The promise of machine learning in predicting treatment outcomes in psychiatry

World Psychiatry, Год журнала: 2021, Номер 20(2), С. 154 - 170

Опубликована: Май 18, 2021

For many years, psychiatrists have tried to understand factors involved in response medications or psychotherapies, order personalize their treatment choices. There is now a broad and growing interest the idea that we can develop models decisions using new statistical approaches from field of machine learning applying them larger volumes data. In this pursuit, there has been paradigm shift away experimental studies confirm refute specific hypotheses towards focus on overall explanatory power predictive model when tested new, unseen datasets. paper, review key predict outcomes psychiatry, ranging psychotherapies digital interventions neurobiological treatments. Next, some sources data are being used for development based learning, such as electronic health records, smartphone social media data, potential utility genetics, electrophysiology, neuroimaging cognitive testing. Finally, discuss how far come implementing prediction tools real-world clinical practice. Relatively few retrospective to-date include appropriate external validation procedures, even fewer prospective testing feasibility effectiveness models. Applications psychiatry face same ethical challenges posed by these techniques other areas medicine computer science, which here. short, nascent but important approach improve mental care, several suggest it may be working already.

Язык: Английский

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Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions

World Psychiatry, Год журнала: 2023, Номер 22(3), С. 394 - 412

Опубликована: Сен. 15, 2023

Treatment-resistant depression (TRD) is common and associated with multiple serious public health implications. A consensus definition of TRD demonstrated predictive utility in terms clinical decision-making outcomes does not currently exist. Instead, a plethora definitions have been proposed, which vary significantly their conceptual framework. The absence hampers precise estimates the prevalence TRD, also belies efforts to identify risk factors, prevention opportunities, effective interventions. In addition, it results heterogeneity practice decision-making, adversely affecting quality care. US Food Drug Administration (FDA) European Medicines Agency (EMA) adopted most used (i.e., inadequate response minimum two antidepressants despite adequacy treatment trial adherence treatment). It estimated that at least 30% persons meet this definition. significant percentage are actually pseudo-resistant (e.g., due inadequacy trials or non-adherence Although sociodemographic, clinical, contextual factors known negatively moderate depression, very few regarded as non-response across modalities treatment. Intravenous ketamine intranasal esketamine (co-administered an antidepressant) established efficacious management TRD. Some second-generation antipsychotics aripiprazole, brexpiprazole, cariprazine, quetiapine XR) proven adjunctive treatments partial responders, but only olanzapine-fluoxetine combination has studied FDA-defined Repetitive transcranial magnetic stimulation (TMS) FDA-approved for individuals accelerated theta-burst TMS recently showing efficacy. Electroconvulsive therapy acute maintenance intervention preliminary evidence suggesting non-inferiority intravenous ketamine. Evidence extending antidepressant trial, medication switching combining mixed. Manual-based psychotherapies on own offer symptomatic relief when added conventional antidepressants. Digital therapeutics under study represent potential future vista population.

Язык: Английский

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Digital interventions for the treatment of depression: A meta-analytic review.

Psychological Bulletin, Год журнала: 2021, Номер 147(8), С. 749 - 786

Опубликована: Авг. 1, 2021

The high global prevalence of depression, together with the recent acceleration remote care owing to COVID-19 pandemic, has prompted increased interest in efficacy digital interventions for treatment depression.We provide a summary latest evidence base depression based on largest study sample date.A systematic literature search identified 83 studies (N = 15,530) that randomly allocated participants intervention versus an active or inactive control condition.Overall heterogeneity was very (I 2 84%).Using random-effects multilevel metaregression model, we found significant medium overall effect size compared all conditions (g .52).Subgroup analyses revealed differences between and different (WLC: g .70;attention: .36;TAU: .31),significantly higher sizes involved human therapeutic guidance .63)compared self-help .34),and significantly lower effectiveness trials .30)compared .59).We no difference outcomes smartphone-based apps computer-and Internet-based human-guided face-to-face psychotherapy although number both comparisons low.Findings from current meta-analysis variety populations.However, reported may be exaggerated because publication bias, compliance outside highly controlled settings remains challenge. Public Significance StatementThis demonstrates populations.Additionally, it highlights have valuable role play routine care, most notably when accompanied by guidance.However, major challenge, little more than 50% completing full average.

