis of 28 studies examined the empirical evidence for this relationship, and factors affecting the results. Results Overall, the results showed medium effect sizes in patients with PTSD compared to controls on verbal memory across studies. Marked impairment was found in the patient groups compared to healthy controls, while modest impairment was found compared to exposed non-PTSD controls. Meta-analyses found strongest effects in war veterans compared to sexual and physical assault related PTSD. Rather unexpectedly no effect was found for the sexually abused PTSD groups compared to exposed controls. The analyses further showed that the effect was dependent on the test procedures used. The studies using WMS and AVLT had stronger effects than studies using CVLT. Limitations Insufficient data were available to analyze a more complete attention–memory profile. Conclusions This meta-analysis confirms that verbal memory impairment is present in adults with PTSD, and they are consistent across studies. This impairment should be the focus of work in clinical settings.

Background Emotional distress (defined as any negative mood state, including anxiety, depression, trauma symptoms and global distress) is common in people with multiple sclerosis (PwMS). To develop more integrated care for PwMS requires a better understanding of causal variables underlying persistent emotional distress. This systematic review critically appraised and synthesised the findings of prospective studies investigating predictors of emotional distress in PwMS. Method CINAHL, Medline, and PsycINFO, were systematically searched for: i) prospective cohort studies with ≥1-month follow-up period, which; ii) evaluated baseline clinical and demographic, social and/or psychosocial predictors of emotional distress; iii) presented results for adults with MS; and iv) used validated measures to assess emotional distress. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa Scale. Results Thirteen studies, reported in 17 papers, were included. A wide range of outcome measures and statistical methods were used. The most reliable finding was that baseline emotional distress and stress-coping variables predicted emotional distress. Less robust support was found for income, negative cognitive illness appraisals and poor social support. No other variables often predicted emotional distress. Limitations Lack of consistency across included studies may limit confidence in the results obtained. Conclusions Little is currently known about how or why some people become and remain distressed following a diagnosis of MS, whilst others do not. However, psychological and social factors such as emotional distress and stress-coping variables appear to be important. A better understanding of the psychological factors underpinning distress in PwMS is needed.

Background There is extensive lack of awareness of maternal mental health and its impact on child development in low- and middle-income countries (LAMICs). The aim of this systematic review was to analyze evidence for various maternal perinatal mental health disorders and their association with different domains of infant and toddler neurodevelopment during the first two postnatal years in LAMICs. Methods A comprehensive literature search was conducted within six databases from Jan 1990–April 2019. All included studies were narratively synthesized. Results Twenty-four studies, nine cross sectional and 15 longitudinal cohort studies, were included. Three studies were conducted in low-income, 11 in lower-middle-income and ten in upper-middle-income countries. The majority of studies assessed maternal mental health postnatally and 14 of these 22 studies found a significant association with infant and toddler neurodevelopment. Five of the ten studies reporting on exposure to prenatal mental health found a significant association. The most common maternal mental health disorder studied was depression, while the main neurodevelopmental outcomes assessed were motor, cognitive and language development. Limitations Meta-analysis could not be conducted due to the variability in the reported maternal mental health disorders and the different times of assessment of exposures and outcomes. Conclusions Maternal perinatal mental health disorders and their association with different domains of neurodevelopment in LAMICs is still inconclusive due to a limited number of papers. Mother-infant dyads in LAMICs are exposed to multiple and cumulative risk factors and causal pathways between maternal mental health and infant neurodevelopment are still poorly understood.

