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neuropsychiatrie

, Volume 33, Issue 3, pp 123–130 | Cite as

Verstimmt, verzerrt, vergesslich: Das Zusammenwirken emotionaler und kognitiver Dysfunktionen bei Depression

  • Lorenz B. DehnEmail author
  • Thomas Beblo
review
  • 170 Downloads

Zusammenfassung

Bei Depressionen kommt es charakteristischerweise zu Veränderungen des emotionalen Befindens, z. B. dem verminderten Erleben positiver Emotionen, sowie zu kognitiven Beeinträchtigungen, wie Konzentrations- und Gedächtnisschwierigkeiten. Diese emotionalen und kognitiven Dysfunktionen sind eng miteinander verknüpft und tragen entscheidend zur Entstehung und Aufrechterhaltung der depressiven Symptomatik bei. So zeigen Patienten mit Depression beispielsweise eine negativ-verzerrte Informationsverarbeitung, die sowohl die Aufmerksamkeit und das Gedächtnis als auch die Reaktion auf Feedback betrifft. Hinzu kommt eine erhöhte Vermeidungsmotivation bezüglich negativ bewerteter Zustände und eine gleichzeitig verminderte Motivation zur Annährung an positive Ziele. Zudem zeigen depressive Patienten auch häufig einen veränderten Denkstil, der als Rumination bezeichnet wird und das wiederholte, intensive Nachdenken über Ursachen, Folgen und Symptome der eigenen negativen Gefühle umfasst. Die verschiedenen Zusammenhänge zwischen diesen emotionalen, motivationalen und kognitiven Symptomen depressiver Patienten sollen in dieser Arbeit übersichtsartig dargestellt werden. Dabei wird vor allem auch der Einfluss ihres Zusammenwirkens auf die kognitive Leistungsfähigkeit genauer beleuchtet. Die hier hervorgehobene klinische Relevanz der emotional-kognitiven Dysfunktionen sollte auch in therapeutischen Interventionen vermehrt Berücksichtigung finden.

Schlüsselwörter

Depression Emotionen Kognition Motivation Rumination Neuropsychologie 

Depressed, biased, forgetful: The interaction of emotional and cognitive dysfunctions in depression

Summary

Major depressive disorder is characterized by changes in the emotional state, e. g. the diminished experience of positive emotions, as well as cognitive impairments such as concentration and memory difficulties. These emotional and cognitive dysfunctions are closely interrelated and play a key role for the development and maintenance of depressive symptoms. For instance, patients with depression show negatively biased information processing that affects attention and memory as well as their reaction to feedback. In addition, there is an increased motivation to avoid negatively evaluated conditions and at the same time a reduced motivation to approach positive goals. Furthermore, depressed patients often show a specific style of thinking, called rumination, which involves repeated, intensive thinking about the causes, consequences and symptoms of one’s own negative feelings. In this review, the different relationships between emotional, motivational and cognitive symptoms of depressive patients will be presented and the influence of their interaction on cognitive performance will be discussed. The highlighted clinical relevance of emotional-cognitive dysfunctions should be considered more often in therapeutic interventions for depressed patients.

