Using daily monitoring of psychiatric symptoms to evaluate hospital length of stay

Repetitive transcranial magnetic stimulation: Course and early prediction of response in depression

BACKGROUND

Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression, yet few studies have mapped the trajectories of symptom change over treatment. Tracking clinical response during early treatment may be helpful to predict outcome, particularly non-response.

METHODS

We used naturalistic data (N = 117) to examine changes in the Daily Symptom Index (DI-5) scores of adult patients with unipolar or bipolar depression who underwent ≥16 treatment sessions of left dorsolateral prefrontal cortex rTMS at a private psychiatric facility in Western Australia, between 2016 and 2019.

RESULTS

Two response trajectories were charted: non-response (N = 71, 61%) and response (N = 46, 39%). Both trajectories diverged at 99% confidence interval at session 10, which was used as the point to predict treatment response at session 20. The response group showed a reduction of 4.21 in the mean DI-5 score from baseline at session 10. On this basis, a 4-point reduction in the DI-5 score at session 10 was defined as predictor of responder status at session 20. If the improvement is < 4 points at session 10, the probability of non-response at session 20 is 75%. If the improvement is ≥ 4 points, the probability of response at session 20 is 66%.

LIMITATIONS

The DI-5 scores were not examined beyond 20 treatment sessions, which may have shown delayed responders in the non-response group.

CONCLUSIONS

In this study of depression response trajectories with rTMS treatment, prediction of response at session 20 can be made at session 10 of treatment. Further research is required to generalise the current findings.

Improvement in Impaired Social Cognition but Not Seizures by Everolimus in a Child with Tuberous Sclerosis-Associated Autism through Increased Serum Antioxidant Proteins and Oxidant/Antioxidant Status

We investigated the effect of the mammalian target of rapamycin (mTOR) inhibitor everolimus on tuberous sclerosis complex- (TSC-) associated autistic symptoms and focal seizures with impaired awareness in a female child with TSC. We further evaluated the relationship between improved autistic symptoms and seizures and increased the serum levels of the antioxidant proteins, ceruloplasmin (Cp) and transferrin (Tf), and oxidant-antioxidant status indicated by the oxidant marker oxidized low-density lipoprotein (ox-LDL) and the antioxidant marker total antioxidant power (TAP). Everolimus treatment improved impaired social cognition and autistic behaviors; however, seizure and epileptic activity persisted. Serum Cp and Tf levels gradually increased in response to improved autistic symptoms. Serum TAP levels gradually decreased from baseline to the lowest value at 16 weeks and then increased at 24 weeks, showing a trend toward decreased total score of the Aberrant Behavior Checklist. This study revealed that everolimus treatment improved impaired social cognition with increased serum levels of the copper mediator (Cp) and iron mediator (Tf) via homeostatic control of mTOR activity accompanied by overlap of the oxidant-antioxidant system. Everolimus had no effect on TSC-related epileptiform discharges, and thus, the autistic symptoms and epileptic activity may be two independent end results of a common central nervous system disorder including mTOR hyperactivity. This trial is registered with JMAS-IIA00258.

Can Mental Health Anti-stigma Messages Have Untoward Effects on Some People with Depression?: An Exploratory Study

Scholars have warned that mental health anti-stigma campaigns targeting the general public can possibly be detrimental to some who are stigmatized. Scholars also have noted that people with depression respond to some public service announcements (PSAs) differently than those without. Accordingly, the current study explored whether anti-stigma PSAs targeting the general public could cause problematic outcomes for people with depression. Participants with (n = 55) and without (n = 133) heightened depressive symptomatology viewed two mental health anti-stigma PSAs. Participants provided thoughts about the PSAs through a single, open-ended question. To allow for an assessment of convergence, participants rated overall favorability toward each PSA through a close-ended item. Results indicated that most qualitative responses were favorable; however, 23.6% of respondents with heightened depressive symptomatology, compared to 1.5% without, provided responses coded as indicating that at least one PSA caused unintended negative affect, χ²(1) = 25.96, [Formula: see text] p < .001. Evidence of untoward effects primarily came from the Friend PSA and the qualitative responses indicate how this occurred. Moreover, complementing the qualitative coding, the Friend PSA was rated less favorably by participants with heightened depressive symptomatology (M = 5.00, SD = 1.67), than those without (M = 5.64, SD = 1.44), F(1, 186) = 6.99, p = .009, η_p² = .036. There were no significant differences in quantitative favorability ratings regarding the Labeling PSA. Indicating that further investigation is warranted, results suggest it is possible for an anti-stigma PSA targeting the general public to cause unintended negative affect among some people with depression.

