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Birner A, Mairinger M, Elst C, Maget A, Fellendorf FT, Platzer M, Queissner R, Lenger M, Tmava-Berisha A, Bengesser SA, Reininghaus EZ, Kreuzthaler M, Dalkner N. Machine-based learning of multidimensional data in bipolar disorder - pilot results. Bipolar Disord 2024; 26:364-375. [PMID: 38531635 DOI: 10.1111/bdi.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Owing to the heterogenic picture of bipolar disorder, it takes approximately 8.8 years to reach a correct diagnosis. Early recognition and early intervention might not only increase quality of life, but also increase life expectancy as a whole in individuals with bipolar disorder. Therefore, we hypothesize that implementing machine learning techniques can be used to support the diagnostic process of bipolar disorder and minimize misdiagnosis rates. MATERIALS AND METHODS To test this hypothesis, a de-identified data set of only demographic information and the results of cognitive tests of 196 patients with bipolar disorder and 145 healthy controls was used to train and compare five different machine learning algorithms. RESULTS The best performing algorithm was logistic regression, with a macro-average F1-score of 0.69 [95% CI 0.66-0.73]. After further optimization, a model with an improved macro-average F1-score of 0.75, a micro-average F1-score of 0.77, and an AUROC of 0.84 was built. Furthermore, the individual amount of contribution per variable on the classification was assessed, which revealed that body mass index, results of the Stroop test, and the d2-R test alone allow for a classification of bipolar disorder with equal performance. CONCLUSION Using these data for clinical application results in an acceptable performance, but has not yet reached a state where it can sufficiently augment a diagnosis made by an experienced clinician. Therefore, further research should focus on identifying variables with the highest amount of contribution to a model's classification.
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Affiliation(s)
- Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Marco Mairinger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Clemens Elst
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Alexander Maget
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Adelina Tmava-Berisha
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Susanne A Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Markus Kreuzthaler
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
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2
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Pérez-Ramos A, Romero-López-Alberca C, Hidalgo-Figueroa M, Berrocoso E, Pérez-Revuelta JI. A systematic review of the biomarkers associated with cognition and mood state in bipolar disorder. Int J Bipolar Disord 2024; 12:18. [PMID: 38758506 PMCID: PMC11101403 DOI: 10.1186/s40345-024-00340-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a severe psychiatric disorder characterized by changes in mood that alternate between (hypo) mania or depression and mixed states, often associated with functional impairment and cognitive dysfunction. But little is known about biomarkers that contribute to the development and sustainment of cognitive deficits. The aim of this study was to review the association between neurocognition and biomarkers across different mood states. METHOD Search databases were Web of Science, Scopus and PubMed. A systematic review was carried out following the PRISMA guidelines. Risk of bias was assessed with the Newcastle-Ottawa Scale. Studies were selected that focused on the correlation between neuroimaging, physiological, genetic or peripheral biomarkers and cognition in at least two phases of BD: depression, (hypo)mania, euthymia or mixed. PROSPERO Registration No.: CRD42023410782. RESULTS A total of 1824 references were screened, identifying 1023 published articles, of which 336 were considered eligible. Only 16 provided information on the association between biomarkers and cognition in the different affective states of BD. The included studies found: (i) Differences in levels of total cholesterol and C reactive protein depending on mood state; (ii) There is no association found between cognition and peripheral biomarkers; (iii) Neuroimaging biomarkers highlighted hypoactivation of frontal areas as distinctive of acute state of BD; (iv) A deactivation failure has been reported in the ventromedial prefrontal cortex (vmPFC), potentially serving as a trait marker of BD. CONCLUSION Only a few recent articles have investigated biomarker-cognition associations in BD mood phases. Our findings underline that there appear to be central regions involved in BD that are observed in all mood states. However, there appear to be underlying mechanisms of cognitive dysfunction that may vary across different mood states in BD. This review highlights the importance of standardizing the data and the assessment of cognition, as well as the need for biomarkers to help prevent acute symptomatic phases of the disease, and the associated functional and cognitive impairment.
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Affiliation(s)
- Anaid Pérez-Ramos
- Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain
- Centre for Biomedical Research in Mental Health (CIBERSAM), ISCI-III, Madrid, Spain
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, Faculty of Medicine, University of Cadiz, Cadiz, Spain
| | - Cristina Romero-López-Alberca
- Centre for Biomedical Research in Mental Health (CIBERSAM), ISCI-III, Madrid, Spain.
- Personality, Evaluation and Psychological Treatment Area, Department of Psychology, University of Cadiz, Cadiz, Spain.
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cadiz, Spain.
| | - Maria Hidalgo-Figueroa
- Centre for Biomedical Research in Mental Health (CIBERSAM), ISCI-III, Madrid, Spain
- Neuropsychopharmacology and Psychobiology Research Group, Psychobiology Area, Department of Psychology, University of Cadiz, Cadiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cadiz, Spain
| | - Esther Berrocoso
- Centre for Biomedical Research in Mental Health (CIBERSAM), ISCI-III, Madrid, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cadiz, Spain
- Neuropsychopharmacology and Psychobiology Research Group, Department of Neuroscience, Faculty of Medicine, University of Cadiz, Cadiz, Spain
| | - Jose I Pérez-Revuelta
- Centre for Biomedical Research in Mental Health (CIBERSAM), ISCI-III, Madrid, Spain
- Clinical Management of Mental Health Unit, University Hospital of Jerez, Andalusian Health Service, Cadiz, Spain
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cadiz, Spain
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Machine learning approaches for prediction of bipolar disorder based on biological, clinical and neuropsychological markers: a systematic review and meta-analysis. Neurosci Biobehav Rev 2022; 135:104552. [PMID: 35120970 DOI: 10.1016/j.neubiorev.2022.104552] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/11/2022] [Accepted: 01/30/2022] [Indexed: 01/10/2023]
Abstract
Applying machine learning (ML) to objective markers may overcome prognosis uncertainty due to the subjective nature of the diagnosis of bipolar disorder (BD). This PRISMA-compliant meta-analysis provides new systematic evidence of the BD classification accuracy reached by different markers and ML algorithms. We focused on neuroimaging, electrophysiological techniques, peripheral biomarkers, genetic data, neuropsychological or clinical measures, and multimodal approaches. PubMed, Embase and Scopus were searched through 3rd December 2020. Meta-analyses were performed using random-effect models. Overall, 81 studies were included in this systematic review and 65 in the meta-analysis (11,336 participants, 3,903 BD). The overall pooled classification accuracy was 0.77 (95%CI[0.75;0.80]). Despite subgroup analyses for diagnostic comparison group, psychiatric disorders, marker, ML algorithm, and validation procedure were not significant, linear discriminant analysis significantly outperformed support vector machine for peripheral biomarkers (p=0.03). Sample size was inversely related to accuracy. Evidence of publication bias was detected. Ultimately, although ML reached a high accuracy in differentiating BD from other psychiatric disorders, best practices in methodology are needed for the advancement of future studies.
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4
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Mental Health Prediction Using Machine Learning: Taxonomy, Applications, and Challenges. APPLIED COMPUTATIONAL INTELLIGENCE AND SOFT COMPUTING 2022. [DOI: 10.1155/2022/9970363] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The increase of mental health problems and the need for effective medical health care have led to an investigation of machine learning that can be applied in mental health problems. This paper presents a recent systematic review of machine learning approaches in predicting mental health problems. Furthermore, we will discuss the challenges, limitations, and future directions for the application of machine learning in the mental health field. We collect research articles and studies that are related to the machine learning approaches in predicting mental health problems by searching reliable databases. Moreover, we adhere to the PRISMA methodology in conducting this systematic review. We include a total of 30 research articles in this review after the screening and identification processes. Then, we categorize the collected research articles based on the mental health problems such as schizophrenia, bipolar disorder, anxiety and depression, posttraumatic stress disorder, and mental health problems among children. Discussing the findings, we reflect on the challenges and limitations faced by the researchers on machine learning in mental health problems. Additionally, we provide concrete recommendations on the potential future research and development of applying machine learning in the mental health field.
