The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management

World Psychiatry, Год журнала: 2022, Номер 21(3), С. 364 - 387

Опубликована: Сен. 8, 2022

Bipolar disorder is heterogeneous in phenomenology, illness trajectory, and response to treatment. Despite evidence for the efficacy of multimodal-ity interventions, majority persons affected by this do not achieve sustain full syndromal recovery. It eagerly anticipated that combining datasets across various information sources (e.g., hierarchical "multi-omic" measures, electronic health records), analyzed using advanced computational methods machine learning), will inform future diagnosis treatment selection. In interim, identifying clinically meaningful subgroups with having differential specific treatments at point-of-care an empirical priority. This paper endeavours synthesize salient domains clinical characterization adult patient bipolar disorder, overarching aim improve outcomes informing management considerations. Extant data indicate characterizing select provides actionable guides shared decision making. For example, it robustly established presence mixed features - especially during depressive episodes physical psychiatric comorbidities informs treatment, suicide risk. addition, early environmental exposures sexual abuse, emotional neglect) are highly associated more complicated presentations, inviting need developmentally-oriented integrated approaches. There have been significant advances validating subtypes I vs. II disorder), particularly regard pharmacological interventions. As other severe mental disorders, social functioning, interpersonal/family relationships internalized stigma relevant relapse risk, outcomes, quality life. The elevated standardized mortality ratio completed suicidal behaviour invites domain all patients. framework describe above domains, providing a synthesis extant literature recommendations support tools metrics can be implemented point-of-care.

Язык: Английский

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Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management

World Psychiatry, Год журнала: 2023, Номер 22(3), С. 366 - 387

Опубликована: Сен. 15, 2023

Populations with common physical diseases – such as cardiovascular diseases, cancer and neurodegenerative disorders experience substantially higher rates of major depressive disorder (MDD) than the general population. On other hand, people living MDD have a greater risk for many diseases. This high level comorbidity is associated worse outcomes, reduced adherence to treatment, increased mortality, health care utilization costs. Comorbidity can also result in range clinical challenges, more complicated therapeutic alliance, issues pertaining adaptive behaviors, drug‐drug interactions adverse events induced by medications used mental disorders. Potential explanations prevalence above involve shared genetic biological pathways. These latter include inflammation, gut microbiome, mitochondrial function energy metabolism, hypothalamic‐pituitary‐adrenal axis dysregulation, brain structure function. Furthermore, several antecedents related social factors (e.g., socioeconomic status), lifestyle variables activity, diet, sleep), stressful live childhood trauma). Pharmacotherapies psychotherapies are effective treatments comorbid MDD, introduction interventions well collaborative models digital technologies provide promising strategies improving management. paper aims detailed overview epidemiology specific including bidirectional risk; pathways potentially implicated pathogenesis diseases; socio‐environmental that serve both protective factors; management prevention treatment. We conclude future directions emerging research optimal

Язык: Английский

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Modern views of machine learning for precision psychiatry

Patterns, Год журнала: 2022, Номер 3(11), С. 100602 - 100602

Опубликована: Ноя. 1, 2022

In light of the National Institute Mental Health (NIMH)'s Research Domain Criteria (RDoC), advent functional neuroimaging, novel technologies and methods provide new opportunities to develop precise personalized prognosis diagnosis mental disorders. Machine learning (ML) artificial intelligence (AI) are playing an increasingly critical role in era precision psychiatry. Combining ML/AI with neuromodulation can potentially explainable solutions clinical practice effective therapeutic treatment. Advanced wearable mobile also call for digital phenotyping health. this review, we a comprehensive review ML methodologies applications by combining neuromodulation, advanced psychiatry practice. We further molecular cross-species biomarker identification discuss AI (XAI) closed human-in-the-loop manner highlight potential multi-media information extraction multi-modal data fusion. Finally, conceptual practical challenges future research.

