Assess Symptom Severity Research Articles

Diagnostic Accuracy of Primary Care Clinicians Across a Statewide System of Autism Evaluation.

To evaluate the diagnostic accuracy of the Early Autism Evaluation (EAE) Hub system, a statewide network that provides specialized training and collaborative support to community primary care providers in the diagnosis of young children at risk for autism spectrum disorder (ASD). EAE Hub clinicians referred children, aged 14 to 48 months, to this prospective diagnostic study for blinded follow-up expert evaluation including assessment of developmental level, adaptive behavior, and ASD symptom severity. The primary outcome was agreement on categorical ASD diagnosis between EAE Hub clinician (index diagnosis) and ASD expert (reference standard). Among 126 children (mean age: 2.6 years; 77% male; 14% Latinx; 66% non-Latinx white), 82% (n = 103) had consistent ASD outcomes between the index and reference evaluation. Sensitivity was 81.5%, specificity was 82.4%, positive predictive value was 92.6%, and negative predictive value was 62.2%. There was no difference in accuracy by EAE Hub clinician or site. Across measures of development, there were significant differences between true positive and false negative (FN) cases (all Ps < .001; Cohen's d = 1.1-1.4), with true positive cases evidencing greater impairment. Community-based primary care clinicians who receive specialty training can make accurate ASD diagnoses in most cases. Diagnostic disagreements were predominately FN cases in which EAE Hub clinicians had difficulty differentiating ASD and global developmental delay. FN cases were associated with a differential diagnostic and phenotypic profile. This research has significant implications for the development of future population health solutions that address ASD diagnostic delays.

Traumatized German soldiers with moral injury - value-based cognitive-behavioral group therapy to treat war-related shame.

During deployment, soldiers are confronted with potentially morally injurious events. In many cases, these events violate their personal values and belief systems, resulting in feelings of anger, alienation, guilt, and shame. The psychological distress caused by such transgressions is defined as moral injury. It remains unclear to date, which therapeutic interventions are most appropriate for addressing this specific psychological condition. This study examines the effectiveness of value-based cognitive-behavioral group therapy combining elements of cognitive-behavioral therapy, acceptance and commitment therapy, spiritual care, and adaptive disclosure therapy. This controlled study uses the Compass of Shame Scale to assess symptom severity among participants both before and after a three-week inpatient group therapy regimen for moral injury. An intervention group (n = 45) was compared to a waiting-list control group (n = 40). A one-way between subjects ANOVA was conducted to determine the differences between the two measurement points in the intervention group compared to the control group. A positive ethics vote from the Humboldt University Berlin (Charité) was available (No.EA1/092/15). A significant difference was found on the shame-associated maladaptive strategies subscales of attack self (F (1, 83) = 5.942, p = 0.017, Cohen's f = 0,27), withdrawal (F (1, 83) = 8.263, p = 0.005, Cohen's f = 0,32), and attack others (F (1, 83) = 10.552, p = 0.002, Cohen's f = 0,36) of the Compass of Shame Scale between the intervention group and the control group at the p < 0.05 level in the pre- and post-treatment (t1-t2) comparison. This study suggests that the special therapeutic focus in cognitive-behavioral group therapy can alter shame-based maladaptive coping behaviors in response to war-related moral injury. This study provides further evidence that therapeutic approaches - through fostering a reconciliatory, compassionate, and forgiving approach toward oneself and others - target the underlying mechanisms of moral injury. Therefore, value-based cognitive-behavioral interventions should be considered as a standard element of trauma care in a military setting. Future studies should further examine such interventions in randomized control trials. It would also be particularly valuable for future studies to include a follow-up time point.

