Text mining methods for the characterisation of suicidal thoughts and behaviour

Traditional research methods have shown low predictive value for suicidal risk assessments and limitations to be applied in clinical practice. The authors sought to evaluate natural language processing as a new tool for assessing self-injurious thoughts and behaviors and emotions related. We used MEmind project to assess 2838 psychiatric outpatients. Anonymous unstructured responses to the open-ended question "how are you feeling today?" were collected according to their emotional state. Natural language processing was used to process the patients' writings. The texts were automatically represented (corpus) and analyzed to determine their emotional content and degree of suicidal risk. Authors compared the patients' texts with a question used to assess lack of desire to live, as a suicidal risk assessment tool. Corpus consists of 5,489 short free-text documents containing 12,256 tokenized or unique words. The natural language processing showed an ROC-AUC score of 0.9638 when compared with the responses to lack of a desire to live question. Natural language processing shows encouraging results for classifying subjects according to their desire not to live as a measure of suicidal risk using patients' free texts. It is also easily applicable to clinical practice and facilitates real-time communication with patients, allowing better intervention strategies to be designed.

Clinical Note: Bipolar disorder in Cerebrotendinous Xanthomatosis: a case report

Cerebrotendinous X anthomatosis (CTX) is a rare autosomal recessive disorder presenting with possible psychiatric manifestations that, once established, are difficult to control. We present the case of a 29-year-old woman diagnosed with CTX who developed bipolar disorder. Owing to difficulties in pharmacological management, the patient underwent electroconvulsive therapy (ECT), which lead to a favorable outcome. Little is known about the treatment of psychiatric symptoms of CTX, un uncommon disorder, though ECT may be an effective and safe approach.

Comparison of Mental Health Treatment Adequacy and Costs in Public Hospitals in Boston and Madrid

Analyses of healthcare expenditures and adequacy are needed to identify cost-effective policies and practices that improve mental healthcare quality. Data are from 2010 to 2012 electronic health records from three hospital psychiatry departments in Madrid (n = 29,944 person-years) and three in Boston (n = 14,109 person-years). Two-part multivariate generalized linear regression and logistic regression models were estimated to identify site differences in mental healthcare expenditures and quality of care. Annual total average treatment expenditures were $4442.14 in Boston and $2277.48 in Madrid. Boston patients used inpatient services more frequently and had higher 30-day re-admission rates (23.7 vs. 8.7%) despite higher rates of minimally adequate care (49.5 vs. 34.8%). Patients in Madrid were more likely to receive psychotropic medication, had fewer inpatient stays and readmissions, and had lower expenditures, but had lower rates of minimally adequate care. Differences in insurance and healthcare system policies and mental health professional roles may explain these dissimilarities.

Pain as a Predictor of Opioid Use Disorder in a Nationally Representative Sample

OBJECTIVE

The authors sought to ascertain the relationship between moderate and more severe pain and prescription opioid use disorders in the noninstitutionalized U.S.

METHOD

A structural equation model was used to assess prospectively the interdependency of pain and prescription opioid use disorder at waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Pain was measured with a 5-point scale of pain-related interference in daily activities and dichotomized as "no pain" (no or little interference) or "pain" (moderate to extreme interference). Prescription opioid use disorder was assessed with a structured interview (the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version). Other covariates included age, sex, anxiety or mood disorders, and family history of drug, alcohol, and behavioral problems.

RESULTS

In the structural equation model, pain and prescription opioid use disorders were significantly associated with one another at baseline and at 3-year follow-up. However, whereas pain at baseline was also significantly associated with prescription opioid use disorder at follow-up, prescription opioid use disorder at baseline was not associated with pain at follow-up. These associations were independent of several background demographic and clinical characteristics. The path for pain interference was associated with a 41% relative increase in the risk of developing a prescription opioid use disorder.

CONCLUSIONS

Painful conditions contribute to the risk of prescription opioid use disorders. To help reduce the incidence of prescription opioid abuse and dependence among adults with moderate to severe pain, careful monitoring and consideration of nonopioid alternative treatments is warranted.

Use of inhaled loxapine in acute psychiatric agitation

Objectives

The aim of this work is to study the efficacy of loxapine inhalation powder on agitated patients in a psychiatric inpatient unit.