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5
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Jan Z, Ai-Ansari N, Mousa O, Abd-Alrazaq A, Ahmed A, Alam T, Househ M. The Role of Machine Learning in Diagnosing Bipolar Disorder: Scoping Review. J Med Internet Res 2021; 23:e29749. [PMID: 34806996 PMCID: PMC8663682 DOI: 10.2196/29749] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/02/2021] [Accepted: 07/27/2021] [Indexed: 01/10/2023] Open
Abstract
Background Bipolar disorder (BD) is the 10th most common cause of frailty in young individuals and has triggered morbidity and mortality worldwide. Patients with BD have a life expectancy 9 to 17 years lower than that of normal people. BD is a predominant mental disorder, but it can be misdiagnosed as depressive disorder, which leads to difficulties in treating affected patients. Approximately 60% of patients with BD are treated for depression. However, machine learning provides advanced skills and techniques for better diagnosis of BD. Objective This review aims to explore the machine learning algorithms used for the detection and diagnosis of bipolar disorder and its subtypes. Methods The study protocol adopted the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We explored 3 databases, namely Google Scholar, ScienceDirect, and PubMed. To enhance the search, we performed backward screening of all the references of the included studies. Based on the predefined selection criteria, 2 levels of screening were performed: title and abstract review, and full review of the articles that met the inclusion criteria. Data extraction was performed independently by all investigators. To synthesize the extracted data, a narrative synthesis approach was followed. Results We retrieved 573 potential articles were from the 3 databases. After preprocessing and screening, only 33 articles that met our inclusion criteria were identified. The most commonly used data belonged to the clinical category (19, 58%). We identified different machine learning models used in the selected studies, including classification models (18, 55%), regression models (5, 16%), model-based clustering methods (2, 6%), natural language processing (1, 3%), clustering algorithms (1, 3%), and deep learning–based models (3, 9%). Magnetic resonance imaging data were most commonly used for classifying bipolar patients compared to other groups (11, 34%), whereas microarray expression data sets and genomic data were the least commonly used. The maximum ratio of accuracy was 98%, whereas the minimum accuracy range was 64%. Conclusions This scoping review provides an overview of recent studies based on machine learning models used to diagnose patients with BD regardless of their demographics or if they were compared to patients with psychiatric diagnoses. Further research can be conducted to provide clinical decision support in the health industry.
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Affiliation(s)
- Zainab Jan
- College of Health and Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Education City, Doha, Qatar
| | - Noor Ai-Ansari
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Education City, Doha, Qatar
| | - Osama Mousa
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Education City, Doha, Qatar
| | - Alaa Abd-Alrazaq
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Education City, Doha, Qatar
| | - Arfan Ahmed
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Education City, Doha, Qatar.,Department of Psychiatry, Weill Cornell Medicine, Education City, Doha, Qatar
| | - Tanvir Alam
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Education City, Doha, Qatar
| | - Mowafa Househ
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Education City, Doha, Qatar
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6
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Lee EE, Torous J, De Choudhury M, Depp CA, Graham SA, Kim HC, Paulus MP, Krystal JH, Jeste DV. Artificial Intelligence for Mental Health Care: Clinical Applications, Barriers, Facilitators, and Artificial Wisdom. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:856-864. [PMID: 33571718 PMCID: PMC8349367 DOI: 10.1016/j.bpsc.2021.02.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/19/2022]
Abstract
Artificial intelligence (AI) is increasingly employed in health care fields such as oncology, radiology, and dermatology. However, the use of AI in mental health care and neurobiological research has been modest. Given the high morbidity and mortality in people with psychiatric disorders, coupled with a worsening shortage of mental health care providers, there is an urgent need for AI to help identify high-risk individuals and provide interventions to prevent and treat mental illnesses. While published research on AI in neuropsychiatry is rather limited, there is a growing number of successful examples of AI's use with electronic health records, brain imaging, sensor-based monitoring systems, and social media platforms to predict, classify, or subgroup mental illnesses as well as problems such as suicidality. This article is the product of a study group held at the American College of Neuropsychopharmacology conference in 2019. It provides an overview of AI approaches in mental health care, seeking to help with clinical diagnosis, prognosis, and treatment, as well as clinical and technological challenges, focusing on multiple illustrative publications. Although AI could help redefine mental illnesses more objectively, identify them at a prodromal stage, personalize treatments, and empower patients in their own care, it must address issues of bias, privacy, transparency, and other ethical concerns. These aspirations reflect human wisdom, which is more strongly associated than intelligence with individual and societal well-being. Thus, the future AI or artificial wisdom could provide technology that enables more compassionate and ethically sound care to diverse groups of people.
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Affiliation(s)
- Ellen E Lee
- Department of Psychiatry, University of California San Diego, San Diego, California; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California; VA San Diego Healthcare System, San Diego, California
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard University, Boston, Massachusetts
| | - Munmun De Choudhury
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, Georgia
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, San Diego, California; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California; VA San Diego Healthcare System, San Diego, California
| | - Sarah A Graham
- Department of Psychiatry, University of California San Diego, San Diego, California; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California
| | - Ho-Cheol Kim
- AI and Cognitive Software, IBM Research-Almaden, San Jose, California
| | | | - John H Krystal
- Department of Psychiatry, Yale University, New Haven, Connecticut
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, San Diego, California; Department of Neurosciences, University of California San Diego, San Diego, California; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, San Diego, California.
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7
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Jan Z, Ai-ansari N, Mousa O, Abd-alrazaq A, Ahmed A, Alam T, Househ M. The Role of Machine Learning in Diagnosing Bipolar Disorder: Scoping Review (Preprint).. [DOI: 10.2196/preprints.29749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND
Bipolar disorder (BD) is the 10th most common cause of frailty in young individuals and has triggered morbidity and mortality worldwide. Patients with BD have a life expectancy 9 to 17 years lower than that of normal people. BD is a predominant mental disorder, but it can be misdiagnosed as depressive disorder, which leads to difficulties in treating affected patients. Approximately 60% of patients with BD are treated for depression. However, machine learning provides advanced skills and techniques for better diagnosis of BD.
OBJECTIVE
This review aims to explore the machine learning algorithms used for the detection and diagnosis of bipolar disorder and its subtypes.
METHODS
The study protocol adopted the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We explored 3 databases, namely Google Scholar, ScienceDirect, and PubMed. To enhance the search, we performed backward screening of all the references of the included studies. Based on the predefined selection criteria, 2 levels of screening were performed: title and abstract review, and full review of the articles that met the inclusion criteria. Data extraction was performed independently by all investigators. To synthesize the extracted data, a narrative synthesis approach was followed.
RESULTS
We retrieved 573 potential articles were from the 3 databases. After preprocessing and screening, only 33 articles that met our inclusion criteria were identified. The most commonly used data belonged to the clinical category (19, 58%). We identified different machine learning models used in the selected studies, including classification models (18, 55%), regression models (5, 16%), model-based clustering methods (2, 6%), natural language processing (1, 3%), clustering algorithms (1, 3%), and deep learning–based models (3, 9%). Magnetic resonance imaging data were most commonly used for classifying bipolar patients compared to other groups (11, 34%), whereas microarray expression data sets and genomic data were the least commonly used. The maximum ratio of accuracy was 98%, whereas the minimum accuracy range was 64%.
