Introduction:Major depressive disorder (MDD) is associated with cognitive impairment, including verbal memory. Limited knowledge exists following memory performance in first episode (FE) MDD. This study investigated verbal memory, depressive symptoms, and relapse in FE MDD over five years, from the trait, state, and scar perspectives. These perspectives suggests that deficits in memory either preexists, manifest in MDD, or exacerbates with every MDD episode, respectively. Methods:Thirty patients and 30 healthy matched controls (HC) were assessed using the California Verbal Learning Test, second edition (CVLT-II) across three test occasions; in the acute phase (Y0), at one-year (Y1) and five-year (Y5) follow-up. The relationship between CVLT-II scores and depression severity (measured by the Montgomery Åsberg Depression Rating Scale) and relapse at the five-year follow-up, was assessed. Results:The FE MDD group demonstrated significantly poorer performance on List A, Trial 1 immediate free recall at Y0 compared to HC, however correction for multiple comparisons the difference did not reach significance. No differences were observed in any other condition at any time point. Further, the PG had a significant improvement on List A, trial 1 from Y0 to Y5. No associations were found between symptom severity and verbal memory, and no performance differences were identified between patients with and without relapse in a five -year perspective. Discussion:In conclusion, individuals with FE MDD show normal verbal memory performance, but exhibit impaired performance on List A, Trial 1 immediate free recall in the acute phase improving in remission, indicative of a state-related deficit in auditory attention. No evidence of scarring deficits in the FE MDD group was observed in the follow-up period.

PURPOSE:Discharge from a psychiatric hospital is associated with an elevated risk of suicide. Previous studies have linked a higher number of psychiatric admissions to suicide risk. However, findings are mixed, and the association between admission frequency and suicide risk remains unclear. This study aimed to investigate whether frequent psychiatric admissions and the persistence of readmission patterns serve as risk factors for suicide. METHODS:This prospective total cohort study included all patients consecutively admitted to the psychiatric acute ward at Haukeland University Hospital in Bergen, Norway, between 2005 and 2014 (N = 7000). The cohort was divided into independent groups according to the number of admissions per year and the persistence of this pattern. Demographic and clinical data were collected at each admission. Patients were followed for up to 19 years by linking the cohort to the Norwegian Cause of Death Registry. Cox and competing risk regression analyses were applied to investigate the association between the frequency of admissions and the risk of suicide. RESULTS:There was an approximately threefold (AHR = 2.91) increase in the risk of suicide in patients with five or more admissions on average per utilisation year, when adjusted for gender, suicidal ideation, self-harm and diagnosis. The risk was particularly high (AHR = 5.93) immediately after the last discharge. CONCLUSIONS:These findings might assist the identification of a subgroup of individuals at particular risk of suicide within a population of hospitalised psychiatric patients.

To study the prospective associations between social factors and recovery in patients with psychotic disorders in mental health specialist services. In this prospective observational cohort study, analyzes were based on baseline- and follow-up data after 18 months from 108 patients with psychosis. Personal recovery was assessed by the Questionnaire about the Process of Recovery (QPR). Linear regression models were used to test the prospective associations between social predictor variables and QPR. An association was found between experienced quality of interpersonal relationships at baseline and change in QPR score over the next 18 months. Stratified analyzes showed that the effect of experienced quality of interpersonal relationships on recovery was due to an association among persons living with others. Patients’ experience of quality of interpersonal relationships are prospectively associated with recovery. In conclusion, findings indicate that interpersonal relationships and social interaction are central drivers of recovery in patients with psychotic disorders.

PTSD symptomatology is known to be associated with executive dysfunction. Inhibitory control is a core component of executive functioning, and inhibitory skills are essential both for adequate functioning in everyday life and important in situations following trauma. The aim of the present study was to examine the relationship between trauma exposure, inhibitory control and PTSD symptomatology in adolescent survivors of the terror attack at Utøya, Norway on the 22nd of July, 2011. In this cross-sectional case-control study, 20 trauma exposed adolescents and 20 healthy controls matched in age and gender were compared on a neuropsychological test of cognitive inhibition (Color-Word Interference Test) and a self-report measure of inhibition ability (BRIEF-A). Our analyses revealed that the trauma exposed group differed significantly on the self-reported measure of inhibitory control compared to the control group, but there were no differences between groups on the objective measures of cognitive inhibition. Follow-up analyses with subgroups in the trauma exposed group based on PTSD symptomatology (PTSD + and PTSD-) and the control group revealed that the PTSD- group showed significantly better results than both the PTSD + and the control group on the measures of inhibitory control. Moreover, the follow-up analyses showed that the PTSD + group showed significantly poorer results from the other two groups on the measures of inhibitory control and self-reported inhibition. We conclude that impaired inhibitory control, measured both objectively and by self-reported questionnaire, is related to PTSD symptomatology. Findings suggest that inhibitory dysfunctions may be a vulnerability factor for the development of PTSD symptomatology in trauma exposed adolescents, and thus it seems that the ability to exhibit inhibitory control could be a possible resilience factor to prevent the development of PTSD symptoms.