Rasch analysis of the beck depression inventory in a homeless and precariously housed sample

The approach to analysis of and interpretation of findings from the Beck Depression Inventory (BDI), a self-report questionnaire, depends on sample characteristics. To extend work using conventional BDI scoring, the BDI's suitability in assessing symptom severity in a homeless and precariously housed sample was examined using Rasch analysis. Participants (n=478) recruited from an impoverished neighbourhood in Vancouver, Canada, completed the BDI. Rasch analysis using the partial credit model was done, and the structural validity, unidimensionality, and reliability of the BDI were studied. A receiver operating characteristic curve determined a Rasch cut-off score consistent with clinical depression, and Rasch scores were correlated with raw scores. Good fit to the Rasch model was observed after rescoring all items and removing Item 19 (Weight Loss), and unidimensionality and reliability were satisfactory. Item 9 (Suicidal Wishes) represented the most severe symptom. Rasch-based scores detected clinical depression with moderate sensitivity and specificity, and were positively correlated with conventional scores. The BDI in a community-based sample of homeless and precariously housed adults satisfied Rasch model expectations in a 20-item format, and is suitable for assessing symptom severity. Future research on depression in similar samples may reveal more information on using specific symptoms to determine clinical significance.

Tremor detection Transformer: An automatic symptom assessment framework based on refined whole-body pose estimation

Essential tremor (ET) is a prevalent neurological disorder that necessitates using objective and non-invasive methods for assessing symptom severity. Traditional visual assessments are often limited by subjectivity, while other wearable sensors or visual markers may result in unnatural movements. This study presents a novel contact-free visual-based pipeline for ET assessment that integrates refined whole-body pose estimation with Transformer-based tremor detection to quantify tremor severity at a fine-grained level. The proposed pose estimation method combines the Transformer with HRNet, effectively capturing spatial-temporal complementary information from multiple body parts and enabling highly accurate tremor detection. The Transformer-based tremor detection is well-suited for modeling long-range dependencies and sequential tremor data extracted by the pose estimation model, further improving the performance of our proposed method. Our study collected data from 61 patients with ET, achieving an average accuracy, recall, and F1 score of 95.6%/95.6%, 89.2%/95.0%, and 83.0%/92.4% for classifying ET severity both during rest and postural tasks, respectively. Our proposed method outperforms the temporal convolutional network baseline, increasing F1 scores by 21.17% and 14.22% for rest and postural tasks, respectively. This high level of accuracy makes our method highly useful for clinical applications such as remote monitoring, diagnosis, and treatment evaluation. Our proposed technique has many advantages over traditional ET assessment techniques, including non-invasiveness, contact-free operation, and not requiring any wearable sensors or visual markers. Moreover, our method can be applied to other movement disorders requiring objective measurements of symptom severity. In summary, our contact-free visual-based pipeline for ET assessment represents a significant improvement over traditional ET assessment techniques, and our quantification results demonstrate its potential for use in clinical settings.

Clinical Evolution and Risk Factors in Patients Infected during the First Wave of COVID-19: A Two-Year Longitudinal Study.

A limited number of longitudinal studies have examined the symptoms associated with long-COVID-19. We conducted an assessment of symptom onset, severity and patient recovery, and determined the percentage of patients who experienced reinfection up to 2 years after the initial onset of the disease. Our cohort comprises 377 patients (≥18 years) with laboratory-confirmed COVID-19 in a secondary hospital (Madrid, Spain), throughout March 3-16, 2020. Disease outcomes and clinical data were followed-up until August 12, 2022. We reviewed the evolution of the 253 patients who had survived as of April 2020 (67.1%). Nine died between April 2020 and August 2022. A multivariate regression analysis performed to detect the risk factors associated with long-COVID-19 revealed that the increased likelihood was associated with chronic obstructive lung disease (OR 14.35, 95% CI 1.89-109.09; p = 0.010), dyspnea (5.02, 1.02-24.75; p = 0.048), higher LDH (3.23, 1.34-7.52; p = 0.006), and lower D-dimer levels (0.164, 0.04-0.678; p = 0.012). Reinfected patients (n = 45) (47.8 years; 39.7-67.2) were younger than non-reinfected patients (64.1 years; 48.6-74.4)) (p < 0.001). Patients who received a combination of vaccines exhibited fewer symptoms (44.4%) compared to those who received a single type of vaccine (77.8%) (p = 0.048). Long-COVID-19 was detected in 27.05% (66/244) of patients. The early detection of risk factors helps predict the clinical course of patients with COVID-19. Middle-aged adults could be susceptible to reinfection, highlighting the importance of prevention and control measures regardless of vaccination status.