Keywords

Depressive Disorder Emotions Cognition Motivation Rumination Neuropsychology 

Notes

Interessenkonflikt

L.B. Dehn und T. Beblo geben an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    American Psychiatric Association. Diagnostisches und statistisches Manual psychischer Störungen-DSM-5®. Göttingen: Hogrefe Verlag; 2014.Google Scholar
  2. 2.
    Weltgesundheitsorganisation, WHO. Internationale Klassifikation psychischer Störungen. ICD-10 Kapitel V (F) Klinisch-diagnostische Leitlinien. ICD-10. Bern/Göttingen: Verlag Hans Huber; 1991.Google Scholar
  3. 3.
    Christensen H, Griffiths K, Mackinnon A, Jacomb P. A quantitative review of cognitive deficits in depression and Alzheimer-type dementia. J Int Neuropsychol Soc. 1997;3:631–51.CrossRefGoogle Scholar
  4. 4.
    Bora E, Harrison B, Yücel M, Pantelis C. Cognitive impairment in euthymic major depressive disorder: a meta-analysis. Psychol Med. 2013;43:2017–26.CrossRefGoogle Scholar
  5. 5.
    Rock PL, Roiser JP, Riedel WJ, Blackwell AD. Cognitive impairment in depression: a systematic review and meta-analysis. Psychol Med. 2014;44:2029–40.CrossRefGoogle Scholar
  6. 6.
    Baune BT, McAfoose J, Leach G, Quirk F, Mitchell D. Impact of psychiatric and medical comorbidity on cognitive function in depression: Comorbidity and cognition in MDD. Psychiatry Clin Neurosci. 2009;63:392–400.CrossRefGoogle Scholar
  7. 7.
    Beblo T. Die Bedeutung kognitiver Beeinträchtigungen bei depressiven Patienten. Z Für. Neuropsychol. 2016;27:69–83.CrossRefGoogle Scholar
  8. 8.
    Porter RJ, Robinson LJ, Malhi GS, Gallagher P. The neurocognitive profile of mood disorders – a review of the evidence and methodological issues. Bipolar Disord. 2015;17:21–40.CrossRefGoogle Scholar
  9. 9.
    Hasselbalch BJ, Knorr U, Kessing LV. Cognitive impairment in the remitted state of unipolar depressive disorder: A systematic review. J Affect Disord. 2011;134:20–31.CrossRefGoogle Scholar
  10. 10.
    Lee RS, Hermens DF, Porter MA, Redoblado-Hodge MA. A meta-analysis of cognitive deficits in first-episode major depressive disorder. J Affect Disord. 2012;140:113–24.CrossRefGoogle Scholar
  11. 11.
    Gorwood P, Corruble E, Falissard B, Goodwin GM. Toxic Effects of Depression on Brain Function: Impairment of Delayed Recall and the Cumulative Length of Depressive Disorder in a Large Sample of Depressed Outpatients. Am J Psychiatry. 2008;165:731–9.CrossRefGoogle Scholar
  12. 12.
    Porter RJ, Bourke C, Gallagher P. Neuropsychological Impairment in Major Depression: Its Nature, Origin and Clinical Significance. Aust N Z J Psychiatry. 2007;41:115–28.CrossRefGoogle Scholar
  13. 13.
    Beblo T, Sinnamon G, Baune BT. Specifying the neuropsychology of affective disorders: clinical, demographic and neurobiological factors. Neuropsychol Rev. 2011;21:337–59.CrossRefGoogle Scholar
  14. 14.
    Bosaipo NB, Foss MP, Young AH, Juruena MF. Neuropsychological changes in melancholic and atypical depression: A systematic review. Neurosci Biobehav Rev. 2017;73:309–25.CrossRefGoogle Scholar
  15. 15.
    Herrmann LL, Goodwin GM, Ebmeier KP. The cognitive neuropsychology of depression in the elderly. Psychol Med. 2007;37:1693–1702.CrossRefGoogle Scholar
  16. 16.
    Conradi H, Ormel J, De Jonge P. Presence of individual (residual) symptoms during depressive episodes and periods of remission: a 3-year prospective study. Psychol Med. 2011;41:1165–74.CrossRefGoogle Scholar
  17. 17.
    Richard-Devantoy S, Berlim M, Jollant F. A meta-analysis of neuropsychological markers of vulnerability to suicidal behavior in mood disorders. Psychol Med. 2014;44:1663–73.CrossRefGoogle Scholar
  18. 18.
    McIntyre RS, Cha DS, Soczynska JK, Woldeyohannes HO, Gallaugher LA, Kudlow P, et al. Cognitive deficits and functional outcomes in major depressive disorder: determinants, substrates, and treatment interventions. Depress Anxiety. 2013;30:515–27.CrossRefGoogle Scholar
  19. 19.
    Evans VC, Iverson GL, Yatham LN, Lam RW. The relationship between neurocognitive and psychosocial functioning in major depressive disorder: a systematic review. J Clin Psychiatry. 2014;75:1359–70.CrossRefGoogle Scholar
