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Catherine J. Harmer - One of the best experts on this subject based on the ideXlab platform.
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Value of monitoring negative Emotional Bias in primary care in England for personalised antidepressant treatment: a modelling study.
Evidence Based Mental Health, 2019Co-Authors: Judit Simon, Catherine J. Harmer, J Kingslake, Gerard R. Dawson, Colin T. Dourish, Guy M. GoodwinAbstract:Background Depressed patients often focus on negative life events. Effective antidepressant therapy reverses this negative Emotional Bias (NEB) within 1 week. Clinical therapeutic effect usually requires 4–6 weeks. The value of implementing NEB monitoring for the personalisation of antidepressant therapy is unknown. Objective To estimate the likely outcome and cost consequences of adopting the P1vital Oxford Emotional Test Battery (ETB) for this purpose in routine primary care in England. Methods A hybrid decision analytic model (decision tree plus Markov model) was developed to estimate the cost-effectiveness of ETB monitoring versus no ETB over 52 weeks using quality-adjusted life years (QALYs). Differences in depression severity, episode type and analytical perspectives were considered. Input data were derived from relevant guidelines, literature, national databases, expert opinion and the developers for the year 2013. Multiple sensitivity analyses addressed uncertainty. Findings The mean number of ETB tests is 2.162 per newly diagnosed patient and 2.166 per patient with recurrent depression. The incremental cost-effectiveness of ETB versus ‘no ETB’ is £4355/QALY from the healthcare perspective. From the broader societal perspective, ETB is more effective and cost saving. Conclusions Monitoring negative Emotional Bias in primary care in England for personalised antidepressant treatment using ETB seems as an effective and cost-effective option under all considered scenarios (including worst case). Its main economic value seems to lie in reduced productivity loss as opposed to healthcare savings. Clinical implications The test supports accelerated application of evidence-based depression care. Further optimisation and implementation in the ongoing European PReDicT trial is ongoing.
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Emotional Biases and Recurrence in Major Depressive Disorder. Results of 2.5 Years Follow-Up of Drug-Free Cohort Vulnerable for Recurrence.
Frontiers in Psychiatry, 2019Co-Authors: Henricus G. Ruhé, Catherine J. Harmer, Michael Browning, Roel J. T. Mocking, Caroline A. Figueroa, Paulien W. J. Seeverens, Nessa Ikani, Anna Tyborowska, Janna N. Vrijsen, Aart H. ScheneAbstract:An interesting factor explaining recurrence risk in Major Depressive Disorder (MDD) may be neuropsychological functioning, i.e., processing of Emotional stimuli/information. Negatively Biased processing of Emotional stimuli/information has been found in both acute and (inconclusively) remitted states of MDD, and may be causally related to recurrence of depression. We aimed to investigate self-referent, memory and interpretation Biases in recurrently depressed patients in remission and relate these Biases to recurrence. We included 69 remitted recurrent MDD-patients (rrMDD-patients), 35–65 years, with ≥2 episodes, voluntarily free of antidepressant maintenance therapy for at least 4 weeks. We tested self-referent Biases with an Emotional categorization task, Bias in Emotional memory by free recall of the emotion categorization task 15 min after completing it, and interpretation Bias with a facial expression recognition task. We compared these participants with 43 never-depressed controls matched for age, sex and intelligence. We followed the rrMDD-patients for 2.5 years and assessed recurrent depressive episodes by structured interview. The rrMDD-patients showed Biases toward Emotionally negative stimuli, faster responses to negative self-relevant characteristics in the Emotional categorization, better recognition of sad faces, worse recognition of neutral faces with more misclassifications as angry or disgusting faces and less misclassifications as neutral faces (0.001 < p < 0.05). Of these, the number of misclassifications as angry and the overall performance in the Emotional memory task were significantly associated with the time to recurrence (p ≤ 0.04), independent of residual symptoms and number of previous episodes. In a support vector machine data-driven model, prediction of recurrence-status could best be achieved (relative to observed recurrence-rate) with demographic and childhood adversity parameters (accuracy 78.1%; 1-sided p = 0.002); neuropsychological tests could not improve this prediction. Our data suggests a persisting (mood-incongruent) Emotional Bias when patients with recurrent depression are in remission. Moreover, these persisting Biases might be mechanistically important for recurrence and prevention thereof.