Methods

Nineteen patients sample, with an average age of 39.4 years old, diagnosed with schizophrenia, bipolar disorder or schizoaffective disorder. Patients inhaled loxapine 10 mg, using the staccato system, when they suffered a psychomotor agitation. The clinical efficacy was measured as a change from baseline in the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) and in the Young Mania Rating Scale (YMRS) one hour after the administration of loxapine.

Results

A mean of 9.8 points reduction (22.6 at baseline and 12.7 one hour after the administration) was found on the PANSS-EC (t-test, P < .001) and 68.4% of the patients were considered responders as they obtained a reduction of at least 40% of the basal score. On 10 of the total of the agitated patients showed an improvement of the psychomotor excitement, and this allowed the clinicians to remove the physical restraint; on 6 of the agitated patients the physical restraint could be avoided during the whole treatment; and 3 of the patients experienced a reduction of the excitement. The reduction on PANNS-EC on the latest group was not statistically significant (t-test, P = .121).

Conclusions

Inhaled loxapine was a non-invasive, rapid and effective alternative treatment for acute agitation in a psychiatric inpatient unit. It resulted more effective on mild and moderate cases; not been significantly effective on the severe cases of agitation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Probability and predictors of treatment-seeking for substance use disorders in the U.S

BACKGROUND

Little is known about to what extent treatment-seeking behavior varies across individuals with alcohol abuse, alcohol dependence, drug abuse, and drug dependence.

METHODS

The sample included respondents from the Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who reported a lifetime diagnosis alcohol abuse, alcohol dependence, drug abuse, or drug dependence. Unadjusted and adjusted hazard ratios are presented for time to first treatment contact by sociodemographic characteristics and comorbid psychiatric disorders. Individuals were censored from the analyses if their condition remitted prior to seeking treatment.

RESULTS

In the first year after disorder onset, rates of treatment-seeking were 13% for drug dependence, 5% for alcohol dependence, 2% for drug abuse, and 1% for alcohol abuse. The lifetime probability of seeking treatment among individuals who did not remit was also highest for drug dependence (90%), followed by drug abuse (60%), alcohol dependence (54%), and alcohol abuse (16%). Having had previous treatment contact for a substance use disorder (SUD) increased the probability of seeking treatment for another SUD. By contrast, an early age of SUD onset, belonging to an older cohort, and a higher level of education decreased the lifetime probability of treatment contact for SUD. The role of comorbid mental disorders was more complex, with some disorders increasing and other decreasing the probability of seeking treatment.

CONCLUSIONS

Given high rates of SUD and their substantial health and economic burden, these patterns suggest the need for innovative approaches to increase treatment access for individuals with SUD.

Latent structure of social fears and social anxiety disorders

BACKGROUND

Despite its high prevalence and associated levels of impairment, the latent structure of social anxiety disorder (SAD) is not well understood, with published studies reporting inconsistent results. Furthermore, it is unknown whether the latent structure of social fears in individuals with and without SAD is the same.

METHOD

Exploratory factor analysis (EFA) and confirmatory factor analysis followed by multiple indicators multiple causes (MIMIC) analysis were conducted on 13 commonly feared social situations assessed in a nationally representative sample including individuals with SAD and those with social fears but who did not meet DSM-IV criteria for SAD.

RESULTS

An EFA conducted in the full sample, including individuals with no social fears (88% of the sample), yielded only one factor. When the sample was restricted to those with at least one social fear, the EFA yielded three factors, in both the subsample with at least one social fear but no SAD and the subsample with SAD. The three factors represented feared situations related to public performance, close scrutiny and social interaction. The MIMIC analyses further indicated that the three-factor structure was able to explain differences in prevalence of social fears across a broad range of sociodemographic covariates.

CONCLUSIONS

Among individuals with at least one social fear and those with DSM-IV SAD the latent structure of social fears appears to be best described by three factors, although this may partially depend on how the sample is specified. These results may help reconcile the findings of different numbers of factors identified in previous studies.

Increased prospective health service use for depression among adults with childhood onset bipolar disorder

OBJECTIVE

To examine the prospective relationship between age of onset of bipolar disorder and the demographic and clinical characteristics, treatment, new onset of psychiatric comorbidity, and psychosocial functioning among adults with bipolar disorder.