Background Borderline Personality Disorder (BPD) is a severe and disabling psychiatric syndrome, frequently associated with self-injurious behaviours (SIB). In recent years, functional magnetic resonance imaging (fMRI) investigations have tried to identify alterations associated with SIB amongst BPD patients, in order to better delineate possible neurobiological underpinnings of these manifestations. In this mini-review, we aimed at summarizing fMRI studies exploring patterns of neural activation associated with SIB in BPD patients. Methods Literature searches on PubMed, Psych-Info and Embase databases were performed for all fMRI studies including adult patients with BPD and SIB undergoing different tasks, including painful or thermic stimulation, affective stimulation through the presentation of picturesor the recollection of personal memories as well as tasks that evaluate sustained attention and impulsivity, and reward processing. Thirteen relevant papers were considered eligible for the present review. Results Patients with BPD and SIB, compared to HC, showed prefrontal, nucleus accumbens overactivation and amygdala deactivation during pain stimulation. During negative affective stimulation, BPD patients showed a hyperactivation of the amygdala and a hypoactivation of the orbitofrontal cortex (OFC), which was also found to be enhanced during a gambling task and during a recalling of aversive memories. In contrast, during cognitive tasks with negative affective interference, BPD patients showed hypoactivation of OFC, anterior cingulated cortex, and basal ganglia. Limitations The limited number of studies and the heterogeneity regarding the fMRI tasks employed allowed only suggestive conclusions. Conclusions The reviewed fMRI studies highlighted that BPD patients with a history of SIB showed altered brain activity, compared to HC, in regions involved in inhibitory cognitive processes and affect regulation, which may in turn, explain the overwhelming emotional experiences eliciting SIB in these patients.

Background Social functioning impairment has been described in several psychiatric illness, including depressive disorders. It is associated with a deterioration in global functioning and quality of life, thus there is a growing interest in psychosocial functioning remediation interventions. This systematic review aims to review all psychotherapeutic, pharmacological and biological social functioning interventions in depressive disorders. Methods A systematic search was conducted on PubMed, PsycINFO and Scopus from the first articles to 2019 following the PRISMA guidelines. 72 original papers were extracted from an initial number of 1827, based on the selected eligibility criteria. Results A growing body of research was observed in the last 10 years, with most studies showing a low level of scientific evidence. The main diagnosis found was major depressive disorder and the principal social cognition domains assessed were emotional processing and attributional style. The type of intervention most found was the pharmacological one, followed by psychotherapeutic interventions classified as "non-specific. The efficacy of treatments showed an improvement in depressive symptoms and positive results for emotional processing and attributional style. Limitations Because there is a lack of well-controlled designs and really few interventions focusing on its remediation, and low homogeneity on the assessment of social aspects across, a comparison of results and the extraction of general conclusions is quite difficult. Conclusions Although a promising body of literature has been developed in recent years on the improvement of psychosocial functioning in patients with depressive disorders, more studies are needed to clarify relevant aspects in this area.

Background Metabolic risk factors, low cognitive function and history of depression are known risk factors for future depressive episodes. This paper aims to evaluate the potential interactions between these factors on the risk of a major depressive episodes in middle-age. Methods Baseline and follow-up data from a population-based study of Quebec, Canada were used. The sample consisted of 1788 adults between 40 and 69 years of age without diabetes. Cognitive function and metabolic risk factors were assessed at baseline. Three cognitive domains were assessed: processing speed, episodic memory and executive function. History of depression was assessed five years later by a clinical interview. Logistic regression analysis was conducted to evaluate interactions between individual metabolic factors, low cognitive function, and depression history. Results : Participants with a comorbidity of at least one metabolic factor, history of depression and low cognitive function had the highest risk of experiencing a depressive episode in middle age. The highest risk was observed in individuals with abdominal obesity, low cognitive function, and a history of depression (OR= 8.66, 95% CI 3.83–19.59). The risks for those with abdominal obesity only, depression history only, and low cognitive function were 1.20 (95%CI 0.71–2.02), 3.10 (95%CI 1.81–5.24), and 1.39 (95%CI 0.72–2.67), respectively. Limitations Depression was only assessed at follow-up. Conclusion Metabolic risk factors comorbid with low cognitive function in middle-aged individuals with a history of depression were associated with an increased risk of a future depressive episode. This study highlights the importance of screening for metabolic and cognitive comorbidities in patients with a history of depression.

