Development of scales to screen for eight common psychiatric disorders

Symptoms Profile and Psychopathological Correlates of (Hypo)Manic and Depressive Symptoms in Saudis With Bipolar Disorder: Preliminary Evidence

ABSTRACT

Although scientific knowledge about bipolar disorder (BD) is readily available and accumulating, there is still a particular need to inform this inquiry with evidence generated in understudied cultures. This study was set up to fulfill this need, focusing on two objectives: ascertaining the levels of hypo(manic) and depressive symptoms ( i.e. , symptom profile) in Saudis with BD and looking at the psychopathological correlates of bipolarity. These objectives were addressed using data from 87 individuals with BD (M age = 30.95, ±9.58 years) and 86 nonclinical persons (M age = 22.20, ±1.29 years). Racing thoughts was the most common hypo(manic) symptom, whereas depressed mood was the most depressive symptom reported. Somatization and hostility psychopathological dimensions appeared to constitute significant independent predictors of bipolarity, independent of depression and hypo(mania). Findings partially replicate previous ones, indicating a cross-cultural resemblance for BD.

Mindfulness-based intervention improves residual negative symptoms and cognitive impairment in schizophrenia: a randomized controlled follow-up study

BACKGROUND

Residual negative symptoms and cognitive impairment are common for chronic schizophrenia patients. The aim of this study was to investigate the efficacy of a mindfulness-based intervention (MBI) on negative and cognitive symptoms of schizophrenia patients with residual negative symptoms.

METHODS

In this 6-week, randomized, single-blind, controlled study, a total of 100 schizophrenia patients with residual negative symptoms were randomly assigned to the MBI or control group. The 6-week MBI group and the control group with general rehabilitation programs maintained their original antipsychotic treatments. The scores for the Positive and Negative Syndrome Scale (PANSS), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and the Symptom Checklist 90 (SCL-90) were recorded at baseline and week 6 to assess psychotic symptoms, cognitive performance, and emotional state, respectively.

RESULTS

Compared with general rehabilitation programs, MBI alleviated the PANSS-negative subscore, general psychopathology subscore, and PANSS total score in schizophrenia patients with residual negative symptoms (F = 33.77, pBonferroni < 0.001; F = 42.01, pBonferroni < 0.001; F = 52.41, pBonferroni < 0.001, respectively). Furthermore, MBI improved RBANS total score and immediate memory subscore (F = 8.80, pBonferroni = 0.024; F = 11.37, pBonferroni = 0.006), as well as SCL-90 total score in schizophrenia patients with residual negative symptoms (F = 18.39, pBonferroni < 0.001).

CONCLUSIONS

Our results demonstrate that MBI helps schizophrenia patients with residual negative symptoms improve clinical symptoms including negative symptom, general psychopathology symptom, and cognitive impairment.

TRIAL REGISTRATION

ChiCTR2100043803.

Using machine learning to improve the discriminative power of the FERD screener in classifying patients with schizophrenia and healthy adults

Background Facial emotion recognition deficit (FERD) seems to be an obvious feature of patients with schizophrenia and has great potential for classifying patients and non-patients. The FERD screener was previously developed to classify patients from healthy adults. However, an obvious drawback of this screener is that the recommended cut-off scores could enhance either sensitivity or specificity (about 0.92) only, while the other one is at an only acceptable level (about 0.66). Machine learning (ML) algorithms are famous for their feature extraction and data classification abilities, which are promising for improving the discriminative power of screeners. This study aimed to improve the discriminative power of the FERD screener using an ML algorithm. Methods The data were extracted from a previous study. Artificial neural networks were generated to estimate the probability of being a patient with schizophrenia or a healthy adult based on the examinee's responses on the FERD screener (168 items). The performances of the ML-FERD screener were examined using a stratified five-fold cross-validation method. Results Across the five subsets of data, the ML-FERD screener showed extremely high areas under the receiver operating characteristic curve of 0.97-0.99. With the optimized cut-off scores, the average sensitivity and specificity of the ML-FERD screener were 0.90 (0.85-0.93) and 0.93 (0.86-1.00), respectively. Limitations The characteristics of patients were not representative, and the age was mismatched to control group. Conclusion The ML-FERD screener appears to have a better discriminative power to classify patients with schizophrenia and healthy adults than does the FERD screener.

