Abstract Background The effects of therapeutic relationship (TR) in elder mental health are understudied. A greater understanding of TR in geriatric psychotherapy is particularly needed for treating ...late-life depression with executive dysfunction, which predicts poor response to antidepressant medication and presents unique clinical challenges. Methods Participants were older patients (N = 220) with major depression and executive dysfunction who received 12 weeks of problem-solving therapy or supportive therapy in a randomized control trial. Multilevel growth curve modeling and latent change scores were used to analyze TR dimensions of Understanding and Accepting at the patient level (individual patient ratings, N = 194) and therapist level (ratings of each therapist averaged across participants, N = 10). Results TR predicted reduction of depression in both treatment groups, while treatment x TR interactions were not significant. Patients treated by therapists with higher average Understanding (patient and therapist level) and Accepting (therapist level) ratings had greater decreases in depression. The patient level x therapist level interaction for Understanding approached statistical significance (p = .065), suggesting a synergistic effect on treatment outcome. Together, Understanding and Accepting predicted 21% of variance in depression level changes. Limitations TR was not assessed throughout the course of treatment (only after the first therapy session and at post-treatment) and did not include ratings from an objective evaluator. Conclusions Assessment of patient's experience of the TR and of therapist ability to foster Understanding and Accepting can play a significant role in the delivery of geriatric psychosocial interventions.
The association between orbital frontal cortex (OFC) volume and aggression and impulsivity was investigated among a heterogeneous group of non-psychotic psychiatric clients. Fifteen non-psychotic ...subjects from two different psychiatric clinics (New England Medical Center and Lemuel Shattuck Hospital) with a variety of diagnoses were sequentially referred for magnetic resonance imaging (MRI) for clinical purposes. This convenience sample, clinically stable at the time of evaluation, received a standardized psychiatric diagnostic interview, aggression and impulsivity psychometrics (Barratt Impulsivity, Lifetime History of Aggression, and Buss-Perry Aggression scales), and an MRI protocol with image analysis. OFC gray matter volume, total as well as left and right, was significantly and positively associated with motor impulsivity. OFC asymmetry was associated with aggression, though total, left, and right OFC volume measurements were not. For subjects without affective disorder, there was a strong and positive association of the OFC to motor and no-planning subscales of the Barratt Impulsivity Scale. For subjects with affective disorder, there was a strong association of OFC asymmetry to both of the aggression psychometrics. Consistent with expectation, results are suggestive of OFC involvement in the neural circuitry of impulsivity and aggression. The findings suggest a dissociation of the role of the OFC in relation to aggression and impulsivity, such that the OFC may play a part in the regulation of aggressive behavior and a generative role in impulsive behavior.
This study was conducted in response to calls to develop Iowa Gambling Task (IGT) metrics reflecting more homogeneous aspects of decision making, as well as to add to the literature on reliability ...and validity of the instrument. The conventional IGT metric, advantageous minus disadvantageous deck selections, was compared to alternatives in which Decks B and C or the first 40 selections were eliminated. We correlated these alternative metrics with performance on other neuropsychological tests in 214 healthy adults, and we compared participant subgroups stratified by health status (214 healthy and 43 unhealthy participants). Internal consistency of the IGT was low and could explain the modest levels of construct validity observed. Alternative metrics, especially Deck D minus Deck A selections (D-A), did improve construct and criterion validity of the IGT. They also showed different patterns of correlation with other neuropsychological measures and might enhance the clinical and scientific usefulness of this test. Future research with an eye to modifying the paradigm and/or administration procedures to increase intertrial consistency might also give a needed boost to construct and criterion validity.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
This study investigated neuroanatomic, genetic, cognitive, sociodemographic and emotional underpinnings of the Negative Urgency subscale of the Urgency, Premeditation, Perseverance, Sensation-Seeking ...and Positive Urgency Impulsive Behavior Scale in a healthy developmental sample. The goal of the investigation is to contribute to the harmonisation of behavioural, brain and neurogenetic aspects of behavioural self-control. Three domains – (1) Demographic, developmental, psychiatric and cognitive ability; (2) Regional brain volumes (neurobiological); and (3) Genetic variability (single nucleotide polymorphisms) – were examined, and models with relevant predictor variables were selected. Least absolute shrinkage and selection operator and best subset regressions were used to identify sparse models predicting negative urgency scores, which revealed that variables related to emotional regulation and right cingulate volume, as well as single nucleotide polymorphisms in CADM2 and SLC6A4, were associated with negative urgency. Our results contribute to the construct and criterion validity of negative urgency and support the hypothesis that negative urgency is a result of a complex array of influences across domains whose integration furthers developmental psychopathology research.
Functional magnetic resonance imaging (fMRI) was used in a non-patient experimental sample to assess the neuroanatomical dissociation of picture and description naming (PN and DN) in temporal lobe ...(TL). The purpose was to determine the generalizability of findings in semantic organization in the epilepsy patient population to the broader population. It was hypothesized that, akin to patient derived findings, DN would uniquely activate left TL regions anterior to those associated with PN, while overlapping in middle and posterior left TL. Participants (
n
= 16) underwent fMRI while silently naming target words during a picture naming task (PNT; line drawings) and description naming task (DNT; orthographic phrases). Analysis was a priori restricted to the left TL. Group results of direct contrasts (DNT > PNT and PNT > DNT) confirmed the hypothesized dissociation with DNT > PNT activating anterior left TL. Within-condition contrasts (DNT and PNT alone) yielded additional support, revealing areas of shared and unique activation in each condition. This is the first imaging study to contrast DN and PN in the same sample. The results suggest DN and PN are meaningfully different constructs subserved by converging and diverging TL neuroanatomy and may be differentially affected by disease.