Background Smartphone apps are becoming increasingly used by service users in mental health care and research for diverse aims. However, it is well-known the high prevalence of cognitive impairment in some people suffering from severe mental illnesses such as bipolar disorder (BD), which impacts on their psychosocial functioning and quality of life. In this context, the main aim of this paper is to investigate through exploratory analyses the role of specific cognitive deficits in the retention, engagement, and usability of a psychoeducational smartphone app in a group of patients with BD. Methods 51 remitted BD patients were asked to use the app for 3 months. Baseline and 3-months follow-up clinical and usability assessments were conducted. Twenty-seven independent results from a comprehensive neurocognitive test of the same participants were retrieved separately of the 2 years before or after the use of the app. Post-hoc exploratory analyses were carried out using Spearman correlations to identify significant cognitive deficits domains influencing the usability and retention with the app. Results There were no statistically significant cognitive variables associated with the use, reported usability or retention with the app. Some variables associated with executive functions, verbal and visual memory correlated significantly with previous use of smartphones. Limitations Post-hoc analysis with a limited sample size. Conclusion These preliminary results suggests that patients with BD and mild cognitive deficits do not present any limitation in using mental health apps. In our case, the adoption of a user-centred design in the development process of the app could have mitigated the participants' difficulties when using the app.

Objective Previous work has shown that neuropsychological performance can predict outcome of psychotherapy. The present paper explores whether an affective bias in verbal memory is associated with recurrence of mood episodes in patients with Bipolar Disorder (BD). Method 76 euthymic adult patients with BD were randomly assigned to either 9 months of Cognitive Behavioral Therapy (CBT) or Support Therapy (ST), and followed up for 2 years after completing therapy. At baseline, affective learning memory (Emotional Auditory Verbal Learning Test; EMO-AVLT) and other measures were assessed. Recurrence of a mood episode was the primary outcome. Results The survival analyses revealed that the interaction between therapy condition, more specifically ST, and a recognition bias in favor of mania-related, but not depression-related words predicted recurrence of mania. Recurrence of depression was predicted by neither affective memory bias nor their interaction with treatment. Conclusions A mania-related memory bias emerged as a predictor of mania recurrence, specifically in an unstructured setting such as ST. Perhaps mania-related schemata are more salient or more easily activated in those at high risk for recurrence. Interventions targeting patients’ insight into their internal states as potential indicators of prodromal manic symptoms could be the key to improve the outcome of psychological interventions in BD. Additional research in the role of cognitive factors in relapse prevention is warranted.

Cognitive therapy (CT) has been shown to be efficacious in the treatment of depression in numerous randomized controlled trials (RCTs). However, little evidence is available that speaks to the effectiveness of this treatment under routine clinical conditions.This paper examines outcomes of depressed individuals seeking cognitive therapy at an outpatient clinic (N=217, Center for Cognitive Therapy; CCT). Outcomes were then compared to those of participants in a large NIMH-funded RCT of cognitive therapy and medications as treatments for depression.The CCT is shown to be a clinically representative setting, and 61% of participants experienced reliable change in symptoms over the course of treatment; of those, 45% (36% of the total sample) met criteria for recovery by the end of treatment. Participants at CCT had similar outcomes to participants treated in the RCT, but there was some evidence that those with more severe symptoms at intake demonstrated greater improvement in the RCT than their counterparts at CCT.The CCT may not be representative of all outpatient settings, and the structure of treatment there was considerably different from that in the RCT. Treatment fidelity was not assessed at CCT.Depressed individuals treated with cognitive therapy in a routine clinical care setting showed a significant improvement in symptoms. When compared with outcomes evidenced in RCTs, there was little evidence of superior outcomes in either setting. However, for more severe participants, outcomes were found to be superior when treatment was delivered within an RCT than in an outpatient setting. Clinicians treating such patients in non-research settings may thus benefit from making modifications to treatment protocols to more closely resemble research settings.

Background There is growing evidence for cognitive dysfunction in depressive and anxiety disorders. Nevertheless, the neuropsychological profile of young adult patients has not received much systematic investigation. The following paper reviews the existing literature on cognitive impairments in depressive and anxiety disorders particularly among young adults. Additionally, the focus of young adult age group and the effect of confounding variables on study results are discussed. Methods Electronic database searches were conducted to identify research articles focusing on cognitive impairments in depressive or anxiety disorders among young adults published in English during years 1990–2006. Results Cognitive impairments are common in young adults with major depression and anxiety disorders, although their nature remains partly unclear. Accordingly, executive dysfunction is evident in major depression, but other more specific deficits appear to depend essentially on disorder characteristics. The profile of cognitive dysfunction seems to depend on anxiety disorder subtype, but at least obsessive–compulsive disorder is associated with deficits in executive functioning and visual memory. The conflicting results may be explained by heterogeneity within study participants, such as illness status, comorbid mental disorders, and medication, and other methodological issues, including inadequate matching of study groups and varying testing procedures. Limitations The study is a comprehensive review, but not a formal meta-analysis, due to methodological heterogeneity. Conclusions Cognitive impairments are common in major depression and anxiety disorders. However, more research is needed to confirm and widen these findings, and to expand the knowledge into clinical practice. Controlling of confounding variables in future studies is highly recommended.

