Although major depressive disorder (MDD) and bipolar depression can present with similar symptoms, biological differences exist. One difference is the possible variance in adverse effects associated with treatment. This study examined the association of cognitive impairment and delirium in patients treated with electroconvulsive therapy (ECT) plus lithium for MDD or bipolar depression. The Nationwide Inpatient Sample included 210 adults receiving ECT plus lithium. Descriptive statistics and a Chi-square test were used to evaluate the differences between mild cognitive impairment and drug-induced delirium for those with MDD or bipolar depression. We calculated the odds ratio (OR) for drug-induced delirium in inpatients with MDD (compared to inpatients with bipolar depression) using a binomial logistic regression model. Mild cognitive impairment was observed in 9.1% of patients with MDD (n = 110), compared to 0 in bipolar depression (n = 100) (P = .002). Drug-induced delirium was more prevalent in MDD (OR 1.19; 95% CI, 1.11 to 1.30). ECT plus lithium is associated with less cognitive impairment and drug-induced delirium in bipolar depression compared to MDD. This study may also support biological differences between the 2 types of depression.

Gambling is common and there is growing concern about its public health implications. Little is known about how gambling differs in people with minority sexual identities. We sought to understand whether lesbian, gay, and bisexual (LGB) individuals differ from non-LGB individuals in terms of gambling and associated characteristics. A total of 534 participants age 18 to 29 who gambled at least 5 times in the preceding year undertook clinical and neurocognitive evaluations. Those who identified as LGB were compared to heterosexuals on clinical and cognitive measures. Overall, 51 participants (9.6%) identified as LGB. These individuals showed significantly higher levels of problem gambling, suicide risk, substance use disorders, traits of obsessive-compulsive personality disorder (OCPD), higher errors on a set-shifting task, and higher rates of family history of addiction. These results indicate that individuals with minority sexual orientations may be at higher risk of experiencing problem gambling and associated factors, such as increased suicidality, OCPD traits, and some degree of cognitive differences. Future studies should establish whether these associations also exist in clinical samples of people with full gambling disorder. Large-scale longitudinal research in neglected minority groups is needed to further explore these associations.

Antisocial personality disorder (ASPD) is a serious psychiatric disorder that can be incapacitating and costly to individuals and society. The ASPD diagnosis has 2 main components, childhood conduct problems and adult antisocial behaviors, with specific age requirements. The nosological effects of these criteria on population subgroups defined by these aspects of the criteria have not been fully explored. Data for ASPD were analyzed for 3,498 individuals in the St Louis, Missouri, site of the Epidemiologic Catchment Area study of general population psychiatric disorders collected in the early 1980s using structured diagnostic interviews for DSM-III criteria. Effects of the criteria on population subgroups defined by various combinations of the criteria were examined. Earlier-onset conduct disorder was more severe than later-onset childhood conduct disorder, with more total childhood and adult symptoms and negative psychosocial adult outcomes (substance use disorders, criminality, and homelessness). Three subgroups with adult antisocial behaviors (differentiated by no conduct disorder, later-onset conduct disorder, and earlier-onset conduct disorder meeting ASPD criteria) were similar in numbers of adult antisocial symptoms, but the ASPD subgroup had more negative psychosocial adult outcomes. These findings provide evidence for and against reconsideration of the 15-year age-of-onset requirement for conduct symptoms in ASPD criteria.

The ways patients with psychosis and depression engage in therapeutic treatment is not well understood. To determine if an intensive outpatient psychotherapy program could benefit patients experiencing psychotic symptoms, it is important to know how these individuals engage with psychotherapeutic treatment. The present study from the Rhode Island Hospital Methods to Improve Diagnostic Assessment and Services (MIDAS) project compared dropout rates, treatment response, and satisfaction among 219 individuals with psychosis and major depressive disorder (MDD) to 2,545 individuals with MDD at a general, Acceptance and Commitment Therapy-based partial hospital program (PHP). Those with psychosis were significantly less likely to complete treatment. Approximately one-fifth of all patients experienced at least a 50% reduction in depressive and anxiety symptoms. The vast majority of patients with psychosis were highly satisfied with treatment. Findings suggest patients with psychosis have a higher risk of premature dropout. Patients with psychosis demonstrated a reduction in symptoms during PHP treatment and self-reported high satisfaction with treatment. This study calls for the implementation of practices to reduce premature dropout for patients with psychosis, and for future research on the effectiveness of general psychiatric treatment for those with psychotic symptoms.

Identifying individuals at increased risk of suicide is important, particularly those who present for treatment for nonpsychiatric chief complaints who may go undetected. It has been found that pain symptoms, such as headache, are associated with suicide, although this association requires further characterization. This study examined specific components of suicidality in relation to headache subtypes. This study retrospectively reviewed 2,832,835 nonpsychiatric adult clinical encounters at a large county hospital, where a standardized suicide risk screening tool, the Columbia-Suicide Severity Rating Scale (C-SSRS), was universally implemented. The C-SSRS assesses specific components of suicidality: wish to be dead and suicidal ideation, method, intent, plan, and action. Multivariate logistic regressions were performed to assess the association between headache, as well as headache subtype (migraine, tension, or cluster), and each component of suicidality. There were significant positive associations between presenting with a headache and 2 specific components of suicidality: wish to be dead and suicidal action. Individuals with tension headache may have a lower risk of wishing to be dead compared to those with migraine and cluster headaches. The association of headaches with specific elements of sui-cidality demonstrates the potential yield of identification of suicide risk among individuals with nonpsychiatric presentations.

Mood disorders often are diagnosed by clinical interview, yet many cases are missed or misdiagnosed. Mood disorders increase the risk of suicide, making it imperative to diagnose and treat these disorders quickly. Artificial intelligence (AI) has been investigated for diagnosing mood disorders, but the merits of the literature have not been evaluated. This systematic review aims to understand and explain AI methods and evaluate their use in augmenting clinical diagnosis of mood disorders as well as identifying individuals at increased suicide risk. We conducted a systematic literature review of all studies until August 1, 2020 examining the efficacy of different AI techniques for diagnosing mood disorders and identifying individuals at increased suicide risk because of a mood disorder. Our literature search generated 13 studies (10 of mood disorders and 3 describing suicide risk) where AI techniques were used. Machine learning and artificial neural networks were most commonly used; both showed merit in helping to diagnose mood disorders and assess suicide risk. The data shows that AI methods have merit in improving the diagnosis of mood disorders as well as identifying suicide risk. More research is needed for bipolar disorder because only 2 studies explored this condition, and it is often misdiagnosed. Although only a few AI techniques are discussed in detail in this review, there are many more that can be employed, and should be evaluated in future studies.