Electroencephalogram (EEG) based automated detection of mental disorders using artificial intelligence processing pipelines

A convolutional neural network-based diagnostic method using resting-state electroencephalograph signals for major depressive and bipolar disorders

Despite a marked increase in treatment for bipolar disorder among youths, little is known about their pattern of service use. This article describes mental health service use in the year before and after a new clinical diagnosis of bipolar disorder. Claims were reviewed between April 1, 2004, and March 31, 2005, for 1,274,726 privately insured youths (17 years and younger) who were eligible for services at least one year before and after a service claim; 2,907 youths had new diagnosis of bipolar disorder during this period. Diagnoses of other mental disorders and prescriptions filled for psychotropic drugs were assessed in the year before and after the initial diagnosis of bipolar disorder. The one-year rate of a new diagnosis of bipolar disorder was .23%. During the year before the new diagnosis of bipolar disorder, youths were commonly diagnosed as having depressive disorder (46.5%) or disruptive behavior disorder (36.7%) and had often filled a prescription for an antidepressant (48.5%), stimulant (33.0%), mood stabilizer (31.8%), or antipsychotic (29.1%). Most youths with a new diagnosis of bipolar disorder had only one (28.8%) or two to four (28.7%) insurance claims for bipolar disorder in the year starting with the index diagnosis. The proportion starting mood stabilizers after the index diagnosis was highest for youths with five or more insurance claims for bipolar disorder (42.1%), intermediate for those with two to four claims (24.2%), and lowest for those with one claim (13.8%). Most youths with a new diagnosis of bipolar disorder had recently received treatment for depressive or disruptive behavior disorders, and many had no claims listing a diagnosis of bipolar disorder after the initial diagnosis. The service pattern suggests that a diagnosis of bipolar disorder is often given tentatively to youths treated for mental disorders with overlapping symptom profiles and is subsequently reconsidered.

Bipolar Disorder: Imaging State Versus Trait

Polygenic Risk Scores and Genetics in Psychiatry.

Objective-This retrospective cohort study examined the association between co-occurring serious mental illness and substance use disorders and parole revocation among inmates from the Texas Department of Criminal Justice, the nation's largest state prison system. Methods-The study population included all 8,149 inmates who were released under parole supervision between September 1, 2006, and November 31, 2006.An electronic database was used to identify inmates whose parole was revoked within 12 months of their release.The independent risk of parole revocation attributable to psychiatric disorders, substance use disorders, and other covariates was assessed with logistic regression analysis.Results-Parolees with a dual diagnosis of a major psychiatric disorder (major depressive disorder, bipolar disorder, schizophrenia, or other psychotic disorder) and a substance use disorder had a substantially increased risk of having their parole revoked because of either a technical violation (adjusted odds ratio [OR]=1.7,95% confidence interval [CI]=1.4-2.4) or commission of a new criminal offense (OR=2.8,95% CI=1.7-4.5) in the 12 months after their release.However, parolees with a diagnosis of either a major psychiatric disorder alone or a substance use disorder alone demonstrated no such increased risk.Conclusions-These findings highlight the need for future investigations of specific social, behavioral, and other factors that underlie higher rates of parole revocation among individuals with co-occurring serious mental illness and substance use disorders.Over the past four decades the widespread deinstitutionalization of persons with serious mental illness (1-3), the increase in drug-related arrests (4,5), and the reduction of community-based mental health care (1,2) have resulted in a substantial overrepresentation of persons with serious mental illness in the U.S. correctional system (1,2,6).Approximately 10% to 20% of U.S. prison inmates are estimated to have an axis I major mental disorder of thought or mood, such as major depressive disorder, bipolar disorder, or schizophrenia (7-12).Moreover, a majority of inmates with serious mental illness have a comorbid substance use disorder (7,(12)(13)(14)(15).A number of investigations have examined predictors of recidivism among released inmates (16)(17)(18)(19).Although results of these studies-conducted throughout a variety of criminal justice

Diagnostic Instability: How Much Is Too Much?