CONCLUSIONS
This scoping review provides an overview of recent studies based on machine learning models used to diagnose patients with BD regardless of their demographics or if they were compared to patients with psychiatric diagnoses. Further research can be conducted to provide clinical decision support in the health industry.
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8
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Hirjak D, Reininghaus U, Braun U, Sack M, Tost H, Meyer-Lindenberg A. [Cross-sectoral therapeutic concepts and innovative technologies: new opportunities for the treatment of patients with mental disorders]. DER NERVENARZT 2021; 93:288-296. [PMID: 33674965 PMCID: PMC8897366 DOI: 10.1007/s00115-021-01086-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 01/04/2023]
Abstract
Mental disorders are widespread and a major public health problem. The risk of developing a mental disorder at some point in life is around 40%. Therefore, mental disorders are among the most common diseases. Despite the introduction of newer psychotropic drugs, disorder-specific psychotherapy and stimulation techniques, many of those affected still show insufficient symptom remission and a chronic course of the disorder. Conceptual and technological progress in recent years has enabled a new, more flexible and personalized form of mental health care. Both the traditional therapeutic concepts and newer decentralized, modularly structured, track units, together with innovative digital technologies, will offer individualized therapeutic options in order to alleviate symptoms and improve quality of life of patients with mental illnesses. The primary goal of closely combining inpatient care concepts with innovative technologies is to provide comprehensive therapy and aftercare concepts for all individual needs of patients with mental disorders. Last but not least, this also ensures that specialist psychiatric treatment is available regardless of location. In twenty-first century psychiatry, modern care structures must be effectively linked to the current dynamics of digital transformation. This narrative review is dedicated to the theoretical and practical aspects of a cross-sectoral treatment system combined with innovative digital technologies in the psychiatric-psychotherapeutic field. The authors aim to illuminate these therapy modalities using the example of the Central Institute of Mental Health in Mannheim.
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Affiliation(s)
- Dusan Hirjak
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland.
| | - Ulrich Reininghaus
- Abteilung Public Mental Health, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland.,ESRC Centre for Society and Mental Health, King's College London, London, Großbritannien.,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, Großbritannien
| | - Urs Braun
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Markus Sack
- Abteilung Neuroimaging, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Heike Tost
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
| | - Andreas Meyer-Lindenberg
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, J5, 68159, Mannheim, Deutschland
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9
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Vaughn-Coaxum RA, Merranko J, Birmaher B, Dickstein DP, Hafeman D, Levenson JC, Liao F, Gill MK, Hower H, Goldstein BI, Strober M, Ryan ND, Diler R, Keller MB, Yen S, Weinstock LM, Axelson D, Goldstein TR. Longitudinal course of depressive symptom severity among youths with bipolar disorders: Moderating influences of sustained attention and history of child maltreatment. J Affect Disord 2021; 282:261-271. [PMID: 33418377 PMCID: PMC8073228 DOI: 10.1016/j.jad.2020.12.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric bipolar disorders are often characterized by disruptions in cognitive functioning, and exposure to child maltreatment (e.g., physical and sexual abuse) is associated with a significantly poorer course of illness. Although clinical and developmental research has shown maltreatment to be robustly associated with poorer cognitive functioning, it is unclear whether maltreatment and cognitive function jointly influence the clinical course of bipolar symptoms. METHODS This secondary analysis examined moderating effects of lifetime childhood physical and sexual abuse, and cognitive disruptions (sustained attention, affective information processing), on longitudinal ratings of depression symptom severity in youths from the Course and Outcome of Bipolar Youth (COBY) study, examined from intake (M = 12.24 years) through age 22 (N = 198; 43.9% female; Mean age of bipolar onset = 8.85 years). RESULTS A significant moderating effect was detected for sustained attention and maltreatment history. In the context of lower sustained attention, maltreatment exposure was associated with higher depression symptom severity during childhood, but not late adolescence. There was no association between maltreatment and symptom severity in the context of higher sustained attention, and no association between attention and depression symptom severity for non-maltreated youths. LIMITATIONS Depression symptom ratings at each assessment were subject to retrospective recall bias despite the longitudinal design. Cognitive assessments were administered at different ages across youths. CONCLUSIONS Depressive symptoms in pediatric bipolar may be jointly moderated by impairments in attention and exposure to maltreatment. Assessment of these risks, particularly in childhood, may be beneficial for considering risk of recurrence or chronicity of depressive symptoms.
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Affiliation(s)
- Rachel A Vaughn-Coaxum
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Bellefield Towers, Pittsburgh, PA 15213, United States.
| | - John Merranko
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Bellefield Towers, Pittsburgh, PA 15213, United States
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Bellefield Towers, Pittsburgh, PA 15213, United States
| | - Daniel P Dickstein
- Simches Center of Excellence in Child and Adolescent Psychiatry, Harvard Medical School, McLean Hospital, United States; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, United States
| | - Danella Hafeman
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Bellefield Towers, Pittsburgh, PA 15213, United States
| | - Jessica C Levenson
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Bellefield Towers, Pittsburgh, PA 15213, United States; Department of Pediatrics, University of Pittsburgh School of Medicine, United States
| | - Fangzi Liao
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Bellefield Towers, Pittsburgh, PA 15213, United States
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Bellefield Towers, Pittsburgh, PA 15213, United States
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, United States; Department of Health Services, Policy, and Practice, Brown University School of Public Health, United States; Department of Psychiatry, School of Medicine, University of California at San Diego, United States
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, Canada
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, United States
| | - Neal D Ryan
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Bellefield Towers, Pittsburgh, PA 15213, United States
| | - Rasim Diler
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Bellefield Towers, Pittsburgh, PA 15213, United States
| | - Martin B Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, United States
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, United States; Massachusetts Mental Health Center and Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, United States
| | - Lauren M Weinstock
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, United States
| | - David Axelson
- Department of Psychiatry, Nationwide Children's Hospital and The Ohio State University, United States
| | - Tina R Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Bellefield Towers, Pittsburgh, PA 15213, United States
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10
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Individualized identification of first-episode bipolar disorder using machine learning and cognitive tests. J Affect Disord 2021; 282:662-668. [PMID: 33445089 DOI: 10.1016/j.jad.2020.12.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 02/05/2023]
Abstract
Identifying cognitive dysfunction in the early stages of Bipolar Disorder (BD) can allow for early intervention. Previous studies have shown a strong correlation between cognitive dysfunction and number of manic episodes. The objective of this study was to apply machine learning (ML) techniques on a battery of cognitive tests to identify first-episode BD patients (FE-BD). Two cohorts of participants were used for this study. Cohort #1 included 74 chronic BD patients (CHR-BD) and 53 healthy controls (HC), while the Cohort #2 included 37 FE-BD and 18 age- and sex-matched HC. Cognitive functioning was assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB). The tests examined domains of visual processing, spatial memory, attention and executive function. We trained an ML model to distinguish between chronic BD patients (CHR-BD) and HC at the individual level. We used linear Support Vector Machines (SVM) and were able to identify individual CHR-BD patients at 77% accuracy. We then applied the model to Cohort #2 (FE-BD patients) and achieved an accuracy of 76% (AUC = 0.77). These results reveal that cognitive impairments may appear in early stages of BD and persist into later stages. This suggests that the same deficits may exist for both CHR-BD and FE-BD. These cognitive deficits may serve as markers for early BD. Our study provides a tool that these early markers can be used for detection of BD.