Mood disorders are associated with cognitive deficits, even in remission. There is heterogeneity in prevalence- and severity of such deficits, however. Risk factors like relapse, depressive symptoms, rumination, comorbidity, and family history of mental disorders, could exacerbate cognitive deficits. Longitudinal assessment of first episode depression could elucidate on how such risk factors are related to cognition.

Objective: Major Depressive Disorder (MDD) is associated with cognitive impairment in general, and Executive Functioning (EF) in particular, even in remitted phase of the disorder, suggesting residual cognitive symptoms. The aim of the present study was to investigate self-reported EF 1 year after the first episode of MDD and to explore this in relation to depressive mood symptoms, remission and relapse. Method: The study included data from 24 patients and 23 healthy control subjects 1 year after the patients' initial first episode of MDD. All participants completed the Behavior Rating Inventory of Executive Functioning-Adult version (BRIEF-A), a standardized self-report measure of perceived EF in everyday life, measuring nine different EF. Total index scores for metacognitive functions, behavior/emotional regulation functions and a global EF score is also calculated. Results: The patient group in total, independent of symptom status, reported significantly lower EF in all indexes compared to the healthy controls 1 year after the initial episode. However, higher depressive mood symptom load correlated with self-reported difficulties in metacognitive functions and poor global EF scores. Regulatory control of behavior and emotional responses did not show such strong association with mood symptoms, but low self-report scores on this measure was associated with relapse during the first year after the initial episode. Conclusion: First-episode patients report significant lower executive functioning in everyday life compared to individually matched healthy controls, 1 year after onset, independent of symptom load. Residual cognitive symptoms seem to be evident and associated with risk of relapse and should be targeted in treatment and prevention of recurrence in MDD.

Drug-death bereaved parents are at risk of high levels of prolonged grief (PG) symptoms. We included 93 Norwegian drug-death bereaved parents in a cross-sectional survey and aimed to explain PG symptoms. High levels of PG symptoms (M = 30.69) were identified. Low level of self-efficacy and withdrawal from others were the most strongly associated with high levels of grief symptoms (p < .001). However, contrary to our expectations, social support, gender, employment, demanding life situations, and perceived proximity did not correlate significantly to PG symptoms. Our findings can enhance individual follow-up of drug-death bereaved parents.

Major depression (MDD) is associated with cognitive deficits in processing speed and executive function (EF) following first episode (FE). It is unclear whether deficits are state or trait related. Studies following FE MDD over longer periods are lacking, making it uncertain how cognition and symptoms develop after the initial episode. The present study assessed cognitive function and symptoms 5 years following FE MDD. In addition, the study explored relationships between MDD symptoms, rumination, and cognitive deficits with regards to the trait, state, and scar perspective. Twenty-three participants with previous FE MDD, and 20 matched control participants were compared on Delis-Kaplan Executive Function System measures of processing speed and EF, in a 5-year longitudinal follow-up study. Correlations between current symptoms- and history of MDD, rumination, cognition were investigated. Findings indicated that cognitive deficits persisted with no clear signs of exacerbation after initial episode. Inhibition appeared independent of current and previous symptoms of depression. Processing speed was related to depressive- symptoms and rumination. In conclusion, results indicated persisting, stable deficits in both EFs and processing speed. Findings further suggest that depressive symptoms could be related to deficits in processing speed, indicating state effects. There was limited support for worsening of cognition after initial episode. Some aspects of EF like Inhibition could show persistent deficits independent of depressive symptoms indicating trait effects.

The aim of the present study was to investigate delayed recall, recognition, and visual-spatial memory among subjects (N=24) with major depressive disorder (MDD) following 9 months of recovery from acute depression. Visual-spatial memory assessment was conducted using the Rey Complex Figure Test. In the acute phase, the MDD subjects performed significantly worse compared with control subjects in delayed recall and recognition. Following 9 months of recovery, there were no longer differences between groups. The MDD group made a significant improvement in terms of depressive symptoms and performed better in recall and recognition. The results suggest that depression and memory performance are linked.

Introduction. Executive Functions (EF) has been documented to be impaired in patients with recurrent Major Depressive Disorder (MDD) in several studies. Longitudinal studies have suggested that these impairments may be a result of several episodes of depression or they may represent stable traits in this patient group. However, few studies have addressed these issues and investigated cognitive functioning with a particular focus on EF in patients who experience MDD for the first time. Methods. In the present study, the executive functions of inhibition, verbal fluency, mental flexibility, and planning and problem solving were investigated in a group of patients diagnosed with first episode MDD. Thirty patients and 30 control subjects were included in the study. Results. The patient group performed significantly more poorly in the cognitive functions of inhibition and semantic fluency. In addition, the patient group showed a reduced speed of mental processing on some of the measures. However, the results showed that reduced processing speed alone could not account for the poor performance in inhibition and semantic fluency. There were no differences between the two groups in the other measures of EF, indicating that functioning of mental flexibility, phonemic fluency, planning, and problem solving was intact in the patient group. Conclusions. The results show that impaired inhibition and semantic fluency are present early in the course of MDD. The present findings indicate that poor inhibition and performance in semantic fluency may represent stable traits in MDD, independent of symptom severity and the number of depressive episodes.