Background Higher cardiorespiratory fitness is associated with lower trait anxiety, but research has not examined whether fitness is associated with state anxiety levels and the interpretation of these symptoms. The aim of this paper was to (1) reexamine the association between cardiorespiratory fitness and general anxiety and (2) examine anxiety intensity and perceptions of these symptoms prior to an acute psychological stress task. Methods Participants (N=185; 81% female; Mage=18.04, SD=0.43 years) completed a 10-minute Paced Serial Addition Test. General anxiety was assessed using the anxiety subscale of the Hospital Anxiety Depression Scale. Cognitive and somatic anxiety intensity and perceptions of symptoms was assessed immediately prior to the acute psychological stress task using the Immediate Anxiety Measures Scale. Cardiorespiratory fitness was calculated using a validated standardized formula. Results Higher levels of cardiorespiratory fitness were associated with lower levels of general anxiety. Path analysis supported a model whereby perceptions of anxiety symptoms mediated the relationship between cardiorespiratory fitness and levels of anxiety experienced during the stress task; results remained significant after adjusting for general anxiety levels. Specifically, higher levels of cardiorespiratory fitness were positively associated with more positive perceptions of anxiety symptoms and lower levels of state anxiety. Limitations A standard formula rather than maximal testing was used to assess cardiorespiratory fitness, self-report questionnaires were used to assess anxiety, and the study was cross-sectional in design. Conclusions Results suggest a potential mechanism explaining how cardiorespiratory fitness can reduce anxiety levels.

This paper reviews evidence from both human and non-human primate studies concerning the role of early adverse experiences in the onset and course of adult depressive disorders. Despite accumulating evidence that stressful life events can play a major role in precipitating the onset of depressive episodes in humans, the mechanisms by which early experiences mediate and moderate the risk for later affective illnesses are not fully understood. Experimental paradigms in primates have documented the important role of undeveloped (social deprivation) or disrupted attachment systems (social separation). Effects of early social deprivation can be seen in many domains. Behavioral effects include repetitive idiosyncratic behaviors, increased self-directed behaviors, inappropriate expression of aggressive behaviors, non-modulated patterns of consumption, and inappropriate sexual and maternal behaviors. Cognitively, such animals require longer habituation time for any task and demonstrate increased perseverance on tasks following non-reward. Physiological effects include an altered hypothalamic-pituitary-adrenal response to stress, changes in diurnal temperature regulation, and alterations in immune function. Neurochemical effects include abnormalities in noradrenergic, serotonergic, and dopaminergic systems. Even neuroanatomical changes following early social deprivation have been reported. Studies with primates have also confirmed that early maternal and peer separations are major behavioral and neurobiological events with both short- and long-term consequences that parallel human depression. Future utilization of experimental paradigms in non-human primates may assist in better understanding the role of early experiences in predisposing to the development of affective illnesses in humans. This review concludes by presenting a model for understanding a developmentally based vulnerability to adult depressions.

With the increasing recognition of attention deficit hyperactivity disorder (ADHD) in adults and psychotic disorders in children and adolescents, the possibility of a relationship between bipolar disorder (BP) and ADHD has attracted growing interest. This paper critically reviews the scientific literature concerning this postulated relationship by examining evidence from clinico-epidemiological, follow up, family and laboratory studies, including neuroimaging, neuropsychology and genetic studies. The evidence suggests that although the diagnostic categories of BP and ADHD appear to be unrelated, there is support for a possible relationship between some ADHD and manic-like symptoms. However, several fundamental methodological issues require rectification in future research in order to further elucidate the relationship between these disorders.