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Mansourian M, Khademi S, Marateb HR. A Comprehensive Review of Computer-Aided Diagnosis of Major Mental and Neurological Disorders and Suicide: A Biostatistical Perspective on Data Mining. Diagnostics (Basel) 2021; 11:393. [PMID: 33669114 PMCID: PMC7996506 DOI: 10.3390/diagnostics11030393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/13/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
The World Health Organization (WHO) suggests that mental disorders, neurological disorders, and suicide are growing causes of morbidity. Depressive disorders, schizophrenia, bipolar disorder, Alzheimer's disease, and other dementias account for 1.84%, 0.60%, 0.33%, and 1.00% of total Disability Adjusted Life Years (DALYs). Furthermore, suicide, the 15th leading cause of death worldwide, could be linked to mental disorders. More than 68 computer-aided diagnosis (CAD) methods published in peer-reviewed journals from 2016 to 2021 were analyzed, among which 75% were published in the year 2018 or later. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was adopted to select the relevant studies. In addition to the gold standard, the sample size, neuroimaging techniques or biomarkers, validation frameworks, the classifiers, and the performance indices were analyzed. We further discussed how various performance indices are essential based on the biostatistical and data mining perspective. Moreover, critical information related to the Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) guidelines was analyzed. We discussed how balancing the dataset and not using external validation could hinder the generalization of the CAD methods. We provided the list of the critical issues to consider in such studies.
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Affiliation(s)
- Mahsa Mansourian
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran;
| | - Sadaf Khademi
- Biomedical Engineering Department, Faculty of Engineering, University of Isfahan, Isfahan 8174-67344, Iran;
| | - Hamid Reza Marateb
- Biomedical Engineering Department, Faculty of Engineering, University of Isfahan, Isfahan 8174-67344, Iran;
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12
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Todesco S, Chao T, Schmid L, Thiessen KA, Schütz CG. Changes in Loss Sensitivity During Treatment in Concurrent Disorders Inpatients: A Computational Model Approach to Assessing Risky Decision-Making. Front Psychiatry 2021; 12:794014. [PMID: 35153861 PMCID: PMC8831914 DOI: 10.3389/fpsyt.2021.794014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent studies have employed computational modeling to characterize deficits in aspects of decision-making not otherwise detected using traditional behavioral task outcomes. While prospect utility-based modeling has shown to differentiate decision-making patterns between users of different drugs, its relevance in the context of treatment has yet to be examined. This study investigated model-based decision-making as it relates to treatment outcome in inpatients with co-occurring mental health and substance use disorders. METHODS 50 patients (Mage = 38.5, SD = 11.4; 16F) completed the Cambridge Gambling Task (CGT) within 2 weeks of admission (baseline) and 6 months into treatment (follow-up), and 50 controls (Mage = 31.9, SD = 10.0; 25F) completed CGT under a single outpatient session. We evaluated 4 traditional CGT outputs and 5 decisional processes derived from the Cumulative Model. Psychiatric diagnoses and discharge data were retrieved from patient health records. RESULTS Groups were similar in age, sex, and premorbid IQ. Differences in years of education were included as covariates across all group comparisons. All patients had ≥1 mental health diagnosis, with 80% having >1 substance use disorder. On the CGT, patients showed greater Deliberation Time and Delay Aversion than controls. Estimated model parameters revealed higher Delayed Reward Discounting, and lower Probability Distortion and Loss Sensitivity in patients relative to controls. From baseline to follow-up, patients (n = 24) showed a decrease in model-derived Loss Sensitivity and Color Choice Bias. Lastly, poorer Quality of Decision-Making and Choice Consistency, and greater Color Choice Bias independently predicted higher likelihood of treatment dropout, while none were significant in relation to treatment length of stay. CONCLUSION This is the first study to assess a computational model of decision-making in the context of treatment for concurrent disorders. Patients were more impulsive and slower to deliberate choice than controls. While both traditional and computational outcomes predicted treatment adherence in patients, findings suggest computational methods are able to capture treatment-sensitive aspects of decision-making not accessible via traditional methods. Further research is needed to confirm findings as well as investigate the relationship between model-based decision-making and post-treatment outcomes.
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Affiliation(s)
- Stefanie Todesco
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Chao
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Laura Schmid
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Karina A Thiessen
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Christian G Schütz
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada.,BC Mental Health and Substance Use Services Research Institute, Provincial Health Services Authority (PHSA), Vancouver, BC, Canada
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13
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Wang C, Zhao H, Zhang H. Chinese College Students Have Higher Anxiety in New Semester of Online Learning During COVID-19: A Machine Learning Approach. Front Psychol 2020; 11:587413. [PMID: 33343461 PMCID: PMC7744590 DOI: 10.3389/fpsyg.2020.587413] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022] Open
Abstract
The COVID-19 pandemic has caused tremendous loss starting from early this year. This article aims to investigate the change of anxiety severity and prevalence among non-graduating undergraduate students in the new semester of online learning during COVID-19 in China and also to evaluate a machine learning model based on the XGBoost model. A total of 1172 non-graduating undergraduate students aged between 18 and 22 from 34 provincial-level administrative units and 260 cities in China were enrolled onto this study and asked to fill in a sociodemographic questionnaire and the Self-Rating Anxiety Scale (SAS) twice, respectively, during February 15 to 17, 2020, before the new semester started, and March 15 to 17, 2020, 1 month after the new semester based on online learning had started. SPSS 22.0 was used to conduct t-test and single factor analysis. XGBoost models were implemented to predict the anxiety level of students 1 month after the start of the new semester. There were 184 (15.7%, Mean = 58.45, SD = 7.81) and 221 (18.86%, Mean = 57.68, SD = 7.58) students who met the cut-off of 50 and were screened as positive for anxiety, respectively, in the two investigations. The mean SAS scores in the second test was significantly higher than those in the first test (P < 0.05). Significant differences were also found among all males, females, and students majoring in arts and sciences between the two studies (P < 0.05). The results also showed students from Hubei province, where most cases of COVID-19 were confirmed, had a higher percentage of participants meeting the cut-off of being anxious. This article applied machine learning to establish XGBoost models to successfully predict the anxiety level and changes of anxiety levels 4 weeks later based on the SAS scores of the students in the first test. It was concluded that, during COVID-19, Chinese non-graduating undergraduate students showed higher anxiety in the new semester based on online learning than before the new semester started. More students from Hubei province had a different level of anxiety than other provinces. Families, universities, and society as a whole should pay attention to the psychological health of non-graduating undergraduate students and take measures accordingly. It also confirmed that the XGBoost model had better prediction accuracy compared to the traditional multiple stepwise regression model on the anxiety status of university students.