Abstract The associations between brain matter volume in the cerebral cortex and set shifting and attentional control as operationalized by the Wisconsin Card Sort Test (WCST) and Condition Three of ...the Delis–Kaplan version of the Color Word Interference Test (CWIT) were investigated in 15 healthy controls and 16 heterogeneously diagnosed psychiatric patients with self-control problems using voxel based morphometry. Both groups underwent standardized magnetic resonance imaging and neuropsychological assessment. WCST and CWIT variables, and a composite, were regressed across the whole brain. Although CWIT performance levels were the same in both groups, neuroanatomic correlates for the psychiatric participants invoked the left hemisphere language system, but the bilateral dorsal attention system in the healthy controls. On its own, no neuroanatomic correlates were observed for the WCST. But when part of a composite with CWIT, neuroanatomic correlates in the dorsal attention system emerged for the psychiatric participants. Psychometric combinations of manifest executive task variables may best represent higher level latent neuro-cognitive control systems. Factor analytic studies of neuropsychological test performances suggest the constructs being measured are the same across psychiatric and non-diagnosed participants, however, imaging modalities indicate the relevant neural architecture can vary by group.
Divergent thinking is an important measurable component of creativity. This study tested the postulate that divergent thinking depends on large distributed inter- and intra-hemispheric networks. ...Although preliminary evidence supports increased brain connectivity during divergent thinking, the neural correlates of this characteristic have not been entirely specified. It was predicted that visuospatial divergent thinking would correlate with right hemisphere white matter volume (WMV) and with the size of the corpus callosum (CC).
Volumetric magnetic resonance imaging (MRI) analyses and the Torrance Tests of Creative Thinking (TTCT) were completed among 21 normal right-handed adult males.
TTCT scores correlated negatively with the size of the CC and were not correlated with right or, incidentally, left WMV.
Although these results were not predicted, perhaps, as suggested by
Bogen and Bogen (1988), decreased callosal connectivity enhances hemispheric specialization, which benefits the incubation of ideas that are critical for the divergent-thinking component of creativity, and it is the momentary inhibition of this hemispheric independence that accounts for the illumination that is part of the innovative stage of creativity. Alternatively, decreased CC size may reflect more selective developmental pruning, thereby facilitating efficient functional connectivity.
The Iowa Gambling Task (IGT) is a measure of decision-making, in which alternative metrics have greater construct validity than conventional metrics. No large scale study has examined the neural ...correlates in healthy adults. We administered the IGT and structural MRI to 124 healthy participants. We analyzed the conventional IGT metric of advantageous minus disadvantageous choices (i.e., decks C + D minus decks A + B), and three alternative metrics based on choices from decks D and A alone, and all selections from each deck. Using regression and voxel-based morphometry, we examined regional gray matter volumes as predictors of IGT performance. No neural correlates of the conventional metric emerged, and the neural correlates of individual deck selections were disparate from one another. Alternative metrics showed expected neural correlates of decision-making in prefrontal cortex, insula, thalamus, and other regions. IGT alternative metrics have neural correlates consistent with decision-making theory as those difference scores reduce heterogeneity in cognitive processes. The CD-AB metric construct failure may reflect an artificial amalgamation of processes. The D-A metric appears to more successfully combine multiple levels of representation (dorsolateral prefrontal cortex, sub-cortical, cerebellar).
Abstract The association between orbital frontal cortex (OFC) volume and aggression was investigated in an at-risk psychiatric population. Forty-one psychiatric patients were referred for magnetic ...resonance imaging and a standardized psychometric assessment of aggression (Lifetime History of Aggression-Revised). Nineteen matched controls had lower levels of aggression and greater OFC volume, establishing the appropriateness of the psychiatric group for studying aggression pathophysiology. Consistent with study hypotheses, left OFC gray matter volume predicted 34% of the variance in self-reported aggression ratings. When impulsivity was not controlled for, left OFC gray matter only accounted for 26% of aggression variance, suggesting a complex relationship between impulsivity and OFC–aggression pathophysiology. Contrary to study hypotheses, right OFC gray matter volume did not predict degree of aggressive behavior. Current models do not account for lateralization, yet this may be quite important. Greater consideration should be given to laterality in OFC regulation of social/emotional behavior. Regulatory focus theory, positing two motivational systems, promotion and prevention, lateralized to the left and right hemispheres, respectively, may provide an explanatory framework for these results. Dysregulation of the left hemisphere ‘promotion’ motivational system may help to explain the aggressive behavior present in psychiatric populations.
Abstract Investigating the organization of trait aggression and impulsivity in the prefrontal cortex (PFC) advances our understanding of the neuropsychobiology of self-control. While the orbital ...aspect of the PFC (OFC) has received attention, there is reason to believe the lateral aspect is also relevant. In the current study using magnetic resonance imaging, gray matter volumes in lateral PFC (LPFC) were derived in a heterogeneous male psychiatric sample ( N = 36) in which OFC volumes had previously been reported. In an analysis using self-report measures of trait impulsivity and aggression, the left LPFC accounted for significant variance in attentional aspects of impulsivity (13%) and aggression (10%) but not motor aspects of impulsivity, as hypothesized. The OFC was associated with motor impulsivity (left-20%; right-14%) and was also more robustly associated with aggression (left-36%; right-16%). A social/emotional information processing model was explored, based upon whether the LPFC or the OFC depended upon one another for their association to trait aggression and impulsivity. It was demonstrated that association of the LPFC to both aggression and attentional impulsivity depended upon the OFC, while the converse was not supported. The LPFC appears relevant to the higher-order aspects of a cortical self-control network, and that relevance is dependent upon the robust contribution of the OFC.
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