The diagnosis of lifetime major depressive disorders (MDDs) and of current major depressive episodes (MDEs) are relatively common in HIV-infected individuals, and often are assumed to influence neuropsychological (NP) performance. Although cross-sectional studies of HIV-infected individuals generally have found no systematic link between current MDE or depressive symptoms and NP performance, longitudinal studies are needed to clarify whether incident MDE may impact NP functioning in at least some cases. Two hundred twenty-seven human immunodeficiency virus (HIV)-infected adult men, who did not meet criteria for a current MDE at baseline, participated in a longitudinal NP study for an average of two years. Participants received repeated NP assessments, as well as structured psychiatric interviews to ascertain presence or absence of both lifetime MDD and current MDE. Ninety-eight participants had a lifetime history of MDD, and 23 participants met criteria for incident MDE at one of their follow-up evaluations. Groups with and without lifetime MDD and/or incident MDE had comparable demographics, HIV disease status and treatment histories at baseline, and numbers of intervening assessments between baseline and the final follow-up. Lifetime MDD was associated with greater complaints of cognitive difficulties in everyday life, and such complaints were increased at the times of incident MDE. However, detailed group comparisons revealed no NP performance differences in association with either lifetime or incident major depression. Finally, NP data from consistently nondepressed participants were used to develop "norms for change" and these findings failed to show any increased rates of NP worsening among individuals with incident MDE. Our results suggest that neurocognitive impairment and major depression should be considered as two independent processes.

Pre-injury psychosocial data provide an important context for understanding post-discharge outcome after brain injury. Holistic milieu-oriented rehabilitation facilitates long-term successful work, driving and relationship stability.

Cognitive Retraining exercises that incorporate both process variables and metacognitive skills, as well as a better working alliance with patients, positively related to return to work and school at the time of discharge from a holistic milieu-oriented programme.

This study was undertaken to investigate whether alcoholics differ qualitatively from controls in their organizational approach to the Rey–Osterrieth Complex Figure (ROCF) and to examine the effects of problem-solving and organizational ability on learning and retention. Data were collected on 3 groups of neuromedically healthy, middle-aged men: 29 recently detoxified alcoholics (RDA) abstinent at least 2 weeks, 29 long-term abstinent alcoholics (LTA) abstinent at least 18 months, and 29 nonalcoholic controls (NAC). Groups were comparable in age, education, WAIS–R Vocabulary score, and ANART IQ. Three indices of problem-solving approach were used to score how participants produce the ROCF during the copy condition: perceptual clustering, organization, and constructional accuracy. Learning and retention were measured by immediate recall, 20-min delayed recall, and recognition performance. RDAs had significantly impaired immediate recall, delayed recall, and recognition scores compared to NACs. RDAs also had significantly lower perceptual clustering, organization, and constructional accuracy scores than their long-term abstinent and nonalcoholic counterparts. Multiple regression analyses revealed that problem-solving ability at copy accounted for a significant proportion of the variance in immediate recall, delayed recall, and recognition. Further investigation of memory performance using a repeated measures design revealed that across the 3 groups, little forgetting occurred between immediate and delayed recall, while performance improved significantly on the recognition trial. Use of less efficient problem-solving strategies appears to affect RDAs' ability to learn and retrieve complex figural information. (JINS, 2000, 6, 12–19.)

Objective To evaluate the effect of a theory-based, culturally-targeted intervention on adherence to follow-up among low-income and minority women who experience an abnormal Pap test. Methods 5,049 women were enrolled and underwent Pap testing. Of these, 378 had an abnormal result and 341 (90%) were randomized to 1 of 3 groups to receive their results: Intervention (I): culturally-targeted behavioral and normative beliefs + knowledge/skills + salience + environmental constraints/barriers counseling; Active Control (AC): non-targeted behavioral and normative beliefs + knowledge/skills + salience + environmental constraints/barriers counseling; or Standard Care Only (SCO). The primary outcome was attendance at the initial follow-up appointment. Secondary outcomes included delay in care, completion of care at 18 months, state anxiety (STAI Y-6), depressive symptoms (CES-D), and distress (CDDQ). Anxiety was assessed at enrollment, notification of results, and 7–14 days later with the CDDQ and CES-D. Results 299 women were included in intent-to-treat analyses. Adherence rates were 60% (I), 54% (AC), and 58% (SCO), p=0.73. Completion rates were 39% (I) and 35% in the AC and SCO groups, p=0.77. Delay in care (in days) was (M ±SD): 58 ±75 (I), 69 ±72 (AC), and 54 ±75 (SCO), p=0.75. Adherence was associated with higher anxiety at notification, p<0.01 while delay <90 days (vs. 90+) was associated with greater perceived personal responsibility, p<0.05. Women not completing their care (vs. those who did) had higher CES-D scores at enrollment, p<0.05. Conclusions A theory-based, culturally-targeted message was not more effective than a non-targeted message or standard care in improving behavior.

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Cognitive retraining exercises that incorporate skill remediation, 'process' variables and metacognitive skills, as well as a better WA with patients, positively related to clearance to drive at the time of discharge from a holistic milieu-oriented programme.

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