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Affiliation(s)
- Chongying Wang
- Department of Social Psychology, Zhou Enlai School of Government, Nankai University, Tianjin, China
| | - Hong Zhao
- Department of General Computer, College of Computer Science, Nankai University, Tianjin, China
| | - Haoran Zhang
- Department of General Computer, College of Computer Science, Nankai University, Tianjin, China
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14
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Sonkurt HO, Altınöz AE, Çimen E, Köşger F, Öztürk G. The role of cognitive functions in the diagnosis of bipolar disorder: A machine learning model. Int J Med Inform 2020; 145:104311. [PMID: 33202371 DOI: 10.1016/j.ijmedinf.2020.104311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/05/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Considering the clinical heterogeneity of the bipolar disorder, difficulties are encountered in making the correct diagnosis. Although a number of common findings have been found in studies on the neurocognitive profile of bipolar disorder, the search for a neurocognitive endophenotype has failed. The aim of this study is to separate bipolar disorder patients from healthy controls with higher accuracy by using a broader neurocognitive evaluation and a novel machine-learning algorithm. METHODS Individuals who presented to the Bipolar Outpatient Clinic of the Medical Faculty of Eskişehir Osmangazi University and met the inclusion criteria of the research are included in the study. Six neurocognitive tests from the CANTAB test battery were used for neurocognitive evaluation, Polyhedral Conic Functions algorithm was used to classify the participants. RESULTS Bipolar disorder patients differentiated from healthy controls with an accuracy of 78 %. DISCUSSION Our study presents a prediction algorithm that separates bipolar disorder from healthy controls with high accuracy by using CANTAB neurocognitive battery.
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Affiliation(s)
| | - Ali Ercan Altınöz
- Department of Psychiatry, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey.
| | - Emre Çimen
- Computational Intelligence and Optimization Laboratory, Department of Industrial Engineering, Eskisehir Technical University, Eskisehir, Turkey
| | - Ferdi Köşger
- Department of Psychiatry, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Gürkan Öztürk
- Computational Intelligence and Optimization Laboratory, Department of Industrial Engineering, Eskisehir Technical University, Eskisehir, Turkey
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15
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Achalia R, Sinha A, Jacob A, Achalia G, Kaginalkar V, Venkatasubramanian G, Rao NP. A proof of concept machine learning analysis using multimodal neuroimaging and neurocognitive measures as predictive biomarker in bipolar disorder. Asian J Psychiatr 2020; 50:101984. [PMID: 32143176 DOI: 10.1016/j.ajp.2020.101984] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 02/18/2020] [Accepted: 02/24/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Concomitant use of complementary, multimodal imaging measures and neurocognitive measures is reported to have higher accuracy as a biomarker in Alzheimer's dementia. However, such an approach has not been examined to differentiate healthy individuals from Bipolar disorder. In this study, we examined the utility of support vector machine (SVM) technique to differentiate bipolar disorder patients and healthy using structural, functional and diffusion tensor images of brain and neurocognitive measures. METHODS 30 patients with Bipolar disorder-I and 30 age, sex matched individuals participated in the study. Structural MRI, resting state functional MRI and diffusion tensor images were obtained using a 1.5 T scanner. All participants were administered neuropsychological tests to measure executive functions. SVM, a supervised machine learning technique was applied to differentiate patients and healthy individuals with k-fold cross validation over 10 trials. RESULTS The composite marker consisting of both neuroimaging and neuropsychological measures, had an accuracy of 87.60 %, sensitivity of 82.3 % and specificity of 92.7 %. The performance of composite marker was better compared to that of individual markers on classificatory. CONCLUSIONS We were able to achieve a high accuracy for machine learning technique in distinguishing BD from HV using a combination of multimodal neuroimaging and neurocognitive measures. Findings of this proof of concept study, if replicated in larger samples, could have potential clinical applications.
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Affiliation(s)
| | - Anannya Sinha
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Arpitha Jacob
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Garimaa Achalia
- Achalia Neuropsychiatry Hospital, Aurangabad, Maharashtra, India
| | | | | | - Naren P Rao
- National Institute of Mental Health and Neurosciences, Bangalore, India.
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16
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Silveira ÉDM, Passos IC, Scott J, Bristot G, Scotton E, Teixeira Mendes LS, Umpierre Knackfuss AC, Gerchmann L, Fijtman A, Trasel AR, Salum GA, Kauer-Sant'Anna M. Decoding rumination: A machine learning approach to a transdiagnostic sample of outpatients with anxiety, mood and psychotic disorders. J Psychiatr Res 2020; 121:207-213. [PMID: 31865210 DOI: 10.1016/j.jpsychires.2019.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/15/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To employ machine learning algorithms to examine patterns of rumination from RDoC perspective and to determine which variables predict high levels of maladaptive rumination across a transdiagnostic sample. METHOD Sample of 200 consecutive, consenting outpatient referrals with clinical diagnoses of schizophrenia, schizoaffective, bipolar, depression, anxiety disorders, obsessive compulsive and post-traumatic stress. Machine learning algorithms used a range of variables including sociodemographics, serum levels of immune markers (IL-6, IL-1β, IL-10, TNF-α and CCL11) and BDNF, psychiatric symptoms and disorders, history of suicide and hospitalizations, functionality, medication use and comorbidities. RESULTS The best model (with recursive feature elimination) included the following variables: socioeconomic status, illness severity, worry, generalized anxiety and depressive symptoms, and current diagnosis of panic disorder. Linear support vector machine learning differentiated individuals with high levels of rumination from those ones with low (AUC = 0.83, sensitivity = 75, specificity = 71). CONCLUSIONS Rumination is known to be associated with poor prognosis in mental health. This study suggests that rumination is a maladaptive coping style associated not only with worry, distress and illness severity, but also with socioeconomic status. Also, rumination demonstrated a specific association with panic disorder.
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Affiliation(s)
- Érico de Moura Silveira
- Laboratory of Molecular Psychiatry, Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Ives Cavalcante Passos
- Laboratory of Molecular Psychiatry, Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Jan Scott
- Professor at the Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Giovana Bristot
- Graduate Program in Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ellen Scotton
- Laboratory of Molecular Psychiatry, Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lorenna Sena Teixeira Mendes
- Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ana Claudia Umpierre Knackfuss
- Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Luciana Gerchmann
- Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Adam Fijtman
- Laboratory of Molecular Psychiatry, Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Andrea Ruschel Trasel
- Laboratory of Molecular Psychiatry, Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Giovanni Abrahão Salum
- Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Márcia Kauer-Sant'Anna
- Laboratory of Molecular Psychiatry, Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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17
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Overlapping mechanisms linking insulin resistance with cognition and neuroprogression in bipolar disorder. Neurosci Biobehav Rev 2020; 111:125-134. [PMID: 31978440 DOI: 10.1016/j.neubiorev.2020.01.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 12/26/2022]
Abstract
Cognitive impairment is highly prevalent in the progression of both diabetes mellitus and bipolar disorder. The relationship between insulin resistance in diabetes and the risk of developing major neurocognitive disorders such as Alzheimer's disease has been well described. Insulin resistance and the associated metabolic deficiencies lead to biochemical alteration which hasten neurodegeneration and subsequent cognitive impairment. For bipolar disorder, some patients experience a cyclical, yet progressive course of illness. These patients are also more likely to have medical comorbidities such as cardiovascular disease and diabetes, and insulin resistance in particular may precede the neuroprogressive course. Diabetes and bipolar disorder share epidemiological, biochemical, and structural signatures, as well as cognitive impairment within similar domains, suggesting a common mechanism between the two conditions. Here we describe the association between insulin resistance and cognitive changes in bipolar disorder, as well as potential implications for therapeutic modulation of neuroprogression.
