Nonverbal interaction of patients and therapists during psychiatric interviews

The project for objective measures using computational psychiatry technology (PROMPT): Rationale, design, and methodology

Introduction

Depressive and neurocognitive disorders are debilitating conditions that account for the leading causes of years lived with disability worldwide. However, there are no biomarkers that are objective or easy-to-obtain in daily clinical practice, which leads to difficulties in assessing treatment response and developing new drugs. New technology allows quantification of features that clinicians perceive as reflective of disorder severity, such as facial expressions, phonic/speech information, body motion, daily activity, and sleep.

Methods

Major depressive disorder, bipolar disorder, and major and minor neurocognitive disorders as well as healthy controls are recruited for the study. A psychiatrist/psychologist conducts conversational 10-min interviews with participants ≤10 times within up to five years of follow-up. Interviews are recorded using RGB and infrared cameras, and an array microphone. As an option, participants are asked to wear wrist-band type devices during the observational period. Various software is used to process the raw video, voice, infrared, and wearable device data. A machine learning approach is used to predict the presence of symptoms, severity, and the improvement/deterioration of symptoms.

Discussion

The overall goal of this proposed study, the Project for Objective Measures Using Computational Psychiatry Technology (PROMPT), is to develop objective, noninvasive, and easy-to-use biomarkers for assessing the severity of depressive and neurocognitive disorders in the hopes of guiding decision-making in clinical settings as well as reducing the risk of clinical trial failure. Challenges may include the large variability of samples, which makes it difficult to extract the features that commonly reflect disorder severity.

Trial Registration

UMIN000021396, University Hospital Medical Information Network (UMIN).

Evaluating the severity of depressive symptoms using upper body motion captured by RGB-depth sensors and machine learning in a clinical interview setting: A preliminary study

BACKGROUND

Mood disorders have long been known to affect motor function. While methods to objectively assess such symptoms have been used in experiments, those same methods have not yet been applied in clinical practice because the methods are time-consuming, labor-intensive, or invasive.

METHODS

We videotaped the upper body of each subject using a Red-Green-Blue-Depth (RGB-D) sensor during a clinical interview setting. We then examined the relationship between depressive symptoms and body motion by comparing the head motion of patients with major depressive disorders (MDD) and bipolar disorders (BD) to the motion of healthy controls (HC). Furthermore, we attempted to predict the severity of depressive symptoms by using machine learning.

RESULTS

A total of 47 participants (HC, n = 16; MDD, n = 17; BD, n = 14) participated in the study, contributing to 144 data sets. It was found that patients with depression move significantly slower compared to HC in the 5th percentile and 50th percentile of motion speed. In addition, Hamilton Depression Rating Scale (HAMD)-17 scores correlated with 5th percentile, 50th percentile, and mean speed of motion. Moreover, using machine learning, the presence and/or severity of depressive symptoms based on HAMD-17 scores were distinguished by a kappa coefficient of 0.37 to 0.43.

LIMITATIONS

Limitations include the small number of subjects, especially the number of severe cases and young people.

CONCLUSIONS

The RGB-D sensor captured some differences in upper body motion between depressed patients and controls. If much larger samples are accumulated, machine learning may be useful in identifying objective measures for depression in the future.

Effects of Handshake Duration on Other Nonverbal Behavior

Although detailed descriptions of proper handshakes partly comprise many etiquette books, how a normal handshake can be described, its proper duration, and the consequences of violating handshake expectations remain empirically unexplored. This study measured the effect of temporal violations of the expected length of a handshake (less than three seconds according to previous studies) administered unobtrusively in a naturalistic experiment. We compared volunteer participants' (N = 34; 25 females; 9 males; M_age = 23.76 years, SD = 6.85) nonverbal behavior before and after (a) a prolonged handshake (>3 seconds), (b) a normal length handshake (average length <3 seconds), and (c) a control encounter with no handshake. Frame-by-frame behavioral analyses revealed that, following a prolonged handshake (vs. a normal length or no handshake), participants showed less interactional enjoyment, as indicated by less laughing. They also showed evidence of anxiety and behavioral freezing, indicated by increased hands-on-hands movements, and they showed fewer hands-on-body movements. Normal length handshakes resulted in less subsequent smiling than did prolonged handshakes, but normal length handshakes were also followed by fewer hands-on-face movements than prolonged handshakes. No behavior changes were associated with the no-handshake control condition. We found no differences in participants' level of empathy or state/trait anxiety related to these conditions. In summary, participants reacted behaviorally to temporal manipulations of handshakes, with relevant implications for interactions in interviews, business, educational, and social settings and for assisting patients with social skills difficulties.

Association between uncooperativeness and the glucose metabolism of patients with chronic behavioral disorders after severe traumatic brain injury: a cross-sectional retrospective study

Bakground

Patients with behavioral disorders following severe traumatic brain injury (sTBI) often have disorders of consciousness that make expressing their emotional distress difficult. However, no standard method for assessing the unsettled and unforeseen responses that are associated with behavioral disorders has yet to be established. Because the thalamus is known to play a role in maintaining consciousness and cognition, we used 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) to examine the association between brain glucose metabolism in the thalamus and behavioral disorders.