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predicting treatment response to antidepressant medication using early changes in Emotional processing
European Neuropsychopharmacology, 2019Co-Authors: Catherine J. Harmer, J Kingslake, Guy M. Goodwin, Michael Browning, C T Dourish, Gerard R. DawsonAbstract:Abstract Antidepressants must be taken for weeks before response can be assessed with many patients not responding to the first medication prescribed. This often results in long delays before effective treatment is started. Antidepressants induce changes in the processing of Emotional stimuli early in the course of treatment. In the current study we assessed whether changes in Emotional processing and subjective symptoms over the first week of antidepressant treatment predicted clinical response after 4–8 weeks of treatment. Such a predictive test may shorten the time taken to initiate effective treatment in depressed patients. Seventy-four depressed primary care patients completed measures of Emotional Bias and subjective symptoms before starting antidepressant treatment and then again 1 week later. Response to treatment was assessed after 4–6 weeks. The performance of classifiers based on these measures was assessed using a leave-one-out validation procedure with the best classifier then tested in an independent sample from a second study of 239 patients. The combination of a facial emotion recognition task and subjective symptoms predicted response with 77% accuracy in the training sample and 60% accuracy in the independent study, significantly better than possible using baseline response rates. The face based measure of Emotional Bias provided good quality data with high acceptability ratings. Changes in Emotional processing can provide a sensitive early measure of antidepressant efficacy for individual patients. Early treatment induced changes in Emotional processing may be used to guide antidepressant therapy and reduce the time taken for depressed patients to return to good mental health.
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Investigating d-cycloserine as a potential pharmacological enhancer of an Emotional Bias learning procedure.
Journal of Psychopharmacology, 2018Co-Authors: Marcella L. Woud, Catherine J. Harmer, Emily A. Holmes, Simon E. Blackwell, Susann Steudte-schmiedgen, Michael Browning, Juergen Margraf, Andrea ReineckeAbstract:The partial N-methyl-D-aspartate receptor agonist d-cycloserine may enhance psychological therapies. However, its exact mechanism of action is still being investigated. Cognitive Bias modification ...
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Associations between mood instability and Emotional processing in a large cohort of bipolar patients.
Psychological Medicine, 2016Co-Authors: Amy Bilderbeck, Guy M. Goodwin, Zoe E Reed, H Mcmahon, Lauren Z Atkinson, Jonathan Price, John R. Geddes, Catherine J. HarmerAbstract:Background Aberrant Emotional Biases have been reported in bipolar disorder (BD), but results are inconsistent. Despite the clinical relevance of chronic mood variability in BD, there is no previous research investigating how the extent of symptom fluctuations in bipolar disorder might relate to Emotional Biases. This exploratory study investigated, in a large cohort of bipolar patients, whether instability in weekly mood episode symptoms and other clinical and demographic factors were related to Emotional Bias as measured in a simple laboratory task. Method Participants (N = 271, BDI = 206, BDII = 121) completed an ‘Emotional categorization and memory’ task. Weekly self-reported symptoms of depression and mania were collected prospectively. In linear regression analyses, associations between cognitive Bias and mood variability were explored together with the influence of demographic and clinical factors, including current medication. Results Greater accuracy in the classification of negative words relative to positive words was associated with greater instability in depressive symptoms. Furthermore, greater negative Bias in free recall was associated with higher instability in manic symptoms. Participants diagnosed with BDII, compared with BDI, showed overall better word recognition and recall. Current antipsychotic use was associated with reduced instability in manic symptoms but this did not impact on Emotional processing performance. Conclusions Emotional processing Biases in bipolar disorder are related to instability in mood. These findings prompt further investigation into the underpinnings as well as clinical significance of mood instability.
Marc Vérin - One of the best experts on this subject based on the ideXlab platform.
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Effect of dopamine therapy on nonverbal affect burst recognition in Parkinson's disease.
