To investigate whether recent first episode major depression in adolescence is characterised by selected executive difficulties in attentional flexibility, behavioural inhibition and decision-making.
Selected executive functions were compared in adolescents with recent (past year) first episode major depression (n = 30) and community controls (n = 49). Three computerised tests within the CANTAB battery were completed by all subjects (the Intra-Dimensional, Extra-Dimensional Set-Shifting task, the Affective Go, No-Go task, and the Decision-Making task).
Compared with controls, recently depressed cases displayed a bias towards negative stimuli with fewer errors on sad words as well as being more accurate in their responses to sad targets on the Affective Go, No-Go task. Cases also made faster decisions in the context of betting more of their available points compared to controls, as indexed by the Decision-Making task. These results were not influenced by age, gender, IQ, recent mood, severity of depression, medication or comorbidity.
Adolescents with recent first episode major depression show greater attention towards sad stimuli and more impulsive behaviour when making decisions. They were able to switch attentional set to neutral stimuli. This study demonstrates that computerised tests for measuring executive functions can be successfully deployed in adolescents, and suggests that specific patterns of neuropsychological functions may be relatively compromised in first episode major depression. These, together with their underlying neural substrates, deserve further investigation within this age range.
"Although these studies have found evidence of affective bias, they do not precisely mirror those reported in adult studies. Kyte et al. (2005) compared the performance of healthy controls to that of adolescents with a first onset of depression in the past year. Recently depressed adolescents made more commission errors during blocks with happy targets, suggesting they were less able to inhibit responses to sad distractors. "
"There is also substantial evidence that early selfregulatory skills are predictive of children's successful adjustment in the longer term, as higher levels of regulation have been linked with positive developmental outcomes including greater self-esteem, professional attainment, and better health in later childhood and adolescence (Moffitt et al. 2011; Shoda et al. 1990). Conversely , poor self-regulation has been associated with a host of negative outcomes including attention deficit hyperactivity disorder (ADHD), school failure, addiction/ substance abuse, and anxiety and depression (Diamond 2005; Hester and Garavan 2004; Ivanov et al. 2008; Kyte et al. 2005; Moffitt et al. 2011). Thus, there has been increasing interest in intervention and prevention strategies targeting self-regulation during early childhood when children are acquiring these foundational skills (Blair 2002; Higgins and Spiegel 2004). "
"First-episode MDD patients have been found, in the acute phase of illness, to be impaired in verbal inhibition and perserverative tendency (Ilonen et al., 2000; Karabekiroglu et al., 2010). However, this subgroup of MDD patients has also been found to show impulsive behavior in decision-making and to have greater attention toward sad stimuli compared to healthy controls, but intact performance in switching attentional set (Kyte et al., 2005). Intact EF has also been reported in groups consisting of both first and recurrent MDD patients in the acute phase (Grant et al., 2001; Westheide et al., 2007). "
[Show abstract][Hide abstract] ABSTRACT: The present study investigated the Executive Functions (EF) of inhibition, mental flexibility and phonemic and semantic fluency in a 1-year follow-up assessment of patients diagnosed with first episode Major Depressive Disorder (MDD). In the acute phase, the patient group performed significantly poorer compared to the control group (CG) in inhibition and semantic fluency. The present study pursued these findings from the acute phase to see if the impairment seen in inhibition and semantic fluency in the acute phase normalized or persisted in the follow-up assessment. In addition, the present study investigated the association between poor inhibition and semantic fluency performance and the experience of relapse during the 1-year period. Twenty eight patients and 28 individually matched control subjects were included. EF was reassessed using three tests from the Delis Kaplan Executive Function System (D-KEFS).
Results: There was a significant decrease in depression severity score from the acute phase, showing that most of the patients were in remission in the follow-up assessment. Results showed a sustained impairment in inhibition and semantic fluency in the patient group. However, the performance in inhibition was more severe when an additional requirement of mental flexibility was included. There were no group differences in the other EF functions measured. Further, patients with a relapse in the course of 1 year performed significantly poorer in inhibition/switching at inclusion compared to patients that did not relapse and the CG. This relationship was not found for semantic fluency. Poor performance in inhibition and semantic fluency are prolonged despite symptom reduction in patients with a first episode of MDD. Moreover, although based on a small sample of patients, the present study showed that there may be a relationship between impaired ability in the EF of inhibition/switching and vulnerability for the experience of relapse.
Frontiers in Psychology 09/2013; 4:633. DOI:10.3389/fpsyg.2013.00633 · 2.80 Impact Factor
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