Methods

We retrospectively analyzed 70 consecutive patients with sTBI who had been involved in motor vehicle accidents. To assess behavioral disorders, we evaluated 18 symptoms using the Brief Psychiatric Rating Scale (BPRS): Emotional Withdrawal, Conceptual Disorganization, Tension, Mannerisms and Posturing, Motor Retardation, Uncooperativeness, Blunted Affect, Excitement, Somatic Concern, Anxiety, Feeling of Guilt, Grandiosity, Depressive Mood, Hostility, Suspiciousness, Hallucinatory Behavior, Unusual Thought Content, and Disorientation. First, we identified clinical characteristics of sTBI patients with behavioral disorders. Next, we retrospectively analyzed 18F-FDG-PET/CT data to assess how thalamic activity was related with abnormal behaviors.

Results

Twenty-six patients possessed the minimum communicatory ability required for psychiatric interview. Among them, 15 patients (57.7%) were diagnosed with behavioral disorder, 14 of whom had reached a stable psychiatric state after about 426.6 days of treatment. Excitement (13 patients) and uncooperativeness (10 patients) were the most frequently observed symptoms. Available 18F-FDG-PET/CT data indicated that thalamic glucose metabolism was imbalanced and lateralized (p = 0.04) in 6 patients who exhibited uncooperativeness.

Conclusions

Behavioral symptoms of excitement and uncooperativeness were common in patients with sTBI, although most symptoms improved as the chronic stage continued. Our data support the idea that imbalanced laterality of glucose metabolism in the thalamus might be related to behavioral disorders characterized by uncooperativeness.

Trial registration

UMIN 000029531. Registered 27 March 2017, retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s13030-018-0125-0) contains supplementary material, which is available to authorized users.

Contrast of hand preferences between communicative gestures and non-communicative actions in baboons: implications for the origins of hemispheric specialization for language

Gestural communication is a modality considered in the literature as a candidate for determining the ancestral prerequisites of the emergence of human language. As reported in captive chimpanzees and human children, a study in captive baboons revealed that a communicative gesture elicits stronger degree of right-hand bias than non-communicative actions. It remains unclear if it is the communicative nature of this manual behavior which induces such patterns of handedness. In the present study, we have measured hand use for two uninvestigated behaviors in a group of captive olive baboons: (1) a non-communicative self-touching behavior ("muzzle wipe" serving as a control behavior), (2) another communicative gesture (a ritualized "food beg") different from the one previously studied in the literature (a species-specific threat gesture, namely "hand slap") in the same population of baboons. The hand preferences for the "food beg" gestures revealed a trend toward right-handedness and significantly correlated with the hand preferences previously reported in the hand slap gesture within the same baboons. By contrast, the hand preferences for the self-touching behaviors did not reveal any trend of manual bias at a group-level nor correlation with the hand preferences of any communicative gestures. These findings provide additional support to the hypothesized existence in baboons of a specific communicative system involved in the production of communicative gestures that may tend to a left-hemispheric dominance and that may differ from the system involved in purely motor functions. The hypothetical implications of these collective results are discussed within the theoretical framework about the origins of hemispheric specialization for human language.

Observing Conspecifics Scratching Induces a Contagion of Scratching in Japanese Monkeys (Macaca fuscata)

Although a large number of studies have examined self-directed behaviors (SDBs) such as scratching and self-grooming as nonverbal leakage of negative emotional arousal in humans, few studies have investigated the informative function of SDBs in nonhuman primates. The present study investigated whether viewing another monkey scratching itself elicited negative arousal from conspecific observers in Japanese monkeys (Macaca fuscata). An experimental situation was created in which the target monkey watched a stranger through a small peephole and the observer monkey(s) watched the target in turn. Scratching spread when conspecific observers watched the target scratching itself while performing monitoring behavior. The author proposes that the possible contagion of scratching by monkeys observing another's scratching may involve transmission of a psychological state, a primitive style of empathy.

Abnormal, abusive, and stress-related behaviors in baboon mothers

BACKGROUND

Psychiatric disturbances during pregnancy and the postpartum period are especially serious, given the negative effects on the mother as well as the child. Understanding the causes of such disturbances has been difficult owing to the complexity of psychological, social, experiential, biological, and genetic factors involved.

METHODS

To determine the potential utility of a nonhuman primate model for the study of postpartum disorders, the pathologic and stress-related behavior of 62 female baboons living in social groups was studied during pregnancy and after the birth of an infant.

RESULTS

The prevalence of abnormal behavior and self-directed scratching (a measure of stress response) was higher after birth of the infant. Subjects displayed a significantly higher frequency per hour of these behaviors postpartum, which increased over 8 weeks. Abusive behaviors toward the infant were common, occurring in 55% of the subjects. Mothers with low dominance rank, who usually have lower levels of social support, had higher levels of abusive behavior during the postpartum period.