Profiles of Social and Coping Resources in Families of Children with Autism Spectrum Disorder: Relations to Parent and Child Outcomes

This study described empirically derived profiles of parents' personal and social coping resources in a sample of 207 families of children diagnosed with autism spectrum disorder. Latent Profile Analysis identified four family profiles based on socieoeconomic risk, coping strategy utilization, family functioning, available social supports, and perceptions of family-centered support. During the time of children's transition to school, parents in the most disadvantaged group experienced the highest levels of parenting stress and depression, and their children had significantly lower adaptive behaviour scores and more parent-reported behavior problems than children in the other three groups. Results highlight the need for systematic surveillance of family risk factors so that supports can be provided to enhance both parental well-being and children's developmental health.

Heritability and familiality of psychopathologic dimensions in Korean families with schizophrenia

AIM

Categorical syndromes such as schizophrenia could be a combination of many continuous mental structure phenotypes including several personality development/degeneration dimensions. This study investigated the heritability and familiality of symptom check list (SCL) psychopathologic dimensions in Korean schizophrenia linkage disequilibrium families.

METHOD

We recruited 204 probands (with schizophrenia) with their parents and siblings whenever possible. We used the SCL questionnaire to measure psychopathologic dimensions. The heritability of symptomatic dimensions in 543 family members was estimated using Sequential Oligogenic Linkage Analysis Routines (SOLAR). Psychopathologic dimensions in the 543 family members were compared with those in 307 healthy unrelated controls to measure familiality on using analysis of variance (ANOVA) analysis.

RESULTS

Five of the nine SCL variables were significantly heritable and were included in the subsequent analyses. The three groups (control, unaffected first-degree relative, schizophrenia patient) were found to be significantly different with regard to the expected order of average group scores for all heritable dimensions.

CONCLUSION

Aberrations in several symptomatic dimensions could contribute to the complexity of schizophrenia syndrome as a result of genetic-environment coaction or interaction in spite of some limitations (recruited family, phenotyping).

Social cognition in schizophrenia: The role of mentalizing in moral dilemma decision-making

BACKGROUND

Patients with schizophrenia have difficulties in several aspects of social cognition, e.g. emotion recognition and mentalizing. It is yet unclear if patients also show deficits in moral decision-making and whether the two aspects interact. Deficits in moral decision-making abilities might put patients in disadvantageous positions in every-day interactions.

METHOD

Twenty-five patients with schizophrenia and twenty-five matched healthy controls participated in six moral dilemma tasks, a standard moral competency test and two mentalizing tasks. In addition, we assessed psychopathology and empathy abilities. In a brief intervention patients were asked to empathize with characters in the moral dilemmas. We expected that the decisions made by patients with schizophrenia would be more out-come-oriented, i.e. utilitarian, as compared to those made by healthy controls.

RESULTS

Patients and healthy controls did not decide significantly differently on the moral dilemmas and patients showed normal moral competencies. Deficits in mentalizing in patients were replicated. Only in a regression analysis, however, we were able to show that PANSS positive scores and the Comic Strip task scores contributed to the moral decisions. Empathy training did not have an altering influence on decision-making.

DISCUSSION

Although an overlap between social cognition and moral decision-making networks has been proposed, deficits in moral decision-making and explicit associations with mentalizing were not present in patients. Psychopathology together with mentalizing abilities, however, contributed to decision-making in patients. Our findings suggest that in schizophrenia some aspects, e.g. mentalizing, are more strongly impaired while other aspects, e.g. moral decision-making, are preserved. Further research is needed to elucidate the different aspects forming social cognition and their mutual contributions, specifically in schizophrenia.