  20. 20.
    Mathews A, MacLeod C. Cognitive vulnerability to emotional disorders. Annu Rev Clin Psychol. 2005;1:167–95.CrossRefGoogle Scholar
  21. 21.
    Kircanski K, Joormann J, Gotlib IH. Cognitive aspects of depression. Wiley Interdiscip Rev Cogn Sci. 2012;3:301–13.CrossRefGoogle Scholar
  22. 22.
    Roiser JP, Sahakian BJ. Hot and cold cognition in depression. Cns Spectr. 2013;18:139–49.CrossRefGoogle Scholar
  23. 23.
    Gotlib IH, Joormann J. Cognition and depression: current status and future directions. Annu Rev Clin Psychol. 2010;6:285–312.CrossRefGoogle Scholar
  24. 24.
    Beck AT. Kognitive therapie der depression. Bd. 23. Weinheim/Basel: Beltz; 1999.Google Scholar
  25. 25.
    Beck AT. The evolution of the cognitive model of depression and its neurobiological correlates. Am J Psychiatry. 2008;165:969–77.CrossRefGoogle Scholar
  26. 26.
    Bower GH. Mood and memory. Am Psychol. 1981;36:129.CrossRefGoogle Scholar
  27. 27.
    Power M, Dalgleish T. Cognition and emotion. New York: Psychology Press; 2008.Google Scholar
  28. 28.
    Ingram RE. Toward an information-processing analysis of depression. Cogn Ther Res. 1984;8:443–77.CrossRefGoogle Scholar
  29. 29.
    Joormann J. Cognitive Inhibition and Emotion Regulation in Depression. Curr Dir Psychol Sci. 2010;19:161–6.CrossRefGoogle Scholar
  30. 30.
    Everaert J, Koster EH, Derakshan N. The combined cognitive bias hypothesis in depression. Clin Psychol Rev. 2012;32:413–24.CrossRefGoogle Scholar
  31. 31.
    Peckham AD, McHugh RK, Otto MW. A meta-analysis of the magnitude of biased attention in depression. Depress Anxiety. 2010;27:1135–42.CrossRefGoogle Scholar
  32. 32.
    Bourke C, Douglas K, Porter R. Processing of facial emotion expression in major depression: a review. Aust N Z J Psychiatry. 2010;44:681–96.CrossRefGoogle Scholar
  33. 33.
    Beblo T, Mensebach C, Wingenfeld K, Schlosser N, Rullkoetter N, Schaffrath C, et al. The impact of neutral and emotionally negative distraction on memory performance and its relation to memory complaints in major depression. Psychiatry Res. 2010;178:106–11.CrossRefGoogle Scholar
  34. 34.
    Koster EHW, De Raedt R, Leyman L, De Lissnyder E. Mood-congruent attention and memory bias in dysphoria: Exploring the coherence among information-processing biases. Behav Res Ther. 2010;48:219–25.CrossRefGoogle Scholar
  35. 35.
    Wisco BE. Depressive cognition: Self-reference and depth of processing. Clin Psychol Rev. 2009;29:382–92.CrossRefGoogle Scholar
  36. 36.
    Joormann J, Yoon KL, Zetsche U. Cognitive inhibition in depression. Appl Prev Psychol. 2007;12:128–39.CrossRefGoogle Scholar
  37. 37.
    Malhi GS, Byrow Y, Fritz K, Das P, Baune BT, Porter RJ, et al. Mood disorders: neurocognitive models. Bipolar Disord. 2015;17:3–20.CrossRefGoogle Scholar
  38. 38.
    Leppänen JM. Emotional information processing in mood disorders: a review of behavioral and neuroimaging findings. Curr Opin Psychiatry. 2006;19:34–9.  https://doi.org/10.1097/01.yco.0000191500.46411.00.CrossRefGoogle Scholar
  39. 39.
    Trew JL. Exploring the roles of approach and avoidance in depression: An integrative model. Clin Psychol Rev. 2011;31:1156–68.CrossRefGoogle Scholar
  40. 40.
    Ellwart T, Rinck M, Becker ES. Selective memory and memory deficits in depressed inpatients. Depress Anxiety. 2003;17:197–206.CrossRefGoogle Scholar
  41. 41.
    Romero N, Sanchez A, Vazquez C. Memory biases in remitted depression: The role of negative cognitions at explicit and automatic processing levels. J Behav Ther Exp Psychiatry. 2014;45:128–35.CrossRefGoogle Scholar
  42. 42.
    Nolen-Hoeksema S, Wisco BE, Rethinking Rumination LS. Perspect Psychol Sci. 2008;3:400–24.CrossRefGoogle Scholar
  43. 43.
    King MJ, MacDougall AG, Ferris SM, Levine B, MacQueen GM, McKinnon MC. A review of factors that moderate autobiographical memory performance in patients with major depressive disorder. J Clin Exp Neuropsychol. 2010;32:1122–44.CrossRefGoogle Scholar