BACKGROUND:Intracranial arachnoid cysts have been shown to yield cognitive impairment over a range of basic mental functions, and these functions normalize after surgical cyst decompression. We wanted to investigate whether such cysts may also impair executive cognitive functions, and whether surgical cyst decompression leads to an improvement.METHODS:This study included 22 patients with arachnoid cysts and 13 control patients scheduled for low back surgery. All subjects were tested with Delis-Kaplan Executive Function System (D-KEFS) tests, assessing executive function 1 day before surgery and a minimum of 3 months after surgery. The data were analyzed according to scaled score computations based on raw scores provided by D-KEFS, adjusted for age, gender, and educational norms.RESULTS:Preoperatively, the patients with cysts group performed worse than the control group in verbal knowledge, mental flexibility, inhibitory capacity, problem solving, and planning skills. Postoperatively, the patients with cysts group significantly improved performance and were no longer different from the control group in the following subtests: inhibition, inhibition/switching, letter fluency, category switching, and total switching accuracy. The patients with cysts group also significantly improved performance in color naming, category fluency, and in the Tower test, but nevertheless remained impaired at follow-up compared with the control group. The control group did not show a similar improvement, except for the Tower test. Cyst size or postoperative volume reduction did not correlate with cognitive performance or postoperative improvement. Patients with left-sided temporal cysts performed poorer than patients with right-sided cysts on a complex verbal task demanding mental flexibility.CONCLUSIONS:Arachnoid cysts seem to impair not only basic cognition, but also executive functions. Most of this impairment appears to be reversible after surgical cyst decompression. These results may have implications for future preoperative considerations for patients with intracranial arachnoid cysts.

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.

Few studies have investigated cognitive functioning in a group of patients experiencing a first episode of depression. The aim of this study was to investigate how patients diagnosed with a first episode of depression perform in effortful and non-effortful information processing compared to healthy controls. An experimental paradigm based on a visual search test was applied. Thirty-one patients and thirty-one healthy controls were included in the study. All patients experienced a severe level of symptom load at the time of testing. Results showed no significant differences between groups under any of the conditions. Findings in the present study indicate that patients with a first episode of depression perform equally to healthy controls in tasks requiring visual attention in both effortful and non-effortful information processing.

Several studies have demonstrated impaired performance in inhibition and semantic fluency in the acute phase of illness in patients with recurrent major depression. However, few studies have investigated these functions longitudinally, focusing on how these impairments relate to symptoms over time. The present longitudinal study investigated whether the specific impairment in inhibition and semantic fluency seen in the acute phase of Major Depressive Disorder (MDD) was prolonged or normalized with symptom reduction in a 9-month follow-up. Twenty recurrent major depressive patients and 19 control subjects were included in the study. Inhibition and semantic fluency were investigated using tests from the Delis-Kaplan Executive Function System. The results show that the patient group still had significantly lower scores in inhibition and semantic fluency compared with the control group despite significant symptom reduction. Further, the results show that impaired inhibition in the acute phase was strongly correlated with impaired inhibition in the follow-up, suggesting that the inability to inhibit may represent a trait marker in recurrent MDD.

Background: It is widely accepted that depression is associated with deficits in a range of cognitive domains. However, there is no consensus regarding the neuropsychological profile in depression. Aim: The aim of the present report is to test the cognitive effort hypothesis as a possible framework for understanding the observed cognitive impairment in major depressive disorder (MDD), using the Delis Kaplan Executive Function system (D-KEFS). Method: Twenty-four patients with recurrent MDD, in the acute phase of illness, were compared with a healthy control group. We expected that the patient group would show impairment on tests that measure higher-level effortful cognitive processing, whereas basic cognitive skills would be equal to the control group. Results: There were no differences between the two groups on measures of basic cognitive skills, except for Colour Naming. Furthermore, MDD patients performed significantly worse than the control group on three out of seven of the cognitively effortful measures; namely Inhibition, Inhibition/Switching and Category Fluency. Conclusions: We could not find consistent support for the cognitive effort hypothesis in the present study. However, the results indicate that depressed patients have a specific impairment within the Executive Function domain affecting Inhibition, Inhibition/Switching and Category Fluency.

In the present study, verbal and visual memory functioning in a group of recurrent major depressive disorder patients were investigated. The study included 48 participants: 24 patients and 24 control subjects. Verbal and visual memory were investigated using the California Verbal Learning Test and the Rey Complex Figure Test. The results show that the depressed patients performed significantly worse compared with the controls on the very first trial in the verbal memory test. On all other conditions, the patients showed intact verbal memory, while visual memory was impaired. It is important to highlight the intact verbal memory performance in the acute phase of illness to detect cognitive strengths in this patient group.