Objectives Mania in bipolar disorder (BD) and partial (focal) seizures (PS) arising from the temporal lobes, have a number of similarities. Typically, a chronic course of the disorders is punctuated by acute illness episodes. Common features of episodes may include sensory, perceptual, cognitive and affective changes. Both respond to anticonvulsant treatment. Common mechanisms imputed include neurotransmitters and kindling processes. Further investigation may improve understanding of the occurrence of both mania and PS, casting light on the relevance of temporal lobe mediated processes and pathology. One avenue of investigation is to compare aetiological factors and determine the extent of overlap which may indicate shared brain localization or pathophysiology. Aetiology includes predisposing, precipitating or perpetuating factors. This paper examines the literature on precipitating factors of mania, first or subsequent episode, and of PS in diagnosed epilepsy, which is the second or subsequent seizure, to identify the extent and nature of their overlap. Method Narrative review based on a literature search of PubMed and Google Scholar. Results Precipitating factors for both mania and PS were stress, sleep deprivation, antidepressant medication and, tentatively, emotion. For mania alone, goal-attainment events, spring and summer season, postpartum, and drugs include steroids and stimulants. For PS alone, winter season, menstruation and specific triggers in complex reflex epilepsies. Those not substantiated include lunar phase and menopause. A wide range of chemicals may provoke isolated seizures but by definition epilepsy requires at least two seizures. Conclusions The overlap of precipitating factors in mania and PS imply that common brain processes may contribute to both, consistent with findings from neuroscience research.

Background Attachment theory has been conceptualised as an emotion regulation theory. Research attributes the occurrence of depressive symptoms to a dysfunction of emotion regulation. Anxious attachment and avoidant attachment, which are two dimensions of insecure attachment, are hypothesised to lead to the development of hyperactivating and deactivating emotion regulation strategies. Methods This systematic review examines the literature on the role of emotion regulation and its relationship with attachment and depressive symptomatology. Furthermore, we examined evidence for hyperactivating and deactivating strategies. Results Nineteen papers were identified. Adolescent studies demonstrated associations of varying strength and found unreliable and contradictory results for emotion regulation as a mediator. Conversely, adult studies provided strong evidence for emotion regulation as a mediator. The hypothesis that hyperactivating strategies mediate anxious attachment and depressive symptoms was consistently supported. Mixed evidence was provided for deactivating strategies as mediators to avoidant attachment and depressive symptomatology. Limitations Limitations of methodology and quality of studies are identified with particular attention drawn to problems with conceptual singularity and multicollinearity. Conclusions Despite mixed variable findings, this review indicates that emotion regulation is a mediator between attachment and depression. Hyperactivating strategies, in particular, have been consistently noted as mediators for anxious attachment and depressive symptomatology, whereas evidence for deactivating strategies as mediators between avoidant attachment and depressive symptoms has been mixed. Future research should test the mediators of attachment and symptoms and examine theoretically grounded models of psychopathology, such as metacognitive and cognitive models using clinical samples.

The aim of this paper is to explicate what is special about emotional information processing, emphasizing the neural foundations that underlie the experience and expression of fear. A functional, anatomical model of defense behavior in animals is presented and applications are described in cognitive and physiological studies of human affect. It is proposed that unpleasant emotions depend on the activation of an evolutionarily primitive subcortical circuit, including the amygdala and the neural structures to which it projects. This motivational system mediates specific autonomic (e.g., heart rate change) and somatic reflexes (e.g., startle change) that originally promoted survival in dangerous conditions. These same response patterns are illustrated in humans, as they process objective, memorial, and media stimuli. Furthermore, it is shown how variations in the neural circuit and its outputs may separately characterize cue-specific fear (as in specific phobia) and more generalized anxiety. Finally, again emphasizing links between the animal and human data, we focus on special, attentional features of emotional processing: The automaticity of fear reactions, hyper-reactivity to minimal threat-cues, and evidence that the physiological responses in fear may be independent of slower, language-based appraisal processes.