Bipolar disorder is a common condition diagnosed by the occurrence of pathological mood elevation but most often dominated by dysphoria states. Over the past 10 years, understanding of bipolar disorder and the number of evidence-based treatments have increased dramatically. This article offers strategies for improving diagnostic confidence and simple benchmarks that facilitate integrating principles of evidence-based medicine into the management of patients with bipolar disorder. Simple systematic assessment techniques such as focusing the evaluation to assess the most extreme episode of mood elevation and longitudinal factors such as age of onset and course of illness can avoid errors of omission and raise diagnostic confidence. An iterative measurement-based treatment model that aims to bring patients and their supports into the collaborative care process for progressively better outcomes is recommended.

Diabetes and Mental Health

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Depressive Disorders

OBJECTIVE: This study estimated changes during the 1990s in the quality of usual-care treatment among persons diagnosed as having bipolar I disorder in a privately insured population. METHODS: Retrospective private insurance administrative data were analyzed for enrollees aged 18 to 64 who were diagnosed as having bipolar I disorder during 1991 (431 person-years), 1994 (598 person-years), and 1999 (600 person-years). Medication and psychotherapy quality indicators were derived from bipolar disorder expert guidelines published in 1994, which were consistent with guidelines published until year 2002. RESULTS: The unadjusted prevalence of receiving any lithium, valproate, or carbamazepine improved over the study period (68 percent in 1991, 64 percent in 1994, and 77 percent in 1999), whereas, compared with 1991, receiving any antidepressant in the absence of lithium, valproate, or carbamazepine increased in 1994 and then declined in 1999 (13 percent in 1991, 23 percent in 1994, and 14 percent in 1999). The unadjusted prevalence of receiving any psychotherapy declined steadily and sharply (94 percent in 1991, 89 percent in 1994, and 69 percent in 1999). The unadjusted prevalence of receiving any lithium, valproate, or carbamazepine and therapy together declined over time (65 percent in 1991, 58 percent in 1994, and 54 percent in 1999). After the analyses adjusted for patient characteristics, these changes were significant from p<.01 to p<.001. CONCLUSIONS: The prevalence of receiving the pharmacotherapy recommended in the guidelines improved after guideline publication in 1994, whereas other quality measures that included receiving psychotherapy declined throughout the study period. These results suggest different psychotherapeutic modalities are under differing constraints under managed care, constraints that overpower consensus in the literature of quality practice. Policy makers should measure a variety of key therapeutic modalities when measuring quality in order to capture these differences.

