Cognitive dysfunction : Assessed by Questionnaires in a Population Sample and in Patients with Affective or Anxiety Disorders Before, During and After Treatment

Abstract: The aim of the present thesis was to study the Swedish versions of the Dysfunctional Attitude Scale (DAS) and the Automatic Thoughts Questionnaire (ATQ) regarding their psychometric properties and to investigate their place in the cognitive theory of psychopathology. For these purposes samples were collected of the general population and of different psychopathological groups in different stages of illness and the results were compared with clinical diagnoses according to the DSM-III-R and IV and selfand observer ratings of depression and anxiety.The assumed parallelism between DAS-A and DAS-B received strong support through the present study. The correlations between sum scores of the two forms A and B at two occasions indicates a rather high reliability of the Swedish version. The validity of the DAS-A as a measure of depressive cognitive content was supported. The present thesis incorporates, as far as known to the author, the first study which has investigated the DAS in a randomly selected normal sample with sex and age distributions similar to that of the normal population. The psychometric properties iu this sample were similar to the results of earlier normative studies of the scale. A cumulative percentage normative scale of the DAS-A scores is presented. Dysfunctional attitudes was shown to be a state dependent variable in depressive disorder. This is consistent with results from several earlier studies. Contradictory to earlier results a predictive value of the DAS and the ATQ for pharmacological treatment response was not supported. Patients with panic disorder without depression were shown to have scores on the DAS and ATQ in the normal range. The hypothesis of a specificity of dysfunctional attitudes and negative automatic thoughts for major depression contra panic disorder and a sensitivity of negative automatic thoughts to absolute and relative levels of mild depressive symptomatology in patients with panic disorder is supported. Patients with generalised anxiety disorder without major depression were shown to have DAS scores in the same range as patients with major depression and ATQ scores in the same range as patients with panic disorder and normal subjects. The high DAS score was not reduced by pharmacotherapy, in spite of normalised anxiety level, in contrast to the treatment effect on high DAS scores in major depression. The results indicate that the DAS score, apart from being related to depressive mood, reflects a trait quality in GAD, separating GAD from PD. The lack of effect of pharmacological treatment on the dysfunctional attitudes could implicate a need for psychotherapy.