This paper reviews experimental studies of sexual disorders and anxiety disorders. Studies were mainly carried out in the laboratories and clinics with which each of the two authors is associated. Sex and anxiety are rather antipodal emotions but contrary to traditional views, there is no reason to believe that anxiety disorders are driven by underlying sexual problems or that sexual problems are maintained by anxiety. Both sex research and anxiety research focused on selective processing of disorder relevant information in patients. More in particular, studies are clustered in three groups. First, the authors examined selective attention for threat-related material in anxious patients and for non-sex-related material in sexually dysfunctional patients. Second, the (mis)interpretation of response information in both disorders is compared. Finally the authors discuss biased expectancies in anxiety and sexual disorders. Symmetries and asymmetries are highlighted and lines for further research are sketched.

Background It is unclear whether cognitive impairment is prevalent in the remitted state of unipolar disorder. Aim To evaluate whether cognitive function is impaired in the remitted state in patients with unipolar depression compared with healthy control individuals, and to investigate the association to prior course of illness, i.e. the number, duration and severity of prior depressive episodes. Method Systematic search on existing on-line databases and hand-search of original published papers. Results A total of 11 studies fulfilled the selection criteria and were included in the review, including a total of 500 patients remitted from unipolar depression and 471 healthy control individuals. In nine of the eleven studies performance on neuropsychological tests was found to be decreased in patients compared to healthy control individuals in at least one of the tests. Methodological drawbacks were prevalent including non-stringent definition of remission and non-correction for multiple testing. Only few studies investigated the association between cognition and prior course of illness and the results were divergent. Limitations Stringent criteria were used in the assessment of eligibility of studies. The studies were first and foremost selected according to the criteria for remission used. Conclusion Cognitive dysfunction seems to be present in individuals suffering from unipolar disorder in the remitted state. We recommend that future studies should focus on disentangling the state and trait characteristics of cognitive dysfunction in unipolar disorder and further clarify the associations with clinical phenotype, course of illness and subsyndromal psychopathology. Furthermore, there is a need to identify the cognitive difficulties in individuals suffering from unipolar disorder in relation to psychosocial function, quality of life and risk of recurrence and to assess the effect of treatment intervention on cognitive function.

BACKGROUND: Studies examining the way in which cognitive impairment is associated with depression have produced inconsistent findings. Different severity of depressed mood across studies may account for such conflicting reports. However, inconsistent results have also been reported in relation to the specific association of depression severity with cognitive performance. METHODS: A meta-analysis was conducted to examine the relationship between severity of depression and cognitive function, using the correlation (Pearson's r) between depression severity scores and neuropsychological test performance. Individual meta-analyses were conducted for composite measures of cognitive functional domains (episodic memory, executive function, processing speed, semantic memory, and visuo-spatial memory). Analyses were also done across functional domains for timed and un-timed tests. RESULTS: Significant correlations between depression severity and cognitive performance were found in the domains of episodic memory, executive function, and processing speed, but not for semantic memory or visuo-spatial memory. For both timed and un-timed cognitive measures there were equally significant correlations with depression severity. LIMITATIONS: There were few studies meeting inclusion criteria in some cognitive domains, papers had to be excluded due to insufficient data reporting, and there are limitations associated with the cross-sectional design. CONCLUSIONS: The results suggest that previous inconsistent findings of the relationship between the severity of depression and cognitive function may be attributed to random variations and lack of power within studies.

Background The neurocognitive deficits that underlie the unique features of obsessive–compulsive disorder (OCD) are not yet completely understood. This paper reviews the main neuropsychological findings in memory and executive functioning in this disorder, and examines a number of challenges facing this area of research. Method A selective review of the neuropsychological literature on OCD was conducted using MEDLINE and drawing on literature known to the authors. Results The neuropsychological profile of OCD appears to be one of primary executive dysfunction. Although memory functioning may be affected, these deficits appear secondary to an executive failure of organizational strategies during encoding. On tasks of executive functioning patients with OCD demonstrate increased response latencies, perseveration of responses, and difficulties utilizing feedback to adapt to change. Limitations A statistical meta-analysis was not performed and only the cognitive domains of memory and executive functioning were examined. Conclusions Given the prominence of chronic doubt and indecision in clinical settings, it is surprising that decision making as a cognitive construct as related to OCD has not received greater attention in the neuropsychological literature. On the basis of emerging literature we suggest that it is a potential area of dysfunction and one that warrants further investigation as it may assist in enhancing our understanding of the pathophysiology of OCD.