  44. 44.
    Williams JMG, Barnhofer T, Crane C, Herman D, Raes F, Watkins E, et al. Autobiographical memory specificity and emotional disorder. Psychol Bull. 2007;133:122–48.CrossRefGoogle Scholar
  45. 45.
    Williams JMG. Ca pture and r umination, f unctional a voidance, and e x ecutive control (CaRFAX): Three processes that underlie overgeneral memory. Cogn Emot. 2006;20:548–68.CrossRefGoogle Scholar
  46. 46.
    Murphy FC, Sahakian BJ, O’Carroll RE. Cognitive Impairment in Depression: Psychological Models and Clinical Issues. In: Ebert D, Ebmeier KP, Hrsg. Basel: KARGER. Adv. Biol. Psychiatry, Bd. 19. 1998. S. 1–33.Google Scholar
  47. 47.
    Steffens DC, Wagner HR, Levy RM, Horn KA, Krishnan KRR. Performance feedback deficit in geriatric depression. Biol Psychiatry. 2001;50:358–63.CrossRefGoogle Scholar
  48. 48.
    Elliott R, Sahakian BJ, Herrod JJ, Robbins TW, Paykel ES. Abnormal response to negative feedback in unipolar depression: evidence for a diagnosis specific impairment. J Neurol Neurosurg Psychiatry. 1997;63:74–82.CrossRefGoogle Scholar
  49. 49.
    Murphy FC, Michael A, Robbins TW, Sahakian BJ. Neuropsychological impairment in patients with major depressive disorder: the effects of feedback on task performance. Psychol Med. 2003;33:455–67.CrossRefGoogle Scholar
  50. 50.
    Tavares JT, Drevets W, Sahakian B. Cognition in mania and depression. Psychol Med. 2003;33:959–67.CrossRefGoogle Scholar
  51. 51.
    Thomsen KR. Measuring anhedonia: impaired ability to pursue, experience, and learn about reward. Front Psychol. 2015;6:1409.CrossRefGoogle Scholar
  52. 52.
    Treadway MT, Zald DH. Reconsidering anhedonia in depression: lessons from translational neuroscience. Neurosci Biobehav Rev. 2011;35:537–55.CrossRefGoogle Scholar
  53. 53.
    Barch DM, Pagliaccio D, Luking K. Mechanisms underlying motivational deficits in psychopathology: similarities and differences in depression and schizophrenia. In: Simpson E, Balsam PD, Hrsg. Behav. Neurosci. Motiv., Berlin/Heidelberg: Springer; 2015. S. 411–49.Google Scholar
  54. 54.
    Sherdell L, Waugh CE, Gotlib IH. Anticipatory pleasure predicts motivation for reward in major depression. J Abnorm Psychol. 2012;121:51.CrossRefGoogle Scholar
  55. 55.
    Pizzagalli DA. Depression, stress, and anhedonia: toward a synthesis and integrated model. Annu Rev Clin Psychol. 2014;10:393–423.CrossRefGoogle Scholar
  56. 56.
    McFarland BR, Klein DN. Emotional reactivity in depression: diminished responsiveness to anticipated reward but not to anticipated punishment or to nonreward or avoidance. Depress Anxiety. 2009;26:117–22.CrossRefGoogle Scholar
  57. 57.
    Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K. Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol. 1996;64:1152.CrossRefGoogle Scholar
  58. 58.
    Benitez A, Horner MD, Bachman D. Intact cognition in depressed elderly veterans providing adequate effort. Arch Clin Neuropsychol. 2011;26:184–93.CrossRefGoogle Scholar
  59. 59.
    Richards PM, Ruff RM. Motivational effects on neuropsychological functioning: comparison of depressed versus nondepressed individuals. J Consult Clin Psychol. 1989;57:396.CrossRefGoogle Scholar
  60. 60.
    Scheurich A, Fellgiebel A, Schermuly I, Bauer S, Wölfges R, Müller M. Experimental evidence for a motivational origin of cognitive impairment in major depression. Psychol Med. 2008;38:237–46.CrossRefGoogle Scholar
  61. 61.
    Moritz S, Stöckert K, Hauschildt M, Lill H, Jelinek L, Beblo T, et al. Are we exaggerating neuropsychological impairment in depression? Reopening a closed chapter. Expert Rev Neurother. 2017;17:839–46.CrossRefGoogle Scholar
  62. 62.
    Lahr D, Beblo T, Hartje W. Cognitive performance and subjective complaints before and after remission of major depression. Cogn Neuropsychiatry. 2007;12:25–45.CrossRefGoogle Scholar
  63. 63.
    Potvin S, Charbonneau G, Juster R‑P, Purdon S, Tourjman SV. Self-evaluation and objective assessment of cognition in major depression and attention deficit disorder: Implications for clinical practice. Compr Psychiatry. 2016;70:53–64.CrossRefGoogle Scholar