STUDY DESIGN

As part of the National Epidemiologic Survey on Alcohol and Related Conditions, 1600 adults who met lifetime Statistical Manual of Mental Disorders, 4th edition criteria for bipolar disorder-I (n = 1172) and bipolar disorder-II (n = 428) were included. Individuals were evaluated using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV version for Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and data were analyzed from Waves 1 and 2, approximately 3 years apart. Individuals with bipolar disorder were divided into three age at onset groups: childhood (<13 years old, n = 115), adolescence (13-18 years old, n = 396), and adulthood (>19 year old, n = 1017).

RESULTS

After adjusting for confounding factors, adults with childhood-onset bipolar disorder were more likely to see a counselor, have been hospitalized, and have received emergency room treatment for depression compared with those with adulthood-onset bipolar disorder. By contrast, there were no differences in the severity of mania or hypomania, new onset of comorbidity, and psychosocial functioning by age of bipolar disorder onset.

CONCLUSIONS

Childhood-onset bipolar disorder is prospectively associated with seeking treatment for depression, an important proxy for depressive severity. Longitudinal studies are needed in order to determine whether prompt identification, accurate diagnosis, and early intervention can serve to mitigate the burden of childhood onset on the long-term depressive burden of bipolar disorder.

Probability and predictors of first treatment contact for anxiety disorders in the United States: analysis of data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

BACKGROUND

Despite the high prevalence of anxiety disorders and the demonstrated efficacy of their treatment, most individuals with anxiety disorders never utilize mental health services.

OBJECTIVE

To identify predictors of treatment-seeking for DSM-IV anxiety disorders from a range of sociodemographic factors and comorbid mental disorders.

DESIGN

Survival analysis with time-varying covariates was performed using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

SETTING

Face-to-face interviews conducted in the United States.

PARTICIPANTS

34,653 respondents, aged 18 years and older, from the 2004-2005 Wave 2 NESARC.

MAIN OUTCOME MEASURE

The cumulative probability of treatment-seeking (assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version, Wave 2 version) across the anxiety disorders in 1 year, 10 years, and lifetime and the median delay to the first treatment contact.

RESULTS

Most individuals with panic disorder sought treatment within the same year of disorder onset, whereas the median delays to first treatment contact for generalized anxiety disorder, specific phobia, and social anxiety disorder were 1 year, 13 years, and 16 years, respectively. Several personality disorders and earlier age at anxiety disorder onset decreased the probability of treatment contact. By contrast, younger cohort membership, a recent change in marital status, treatment for a psychiatric disorder other than substance use disorder, and comorbid anxiety disorders increased the lifetime probability of treatment contact.

CONCLUSIONS

Treatment-seeking rates for most anxiety disorders are low, are associated with long delays, and sometimes are hindered by co-occurrence of other psychopathology. These patterns highlight the complex interplay of personal characteristics, individual psychopathology, and social variables in the treatment-seeking process.

National trends in the office-based prescription of schedule II opioids

OBJECTIVE

To investigate national trends and patterns in opioid prescription within office-based medical practice.

METHOD

An analysis is presented of 1995-2010 data from the National Ambulatory Medical Care Survey, focusing on overall and stratified trends in the percentage of medical visits involving prescriptions for Schedule II opioids. Among visits with opioid prescriptions in 2003-2010, first-time visits were also compared to return visits, and visits in which pain was the primary complaint were compared to visits with other primary complaints.

RESULTS

Among all office visits, the percentage with an opioid prescription increased from 0.65% in 1995-1998 to 2.63% in 2007-2010 (odds ratio [OR] = 8.01; 95% CI, 4.96-12.94). During the study period (1995-2010), opioid prescriptions significantly increased in visits by male patients (OR = 6.54; 95% CI, 3.21-13.31); female patients (OR = 9.38; 95% CI, 6.70-13.14); and patients aged 18-35 years (OR = 5.82; 95% CI, 2.59-13.10), 36-64 years (OR = 8.30; 95% CI, 4.63-14.86), and ≥ 65 years (OR = 8.85; 95% CI, 6.13-12.77), but not ≤ 17 years (OR = 1.52; 95% CI, 0.50-4.63). Prescriptions for opioids also significantly increased in visits by patients with clinical depression (OR = 9.96; 95% CI, 5.45-18.21) or anxiety (OR = 10.99; 95% CI, 5.02-24.06) diagnoses. However, a significant decline occurred in opioid prescriptions in visits among patients with substance use diagnoses (OR = 0.10; 95% CI, 0.00-3.30). The number of opioid prescriptions rose faster among patients making a first visit (OR = 23.36; 95% CI, 11.82-46.17) versus a return visit (OR = 7.26; 95% CI, 4.38-12.03).

