P.1.j.043
Persisting neuropsychological cognitive-affective
deficits in emotional processing during remission
in recurrent major depressive disorder:
Associations with cognitive reactivity and future recurrence?
R.J.T. Mocking1, C.A. Figueroa1, P.W.J. Seeverens1, M.M. Rive1, M.W.J. Koeter1, C.J. Harmer2, A.H. Schene3, H.G. Ruhé4
1Academic
Medical Center Amsterdam, Psychiatry, Amsterdam, Netherlands; 2University of Oxford, Psychiatry, Oxford, United Kingdom; 3Radboud University Medical Center/Donders Institute
for Brain, Cognition and Behavior Radboud University, Psychiatry, Nijmegen, Netherlands; 4University Medical Center Groningen- University of Groningen, Psychiatry, Groningen, Netherlands.
Background and Aims
During depression, patients show cognitive deficits in “cold” (e.g. mental speed, memory, executive functioning) and “hot” (affective
biases in emotional processing) neuropsychological tasks.
Persisting cognitive dysfunction during remission may form a risk factor for recurrence in depression.
We previously showed persisting “cold” cognitive deficits during remission, but these did not predict recurrence/relapse.
With the present study, we tested to what extent “hot” neuropsychological deficits remain during remission and predict recurrence.
Methods
We included 69 patients with recurrent depression and 44 healthy matched controls. To exclude distortion due to residual symptoms or
antidepressants, patients were in full remission and medication free. We measured affective biases in emotional processing using the
University of Oxford’s "hot“ neuropsychological test battery. We followed-up the patients 2.5 years while monitoring recurrences.
Table 1
Results
Matching was successful. Even though patients were in full remission, they showed
higher levels of rumination and cognitive reactivity (Table 1). In addition, patients
responded differently to several of the “hot” neuropsychological tasks. Findings
remained comparable after correction for residual symptoms. Reaction times in the
emotional categorization task and exogenous cueing task were associated with
cognitive reactivity (P=0.045 and P=0.035, respectively). The facial expression and
exogenous cueing tasks were associated with recurrence (P=0.043 and P=0.016).
Fig. 2
P=0.004
corr 0.024
**
Patients
HDRS at intake
2.65 ±2.36
1.02 ±1.39
0.000
Rumination (RRS-NL)
37.6 ±11.42
26.6 ±5.08
0.000
Cognitive reactivity (LEIDS-R) 39.4 ±15.61
16.2 ±15.95
0.000
NA
NA
Recurrence in 20 months (%)
Fig. 3
Emotional cueing task
Patients responded relatively slower to
angry faces than controls (Fig. 3). Reaction times were also associated with relapse.
Patients that experienced a recurrence
during follow-up responded relatively
quicker, but the three-way interaction
between recurrence, face emotion, and
(in)congruence with the cue was also
significant (P=.016; Fig. 4). This effect also
became weaker after correction for residual
symptoms (P=.140).
48.8
P=0.037
*
Controls
Patients
Fig. 4
Controls
Patients
P=0.016
Corr 0.14
*
Relapse
Emotion & cue (in)congruence
Conclusions
Reference
Biases in emotional processing in recurrently depressed patients
remain during remission. In addition, these “hot”
neuropsychological alterations are associated with prospective
recurrence during follow-up. This latter effect was partially
associated with low levels of residual symptoms.
Protocol paper: Mocking et al. Vulnerability for
new episodes in recurrent major depressive
disorder: protocol for the longitudinal DELTAneuroimaging cohort study. BMJ Open, 2016.
The extent to which emotional processing can be used to predict
and/or prevent recurrence in the clinical setting will be investigated.
No relapse
Reaction time (msec, LN)
Patients responded
relatively quicker to
faces with a disgusted
expression than
controls (Fig. 2). Reaction times were also
associated with recurrence. Patients that
experienced a recurrence responded relatively
quicker to angry, sad, and surprised faces
(P=.043). This effect became weaker after
correction for residual symptoms (P=.285).
*
Controls
P
Reaction time (msec, LN)
Reaction time (msec, LN)
Patients responded
relatively slower to
positive self-referring
words than controls
(Fig. 1). There was no
significant association
with recurrence during follow-up (P=.063). The
emotional memory task showed no
differences.
Facial Expression
Recognition task
P=0.024
corr 0.019
Fig. 1
Healthy
controls
Reaction time (msec, LN)
Emotional
categorization
Remitted
rMDD
No Conflicts of Interest
Presenter: Roel J.T. Mocking, MSc, email: [email protected]