Experts have debated the influence of mental illness on decision-making capacity. This paper reviews concepts of decision-making capacity and existing research on the influence of mental illness on capacity to consent to research. We propose how bipolar disorder, especially mania, may have an effect on consent capacity. The current conceptualization of capacity utilizes legal standards of 'choice', 'understanding', 'appreciation' and 'rational reasoning', as well as voluntarism, or the assurance that the patient is free to agree or to decline to participate in research. Studies of patients with schizophrenia suggest impaired cognition influences 'understanding' and is more important than severity of psychosis in affecting decision-making abilities. There are no studies of sources and extent of impairment to consent to research among manic patients. Mania may influence a patient's understanding of the research protocol, but also alter the patient's views, values and level of insight, thus impairing decision-making abilities at the 'appreciation' standard even when the patient understands the relevant information. Mania may impact freedom to decide, yet paradoxically, manic patients may be less influenced by others and less vulnerable to coercion, undue influence and undue incentives compared to patients without mental illness. We suggest that in patients with mood disorders, the legal standard of appreciation be thoroughly probed during the consent procedure. Studies of the effect of mania and depression on consent capacity and voluntarism are needed in order to develop processes that increase safeguards in the informed consent process.

This paper reviews clinical observations and evolutionary theory in relation to attention deficit hyperactivity disorder (ADHD) on the one hand and mania and its variants on the other. Both groups of disorders resemble each other in regard to high levels of motor activity, perhaps occurring together more often than not, and are confounded in most existing research. Making distinctions requires isolating the contribution of activity level from other characteristics such as those of flawed executive functions for ADHD or grandiosity and lapses in reciprocity for mania. High activity level is an asset throughout nature except in extreme intensities or when it amplifies the characteristics of psychopathology. Fitness, social displays, and behavioral adaptations for survival are clues to some aspects of hypomania and ADHD. While hypomania can be a competitive advantage in certain niches, it appears there can be few opportunities for ADHD to do so. Indeed, the impulsiveness seen in ADHD is probably the outcome of flaws in executive functions rather than being the cause of them. Neither lapses in executive functions nor in reciprocity are apt to be domain general but may interact sharply with each person’s repertoire of psychological adaptations. The author submits that a theoretical orientation as outlined here would not only help in better understanding the disorders under consideration, but could be useful in providing new directions to treatment decisions.

The treatment of severe depression with psychotherapy, alone, is controversial. In this paper, we review the historical, conceptual, and empirical contexts of this controversy. In addition to work by others, we review recent work from our institute which has examined the psychobiological substrates of response to treatment in depressive subtypes. We examine the traditional categories that describe severe depressions. The features and psychobiological correlates of melancholia are discussed, as is the relationship between melancholia and aging. Research on treatment of melancholia and other severe depressive states with psychotherapies such as cognitive behavior therapy (CBT) and interpersonal psychotherapy (IPT) is reviewed in detail. We conclude that although some melancholic patients are responsive to IPT or CBT, there is not yet compelling evidence that melancholic patients respond to psychotherapy as well as they do to medications. The potentially mediating effects of hypercortisolism, alterations of sleep neurophysiology, and disturbances of information processing and regional cerebral metabolism represent fertile grounds for future investigation. We discuss the practical implications of the literature reviewed.

Light therapy, the current treatment for Seasonal Affective Disorder (SAD), does not help everyone suffering from SAD. This paper examines whether patients with SAD potentially might benefit from cognitive behaviour therapy by investigating whether they show a similar cognitive profile to those with non-seasonal depression for whom cognitive therapy has been shown to be effective. Ten subjects with SAD were compared to 11 non-seasonally depressed and 10 normal controls on a range of measures including the Automatic Thoughts Questionnaire and the Dysfunctional Assumptions Scale. One-way analysis of variance showed that the SAD group reported significantly more negative automatic thoughts and dysfunctional attitudes than a non-depressed control group but did not differ from a group with non-seasonal depression. The results suggest that patients with SAD may respond to cognitive behaviour therapy like those with non-seasonal depression. Further research is therefore recommended to examine the efficacy of cognitive therapy as a complementary addition to light therapy in the treatment of SAD and to examine other cognitive aspects of SAD.