Patient-reported outcomes in obsessive-compulsive disorder

The purpose of the article was to provide an overview of patient-reported outcomes (PROs) and related measures that have been examined in the context of obsessive-compulsive disorder (OCD). The current review focused on patient-reported outcome measures (PROMs) that evaluated three broad outcome domains: functioning, health-related quality of life (HRQoL), and OCD-related symptoms. The present review ultimately included a total of 155 unique articles and 22 PROMs. An examination of the PROs revealed that OCD patients tend to suffer from significant functional disability, and report lower HRQoL than controls. OCD patients report greater symptom severity than patients with other mental disorders and evidence indicates that PROMs are sensitive to change and may be even better than clinician-rated measures at predicting treatment outcomes. Nonetheless, it should be noted that the measures reviewed lacked patient input in their development. Future research on PROMs must involve patient perspectives and include rigorous psychometric evaluation of these measures.

Clinical reappraisal of the Composite International Diagnostic Interview Screening Scales (CIDI-SC) in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

A clinical reappraisal study was carried out in conjunction with the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) All-Army Study (AAS) to evaluate concordance of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses based on the Composite International Diagnostic Interview Screening Scales (CIDI-SC) and post-traumatic stress disorder (PTSD) checklist (PCL) with diagnoses based on independent clinical reappraisal interviews (Structured Clinical Interview for DSM-IV [SCID]). Diagnoses included: lifetime mania/hypomania, panic disorder, and intermittent explosive disorder; six-month adult attention-deficit/hyperactivity disorder; and 30-day major depressive episode, generalized anxiety disorder, PTSD, and substance (alcohol or drug) use disorder (abuse or dependence). The sample (n = 460) was weighted for over-sampling CIDI-SC/PCL screened positives. Diagnostic thresholds were set to equalize false positives and false negatives. Good individual-level concordance was found between CIDI-SC/PCL and SCID diagnoses at these thresholds (area under curve [AUC] = 0.69-0.79). AUC was considerably higher for continuous than dichotomous screening scale scores (AUC = 0.80-0.90), arguing for substantive analyses using not only dichotomous case designations but also continuous measures of predicted probabilities of clinical diagnoses.

Composite International Diagnostic Interview screening scales for DSM-IV anxiety and mood disorders

BACKGROUND

Lack of coordination between screening studies for common mental disorders in primary care and community epidemiological samples impedes progress in clinical epidemiology. Short screening scales based on the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI), the diagnostic interview used in community epidemiological surveys throughout the world, were developed to address this problem.

METHOD

Expert reviews and cognitive interviews generated CIDI screening scale (CIDI-SC) item pools for 30-day DSM-IV-TR major depressive episode (MDE), generalized anxiety disorder (GAD), panic disorder (PD) and bipolar disorder (BPD). These items were administered to 3058 unselected patients in 29 US primary care offices. Blinded SCID clinical reinterviews were administered to 206 of these patients, oversampling screened positives.

RESULTS

Stepwise regression selected optimal screening items to predict clinical diagnoses. Excellent concordance [area under the receiver operating characteristic curve (AUC)] was found between continuous CIDI-SC and DSM-IV/SCID diagnoses of 30-day MDE (0.93), GAD (0.88), PD (0.90) and BPD (0.97), with only 9-38 questions needed to administer all scales. CIDI-SC versus SCID prevalence differences are insignificant at the optimal CIDI-SC diagnostic thresholds (χ2 1 = 0.0-2.9, p = 0.09-0.94). Individual-level diagnostic concordance at these thresholds is substantial (AUC 0.81-0.86, sensitivity 68.0-80.2%, specificity 90.1-98.8%). Likelihood ratio positive (LR+) exceeds 10 and LR- is 0.1 or less at informative thresholds for all diagnoses.

CONCLUSIONS

CIDI-SC operating characteristics are equivalent (MDE, GAD) or superior (PD, BPD) to those of the best alternative screening scales. CIDI-SC results can be compared directly to general population CIDI survey results or used to target and streamline second-stage CIDIs.