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19
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Bauer O, Milenkovic VM, Hilbert S, Sarubin N, Weigl J, Bahr LM, Wetter TC, Heckel B, Wetzel CH, Rupprecht R, Nothdurfter C. Association of Chemokine (C-C Motif) Receptor 5 and Ligand 5 with Recovery from Major Depressive Disorder and Related Neurocognitive Impairment. Neuroimmunomodulation 2020; 27:152-162. [PMID: 33503626 PMCID: PMC8006585 DOI: 10.1159/000513093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/01/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Inflammatory processes play an important role in the pathophysiology of major depressive disorder (MDD), but their relevance for specific symptoms such as neurocognitive impairment is rarely investigated. METHODS In this observational study, we investigated the changes of leukocyte chemokine (C-C motif) receptor 5 (CCR5) and ligand 5 (CCL5) mRNA levels and inflammatory cytokines in 60 MDD patients before (PRE) and after 5 weeks (W5) of antidepressive treatment in relation to therapy response and alterations in cognitive functions by means of the Cambridge Neuropsychological Test Automated Battery (CANTAB). We hypothesized that elevated CCR5 and CCL5 levels in depressed patients would decrease upon treatment and could differ with regard to cognitive impairment associated with MDD. RESULTS Both CCR5 and CCL5 levels were significantly decreased in the responder group compared to nonresponders even before treatment. The cytokine IL-6 as a marker of inflammation in depression did not show a difference before treatment in future responders versus nonresponders, but decreased significantly upon antidepressive therapy. Regarding neurocognitive impairment in MDD patients, an increased misperception of the emotion "anger" after 5 weeks of treatment proved to be associated with a more pronounced change in CCR5, and the perception of the emotion "disgust" became faster along with a stronger decrease in CCL5 over the same time. Executive functions typically impaired in MDD patients were not markedly associated with alterations in CCR5/CCL5. DISCUSSION CCR5 and CCL5 are important in the targeting of immune cells by HIV. This is the first study providing valuable hints that both CCR5 and CCL5 might also serve as markers of therapy response prediction in MDD. Regarding neurocognitive impairment in depression, CCR5 and CCL5 did not reveal characteristic changes upon MDD treatment such as executive functions, which are probably delayed. However, changes of emotional perception appear to be an earlier responding feature.
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Affiliation(s)
- Olivia Bauer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Vladimir M Milenkovic
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Sven Hilbert
- Faculty of Human Sciences, University of Regensburg, Regensburg, Germany
| | - Nina Sarubin
- Hochschule Fresenius, University of Applied Sciences, Munich, Germany
- Department of Psychology, Psychological Methods and Assessment, Ludwig-Maximilians-Universität, Munich, Germany
| | - Johannes Weigl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Lisa-Marie Bahr
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Thomas C Wetter
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Barbara Heckel
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Christian H Wetzel
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Caroline Nothdurfter
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany,
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Passos IC, Ballester PL, Barros RC, Librenza-Garcia D, Mwangi B, Birmaher B, Brietzke E, Hajek T, Lopez Jaramillo C, Mansur RB, Alda M, Haarman BCM, Isometsa E, Lam RW, McIntyre RS, Minuzzi L, Kessing LV, Yatham LN, Duffy A, Kapczinski F. Machine learning and big data analytics in bipolar disorder: A position paper from the International Society for Bipolar Disorders Big Data Task Force. Bipolar Disord 2019; 21:582-594. [PMID: 31465619 DOI: 10.1111/bdi.12828] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The International Society for Bipolar Disorders Big Data Task Force assembled leading researchers in the field of bipolar disorder (BD), machine learning, and big data with extensive experience to evaluate the rationale of machine learning and big data analytics strategies for BD. METHOD A task force was convened to examine and integrate findings from the scientific literature related to machine learning and big data based studies to clarify terminology and to describe challenges and potential applications in the field of BD. We also systematically searched PubMed, Embase, and Web of Science for articles published up to January 2019 that used machine learning in BD. RESULTS The results suggested that big data analytics has the potential to provide risk calculators to aid in treatment decisions and predict clinical prognosis, including suicidality, for individual patients. This approach can advance diagnosis by enabling discovery of more relevant data-driven phenotypes, as well as by predicting transition to the disorder in high-risk unaffected subjects. We also discuss the most frequent challenges that big data analytics applications can face, such as heterogeneity, lack of external validation and replication of some studies, cost and non-stationary distribution of the data, and lack of appropriate funding. CONCLUSION Machine learning-based studies, including atheoretical data-driven big data approaches, provide an opportunity to more accurately detect those who are at risk, parse-relevant phenotypes as well as inform treatment selection and prognosis. However, several methodological challenges need to be addressed in order to translate research findings to clinical settings.
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Affiliation(s)
- Ives C Passos
- Laboratory of Molecular Psychiatry and Bipolar Disorder Program, Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pedro L Ballester
- School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Rodrigo C Barros
- School of Technology, Pontifícia Universidade Católica do Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Diego Librenza-Garcia
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Benson Mwangi
- Department of Psychiatry and Behavioral Sciences, UT Center of Excellence on Mood Disorders, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.,National Institute of Mental Health, Klecany, Czech Republic
| | - Carlos Lopez Jaramillo
- Research Group in Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Antioquia, Medellín, Colombia.,Mood Disorders Program, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, ON, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Bartholomeus C M Haarman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erkki Isometsa
- Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Luciano Minuzzi
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Anne Duffy
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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21
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Tai AMY, Albuquerque A, Carmona NE, Subramanieapillai M, Cha DS, Sheko M, Lee Y, Mansur R, McIntyre RS. Machine learning and big data: Implications for disease modeling and therapeutic discovery in psychiatry. Artif Intell Med 2019; 99:101704. [PMID: 31606109 DOI: 10.1016/j.artmed.2019.101704] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 03/04/2019] [Accepted: 08/08/2019] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Machine learning capability holds promise to inform disease models, the discovery and development of novel disease modifying therapeutics and prevention strategies in psychiatry. Herein, we provide an introduction on how machine learning/Artificial Intelligence (AI) may instantiate such capabilities, as well as provide rationale for its application to psychiatry in both research and clinical ecosystems. METHODS Databases PubMed and PsycINFO were searched from 1966 to June 2016 for keywords:Big Data, Machine Learning, Precision Medicine, Artificial Intelligence, Mental Health, Mental Disease, Psychiatry, Data Mining, RDoC, and Research Domain Criteria. Articles selected for review were those that were determined to be aligned with the objective of this particular paper. RESULTS Results indicate that AI is a viable option to build useful predictors of outcome while offering objective and comparable accuracy metrics, a unique opportunity, particularly in mental health research. The approach has also consistently brought notable insight into disease models through processing the vast amount of already available multi-domain, semi-structured medical data. The opportunity for AI in psychiatry, in addition to disease-model refinement, is in characterizing those at risk, and it is likely also relevant to personalizing and discovering therapeutics. CONCLUSIONS Machine learning currently provides an opportunity to parse disease models in complex, multi-factorial disease states (e.g. mental disorders) and could possibly inform treatment selection with existing therapies and provide bases for domain-based therapeutic discovery.
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Affiliation(s)
- Andy M Y Tai
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Alcides Albuquerque
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Nicole E Carmona
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | | | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Margarita Sheko
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Rodrigo Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
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22
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Bauer IE, Suchting R, Van Rheenen TE, Wu MJ, Mwangi B, Spiker D, Zunta-Soares GB, Soares JC. The use of component-wise gradient boosting to assess the possible role of cognitive measures as markers of vulnerability to pediatric bipolar disorder. Cogn Neuropsychiatry 2019; 24:93-107. [PMID: 30774035 PMCID: PMC6675623 DOI: 10.1080/13546805.2019.1580190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/27/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIMS Cognitive impairments are primary hallmarks symptoms of bipolar disorder (BD). Whether these deficits are markers of vulnerability or symptoms of the disease is still unclear. This study used a component-wise gradient (CGB) machine learning algorithm to identify cognitive measures that could accurately differentiate pediatric BD, unaffected offspring of BD parents, and healthy controls. METHODS 59 healthy controls (HC; 11.19 ± 3.15 yo; 30 girls), 119 children and adolescents with BD (13.31 ± 3.02 yo, 52 girls) and 49 unaffected offspring of BD parents (UO; 9.36 ± 3.18 yo; 22 girls) completed the CANTAB cognitive battery. RESULTS CGB achieved accuracy of 73.2% and an AUROC of 0.785 in classifying individuals as either BD or non-BD on a dataset held out for validation for testing. The strongest cognitive predictors of BD were measures of processing speed and affective processing. Measures of cognition did not differentiate between UO and HC. CONCLUSIONS Alterations in processing speed and affective processing are markers of BD in pediatric populations. Longitudinal studies should determine whether UO with a cognitive profile similar to that of HC are at less or equal risk for mood disorders. Future studies should include relevant measures for BD such as verbal memory and genetic risk scores.