Язык: Английский

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The impact of COVID-19 on youth mental health: A mixed methods survey

Psychiatry Research, Год журнала: 2023, Номер 321, С. 115082 - 115082

Опубликована: Янв. 28, 2023

The COVID-19 pandemic has presented profound disruptions to young people at a critical period of psychosocial development. current study aimed explore the perceived negative and positive impacts on people's mental health wellbeing across spectrum clinical needs. A cross-sectional online survey including both quantitative qualitative responses captured 593 with without care Findings revealed high levels depression (48%), anxiety (51%), loneliness in samples. Approximately 75% primary services, over 80% general population, reported impact work, non-work activities wellbeing. Open-ended reflected domains greater capacity for self-care reflection due decreased pressures daily life. Negative worsening health, key developmental milestones regarding relationships self others, limited self-care. Together, these data highlight need early intervention support experienced by pandemic, particularly among those existing

Язык: Английский

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Mental Health Chatbot for Young Adults With Depressive Symptoms During the COVID-19 Pandemic: Single-Blind, Three-Arm Randomized Controlled Trial

Journal of Medical Internet Research, Год журнала: 2022, Номер 24(11), С. e40719 - e40719

Опубликована: Ноя. 3, 2022

Depression has a high prevalence among young adults, especially during the COVID-19 pandemic. However, mental health services remain scarce and underutilized worldwide. Mental chatbots are novel digital technology to provide fully automated interventions for depressive symptoms.The purpose of this study was test clinical effectiveness nonclinical performance cognitive behavioral therapy (CBT)-based chatbot (XiaoE) adults with symptoms pandemic.In single-blind, 3-arm randomized controlled trial, participants manifesting recruited from Chinese university were randomly assigned (XiaoE; n=49), an e-book (n=49), or general (Xiaoai; n=50) group in ratio 1:1:1. Participants received 1-week intervention. The primary outcome reduction according 9-item Patient Health Questionnaire (PHQ-9) at 1 week later (T1) month (T2). Both intention-to-treat per-protocol analyses conducted under analysis covariance models adjusting baseline data. Controlled multiple imputation δ-based sensitivity performed missing secondary outcomes level working alliance measured using Working Alliance (WAQ), usability Usability Metric User Experience-LITE (UMUX-LITE), acceptability Acceptability Scale (AS).Participants on average 18.78 years old, 37.2% (55/148) female. mean PHQ-9 score 10.02 (SD 3.18; range 2-19). Intention-to-treat revealed lower scores XiaoE compared Xiaoai both T1 (F2,136=17.011; P<.001; d=0.51) T2 (F2,136=5.477; P=.005; d=0.31). Better (WAQ; F2,145=3.407; P=.04) (AS; F2,145=4.322; P=.02) discovered XiaoE, while no significant difference arms found (UMUX-LITE; F2,145=0.968; P=.38).A CBT-based is feasible engaging therapeutic approach that allows easy accessibility self-guided assistance symptoms. A systematic evaluation metrics been established study. In future, focus necessary explore mechanism by which work patients. Further evidence required confirm long-term via trails replicated longer dose, as well exploration its stronger efficacy comparison other active controls.Chinese Clinical Trial Registry ChiCTR2100052532; http://www.chictr.org.cn/showproj.aspx?proj=135744.

Язык: Английский

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The future of psychopharmacology: a critical appraisal of ongoing phase 2/3 trials, and of some current trends aiming to de‐risk trial programmes of novel agents

World Psychiatry, Год журнала: 2023, Номер 22(1), С. 48 - 74

Опубликована: Янв. 14, 2023

Despite considerable progress in pharmacotherapy over the past seven decades, many mental disorders remain insufficiently treated. This situation is part due to limited knowledge of pathophysiology these and lack biological markers stratify individualize patient selection, but also a still restricted number mechanisms action being targeted monotherapy or combination/augmentation treatment, as well variety challenges threatening successful development testing new drugs. In this paper, we first provide an overview most promising drugs with innovative that are undergoing phase 2 3 for schizophrenia, bipolar disorder, major depressive anxiety trauma‐related disorders, substance use dementia. Promising repurposing established medications psychiatric indications, variations modulation dopamine, noradrenaline serotonin receptor functioning, considered. We then critically discuss clinical trial parameters need be considered depth when developing pharmacological agents treatment disorders. Hurdles perils success drug include inadequacy imprecision inclusion/exclusion criteria ratings, sub‐optimally suited participants, multiple factors contributing large/increasing placebo effect, problems statistical analyses. information should order de‐risk programmes novel known increasing their chances success.