This paper addresses the question whether negative cognitive style represents a state or trait variable of depressive patients. For this reason, it studies the influence of sleep deprivation on negative self-schemes of those patients. 10 patients suffering from DSM-III-R major depression were compared with 10 age- and sex-matched controls on a task for rating the self-descriptiveness of positive and negative adjectives as well as a subsequent word recognition task. Three sessions were involved: an initial session (baseline), the second following a night of sleep deprivation, and the third after a succesive full night's sleep. During the baseline examination, depressives showed a relatively negative cognitive bias; that is, the same number of positive and negative self-scheme elements. In comparison to controls, they showed significantly more negative and significantly less positive self-scheme elements. The same pattern emerged in a word recognition task for the number of recognized self-scheme elements. These variables indicated no change in the depressive group following sleep deprivation. Depressive subjects' reaction times on self-descriptiveness ratings were significantly longer for positive than for negative self-scheme elements at the baseline session. The opposite was true for controls. Here, a sleep deprivation effect was evident. There was no longer a difference in the speed of information processing for positive as compared to negative self-scheme elements. This applied to both depressive and control groups.

Background The Euro-D depression scale consists of symptom clusters that may be differentially related to demographic and cognitive characteristics in older adults. This hypothesis needs further investigation and the role of measurement bias on substantive conclusions remains to be established. Method The study sample comprised 10,405 community-dwelling older adults from six Latin American countries. We applied a Multiple Indicators Multiple Causes (MIMIC) model for a concurrent investigation of measurement bias and of the association between Euro-D symptom clusters and background variables. Results The factorial validity of Euro-D, with a two-dimensional structure – affective suffering and motivation disturbance, was consistently supported in all countries. Although complete measurement invariance could not be assumed across countries, measurement bias was minor. Both Euro-D factors were unrelated to age, but related to gender, as well as to impairment in memory and verbal fluency. Gender differences were larger for affective suffering than for motivation disturbance, whereas differences in verbal fluency impairment were more strongly related to motivation disturbance. Limitations Our analytic strategies could only examine invariance at the level of indicator thresholds. The generalisability of current findings needs to be examined in clinical populations. A wider set of cognitive tests is needed. We did not examine the compositional factors that could have accounted for the variation in Euro-D scores across countries, as this was beyond the aims of the paper. Conclusion The current study adds evidence for the construct validity of Euro-D and for the possible differential association of depression symptom-clusters with gender and verbal fluency in older adults. An understanding of the heterogeneity of late-life depression may carry clinical implications for the diagnosis and treatment of depression in old age., Highlights • The Euro-D factor structure was invariant across Latin American countries. • Measurement bias was minor and did not alter substantive conclusions. • Depression domains were differentially related to gender and cognitive function. • Depression domains were unrelated to age. • Cognitive function levels confounded the effect of age on depression domains.

Background: The Euro-D depression scale consists of symptom clusters that may be differentially related to demographic and cognitive characteristics in older adults. This hypothesis needs further investigation and the role of measurement bias on substantive conclusions remains to be established. Method: The study sample comprised 10,405 community-dwelling older adults from six Latin American countries. We applied a Multiple Indicators Multiple Causes (MIMIC) model for a concurrent investigation of measurement bias and of the association between Euro-D symptom clusters and background variables. Results: The factorial validity of Euro-D, with a two-dimensional structure – affective suffering and motivation disturbance, was consistently supported in all countries. Although complete measurement invariance could not be assumed across countries, measurement bias was minor. Both Euro-D factors were unrelated to age, but related to gender, as well as to impairment in memory and verbal fluency. Gender differences were larger for affective suffering than for motivation disturbance, whereas differences in verbal fluency impairment were more strongly related to motivation disturbance. Limitations: Our analytic strategies could only examine invariance at the level of indicator thresholds. The generalisability of current findings needs to be examined in clinical populations. A wider set of cognitive tests is needed. We did not examine the compositional factors that could have accounted for the variation in Euro-D scores across countries, as this was beyond the aims of the paper. Conclusion: The current study adds evidence for the construct validity of Euro-D and for the possible differential association of depression symptom-clusters with gender and verbal fluency in older adults. An understanding of the heterogeneity of late-life depression may carry clinical implications for the diagnosis and treatment of depression in old age. & 2015 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license