CONCLUSIONS

Baboons show variation in measurable behaviors related to stress and abnormal functioning during the pre- and postpartum periods, indicating that a nonhuman primate model may be useful in the study of factors affecting postpartum psychiatric disorders and infant abuse.

Effects of cognitive challenge on self-directed behaviors by chimpanzees (Pan troglodytes)

In primates, including humans, scratching and other self-directed behaviors (SDBs) have recently been reported to be differentially displayed as a function of social interactions, anxiety-related drugs, and response outcomes during learning tasks. Yet few studies have focused on the factors influencing SDBs in our closest living relatives, the chimpanzees (Pan troglodytes). Furthermore, no previous experimental study has examined handedness of SDBs as a function of changes in task difficulty. Using matching-to-sample tasks of varying difficulty, the present study examines the effect of manipulations of task difficulty on rates, handedness, and type of SDBs in an experimental study of eight chimpanzees. SDBs were categorized as rubs, gentle scratches, and rough scratches. SDBs increased during difficult discriminations, but only for subjects who started the experiment on an easy discrimination; subjects who started on a difficult discrimination exhibited no differential rates of SDBs as a function of task difficulty. There was a tendency to exhibit relatively more SDBs with the right hand in the more difficult task. Rates of SDBs decreased after auditory feedback signals, suggesting a link between SDBs and uncertainty. Rubs were directed more to the face (trigeminal), and gentle and rough scratches more to the body (spinothalamic), suggesting that face-directed SDBs may index a different motivational basis than scratches. Taken together, these results extend previous research on SDBs to the domain of cognitive stress in nonsocial contexts, demonstrating that SDBs are sensitive to manipulations of task difficulty in chimpanzees.

Incomplete recovery among endogenously depressed patients: an ethological analysis

The paper reports on an ethological study comparing the behavior of hospitalized endogenously depressed (N = 11) and nonpsychiatrically ill control (N = 11) subjects hospitalized for somatic illnesses. All subjects participating in the study signed the Helsinki Declaration of 1964 for protection of human research subjects. Findings include: a) for the first hospital week behavioral differences between the two subject groups were highly significant with the most robust finding being the reduced frequency of social interaction among depressed subjects, b) an increase in communication among depressed subjects over the course of hospitalization but a decline of communication and an increase of self-activity among controls, and c) significant behavior profile differences between the two subject groups at the time of hospital discharge. The findings suggest that clinically remitted depressives are not fully recovered and socially capable when discharged from the hospital.

Major depression: behavioral markers of depression and recovery

The concepts of psychosocial and psychomotor inhibition characteristic of major depression are based primarily on clinical observations. It is possible to describe and define these two types of inhibition by means of a systematic, quantitative ethological (behavioral) approach, which singles out precise and significant behavior markers. This investigation focuses on the behavioral features of psychosocial and psychomotor inhibition in 11 hospitalized depressed subjects and their changes during clinical recovery. The hypothesis that major depression is characterized by a significant reduction of social interaction is tested (psycho-intellectual inhibition is not addressed). Results show significant behavioral differences between depressed and recovered subjects with depression being characterized by a significant reduction of social interaction, whereas self occupation and body mobility are reduced to a lesser degree. Behavior markers for depression include nonspecific gaze, withdrawal, no mouth movements, no eye region movements, and social inactivity. Behavior markers for recovery include socially interested, social smile, verbal social initiative, speech, nod, raised eyebrows, wrinkled eyebrows, social laughter, gesticulation, drum one's fingers, point, and help. Findings point to tendencies toward two types of major depression and two types of recovery. A companion paper (Schelde, this journal) addresses theoretical issues.

Nonverbal behavior and alexithymic traits in normal subjects. Individual differences in encoding emotions

The relationship between nonverbal behavior and emotional awareness, as measured by the Toronto Alexithymia Scale, was studied in 24 young volunteers free of medical and psychiatric disorders. Multiple regression analysis revealed that nonverbal behavior during psychiatric interview was a significant predictor of the Toronto Alexithymia Scale total score independent of situational depression and anxiety. Subjects who had difficulty identifying and describing their feelings showed a combination of poor nonverbal expressivity and frequent self-directed behavior patterns indicative of tension and anxiety. In addition, subjects with a tendency toward externally oriented thinking showed more avoidance behavior during the interview. The ethological data of this study support clinical observations, which suggest that alexithymic traits interfere with both processing of emotion and interpersonal behavior.

Changes in nonverbal behavior of therapists and depressed patients during cognitive therapy

Nonverbal behavior of 8 patients and 7 therapists during the first few minutes of 20 therapeutic sessions (either 2 or 3 per therapist-patient pair) was used as a baseline measure to assess whether there were systematic changes by the end of a single therapeutic session. The nonverbal behavior of both patients and therapists showed increases in prosocial behavior. Also, increases in signs of anxiety were noted in the nonverbal behavior of therapists. Significant correlations between nonverbal behavior of patients and therapists occurred for certain classes of behavior. It appears worthwhile to assess changes in nonverbal behavior during therapeutic sessions.