Язык: Английский

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Digital mental health: challenges and next steps

BMJ Mental Health, Год журнала: 2023, Номер 26(1), С. e300670 - e300670

Опубликована: Фев. 1, 2023

Digital innovations in mental health offer great potential, but present unique challenges. Using a consensus development panel approach, an expert, international, cross-disciplinary met to provide framework conceptualise digital innovations, research into mechanisms and effectiveness approaches for clinical implementation. Key questions outputs from the group were agreed by consensus, are presented discussed text supported case examples accompanying appendix. A number of key themes emerged. (1) may work best across traditional diagnostic systems: we do not have effective ontologies illness transdiagnostic/symptom-based be more fruitful. (2) Approaches implementation tools/interventions need creative require organisational change: only clinicians patients training education confident skilled using technologies support shared care decision-making, roles extended, with working alongside navigators non-clinicians who delivering protocolised treatments. (3) Designing appropriate studies measure is also key: including data raises ethical issues, measurement potential harms just beginning. (4) Accessibility codesign needed ensure long lasting. (5) Standardised guidelines reporting would synthesis evidence inform COVID-19 transition virtual consultations shown us improve access quality health: now ideal time act.

Язык: Английский

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Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

World Psychiatry, Год журнала: 2022, Номер 21(2), С. 220 - 236

Опубликована: Май 7, 2022

Acute services for mental health crises are very important to service users and their supporters, consume a substantial share of resources in many countries. However, acute care is often unpopular sometimes coercive, the evidence on which models best patient experience outcomes remains surprisingly limited, part reflecting challenges conducting studies with people crisis. Evidence ap-proaches initial assessment immediate management particularly lacking, but some innovative involving extended assessment, brief interventions, diversifying settings strategies providing support potentially helpful. wards continue be central intensive treatment phase following crisis, new approaches need developed, evaluated implemented reducing coercion, addressing trauma, treatments inpatient workforce, making decision-making collaborative. Intensive home services, day units, community crisis have supporting diverting from hospital admission: greater understanding how implement them wide range contexts what works would valuable. Approaches voluntary sector more flexible informal: such potential complement provide valuable learning statutory especially groups who tend underserved or disengaged. Such involve staff personal crises, roles improving quality across sectors. Large gaps exist low- middle-income countries, fuelled by poor access care. Responses build foundation existing responses contextually relevant evidence. The necessity moving outside formal systems low-resource may lead wider locally embedded strategies.

Язык: Английский

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Prevalence and trends of common mental disorders from 2007‐2009 to 2019‐2022: results from the Netherlands Mental Health Survey and Incidence Studies (NEMESIS), including comparison of prevalence rates before vs. during the COVID‐19 pandemic

World Psychiatry, Год журнала: 2023, Номер 22(2), С. 275 - 285

Опубликована: Май 9, 2023

Up‐to‐date information on the prevalence and trends of common mental disorders is relevant to health care policy planning, owing high burden associated with these disorders. In first wave third Netherlands Mental Health Survey Incidence Study (NEMESIS‐3), a nationally representative sample was interviewed face‐to‐face from November 2019 March 2022 (6,194 subjects; 1,576 before 4,618 during COVID‐19 pandemic; age range: 18‐75 years). A slightly modified version Composite International Diagnostic Interview 3.0 used assess DSM‐IV DSM‐5 diagnoses. Trends in 12‐month rates were examined by comparing between NEMESIS‐3 NEMESIS‐2 (6,646 18‐64 years; 2007 July 2009). Lifetime estimates 28.6% for anxiety disorders, 27.6% mood 16.7% substance use 3.6% attention‐deficit/hyperactivity disorder. Over last 12 months, 15.2%, 9.8%, 7.1%, 3.2%, respectively. No differences vs. pandemic found (26.7% pre‐pandemic 25.7% pandemic), even after controlling socio‐demographic characteristics respondents two periods. This case all four disorder categories. From 2007‐2009 2019‐2022, rate any significantly increased 17.4% 26.1%. stronger increase students, younger adults (18‐34 years) city dwellers. These data suggest that has past decade, but this not explained pandemic. The already risk young particularly further recent years.

Язык: Английский

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Artificial intelligence in psychiatry research, diagnosis, and therapy

Asian Journal of Psychiatry, Год журнала: 2023, Номер 87, С. 103705 - 103705

Опубликована: Июль 22, 2023

Язык: Английский

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