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The current thesis aims to examine the relationship among attributional styles, eating disorder symptoms and depressive symptoms.

It was hypothesised that major depressive disorder (MDD) is associated with a dysfunctional reinforcement processing system, affecting both simple (“primary”) and social reinforcers.  The main objective of this thesis was to test this hypothesis.  MDD patients and matched healthy controls participated in a Pavlovian reward learning and a social inclusion task, and their neural responses were measured using functional MRI.  In addition, subjects participated in a behavioural facial recognition task.  It was additionally hypothesised that antidepressants may have an effect on reward-learning signals.  Hence, the acute effect of antidepressant (SSRI) administration on healthy controls was investigated in all three tasks.  During the Pavlovian task, neural reward-learning signals that conformed to a computational (temporal-difference) model were found to be abnormal in various brain regions in MDD patients.  In addition, acute SSRI administration reduced the reward-learning signals in controls.  These findings are consistent with existing evidence for opposing interactions between serotonin and dopamine.  Dopamine reward-learning signals are believed to be a fundamental neural substrate for reinforcement learning, hence abnormal signals implies abnormal reinforcement learning.  Consistent with the hypothesis, patients were also found to be impaired in recognising facial expressions of emotions, and acute SSRI administration was found to alter emotional information processing in controls.  Patients were found to have abnormal brain responses during the social inclusion task.  Abnormal emotional and social information processing, both related to abnormal reinforcement learning, may be a cause or effect of impaired social interactions in MDD.

Idag lever det drygt 350 miljoner människor i världen med depression och år 2020 beräknas depression vara det ledande skälet till sjuklighet i världen. I Sverige lever cirka 1,6 miljoner äldre varav runt 150 000 lider av depression. Antalet äldre som drabbas av depression ökar och tillståndet medför ett stort lidande, sänkt livskvalité samt ökar risken för dödlighet och suicid hos äldre. Sjuksköterskan har den avgörande rollen för att sätta in rätt omvårdnadsåtgärder då hen har den närmsta kontakten med denna patientgrupp. Syftet med studien var att belysa sjuksköterskans omvårdnadsåtgärder vid depression hos äldre. En allmän litteraturstudie genomfördes och resultatet baseras på 14 vetenskapliga artiklar som granskades och analyserades. Vid analysen av artiklarna framkom två kategorier: narrativt samtal på olika nivåer och att uppmuntra till meningsfulla handlingar. I resultat framkom omvårdnadsåtgärder som egenvård där sjuksköterskan tillsammans med den äldre fann egenvårdstrategier, att samordna och uppmuntra olika former av aktivitet som dans, musik, rörelseträning och social interaktion samt det narrativa samtalet där den äldre verbaliserade tankar, känslor samt minnen. Då antalet äldre med depression ökar bör utbildningar för allmänsjuksköterskor innehålla mer utbildning om depression hos äldre, dessutom bör kliniska verksamheter ge sjuksköterskan mer tid för att på så sätt ge äldre den omvårdnad som krävs vid depression.

Purpose: Many patients suffer from depression after a stroke. The aims of this feasibility study were to: examine the recruitment process of community dwelling stroke survivors in a study using an interactive computer program (Cognues®), determine the ability to assess cognitive function and depression status in subjects using Cognuse® and ascertain the usability of the Cognuse® program from the perspective of eight study participants. Methods: Stroke survivors in two community support groups and personal contact referrals were provided a research flyer and study synopsis, including background and study participation explanation. Eight stroke survivors agreed to take part in study. Each participant completed a depression and cognitive scale, three weeks of online computer exercises assigned by the PI, then a post-exercise depression and cognitive scale and a usability survey. Results: Recruitment was difficult; the proposed number (8-10) of stroke survivors was successfully fulfilled over a 6 month time period. Of the eight consented subjects, seven completed the study with one lost to follow-up. Pre- and -post depression and cognitive scales were compared and analyzed. Half of the participants showed a small increase in cognitive function and showed a significant positive change after completion of the online exercises. Usability of the Cognuse® program was overall perceived in a neutral capacity by the participants and although the subjects liked the idea of the program, it was not as user friendly as expected. Conclusion: Recruitment of community dwelling stroke survivors is feasible for a study using an online computer exercise program to determine emotional health. However, the usability of the selected program was determined to be neutral; participants liked the idea of the program but found there were many limitations. Upon completion of the three week online exercises, subjects showed an increase in cognitive function and slight decrease in depressive symptoms, illustrating a possible link between cognitive function and depression.

Background: Cognitive behavioral therapy (CBT) is an effective treatment modality for adolescents suffering from depression. Yet, it is often under-utilized among family nurse practitioners (FNPs) in the primary care setting. Known barriers exist within the realm of providers' lack of use of CBT in the primary setting, however, there is little research specifically on FNPs usage of the modality. Purpose: This paper seeks to understand FNPs' use of CBT in the primary care setting to treat adolescents with depression. Method and Sampling: A qualitative design was used to understand FNPs' use of CBT for adolescents suffering from depression. A faculty member and I recruited FNP participants through email. Ten FNPs currently working in the primary care setting with experience ranging from one to ten years participated in the study. Two focus group interviews were conducted in order to have a deeper understanding of the use of CBT in practice to treat adolescent depression. The interviews were audio taped and analyzed to reveal emerging themes. Results: After analyzing the audio recordings two common themes emerged: Unpreparedness and role conflict. Subthemes emerged within the area of unpreparedness that included knowledge regarding screening for depression in the adolescent population, utilization of clinical practice guidelines, available community resources and referrals, and the application of CBT in the treatment of adolescent depression. The theme of role conflict was associated with time constraints within the allotted time frame per patient and the conflict of providing mental health services when feeling as though their primary training is that of a family practice provider. Conclusion: The findings showed that the lack of use of CBT is multifactorial with knowledge being the greatest inhibiting factor. CBT is a recommended, first-line treatment option within the clinical practice guidelines for the treatment of adolescent depression. However, FNPs are not currently utilizing CBT in their practice to treat adolescent depression. There is much to be learned about adolescent depression in its entirety prior to incorporating CBT into practice.

This thesis examines the persistence of the negative contrast effect (NCE), a phenomenon reported in several studies, within the framework of the Spence-Amsel frustration hypothesis.

The primary purpose of the study was to quantify the characteristics of certain self cognitions that occur in depressed adolescents. A secondary purpose was to assess the change that occurs in these self cognitions during a depressive episode. The intervention, in the form of guided imagery about a previous drug-using episode, was used to induce a mood change. The REP, a Personal Construct Theory measure, and the Beck Depression Inventory were used in a repeated measures design.