Yoga use, physical and mental health, and quality of life in adults with irritable bowel syndrome: A mixed-methods study

IntroductionIntervention studies show yoga has several physical and psychological benefits for Irritable Bowel Syndrome (IBS), however few studies have explored yoga use in everyday life amongst people with IBS. This study explored yoga use as a predictor of IBS-related quality of life (QoL) in relation to other physical and psychological factors. It also utilized the Capability, Opportunity, Motivation-Behaviour (COM-B) model to investigate predictors of yoga practice, with a qualitative exploration of perceived IBS-related benefits and barriers to yoga. MethodsA cross-sectional, mixed-methods survey was used. A total of 219 adults with IBS (86.3% female, 32% yoga practitioners, mean age 46.42 years) completed a questionnaire battery to assess symptom severity, psychological symptoms, general health, QoL, COM-B constructs in relation to yoga, and perceived effectiveness of yoga for IBS. Open-ended responses assessing perceptions of yoga in relation to IBS were analysed using thematic analysis. ResultsIn hierarchical linear regression, education, yoga use, symptom severity, anxiety, depression, and general health explained 64.6% of variance in QoL (p<.001). Yoga use explained 6.1% after controlling for education. In hierarchical logistic regression, COM-B constructs explained 37.5% of the variance in yoga use (p<.001). In the final model, only Opportunity (p<.05) and Motivation (p<.001) significantly predicted yoga practice. Qualitative analysis identified three themes reflecting perceived benefits of yoga (IBS Relief, A Valuable Self-Management Tool, Holistic Wellbeing), and three reflecting perceived barriers/limitations (Lack of Physical Capability, Need for a Tailored Approach, Limited Motivation). ConclusionThis study identified significant relationships between yoga use in everyday life, physical and mental health, and IBS-related QoL, and identified the COM-B model as a useful framework for understanding yoga practice amongst people with IBS. The findings demonstrate that practicing yoga as part of daily life may positively impact both physical and mental health of IBS patients. Furthermore, the findings can be used to inform more targeted yoga interventions and increase accessibility of yoga for this group.

The difference between shorter- versus longer-term psychotherapy for adult mental health disorders: a systematic review with meta-analysis

BackgroundThe optimal psychotherapy duration for mental health disorders is unclear. Our aim was to assess the beneficial and harmful effects of shorter- versus longer-term psychotherapy for adult mental health disorders.MethodWe searched relevant databases and websites for published and unpublished randomised clinical trials assessing different durations of the same psychotherapy type before June 27, 2022. Our methodology was based on Cochrane and an eight-step procedure. Primary outcomes were quality of life, serious adverse events, and symptom severity. Secondary outcomes were suicide or suicide-attempts, self-harm, and level of functioning.ResultsWe included 19 trials randomising 3,447 participants. All trials were at high risk of bias. Three single trials met the required information size needed to confirm or reject realistic intervention effects. One single trial showed no evidence of a difference between 6 versus 12 months dialectical behavioral therapy for borderline personality when assessing quality of life, symptom severity, and level of functioning. One single trial showed evidence of a beneficial effect of adding booster sessions to 8 and 12 weeks of internet-based cognitive behavioral therapy for depression and anxiety when assessing symptom severity and level of functioning. One single trial showed no evidence of a difference between 20 weeks versus 3 years of psychodynamic psychotherapy for mood- or anxiety disorders when assessing symptom severity and level of functioning. It was only possible to conduct two pre-planned meta-analyses. Meta-analysis showed no evidence of a difference between shorter- and longer-term cognitive behavioural therapy for anxiety disorders on anxiety symptoms at end of treatment (SMD: 0.08; 95% CI: -0.47 to 0.63; p = 0.77; I2 = 73%; four trials; very low certainty). Meta-analysis showed no evidence of a difference between shorter and longer-term psychodynamic psychotherapy for mood- and anxiety disorders on level of functioning (SMD 0.16; 95% CI -0.08 to 0.40; p = 0.20; I2 = 21%; two trials; very low certainty).ConclusionsThe evidence for shorter versus longer-term psychotherapy for adult mental health disorders is currently unclear. We only identified 19 randomised clinical trials. More trials at low risk of bias and at low risk of random errors assessing participants at different levels of psychopathological severity are urgently needed.Systematic review registrationPROSPERO CRD42019128535.