  64. 64.
    Barnow S, Aldinger M, Ulrich I, Stopsack M. Emotionsregulation bei depression: ein multimethodaler Überblick. Psychol Rundsch. 2013;64:235–43.CrossRefGoogle Scholar
  65. 65.
    Nolen-Hoeksema S. Responses to depression and their effects on the duration of depressive episodes. J Abnorm Psychol. 1991;100:569.CrossRefGoogle Scholar
  66. 66.
    Smith JM, Alloy LB. A roadmap to rumination: A review of the definition, assessment, and conceptualization of this multifaceted construct. Clin Psychol Rev. 2009;29:116–28.CrossRefGoogle Scholar
  67. 67.
    Teismann T, Steinfeld B, Willutzki U, Rumination Ablenkung MJ. Ausgewählte Befunde zur Response Styles Theorie. PPmP. Psychother Psychosom Med Psychol. 2011;61:126–32.CrossRefGoogle Scholar
  68. 68.
    Ciesla JA, Roberts JE. Rumination, negative cognition, and their interactive effects on depressed mood. Emotion. 2007;7:555.CrossRefGoogle Scholar
  69. 69.
    Abramson LY, Seligman ME, Teasdale JD. Learned helplessness in humans: Critique and reformulation. J Abnorm Psychol. 1978;87:49.CrossRefGoogle Scholar
  70. 70.
    Whitmer AJ, Gotlib IH. An attentional scope model of rumination. Psychol Bull. 2013;139:1036.CrossRefGoogle Scholar
  71. 71.
    Fredrickson BL, Branigan C. Positive emotions broaden the scope of attention and thought-action repertoires. Cogn Emot. 2005;19:313–32.CrossRefGoogle Scholar
  72. 72.
    Andrews PW, Thomson JA Jr. The bright side of being blue: depression as an adaptation for analyzing complex problems. Psychol Rev. 2009;116:620.CrossRefGoogle Scholar
  73. 73.
    Joormann J, Gotlib IH. Updating the contents of working memory in depression: Interference from irrelevant negative material. J Abnorm Psychol. 2008;117:182.CrossRefGoogle Scholar
  74. 74.
    Philippot P, Brutoux F. Induced rumination dampens executive processes in dysphoric young adults. J Behav Ther Exp Psychiatry. 2008;39:219–27.CrossRefGoogle Scholar
  75. 75.
    Watkins E, Brown R. Rumination and executive function in depression: An experimental study. J Neurol Neurosurg Psychiatry. 2002;72:400–2.CrossRefGoogle Scholar
  76. 76.
    Donaldson C, Lam D. Rumination, mood and social problem-solving in major depression. Psychol Med. 2004;34:1309–18.CrossRefGoogle Scholar
  77. 77.
    Crane C, Barnhofer T, Visser C, Nightingale H, Williams JMG. The effects of analytical and experiential rumination on autobiographical memory specificity in individuals with a history of major depression. Behav Res Ther. 2007;45:3077–87.CrossRefGoogle Scholar
  78. 78.
    Hayes SC, Wilson KG. Acceptance and commitment therapy: Altering the verbal support for experiential avoidance. Behav Anal. 1994;17:289–303.CrossRefGoogle Scholar
  79. 79.
    Teismann T, Von Brachel R, Hanning S, Grillenberger M, Hebermehl L, Hornstein I, et al. A randomized controlled trial on the effectiveness of a rumination-focused group treatment for residual depression. Psychother Res. 2014;24:80–90.CrossRefGoogle Scholar
  80. 80.
    Wells TT, Beevers CG. Biased attention and dysphoria: Manipulating selective attention reduces subsequent depressive symptoms. Cogn Emot. 2010;24:719–28.CrossRefGoogle Scholar
  81. 81.
    Beblo T. Neuropsychological Impairment of Patients with Depression. In: Baune B Tully P Ed Cardiovasc Dis Depress Heidelberg: Springer;. 2016;p:123–44.Google Scholar
  82. 82.
    Deckersbach T, Nierenberg AA, Kessler R, Lund HG, Ametrano RM, Sachs G, et al. Cognitive rehabilitation for bipolar disorder: an open trial for employed patients with residual depressive symptoms. Cns Neurosci Ther. 2010;16:298–307.CrossRefGoogle Scholar
  83. 83.
    Iacoviello BM, Wu G, Alvarez E, Huryk K, Collins KA, Murrough JW, et al. Cognitive-emotional training as an intervention for major depressive disorder. Depress Anxiety. 2014;31:699–706.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für Psychiatrie und Psychotherapie – ForschungsabteilungEvangelisches Klinikum Bethel (EvKB)BielefeldDeutschland

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