PLoS ONE, 2013Co-Authors: Julie Péron, Didier Grandjean, Sophie Drapier, Marc VérinAbstract:Parkinson's disease (PD) provides a model for investigating the involvement of the basal ganglia and mesolimbic dopaminergic system in the recognition of emotions from voices (i.e., Emotional prosody). Although previous studies of Emotional prosody recognition in PD have reported evidence of impairment, none of them compared PD patients at different stages of the disease, or ON and OFF dopamine replacement therapy, making it difficult to determine whether their impairment was due to general cognitive deterioration or to a more specific dopaminergic deficit. We explored the involvement of the dopaminergic pathways in the recognition of nonverbal affect bursts (onomatopoeias) in 15 newly diagnosed PD patients in the early stages of the disease, 15 PD patients in the advanced stages of the disease and 15 healthy controls. The early PD group was studied in two conditions: ON and OFF dopaminergic therapy. Results showed that the early PD patients performed more poorly in the ON condition than in the OFF one, for overall emotion recognition, as well as for the recognition of anger, disgust and fear. Additionally, for anger, the early PD ON patients performed more poorly than controls. For overall emotion recognition, both advanced PD patients and early PD ON patients performed more poorly than controls. Analysis of continuous ratings on target and nontarget visual analog scales confirmed these patterns of results, showing a systematic Emotional Bias in both the advanced PD and early PD ON (but not OFF) patients compared with controls. These results i) confirm the involvement of the dopaminergic pathways and basal ganglia in Emotional prosody recognition, and ii) suggest a possibly deleterious effect of dopatherapy on affective abilities in the early stages of PD.
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Recognition of Emotional prosody is altered after subthalamic nucleus deep brain stimulation in Parkinson's disease.
Neuropsychologia, 2010Co-Authors: Julie Péron, Didier Grandjean, Florence Le Jeune, Paul Sauleau, Claire Haegelen, Dominique Drapier, Tiphaine Rouaud, Sophie Drapier, Marc VérinAbstract:The recognition of facial emotions is impaired following subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD). These changes have been linked to a disturbance in the STN's limbic territory, which is thought to be involved in Emotional processing. This was confirmed by a recent PET study where these Emotional modifications were correlated with changes in glucose metabolism in different brain regions, including the amygdala and the orbitofrontal regions that are well known for their involvement in Emotional processing. Nevertheless, the question as to whether these Emotional changes induced by STN DBS in PD are modality-specific has yet to be answered. The objective of this study was therefore to examine the effects of STN DBS in PD on the recognition of Emotional prosody. An original Emotional prosody paradigm was administered to twenty-one post-operative PD patients, twenty-one pre-operative PD patients and twenty-one matched controls. Results showed that both the pre- and post-operative groups differed from the healthy controls. There was also a significant difference between the pre and post groups. More specifically, an analysis of their continuous judgments revealed that the performance of the post-operative group compared with that of the other two groups was characterized by a systematic Emotional Bias whereby they perceived emotions more strongly. These results suggest that the impaired recognition of emotions may not be specific to the visual modality but may also be present when emotions are expressed through the human voice, implying the involvement of the STN in the brain network underlying the recognition of Emotional prosody.
Jonathan P Roiser - One of the best experts on this subject based on the ideXlab platform.
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Prefrontal cortex stimulation does not affect Emotional Bias, but may slow emotion identification
Social Cognitive and Affective Neuroscience, 2017Co-Authors: Camilla L. Nord, D. Chamith Halahakoon, Ian S. Penton-voak, Sophie Forster, Marcus Robert Munafo, Jonathan P RoiserAbstract:Transcranial direct current stimulation (tDCS) has recently garnered attention as a putative depression treatment. However, the cognitive mechanisms by which it exerts an antidepressant effect are unclear: tDCS may directly alter 'hot' Emotional processing Biases, or alleviate depression through changes in 'cold' (non-Emotional) cognitive function. Here, 75 healthy participants performed a facial emotion identification task during 20 minutes of anodal or sham tDCS over the left dorsolateral prefrontal cortex (DLPFC) in a double-blind, within-subject crossover design. A subset of 31 participants additionally completed a task measuring attentional distraction during stimulation. Compared to sham stimulation, anodal tDCS of the left DLPFC resulted in an increase in response latency across all Emotional conditions. Bayesian analysis showed definitively that tDCS exerted no emotion-dependent effect on behaviour. Thus, we demonstrate that anodal tDCS produces a general, rather than an emotion-specific, effect. We also report a preliminary finding in the subset of participants who completed the distractibility task: increased distractibility during active stimulation correlated significantly with the degree to which tDCS slowed emotion identification. Our results provide insight into the possible mechanisms by which DLPFC tDCS may treat symptoms of depression, suggesting that it may not alter Emotional Biases, but instead may affect 'cold' cognitive processes.