PCR248 “Global” Problems in PGI Measures: The Patients’ Perspective on and Solutions to Poor PRO Word Choice

Unclear terminology can impact PRO data quality, and can further cause inconsistency in translation validity across languages. Here, we focus on the term global, primarily as it appears in Patient Global Impression (PGI) instruments, which typically assess symptom severity, disease activity or response to treatment, across various languages. Globalis defined as “comprehensive” or “overall” and appears early in PGIs to frame a patient’s assessment of their health. This study extends a series of investigations of conceptually unclear and difficult-to-translate terminology found in PROs1,2,3,4, whose goal is to identify unclear terminology, highlight the problems it creates for patients, and provide alternatives for PRO creation and translation that improve data quality.

Development and Validation of a Joint Attention–Based Deep Learning System for Detection and Symptom Severity Assessment of Autism Spectrum Disorder

Joint attention, composed of complex behaviors, is an early-emerging social function that is deficient in children with autism spectrum disorder (ASD). Currently, no methods are available for objectively quantifying joint attention. To train deep learning (DL) models to distinguish ASD from typical development (TD) and to differentiate ASD symptom severities using video data of joint attention behaviors. In this diagnostic study, joint attention tasks were administered to children with and without ASD, and video data were collected from multiple institutions from August 5, 2021, to July 18, 2022. Of 110 children, 95 (86.4%) completed study measures. Enrollment criteria were 24 to 72 months of age and ability to sit with no history of visual or auditory deficits. Children were screened using the Childhood Autism Rating Scale. Forty-five children were diagnosed with ASD. Three types of joint attention were assessed using a specific protocol. Correctly distinguishing ASD from TD and different levels of ASD symptom severity using the DL model area under the receiver operating characteristic curve (AUROC), accuracy, precision, and recall. The analytical population consisted of 45 children with ASD (mean [SD] age, 48.0 [13.4] months; 24 [53.3%] boys) vs 50 with TD (mean [SD] age, 47.9 [12.5] months; 27 [54.0%] boys). The DL ASD vs TD models showed good predictive performance for initiation of joint attention (IJA) (AUROC, 99.6% [95% CI, 99.4%-99.7%]; accuracy, 97.6% [95% CI, 97.1%-98.1%]; precision, 95.5% [95% CI, 94.4%-96.5%]; and recall, 99.2% [95% CI, 98.7%-99.6%]), low-level response to joint attention (RJA) (AUROC, 99.8% [95% CI, 99.6%-99.9%]; accuracy, 98.8% [95% CI, 98.4%-99.2%]; precision, 98.9% [95% CI, 98.3%-99.4%]; and recall, 99.1% [95% CI, 98.6%-99.5%]), and high-level RJA (AUROC, 99.5% [95% CI, 99.2%-99.8%]; accuracy, 98.4% [95% CI, 97.9%-98.9%]; precision, 98.8% [95% CI, 98.2%-99.4%]; and recall, 98.6% [95% CI, 97.9%-99.2%]). The DL-based ASD symptom severity models showed reasonable predictive performance for IJA (AUROC, 90.3% [95% CI, 88.8%-91.8%]; accuracy, 84.8% [95% CI, 82.3%-87.2%]; precision, 76.2% [95% CI, 72.9%-79.6%]; and recall, 84.8% [95% CI, 82.3%-87.2%]), low-level RJA (AUROC, 84.4% [95% CI, 82.0%-86.7%]; accuracy, 78.4% [95% CI, 75.0%-81.7%]; precision, 74.7% [95% CI, 70.4%-78.8%]; and recall, 78.4% [95% CI, 75.0%-81.7%]), and high-level RJA (AUROC, 84.2% [95% CI, 81.8%-86.6%]; accuracy, 81.0% [95% CI, 77.3%-84.4%]; precision, 68.6% [95% CI, 63.8%-73.6%]; and recall, 81.0% [95% CI, 77.3%-84.4%]). In this diagnostic study, DL models for identifying ASD and differentiating levels of ASD symptom severity were developed and the premises for DL-based predictions were visualized. The findings suggest that this method may allow digital measurement of joint attention; however, follow-up studies are necessary for further validation.

