This thesis sought to investigate the relationships between treatment delays in bipolar disorder (BD) and cognitive impairments which characterize the disorder, measured both objectively and...Show moreThis thesis sought to investigate the relationships between treatment delays in bipolar disorder (BD) and cognitive impairments which characterize the disorder, measured both objectively and subjectively. Previous studies have established that a long delay occurs between the onset of mood symptoms in BD and the first form of treatment received, estimates ranging between 6 and 11 years. Cognitive impairments in the domains of executive functions, processing speed and memory were found to persist in BD patients even during euthymia. Such cognitive impairments burden BD patients, prevent them from regaining an appropriate level of general functioning and diminish their quality of life. Thus, in order to determine whether treatment delay impacts the cognitive impairments present in BD, 69 participants were followed over the course of one year, at three different time points. The participants took part in clinical interviews, and then were asked to complete multiple measures, such as the YMRS, the QIDS, four WAIS subscales (Block Design, Arithmetic, Information and Digit symbol), and the Cognition subscale of the WHODAS. The average treatment delay found in the current sample was 14.53 years. The results of the current study suggest that longer treatment delays did not significantly predict worse cognitive functioning in BD patients, either when measured subjectively, or when measured objectively.Show less
Background: People with type 1 diabetes (T1D) often experience problems with their glucose regulation (glucose variability and glucose control), sleep quality, and cognitive functioning. However,...Show moreBackground: People with type 1 diabetes (T1D) often experience problems with their glucose regulation (glucose variability and glucose control), sleep quality, and cognitive functioning. However, their interrelation has not often been investigated. The aim of this study was to investigate how sleep quality and cognitive functioning are associated with glucose regulation in people with T1D. Method: Continuous glucose monitoring (CGM) data was collected over two weeks, in 18 participants, while each day subjective sleep quality (once in the morning) and cognitive functioning (e.g., ability to concentrate, finding words) (up to five times during the day) was measured using ecological momentary assessments (EMAs). Based on the CGM data, glycemic parameters (glucose variability and glucose control) during the night and day were calculated and a mean value of cognitive functioning per day was composed. Linear mixed model analyses were used to test for 1) whether sleep quality was influenced by glycemic parameters during the night and 2) whether cognitive functioning during the day was influenced by sleep quality and whether cognitive functioning was associated with glycemic parameters during the day. In addition, an interaction effect between sleep quality and glucose variability on cognitive functioning was explored. Lastly, visual plots were used to explore the associations on an individual level. Results: No statistically significant main effects were found for either association. However, an interaction trend (ß = -2.07, p = .070) between sleep quality and glucose variability on cognitive functioning scores was found. For days with normal fluctuations in glucose levels, better sleep quality was associated with better cognitive functioning, whereas for days with high glucose variability, this association could not be found. Regarding the individual plots, both, positive and negative relationships between all mentioned variables were apparent, exemplifying important inter-individual differences. Conclusion: For people with T1D, the relationships between glucose parameters, sleep quality, and cognitive functioning, vary from person to person. This finding advocates for looking at the individual level when implementing possible treatment methods for increasing sleep quality and cognitive functioning. More research in a larger sample is warranted to further examine the inter-individual factors in these associations.Show less
In the Netherlands, more than 1 million people have accumulated debts. They can go to debt counseling to receive help for their financial problems. The current research investigated what type of...Show moreIn the Netherlands, more than 1 million people have accumulated debts. They can go to debt counseling to receive help for their financial problems. The current research investigated what type of help participants prefer to offer to a person in debt, focusing on two types of help: budget coaching, where debtors are being coached to keep their autonomy, and is often offered to people in early debt stages. We defined this as autonomy-oriented help. With budget management, the finances are taken off hands to relieve the debtor from stress, which is often offered to people in late debt stages. We defined this as dependency-oriented help. Previous research showed that people need dependency-oriented help when their financial stress causes cognitive impairments, we think this is also needed in an intermediate debt stage, than only in a late debt stage. We investigated if participants empathized with the help- seeker, would acknowledge the amount of stress, and would offer dependency-oriented help in an intermediate stage. Therefore, we manipulated the three debt stages; early, intermediate, and late, and manipulated perspective-taking. In this experiment, participants (N = 374) were randomly assigned to the manipulation conditions, read a scenario about a debtor in need, and filled out a questionnaire. We found that participants indicated acknowledging the stress of the help-seeker, but by taking perspective, participants indicated offering more autonomy- oriented help than dependency-oriented help. With this research, we suggest the debt counseling of the Netherlands to provide debt counselors the knowledge about debts, stress, and cognitive functioning.Show less
Background: Post-traumatic stress disorder (PTSD) has been associated with impairments across cognitive abilities. While some prior work suggests that the PTSD symptom domain of intrusion may be...Show moreBackground: Post-traumatic stress disorder (PTSD) has been associated with impairments across cognitive abilities. While some prior work suggests that the PTSD symptom domain of intrusion may be most strongly related to cognitive impairment, little is known about the relation of cognitive functioning with individual PTSD symptoms or other symptom domains, and the temporal stability of such relations. The current study addresses these questions. Methods: Data were analysed from 1,484 trauma-exposed U.S. military veterans (Mdn=65 years) who participated in the National Health and Resilience in Veterans Study (NHRVS). We estimated four regularised partial correlation networks of DSM-5 PTSD symptoms at baseline (past month or lifetime) and cognitive functioning at baseline and three-year follow-up, respectively. Network comparison tests examined temporal stability, and sensitivity analyses the robustness of the associations. Results: Across network models, difficulty concentrating and trouble experiencing positive feelings consistently showed unique negative relations to cognitive functioning. Contrary to expectations, the symptom domains of alterations in arousal and reactivity, as well as cognition and mood were more strongly linked to cognitive functioning than the other two domains. Network structures and overall strength did not significantly differ between cross-sectional and longitudinal networks. Conclusion: Overall, we highlight the importance of links between PTSD symptoms and symptom domains on the one hand, and cognitive functioning on the other—relations obfuscated by modelling only PTSD diagnosis or sum score. Given that longitudinal processes between the two constructs appear to be present, we recommend monitoring of cognitive functioning and integrating it into clinical care of PTSD.Show less