Rebecca M. C. Spencer - One of the best experts on this subject based on the ideXlab platform.
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napping reduces Emotional attention Bias during early childhood
Developmental Science, 2017Co-Authors: Amanda Cremone, Laura B F Kurdziel, Ada Fraticellitorres, Jennifer Martin Mcdermott, Rebecca M. C. SpencerAbstract:Sleep loss alters processing of Emotional stimuli in preschool-aged children. However, the mechanism by which sleep modifies Emotional processing in early childhood is unknown. We tested the hypothesis that a nap, compared to an equivalent time spent awake, reduces Biases in attention allocation to affective information. Children (n = 43; M = 55.40 months, SD = 8.05 months) completed a Dot Probe task, which provides a measure of attention Biases to Emotional stimuli, following a mid-day nap and an equivalent interval spent awake. No Emotional attention Biases emerged when children napped. However, when nap-deprived, children exhibited Biases towards negative and positive stimuli. This Emotional Bias after wake was greater in children who napped habitually. Gender differences also emerged such that females were more attentive to positive Emotional stimuli whereas males showed heightened attention to negative Emotional stimuli, regardless of having napped or not. Moreover, greater slow wave activity (SWA) during the nap was associated with faster responding, which suggests that SWA may promote efficiency of attention allocation. A video abstract of this article can be viewed at: https://www.youtube.com/watch?v=JIoZ8mzxQgg
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Emotional Bias of sleep-dependent processing shifts from negative to positive with aging.
Neurobiology of Aging, 2016Co-Authors: Bethany J. Jones, Kurt S. Schultz, Sydney Adams, Bengi Baran, Rebecca M. C. SpencerAbstract:Age-related memory decline has been proposed to result partially from impairments in memory consolidation over sleep. However, such decline may reflect a shift toward selective processing of positive information with age rather than impaired sleep-related mechanisms. In the present study, young and older adults viewed negative and neutral pictures or positive and neutral pictures and underwent a recognition test after sleep or wake. Subjective Emotional reactivity and affect were also measured. Compared with waking, sleep preserved valence ratings and memory for positive but not negative pictures in older adults and negative but not positive pictures in young adults. In older adults, memory for positive pictures was associated with slow wave sleep. Furthermore, slow wave sleep predicted positive affect in older adults but was inversely related to positive affect in young adults. These relationships were strongest for older adults with high memory for positive pictures and young adults with high memory for negative pictures. Collectively, these results indicate preserved but selective sleep-dependent memory processing with healthy aging that may be Biased to enhance Emotional well-being.
Guy M. Goodwin - One of the best experts on this subject based on the ideXlab platform.
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Value of monitoring negative Emotional Bias in primary care in England for personalised antidepressant treatment: a modelling study.
Evidence Based Mental Health, 2019Co-Authors: Judit Simon, Catherine J. Harmer, J Kingslake, Gerard R. Dawson, Colin T. Dourish, Guy M. GoodwinAbstract:Background Depressed patients often focus on negative life events. Effective antidepressant therapy reverses this negative Emotional Bias (NEB) within 1 week. Clinical therapeutic effect usually requires 4–6 weeks. The value of implementing NEB monitoring for the personalisation of antidepressant therapy is unknown. Objective To estimate the likely outcome and cost consequences of adopting the P1vital Oxford Emotional Test Battery (ETB) for this purpose in routine primary care in England. Methods A hybrid decision analytic model (decision tree plus Markov model) was developed to estimate the cost-effectiveness of ETB monitoring versus no ETB over 52 weeks using quality-adjusted life years (QALYs). Differences in depression severity, episode type and analytical perspectives were considered. Input data were derived from relevant guidelines, literature, national databases, expert opinion and the developers for the year 2013. Multiple sensitivity analyses addressed uncertainty. Findings The mean number of ETB tests is 2.162 per newly diagnosed patient and 2.166 per patient with recurrent depression. The incremental cost-effectiveness of ETB versus ‘no ETB’ is £4355/QALY from the healthcare perspective. From the broader societal perspective, ETB is more effective and cost saving. Conclusions Monitoring negative Emotional Bias in primary care in England for personalised antidepressant treatment using ETB seems as an effective and cost-effective option under all considered scenarios (including worst case). Its main economic value seems to lie in reduced productivity loss as opposed to healthcare savings. Clinical implications The test supports accelerated application of evidence-based depression care. Further optimisation and implementation in the ongoing European PReDicT trial is ongoing.