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Affiliation(s)
- Isabelle E. Bauer
- The University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, Houston (Texas), USA
| | - Robert Suchting
- The University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, Houston (Texas), USA
| | - Tamsyn E. Van Rheenen
- Melbourne Neuropsychiatry Centre, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, VIC 3053, Australia
- Brain and Psychological Sciences Research Centre (BPsyC), Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Victoria, Australia
| | - Mon-Ju Wu
- The University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, Houston (Texas), USA
| | - Benson Mwangi
- The University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, Houston (Texas), USA
| | - Danielle Spiker
- The University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, Houston (Texas), USA
| | - Giovana B. Zunta-Soares
- The University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, Houston (Texas), USA
| | - Jair C. Soares
- The University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, Houston (Texas), USA
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23
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Liang S, Brown MRG, Deng W, Wang Q, Ma X, Li M, Hu X, Juhas M, Li X, Greiner R, Greenshaw AJ, Li T. Convergence and divergence of neurocognitive patterns in schizophrenia and depression. Schizophr Res 2018; 192:327-334. [PMID: 28651909 DOI: 10.1016/j.schres.2017.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 05/28/2017] [Accepted: 06/03/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Neurocognitive impairments are frequently observed in schizophrenia and major depressive disorder (MDD). However, it remains unclear whether reported neurocognitive abnormalities could objectively identify an individual as having schizophrenia or MDD. METHODS The current study included 220 first-episode patients with schizophrenia, 110 patients with MDD and 240 demographically matched healthy controls (HC). All participants performed the short version of the Wechsler Adult Intelligence Scale-Revised in China; the immediate and delayed logical memory of the Wechsler Memory Scale-Revised in China; and seven tests from the computerized Cambridge Neurocognitive Test Automated Battery to evaluate neurocognitive performance. The three-class AdaBoost tree-based ensemble algorithm was employed to identify neurocognitive endophenotypes that may distinguish between subjects in the categories of schizophrenia, depression and HC. Hierarchical cluster analysis was applied to further explore the neurocognitive patterns in each group. RESULTS The AdaBoost algorithm identified individual's diagnostic class with an average accuracy of 77.73% (80.81% for schizophrenia, 53.49% for depression and 86.21% for HC). The average area under ROC curve was 0.92 (0.96 in schizophrenia, 0.86 in depression and 0.92 in HC). Hierarchical cluster analysis revealed for MDD and schizophrenia, convergent altered neurocognition patterns related to shifting, sustained attention, planning, working memory and visual memory. Divergent neurocognition patterns for MDD and schizophrenia related to motor speed, general intelligence, perceptual sensitivity and reversal learning were identified. CONCLUSIONS Neurocognitive abnormalities could predict whether the individual has schizophrenia, depression or neither with relatively high accuracy. Additionally, the neurocognitive features showed promise as endophenotypes for discriminating between schizophrenia and depression.
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Affiliation(s)
- Sugai Liang
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Huaxi Brain Research Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Matthew R G Brown
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Wei Deng
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Huaxi Brain Research Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiang Wang
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaohong Ma
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingli Li
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xun Hu
- Huaxi Biobank, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Michal Juhas
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Xinmin Li
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Russell Greiner
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | | | - Tao Li
- Mental Health Centre and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Huaxi Brain Research Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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24
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Bauer IE, Diniz BS, Meyer TD, Teixeira AL, Sanches M, Spiker D, Zunta-Soares G, Soares JC. Increased reward-oriented impulsivity in older bipolar patients: A preliminary study. J Affect Disord 2018; 225:585-592. [PMID: 28886499 PMCID: PMC5626658 DOI: 10.1016/j.jad.2017.08.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/02/2017] [Accepted: 08/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Impulsivity is a well-established trait of bipolar disorder (BD) that persists across mood phases. It is, however, still unknown whether, in BD, impulsivity remains stable or varies in intensity over the lifespan. This cross-sectional study compared impulsive behavior in older euthymic BD patients and healthy individuals using a range of self-rating and behavioral measures of impulsivity. METHODS 28 BD patients (56.07 ± 4.08 years, 16 women) and 15 healthy controls (HC; 55.1 ± 3.95 years, 6 women) were administered the Barratt Impulsivity Scale (BIS) and selected tasks of the Cambridge Neuropsychological Test Automated Batter (CANTAB) reflecting impulsivity. Multivariate analysis of variance controlled for age compared impulsivity measures across BD and HC. RESULTS BD patients displayed poor decision making, risk taking, and increased delay aversion. Other measures of impulsivity such as response inhibition, sustained cognitive control, and BIS scores were, overall, comparable between BD and HC. CONCLUSIONS These preliminary findings suggest that, in BD, aspects of impulsivity related to reward-based decision making persist into late adulthood. Large scale, longitudinal studies are needed to evaluate the relationship of age to impulsivity over time, and explore the link between impulsivity and illness progression in elderly individuals with BD.
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Affiliation(s)
- Isabelle E. Bauer
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Breno Satler Diniz
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Thomas D. Meyer
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Antonio Lucio Teixeira
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Marsal Sanches
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States,Archway Mental Health Services, 58502 Bismarck, ND, United States
| | - Danielle Spiker
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Giovana Zunta-Soares
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
| | - Jair C. Soares
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
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25
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Liang S, Vega R, Kong X, Deng W, Wang Q, Ma X, Li M, Hu X, Greenshaw AJ, Greiner R, Li T. Neurocognitive Graphs of First-Episode Schizophrenia and Major Depression Based on Cognitive Features. Neurosci Bull 2017; 34:312-320. [PMID: 29098645 DOI: 10.1007/s12264-017-0190-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 08/18/2017] [Indexed: 02/05/2023] Open
Abstract
Neurocognitive deficits are frequently observed in patients with schizophrenia and major depressive disorder (MDD). The relations between cognitive features may be represented by neurocognitive graphs based on cognitive features, modeled as Gaussian Markov random fields. However, it is unclear whether it is possible to differentiate between phenotypic patterns associated with the differential diagnosis of schizophrenia and depression using this neurocognitive graph approach. In this study, we enrolled 215 first-episode patients with schizophrenia (FES), 125 with MDD, and 237 demographically-matched healthy controls (HCs). The cognitive performance of all participants was evaluated using a battery of neurocognitive tests. The graphical LASSO model was trained with a one-vs-one scenario to learn the conditional independent structure of neurocognitive features of each group. Participants in the holdout dataset were classified into different groups with the highest likelihood. A partial correlation matrix was transformed from the graphical model to further explore the neurocognitive graph for each group. The classification approach identified the diagnostic class for individuals with an average accuracy of 73.41% for FES vs HC, 67.07% for MDD vs HC, and 59.48% for FES vs MDD. Both of the neurocognitive graphs for FES and MDD had more connections and higher node centrality than those for HC. The neurocognitive graph for FES was less sparse and had more connections than that for MDD. Thus, neurocognitive graphs based on cognitive features are promising for describing endophenotypes that may discriminate schizophrenia from depression.