Are you short of breath? comparing functional capacity using new york heart association class and cardiopulmonary exercise testing

Abstract Funding Acknowledgements Type of funding sources: None. Background New York Heart Association (NYHA) scale is used to assess symptom severity in heart failure patients. Despite it being used routinely in clinical practice, it is heavily dependent on patient and physician subjectivity. Cardiopulmonary exercise testing (CPET) provides a potentially more objective and reproducible measure of functional capacity. Purpose To assess functional capacity in NYHA 1 versus NYHA 2-4 patients. Investigators also wanted to explore any relationship between NYHA class and CPET variables in heart failure patients. Method A retrospective analysis of patients who underwent CPET between 2021 &amp; 2022 was performed. The patients were grouped according to NYHA score and ejection fraction (EF). A separate subgroup analysis was carried out in NYHA 1, comparing patients with an EF &amp;lt; 35% and EF &amp;gt; 35%. Results A total of 160 patients were included, a dominant male (81.3%) Caucasian (95%) population with an average age of 53.9 years. 13.8% had an EF &amp;lt;35%. 51.9% had ischaemic cardiomyopathy. 103 (64.4%) patients had a NYHA score of 1, the rest had a NYHA score of 2-3. There was no significant difference between demographic parameters and co-morbidities between the groups. Figure 1 depicts CPET parameters comparing NYHA 1 vs NYHA 2-4 groups. VO2 MAX and % VO2 Max Predicted were significantly higher in NYHA 1 vs NYHA 2-4 (Figure 1). NT-proBNP levels were lower in the NYHA 1 group (378 pg/mL vs 850 pg/mL, p=0.023). Further analysis of the NYHA Class 1 group, comparing EF&amp;lt; 35% and &amp;gt;35% was carried out. It was discovered that despite being assigned the same NYHA Class, the EF &amp;lt;35% group had significantly lower VO2 max, % predicted VO2 max and VE/VCO2. EF was an important predictor of CPET performance in NYHA 1 patients. Those with an EF &amp;lt;35% had a lower VO2 max (p=0.001), low % VO2 Max predicted (p=0.005) and higher VE/VCO2 (p=0.002). NT-proBNP was also higher in this subgroup (p=0.047). Conclusion NYHA is an effective tool at assessing symptom severity in heart failure patients, albeit subjectively. CPET is particularly useful in NYHA 1 patients as it can give an objective assessment of functional capacity in these asymptomatic individuals. Future studies should explore the possible role of CPET in determining suitability for advanced heart failure therapies in NYHA 1 heart failure patients.

The Impact of Overactive Bladder on Quality of Life Affecting Physical Life, Social Life and Psychological Health among Women