Assessing interpersonal and mood factors to predict trajectories of suicidal ideation within an inpatient setting

BACKGROUND

A limited amount of research has assessed how suicide risk changes over time, and how changes can be predicted. The current study assessed suicidal ideation and risk factors throughout inpatient visits to a psychiatric facility to refine prediction of suicide risk.

METHOD

In total, 491 patients (73% Female; mean age = 39.21) at a psychiatric inpatient facility self-reported the frequency of their suicidal thoughts, perceived burdensomeness, thwarted belongingness, hopelessness, depression, and anxiety in the prior 24 h on a daily basis. Levels of suicidal ideation and risk factors at each quarter of an inpatient's stay were identified, and latent class growth analysis used to identify common patterns of change over time.

RESULTS

Changes in mood and interpersonal factors were associated with changes in suicidal ideation over days and weeks. Further, they contributed to the prediction of future levels of suicidal ideation. Thwarted belongingness at admission predicted whether patients had pervasively high suicidal thoughts over the course of inpatient visits or showed marked improvements, while perceived burdensomeness predicted which patients would develop suicidal thoughts during their visit.

LIMITATIONS

The use of single item measures may limit specificity of measurement of suicide risk factors. Hourly, rather than daily measurement used in the current study, may more accurately identify suicide risk.

CONCLUSIONS

Change in suicidal ideation is associated with changes in a number of psychological risk factors. Regular assessment of interpersonal risk factors may identify warning signs and aid clinical interventions in reducing suicidal thoughts and associated self-injurious behaviours.

Predictors of length of stay in psychiatric inpatient units: Does their effect vary across countries?

BACKGROUND

Previous studies in individual countries have identified inconsistent predictors of length of stay (LoS) in psychiatric inpatient units. This may reflect methodological inconsistencies across studies or true differences of predictors. In this study we assessed predictors of LoS in five European countries and explored whether their effect varies across countries.

METHODS

Prospective cohort study. All patients admitted over 14 months to 57 psychiatric inpatient units in Belgium, Germany, Italy, Poland and United Kingdom were screened. Putative predictors were collected from medical records and in face-to-face interviews and tested for their association with LoS.

RESULTS

Average LoS varied from 17.9days in Italy to 55.1days in Belgium. In the overall sample being homeless, receiving benefits, social isolation, diagnosis of psychosis, greater symptom severity, substance use, history of previous admission and being involuntarily admitted predicted longer LoS. Several predictors showed significant interaction effects with countries in predicting LoS. One variable, homelessness, predicted a different LoS even in opposite directions, whilst for other predictors the direction of the association was the same, but the strength of the association with LoS varied across countries.

CONCLUSIONS

The same patient characteristics have a different impact on LoS in different contexts. Thus, although some predictor variables related to clinical severity and social dysfunction appear of generalisable relevance, national studies on LoS are required to understand the complex influence of different patient characteristics on clinical practice in the given contexts.

Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD

Numerous reports indicate that the incidence of posttraumatic stress disorder (PTSD) in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) military personnel has created a significant behavioural healthcare challenge. These findings have served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. The current article presents the use of Virtual Reality (VR) as a clinical tool to address the assessment, prevention, and treatment of PTSD, based on the VR projects that were evolved at the University of Southern California Institute for Creative Technologies since 2004. A brief discussion of the definition and rationale for the clinical use of VR is followed by a description of a VR application designed for the delivery of prolonged exposure (PE) for treating Service Members (SMs) and Veterans with combat- and sexual assault-related PTSD. The expansion of the virtual treatment simulations of Iraq and Afghanistan for PTSD assessment and prevention is then presented. This is followed by a forward-looking discussion that details early efforts to develop virtual human agent systems that serve the role of virtual patients for training the next generation of clinical providers, as healthcare guides that can be used to support anonymous access to trauma-relevant behavioural healthcare information, and as clinical interviewers capable of automated behaviour analysis of users to infer psychological state. The paper will conclude with a discussion of VR as a tool for breaking down barriers to care in addition to its direct application in assessment and intervention.