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Affiliation(s)
- Sugai Liang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
- Huaxi Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Roberto Vega
- Department of Computing Science, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Xiangzhen Kong
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, 6525 XD, Nijmegen, The Netherlands
| | - Wei Deng
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
- Huaxi Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qiang Wang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaohong Ma
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Mingli Li
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xun Hu
- Huaxi Biobank, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Andrew J Greenshaw
- Department of Psychiatry, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Russell Greiner
- Department of Computing Science, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Tao Li
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Huaxi Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, China.
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26
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Wu MJ, Mwangi B, Passos IC, Bauer IE, Cao B, Frazier TW, Zunta-Soares GB, Soares JC. Prediction of vulnerability to bipolar disorder using multivariate neurocognitive patterns: a pilot study. Int J Bipolar Disord 2017; 5:32. [PMID: 28861763 PMCID: PMC5578943 DOI: 10.1186/s40345-017-0101-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 07/19/2017] [Indexed: 12/03/2022] Open
Abstract
Bipolar disorder (BD) is a common disorder with high reoccurrence rate in general population. It is critical to have objective biomarkers to identify BD patients at an individual level. Neurocognitive signatures including affective Go/No-go task and Cambridge Gambling task showed the potential to distinguish BD patients from health controls as well as identify individual siblings of BD patients. Moreover, these neurocognitive signatures showed the ability to be replicated at two independent cohorts which indicates the possibility for generalization. Future studies will examine the possibility of combining neurocognitive data with other biological data to develop more accurate signatures.
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Affiliation(s)
- Mon-Ju Wu
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA. .,Department of Psychiatry & Behavioral Sciences, The University of Texas Health Science Center, 1941 East Road, Houston, TX, 77054, USA.
| | - Benson Mwangi
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA
| | - Ives Cavalcante Passos
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA
| | - Isabelle E Bauer
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA
| | - Bo Cao
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA
| | - Thomas W Frazier
- Cleveland Clinic Children's Hospital Center for Pediatric Behavioral Health, Cleveland, OH, USA
| | - Giovana B Zunta-Soares
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA
| | - Jair C Soares
- UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA
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Cao B, Passos IC, Mwangi B, Amaral-Silva H, Tannous J, Wu MJ, Zunta-Soares GB, Soares JC. Hippocampal subfield volumes in mood disorders. Mol Psychiatry 2017; 22:1352-1358. [PMID: 28115740 PMCID: PMC5524625 DOI: 10.1038/mp.2016.262] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 12/08/2016] [Accepted: 12/19/2016] [Indexed: 01/01/2023]
Abstract
Volume reduction and shape abnormality of the hippocampus have been associated with mood disorders. However, the hippocampus is not a uniform structure and consists of several subfields, such as the cornu ammonis (CA) subfields CA1-4, the dentate gyrus (DG) including a granule cell layer (GCL) and a molecular layer (ML) that continuously crosses adjacent subiculum (Sub) and CA fields. It is known that cellular and molecular mechanisms associated with mood disorders may be localized to specific hippocampal subfields. Thus, it is necessary to investigate the link between the in vivo hippocampal subfield volumes and specific mood disorders, such as bipolar disorder (BD) and major depressive disorder (MDD). In the present study, we used a state-of-the-art hippocampal segmentation approach, and we found that patients with BD had reduced volumes of hippocampal subfields, specifically in the left CA4, GCL, ML and both sides of the hippocampal tail, compared with healthy subjects and patients with MDD. The volume reduction was especially severe in patients with bipolar I disorder (BD-I). We also demonstrated that hippocampal subfield volume reduction was associated with the progression of the illness. For patients with BD-I, the volumes of the right CA1, ML and Sub decreased as the illness duration increased, and the volumes of both sides of the CA2/3, CA4 and hippocampal tail had negative correlations with the number of manic episodes. These results indicated that among the mood disorders the hippocampal subfields were more affected in BD-I compared with BD-II and MDD, and manic episodes had focused progressive effect on the CA2/3 and CA4 and hippocampal tail.
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Affiliation(s)
- Bo Cao
- Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
| | - Ives Cavalcante Passos
- Graduation Program in Psychiatry and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Benson Mwangi
- Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
| | - Henrique Amaral-Silva
- Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
| | - Jonika Tannous
- Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
| | - Mon-Ju Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
| | - Giovana B. Zunta-Soares
- Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
| | - Jair C. Soares
- Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, Texas, USA
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28
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The impact of machine learning techniques in the study of bipolar disorder: A systematic review. Neurosci Biobehav Rev 2017; 80:538-554. [PMID: 28728937 DOI: 10.1016/j.neubiorev.2017.07.004] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/15/2017] [Accepted: 07/08/2017] [Indexed: 01/10/2023]
Abstract
Machine learning techniques provide new methods to predict diagnosis and clinical outcomes at an individual level. We aim to review the existing literature on the use of machine learning techniques in the assessment of subjects with bipolar disorder. We systematically searched PubMed, Embase and Web of Science for articles published in any language up to January 2017. We found 757 abstracts and included 51 studies in our review. Most of the included studies used multiple levels of biological data to distinguish the diagnosis of bipolar disorder from other psychiatric disorders or healthy controls. We also found studies that assessed the prediction of clinical outcomes and studies using unsupervised machine learning to build more consistent clinical phenotypes of bipolar disorder. We concluded that given the clinical heterogeneity of samples of patients with BD, machine learning techniques may provide clinicians and researchers with important insights in fields such as diagnosis, personalized treatment and prognosis orientation.
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Passos IC, Mwangi B, Vieta E, Berk M, Kapczinski F. Areas of controversy in neuroprogression in bipolar disorder. Acta Psychiatr Scand 2016; 134:91-103. [PMID: 27097559 DOI: 10.1111/acps.12581] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We aimed to review clinical features and biological underpinnings related to neuroprogression in bipolar disorder (BD). Also, we discussed areas of controversy and future research in the field. METHOD We systematically reviewed the extant literature pertaining to neuroprogression and BD by searching PubMed and EMBASE for articles published up to March 2016. RESULTS A total of 114 studies were included. Neuroimaging and clinical evidence from cross-sectional and longitudinal studies show that a subset of patients with BD presents a neuroprogressive course with brain changes and unfavorable outcomes. Risk factors associated with these unfavorable outcomes are number of mood episodes, early trauma, and psychiatric and clinical comorbidity. CONCLUSION Illness trajectories are largely variable, and illness progression is not a general rule in BD. The number of manic episodes seems to be the clinical marker more robustly associated with neuroprogression in BD. However, the majority of the evidence came from cross-sectional studies that are prone to bias. Longitudinal studies may help to identify signatures of neuroprogression and integrate findings from the field of neuroimaging, neurocognition, and biomarkers.
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Affiliation(s)
- I C Passos
- Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - B Mwangi
- Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA
| | - E Vieta
- Bipolar Disorders Program, Institut d'Investigacions Biomédiques Agustí Pi Sunyer, CIBERSAM, University of Barcelona Hospital Clinic, Barcelona, Catalonia, Spain
| | - M Berk
- IMPACT Strategic Research Centre, School of Medicine, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, the Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, the University of Melbourne, Parkville, VIC, Australia
| | - F Kapczinski
- Bipolar Disorder Program, Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.,Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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