Introduction: Overactive bladder (OAB) has profound impacts on the quality of life (QoL) in women, affecting their physical, social, and psychological well-being. However, comprehensive studies on the impacts of OAB among women in Bangladesh, a low-middle income country with unique cultural, social, and economic contexts, remain scarce. Methods: This prospective observational study, conducted at the Department of Obstetrics and Gynecology, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh, from January 2021 to December 2022, included 120 women visiting the study hospital with complaints of urinary leakage. Participants were surveyed on the prevalence and severity of OAB symptoms and their impact on physical life, social life, and psychological health. The Overactive Bladder Symptom Score (OABSS) and the King's Health Questionnaire (KHQ) were used to assess symptom severity and impact on quality of life, respectively. Result: The study found that OAB symptoms were prevalent among the participants, with 50.00% reporting urinary urgency, 40.00% reporting frequency of urination, 30.00% reporting nocturia, and 20.00% reporting incontinence. The severity of OAB symptoms varied, with 40.00% having a mild OABSS score, 50.00% having a moderate OABSS score, and 10.00% having a severe OABSS score. Conclusion: OAB significantly impacts the QoL of women in Bangladesh. This study underscores the need for comprehensive, multi- dimensional approaches to manage OAB, emphasizing the necessity for mental health support. It contributes to the limited literature on OAB's impact in low and middle-income countries, highlighting the need for further research and public health initiatives to improve the management and treatment of OAB in these contexts.

Content validation of a daily patient-reported outcome measure for assessing symptoms in patients with Small Intestinal Bacterial Overgrowth.

The aim of this study was to generate evidence supporting the development and content validity of a new PRO instrument, the Small Intestinal Bacterial Overgrowth (SIBO) Symptom Measure (SSM) daily diary. The SSM assesses symptom severity in SIBO patients, with the ultimate goal of providing a fit for purpose PRO for endpoint measurement. Qualitative research included 35 SIBO patients in three study stages, using a hybrid concept elicitation (CE)/cognitive interview (CI) method with US patients, ≥ 18years. Stage 1 included a literature review, clinician interviews, and initial CE interviews with SIBO patients to identify symptoms important to patients for inclusion in the SSM. Stage 2 included hybrid CE/CI to learn more about patients' SIBO experience and test the draft SSM. Finally, stage 3 used CIs to refine the instrument and test its content validity. In stage 1 (n = 8), 15 relevant concepts were identified, with items drafted based on the literature review/clinician interviews and elicitation work. Within stage 2 (n = 15), the SSM was refined to include 11 items; with wording revised for three items. Stage 3 (n = 12) confirmed the comprehensiveness of the SSM, as well as appropriateness of the item wording, recall period, and response scale. The resulting 11-item SSM assesses the severity of bloating, abdominal distention, abdominal discomfort, abdominal pain, flatulence, physical tiredness, nausea, diarrhea, constipation, appetite loss, and belching. This study provides evidence supporting the content validity of the new PRO. Comprehensive patient input ensures that the SSM is a well-defined measure of SIBO, ready for psychometric validation studies.

Coping with Transitions: A Promising Intensive Outpatient DBT Program for Emerging Adults and Their Families.

Emerging adulthood is a period of significant exploration, transformation, variability, and growth. Simultaneously, this developmental period presents unique challenges as emerging adults work to achieve developmental milestones including self-identity formation, the establishment of long-term intimate relationships, career advancement, and independence from parents. For those who are vulnerable, this period is also marked by the development of significant mental health problems and associated impairment, which prevents individuals from successfully reaching these developmental milestones. To address the various challenges unique to this developmental period, we created and implemented a multifaceted DBT treatment protocol to specifically address emotional dysregulation within emerging adults. The current study presents an evaluation of a novel, intensive, outpatient DBT program called System for Adult Growth and Emergence-Foundations (SAGE-F). We aim to first introduce the SAGE-F treatment protocol, and then to assess both its short and long-term therapeutic value. Participants enrolled in SAGE-F were administered a testing battery assessing symptom severity, functioning capacities, and coping strategies at intake, upon completion of the program 6-weeks later, and at 3-month follow-up. It was found participants who completed SAGE-F reported significant reductions in depression and anxiety symptoms, as well as non-suicidal self-injurious behaviors. Simultaneously, participants also reported improvements in their daily functioning and coping capacities. Follow-up assessments indicated therapeutic progress remained.

Using Digital Measurement-Based Care to Address Symptoms of Inattention, Hyperactivity, and Opposition in Youth: Retrospective Analysis of Bend Health.