Язык: Английский

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The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta‐analytic evaluation of recent meta‐analyses

World Psychiatry, Год журнала: 2022, Номер 21(1), С. 133 - 145

Опубликована: Янв. 11, 2022

Mental disorders represent a worldwide public health concern. Psychotherapies and pharmacotherapies are recommended as first line treatments. However, evidence has emerged that their efficacy may be overestimated, due to variety of shortcomings in clinical trials (e.g., publication bias, weak control conditions such waiting list). We performed an umbrella review recent meta-analyses randomized controlled (RCTs) psychotherapies for the main mental adults. selected formally assessed risk bias or quality studies, excluded comparators, used effect sizes target symptoms primary outcome. searched PubMed PsycINFO individual records Cochrane Library published between January 2014 March 2021 comparing with placebo treatment-as-usual (TAU), vs. head-to-head, combination psychotherapy pharmacotherapy either monotherapy. One hundred two meta-analyses, encompassing 3,782 RCTs 650,514 patients, were included, covering depressive disorders, anxiety post-traumatic stress disorder, obsessive-compulsive somatoform eating attention-deficit/hyperactivity substance use insomnia, schizophrenia spectrum bipolar disorder. Across treatments, majority small. A random meta-analytic evaluation reported by largest per disorder yielded standardized mean difference (SMD) 0.34 (95% CI: 0.26-0.42) 0.36 0.32-0.41) compared TAU. The SMD head-to-head comparisons was 0.11 -0.05 0.26). combined treatment monotherapy 0.31 0.19-0.44). Risk often high. After more than half century research, thousands millions invested funds, limited, suggesting ceiling research presently conducted. paradigm shift seems required achieve further progress.

Язык: Английский

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Time for united action on depression: a Lancet–World Psychiatric Association Commission

The Lancet, Год журнала: 2022, Номер 399(10328), С. 957 - 1022

Опубликована: Фев. 15, 2022

Язык: Английский

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Major depressive disorder

Nature Reviews Disease Primers, Год журнала: 2023, Номер 9(1)

Опубликована: Авг. 24, 2023

Язык: Английский

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Risk and protective factors for mental disorders beyond genetics: an evidence‐based atlas

World Psychiatry, Год журнала: 2021, Номер 20(3), С. 417 - 436

Опубликована: Сен. 9, 2021

Decades of research have revealed numerous risk factors for mental disorders beyond genetics, but their consistency and magnitude remain uncer­tain. We conducted a “meta‐umbrella” systematic synthesis umbrella reviews, which are reviews meta‐analyses individual studies, by searching international databases from inception to January 1, 2021. included on non‐purely genetic or protective any ICD/DSM disorders, applying an established classification the credibility evidence: class I (convincing), II (highly suggestive), III (suggestive), IV (weak). Sensitivity analyses were prospective studies test temporality (reverse causation), TRANSD criteria applied transdiagnosticity factors, A Measurement Tool Assess Systematic Reviews (AMSTAR) was employed address quality meta‐analyses. Fourteen eligible retrieved, summarizing 390 1,180 associations between putative disorders. 176 evidence associations, relating 142 risk/protective factors. The most robust (class II, designs) 21. For dementia, they type 2 diabetes mellitus (risk ratio, RR 1.54 2.28), depression (RR 1.65 1.99) low frequency social contacts (RR=1.57). opioid use factor tobacco smoking (odds OR=3.07). non‐organic psychotic clinical high state psychosis (OR=9.32), cannabis (OR=3.90), childhood adversities (OR=2.80). depressive widowhood (RR=5.59), sexual dysfunction (OR=2.71), three (OR=1.99) four‐five (OR=2.06) metabolic physical (OR=1.98) (OR=2.42) abuse, job strain (OR=1.77), obesity (OR=1.35), sleep disturbances (RR=1.92). autism spectrum disorder, maternal overweight pre/during pregnancy (RR=1.28). attention‐deficit/hyperactivity disorder (ADHD), pre‐pregnancy (OR=1.63), during (OR=1.60), (OR=1.28). Only one detected: activity (hazard HR=0.62) Alzheimer’s disease. In all, 32.9% quality, 48.9% medium 18.2% quality. Transdiagnostic I‐III mostly involved in early neurodevelopmental period. evidence‐based atlas key identified this study represents benchmark advancing characterization research, expanding intervention preventive strategies