CONCLUSIONS

A substantial increase occurred between 1995 and 2010 in opioid prescriptions in office-based medical visits, especially in visits by middle-aged and older adults and by patients making their first visit to the treating physician. These trends suggest that physicians have pursued greater pain control despite potential risks of nonmedical use of prescription opioids.

Probability and predictors of treatment-seeking for prescription opioid use disorders: a national study

BACKGROUND

Prescription opioid use disorders are the second most common drug use disorder behind only cannabis use disorders. Despite this, very little is known about the help-seeking behavior among individuals with these disorders.

METHODS

The sample included respondents of the Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) with a lifetime diagnosis of prescription drug use disorders (N=623). Unadjusted and adjusted hazard ratios are presented for time to first treatment-seeking by sociodemographic characteristics and comorbid psychiatric disorders.

RESULTS

The lifetime cumulative probability of treatment seeking was 42% and the median delay from prescription drug use disorder onset to first treatment was 3.83 years. Having an earlier onset of prescription opioid use disorder and a history of bipolar disorder, major depression disorder, specific phobia and cluster B personality disorders predicted shorter delays to treatment.

CONCLUSIONS

Although some comorbid psychiatric disorders increase the rate of treatment-seeking and decrease delays to first-treatment contact rates of treatment-seeking for prescription drug use disorder are low, even when compared with rates of treatment for other substance use disorders. Given the high prevalence and adverse consequences of prescription drug use disorder, there is a need to improve detection and treatment of prescription opioid use disorder.

Prospective study of substance-induced and independent major depressive disorder among individuals with substance use disorders in a nationally representative sample

BACKGROUND

Depression and substance use disorders (SUDs) commonly co-occur, which presents diagnostic challenges in classifying independent major depressive disorder (MDD) versus substance-induced depressive disorder (SIDD). It remains unclear if distinct characteristics and/or patterns in temporal course distinguish MDD-SUD and SIDD to guide these decisions. Further, evidence suggests that a significant portion of individuals with SIDD are later reclassified as having independent MDD. Continued research to improve our understanding of differences between these two and changes in reclassification over time is necessary for diagnostic clarification and to guide clinical decisions when treating depression in the context of SUDs.

METHODS

The current study compared individuals with MDD-SUD versus SIDD at baseline and examined reclassification of DSM-IV Axis I diagnoses over a 3-year follow up in a large, nationally representative epidemiological sample (n = 2,121).

RESULTS

Findings demonstrated that SIDD was extremely rare at both time points. At baseline, individuals with SIDD were more likely to be non-White, have less education, less likely to have insurance, less likely to have dysthymia or alcohol abuse, and more likely to have drug dependence compared to those with independent MDD. Of individuals with SIDD at Wave 1 who had a depressive episode between Waves 1 and 2, the overwhelming majority (>95%) had an independent MDD, not SIDD, episode. There were no significant group differences in the incidence of other mood disorders or SUDs at Wave 2.

CONCLUSIONS

Findings have important etiological and treatment implications for the classification and treatment of depression in the context of SUDs.

Hydrogels of poly(ethylene glycol): mechanical characterization and release of a model drug

Thermosensitive polymer networks were synthesized from poly(ethylene glycol), hexamethylene diisocyanate and 1,2,6-hexanetriol in stoichiometric proportions. By varying the amount of 1,2,6-hexanetriol and the molar mass of the poly(ethylene glycol), a wide range of networks with different crosslinking densities was prepared. The networks obtained were characterized by the temperature dependence of their degree of equilibrium swelling in water and by their Young's moduli. For each network, the molecular weight between crosslinks was estimated. The structure of the hydrogels was analysed with respect to scaling laws, and it was found that the results obtained with PEG 1500 and PEG 6000 hydrogels are in agreement with theoretical predictions, whereas those obtained with PEG 400 hydrogels are in disagreement. The release properties of PEG hydrogels were studied by the determination of the diffusion coefficient for acebutolol chlorhydrate and by an analysis of the effect of temperature on these coefficients. Finally, these release properties were correlated with the swelling and structural properties of the hydrogels.