Byline: Rajiv. Tandon Introduction Our modern system of classifying and diagnosing psychiatric disorders originated in Emil Kraepelin's dichotomization between dementia praecox (schizophrenia) and manic-depressive insanity (bipolar and unipolar disorders). Since that time, there have been separate sections on psychotic disorders and mood disorders in both the International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of mental disorders-5 (DSM-5) diagnostic manuals. This dichotomy has increasingly been called into question [sup][1],[2] and genetic, other neurobiological, and pharmacological data suggest that bipolar disorders may be on a continuum between schizophrenia and unipolar depression. [sup][2],[3] In addition, the definitions of these disorders in DSM-IV present a number of problems in clinical practice, including high use of not otherwise specified (NOS) diagnoses, high rates of spurious comorbidity, unclear boundaries schizoaffective disorder, discrepant treatment of catatonia, and poor explanation of the significant heterogeneity within each diagnostic category. DSM-5 [sup][4] sought to address these limitations and incorporate new knowledge about these conditions generated over the past 20 years. Changes in the section on psychotic disorders were summarized in a prior issue of the Journal. [sup][5] Some of those changes relevant to the clinical description of the mood disorders include a single set of criteria to diagnose catatonia and its treatment as a specifier across all disorders [sup][6],[7] and more stringent criteria for schizoaffective disorder. [sup][8],[9],[10] In this article, we address the major changes made in the mood disorders section in DSM-5. Separation of Bipolar Disorders from Depressive Disorders One of the major changes made in DSM-5 is the division of the mood disorders section into two units, one on bipolar and related disorders and the other on depressive disorders. [sup][11] The unit on bipolar and related disorders is placed in between the section on schizophrenia spectrum and other psychotic disorders on the one side and the section on depressive disorders on the other. A conglomerate of genetic and neurobiological findings supports this intermediate position of bipolar disorder between schizophrenia and unipolar depression. Whereas bipolar depression shares clinical features unipolar depression (depressive symptoms, tendency toward an episodic course, family history, comorbidities), bipolar disorder also shares significant features schizophrenia (symptomatology, genetic markers, family history, response of mania to antipsychotic agents). [sup][2],[3],[12],[13],[14] This lends support to the change made in DSM-5 and is also consistent observations that neurocognitive deficits and various neurobiological findings are seen across the spectrum of psychotic disorders, spanning schizophrenia through bipolar disorder to major depression. [sup][15],[16] Although there is much empirical support and sound rationale for this separation between bipolar and depressive (unipolar) disorders, it has been criticized [sup][17] because it conflicts Kraepelinian orthodoxy. [sup][18] Since DSM-5 has also been criticized for being too conservative in its approach, [sup][19] this illustrates the challenges in updating our system of psychiatric classification. [sup][20] Whereas the research implications of this change are evident, placement of bipolar and related disorders and unipolar and related disorders in separate chapters reinforces the clinical imperative of recognizing important differences between bipolar and unipolar depression regard to comorbidities, treatment, and outcome. Bipolar and Related Disorders Five relatively modest changes were made in an effort to improve clinical utility and specificity in the diagnosis of bipolar and related disorders. These include: *The elimination of the category of bipolar disorder, mixed, and its replacement by a new specifier with mixed features; *Addition of a requirement that abnormal and persistently increased goal-directed activity or energy accompany elated or irritable mood as an essential criterion (criterion A) for diagnosing mania or hypomania; *Addition of anxious distress and other specifiers to improve the precision of characterizing these disorders in a clinically pertinent manner; *Provision of specific criteria for defining sub-threshold bipolar disorders; and *Elimination of antidepressant medication as an exclusion criterion for diagnosing mania or hypomania. …

Neuropsychiatric Complications of Traumatic Brain Injury: A Critical Review of the Literature (A Report by the ANPA Committee on Research)

Economic Grand Rounds: The Economic Burden of Bipolar Disorder

This study aimed to determine the prevalence of prescribing antipsychotics to adults without schizophrenia or bipolar disorder and to identify factors associated with such off-label use. Patients with at least one prescription for an antipsychotic medication from the Department of Veterans Affairs (VA) during fiscal year (FY) 2007 were identified in national VA administrative databases. Rates of off-label antipsychotic use were determined along with average doses. Multivariate logistic regression models identified sociodemographic and clinical characteristics associated with off-label use. Of the 279,778 individuals in FY 2007 who received an antipsychotic medication, 168,442 (60.2%) had no record of a diagnosis for which these drugs are approved. The most common mental illness diagnoses among patients given prescriptions for antipsychotics off label were posttraumatic stress disorder (PTSD, 41.8%), minor depression (39.5%), major depression (23.4%), and anxiety disorder (20.0%). Among VA patients with mental illness other than schizophrenia or bipolar disorder, the proportion who received prescriptions for antipsychotic medications ranged from a low of 9.1% among patients with adjustment reaction; to about 20% for those with depression, dementia, or PTSD; and to a high of 40.7% among patients with other psychoses. Doses were low, with over half of patients who received off-label quetiapine, risperidone, or first-generation antipsychotics receiving doses below those recommended for schizophrenia. In logistic regression models, patients diagnosed as having other psychosis or dementia had the highest odds of receiving an antipsychotic medication off label. Off-label use of antipsychotic medications was common. Given that these drugs are expensive, have potentially severe side effects, and have limited evidence supporting their effectiveness for off-label usage, they should be used with greater caution.

Differential diagnosis of bipolar disorder and major depressive disorder