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predicting treatment response to antidepressant medication using early changes in Emotional processing
European Neuropsychopharmacology, 2019Co-Authors: Catherine J. Harmer, J Kingslake, Guy M. Goodwin, Michael Browning, C T Dourish, Gerard R. DawsonAbstract:Abstract Antidepressants must be taken for weeks before response can be assessed with many patients not responding to the first medication prescribed. This often results in long delays before effective treatment is started. Antidepressants induce changes in the processing of Emotional stimuli early in the course of treatment. In the current study we assessed whether changes in Emotional processing and subjective symptoms over the first week of antidepressant treatment predicted clinical response after 4–8 weeks of treatment. Such a predictive test may shorten the time taken to initiate effective treatment in depressed patients. Seventy-four depressed primary care patients completed measures of Emotional Bias and subjective symptoms before starting antidepressant treatment and then again 1 week later. Response to treatment was assessed after 4–6 weeks. The performance of classifiers based on these measures was assessed using a leave-one-out validation procedure with the best classifier then tested in an independent sample from a second study of 239 patients. The combination of a facial emotion recognition task and subjective symptoms predicted response with 77% accuracy in the training sample and 60% accuracy in the independent study, significantly better than possible using baseline response rates. The face based measure of Emotional Bias provided good quality data with high acceptability ratings. Changes in Emotional processing can provide a sensitive early measure of antidepressant efficacy for individual patients. Early treatment induced changes in Emotional processing may be used to guide antidepressant therapy and reduce the time taken for depressed patients to return to good mental health.
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Associations between mood instability and Emotional processing in a large cohort of bipolar patients.
Psychological Medicine, 2016Co-Authors: Amy Bilderbeck, Guy M. Goodwin, Zoe E Reed, H Mcmahon, Lauren Z Atkinson, Jonathan Price, John R. Geddes, Catherine J. HarmerAbstract:Background Aberrant Emotional Biases have been reported in bipolar disorder (BD), but results are inconsistent. Despite the clinical relevance of chronic mood variability in BD, there is no previous research investigating how the extent of symptom fluctuations in bipolar disorder might relate to Emotional Biases. This exploratory study investigated, in a large cohort of bipolar patients, whether instability in weekly mood episode symptoms and other clinical and demographic factors were related to Emotional Bias as measured in a simple laboratory task. Method Participants (N = 271, BDI = 206, BDII = 121) completed an ‘Emotional categorization and memory’ task. Weekly self-reported symptoms of depression and mania were collected prospectively. In linear regression analyses, associations between cognitive Bias and mood variability were explored together with the influence of demographic and clinical factors, including current medication. Results Greater accuracy in the classification of negative words relative to positive words was associated with greater instability in depressive symptoms. Furthermore, greater negative Bias in free recall was associated with higher instability in manic symptoms. Participants diagnosed with BDII, compared with BDI, showed overall better word recognition and recall. Current antipsychotic use was associated with reduced instability in manic symptoms but this did not impact on Emotional processing performance. Conclusions Emotional processing Biases in bipolar disorder are related to instability in mood. These findings prompt further investigation into the underpinnings as well as clinical significance of mood instability.
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Agomelatine facilitates positive versus negative affective processing in healthy volunteer models
Journal of Psychopharmacology, 2010Co-Authors: Catherine J. Harmer, Gerard R. Dawson, Colin T. Dourish, Christian De Bodinat, Lara Waldenmaier, Sally Adams, Philip J. Cowen, Guy M. GoodwinAbstract:Agomelatine is a new antidepressant with a novel profile of pharmacological action. The clinical efficacy of agomelatine has been established in major depression, but its actions on Emotional Bias ...