Язык: Английский

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Psychotherapies for depression: a network meta‐analysis covering efficacy, acceptability and long‐term outcomes of all main treatment types

World Psychiatry, Год журнала: 2021, Номер 20(2), С. 283 - 293

Опубликована: Май 18, 2021

The effects of psychotherapies for depression have been examined in several hundreds randomized trials, but no recent network meta‐analysis (NMA) has integrated the results these studies. We conducted an NMA trials comparing cognitive behavioural, interpersonal, psychodynamic, problem‐solving, behavioural activation, life‐review and “third wave” therapies non‐directive supportive counseling with each other care‐as‐usual, waiting list pill placebo control conditions. Response (50% reduction symptoms) was primary outcome, we also assessed remission, standardized mean difference, acceptability (all‐cause dropout rate). Random‐effects pairwise meta‐analyses were on 331 34,285 patients. All more efficacious than care‐as‐usual conditions, all – except psychodynamic therapy placebo. Standardized differences compared ranged from –0.81 to –0.32 counseling. Individual did not differ significantly other, only exception counseling, which less therapies. similar when studies low risk bias included. Most still had significant at 12‐month follow‐up problem‐solving found a somewhat higher long‐term efficacy some No consistent found. Our conclusion is that most important types psychotherapy are acceptable acute treatment adult depression, few between them. Patient preference availability type may play larger role choice psychotherapy, although it possible detailed characterization patients diagnosis lead precise matching individual psychotherapies.

Язык: Английский

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The clinical characterization of the patient with primary psychosis aimed at personalization of management

World Psychiatry, Год журнала: 2021, Номер 20(1), С. 4 - 33

Опубликована: Янв. 12, 2021

The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica­tion prescribed, second‐generation antipsychotics usually preferred to first‐generation ones. Cognitive behavioral therapy rarely used in the vast majority countries, although there evidence support its efficacy. Psychosocial interventions are provided, especially chronic cases, but those applied frequently not validated by research. Evidence‐based family and supported employment programs seldom implemented ordinary practice. Although notion that at increased risk for cardiovascular diseases diabetes mellitus widely shared, it frequent appropriate measures be address this problem. view patient should personalized endorsed clinicians, personalization lacking or inadequate most clinical contexts. many mental health services would declare themselves “recovery‐oriented”, common a focus on empowerment, identity, meaning resilience ensured present paper aims situation. It describes systematically salient domains considered characterization individual aimed management. These include positive negative symptom dimensions, other psychopathological components, onset course, neurocognition social cognition, neurodevelopmental indicators; functioning, quality life unmet needs; staging, antecedent concomitant psychiatric conditions, physical comorbidities, history, history obstetric complications, early recent environmental exposures, protective factors resilience, internalized stigma. For each domain, simple assessment instruments identified could use practice included standardized decision tools. A encouraged which takes into account available treatment modalities whose efficacy research evidence, selects modulates them basis characterization, addresses patient’s needs terms employment, housing, self‐care, relationships education, offers resilience.

Язык: Английский

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Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration

World Psychiatry, Год журнала: 2022, Номер 21(3), С. 393 - 414

Опубликована: Сен. 8, 2022

Psychiatry has always been characterized by a range of different models and approaches to mental disorder, which have sometimes brought progress in clinical practice, but often also accompanied critique from within without the field. Psychiatric nosology particular focus debate recent decades; successive editions DSM ICD strongly influenced both psychiatric practice research, led assertions that psychiatry is crisis, advocacy for entirely new paradigms diagnosis assessment. When thinking about etiology, many researchers currently refer biopsychosocial model, this approach received significant critique, being considered some observers overly eclectic vague. Despite development evidence-based pharmacotherapies psychotherapies, current evidence points treatment gap research-practice health. In paper, after considering we discuss proposed novel perspectives recently achieved prominence may significantly impact research future: neuroscience personalized pharmacotherapy; statistical nosology, assessment research; deinstitutionalization community health care; scale-up psychotherapy; digital phenotyping therapies; global task-sharing approaches. We consider extent transitions practices reflect hype or hope. Our review indicates each contributes important insights allow hope future, provides only partial view, any promise paradigm shift field not well grounded. conclude there crucial advances that, despite progress, considerable need further improvements intervention; such will likely be specific shifts rather incremental iterative integration.

Язык: Английский

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