Influence of reporting effects on the association between maternal depression and child autism spectrum disorder behaviors

BACKGROUND

Maximizing measurement accuracy is an important aim in child development assessment and research. Parents are essential informants in the diagnostic process, and past research suggests that certain parental characteristics may influence how they report information about their children. This has not been studied in autism spectrum disorders (ASD) to date. We aimed, therefore, to investigate the possible effect that maternal depression might have on a mother's reports of her child's ASD behaviors. Using structural equation modeling, we disaggregated shared from unique variation in the association between latent variable measures of maternal depression and ASD behaviors.

METHODS

Data were obtained from a study of preschoolers aged 2-4 newly diagnosed with ASD (n = 214). Information from a parent questionnaire, a semi-structured parent interview, and a semi-structured observational assessment was used to develop a latent variable measure of child ASD behaviors. Mothers reported on their own depression symptoms. We first modeled the covariance between maternal depression and child ASD behavior. Then, to quantify unique variation, we added covariance terms between maternal depression and the residual variation associated with the individual measures of child ASD behaviors.

RESULTS

The model demonstrated excellent fit to the underlying data. Maternal self-report of depression symptoms exhibited a significant association with the unique variance of the questionnaire report but not with the latent variable measure of child ASD behavior. A gradient pattern of association was demonstrated between maternal depression and the unique variance of the ASD measures: most strongly for the maternal questionnaire report, more weakly for the maternal semi-structured interview, and to a trivial extent for the observational interview.

CONCLUSIONS

Parental depression may influence reporting of ASD behaviors in preschoolers. Shared method effects may also contribute to bias. This finding highlights the importance of obtaining multimethod reports of child ASD symptoms.

Somatization and stimulus entrapment

A "vicious circle" hypothesis is put forward for the common kind of somatization which forms the basis of the DSM's "somatization disorder." Two compounding mechanisms are seen to be operative: (1) a failure of higher order inhibitory systems involved in the "medial pain system"; (2) amplification of stimulus intensity produced by the effect of attention. Attentional failure is produced not only by social factors but also by failure of sensory intensity modulation consequent upon (1). The argument focuses on data from borderline patients in whom the unusual prominence of pain may be due, at least in part, to incompetence of the "medial pain system." This is reflected in enlarged P3a components of the event-related potential suggesting diminished inhibitory function involving prefrontal connections. Two studies are briefly presented in summary form suggesting that somatization may be ameliorated by a form of therapy which focuses on "inner" material as a means of overcoming "stimulus entrapment."

Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students

PURPOSE

To systematically review articles reporting on depression, anxiety, and burnout among U.S. and Canadian medical students.

METHOD

Medline and PubMed were searched to identify peer-reviewed English-language studies published between January 1980 and May 2005 reporting on depression, anxiety, and burnout among U.S. and Canadian medical students. Searches used combinations of the Medical Subject Heading terms medical student and depression, depressive disorder major, depressive disorder, professional burnout, mental health, depersonalization, distress, anxiety, or emotional exhaustion. Reference lists of retrieved articles were inspected to identify relevant additional articles. Demographic information, instruments used, prevalence data on student distress, and statistically significant associations were abstracted.

RESULTS

The search identified 40 articles on medical student psychological distress (i.e., depression, anxiety, burnout, and related mental health problems) that met the authors' criteria. No studies of burnout among medical students were identified. The studies suggest a high prevalence of depression and anxiety among medical students, with levels of overall psychological distress consistently higher than in the general population and age-matched peers by the later years of training. Overall, the studies suggest psychological distress may be higher among female students. Limited data were available regarding the causes of student distress and its impact on academic performance, dropout rates, and professional development.

CONCLUSIONS

Medical school is a time of significant psychological distress for physicians-in-training. Currently available information is insufficient to draw firm conclusions on the causes and consequences of student distress. Large, prospective, multicenter studies are needed to identify personal and training-related features that influence depression, anxiety, and burnout among students and explore relationships between distress and competency.