Attention-deficit/hyperactivity disorder (ADHD) and associated behavioral disorders are highly prevalent in children and adolescents, yet many of them do not receive the care they need. Digital mental health interventions (DMHIs) may address this need by providing accessible and high-quality care. Given the necessity for high levels of caregiver and primary care practitioner involvement in addressing ADHD symptoms and behavioral problems, collaborative care interventions that adopt a whole-family approach may be particularly well suited to reduce symptoms of inattention, hyperactivity, and opposition in children and adolescents. The purpose of this study is to use member (ie, child and adolescent) data from Bend Health, Inc, a collaborative care DMHI that uses a whole-family approach to address child and adolescent mental health concerns, to (1) determine the effects of a collaborative care DMHI on inattention, hyperactivity, and oppositional symptoms in children and adolescents and (2) assess whether the effects of a collaborative care DMHI vary across ADHD subtypes and demographic factors. Caregivers of children and adolescents with elevated symptoms of inattention, hyperactivity, or opposition assessed their children's symptom severity approximately every 30 days while participating in Bend Health, Inc. Data from 107 children and adolescents aged 6-17 years who exhibited clinically elevated symptoms at baseline were used to assess symptom severity across monthly assessments (inattention symptom group: n=91, 85.0%; hyperactivity symptom group: n=48, 44.9%; oppositional symptom group: n=70, 65.4%). The majority of the sample exhibited elevated symptoms of at least 2 symptom types at baseline (n=67, 62.6%). Members received care for up to 5.52 months and attended between 0 and 10 coaching, therapy, or psychiatry sessions through Bend Health, Inc. For those with at least 2 assessments, 71.0% (n=22) showed improvements in inattention symptoms, 60.0% (n=9) showed improvements in hyperactivity symptoms, and 60.0% (n=12) showed improvements in oppositional symptoms. When considering group-level change over time, symptom severity decreased over the course of treatment with Bend Health, Inc, for inattention (average decrease=3.51 points, P=.001) and hyperactivity (average decrease=3.07 points, P=.049) but not for oppositional symptoms (average decrease=0.70 points, P=.26). There was a main effect of the duration of care on symptom severity (P<.001) such that each additional month of care was associated with lower symptom scores. This study offers promising early evidence that collaborative care DHMIs may facilitate improvements in ADHD symptoms among children and adolescents, addressing the growing need for accessible and high-quality care for behavioral health problems in the United States. However, additional follow-up studies bolstered by larger samples and control groups are necessary to further establish the robustness of these findings.

Continued Validation of the RBD Symptom Severity Scale (RBDSSS) in Participants of the North American Prodromal Synucleinopathy (NAPS) Consortium (P6-13.004)

Continued Validation of the RBD Symptom Severity Scale (RBDSSS) in Participants of the North American Prodromal Synucleinopathy (NAPS) Consortium (P6-13.004)

Reliability and validity of the Tibetan version of the International Prostate Symptom Score.

To validate the Tibetan version of the International Prostate Symptom Score (IPSS-Tib) in patients with and without urinary symptoms in a Tibetan population. The validity and reliability of IPSS-Tib were studied in 85 patients with benign prostatic hyperplasia (BPH) and 62 controls without lower urinary tract symptoms (LUTS). Reliability was evaluated using the test-retest method and internal consistency using Cronbach's α, and the construct validity was assessed by the correlation between IPSS-Tib scores and quality of life questions (QoL-Tib). The Cronbach's α coefficient of the IPSS-Tib was 0.80 and of a single IPSS scoring item ranged from 0.77 to 0.86. The IPSS-Tib test-retest reliability was evaluated by the intraclass correlation coefficient, and its average value was 0.79 (P < 0.001). The mean (SEM, 95% CI) area under the ROC curve for the IPSS-Tib was 0.91 (0.87-0.96). The IPSS-Tib had a high correlation with the QoL-Tib (Spearman's rank correlation coefficient 0.84, P < 0.01). The mean IPSS score before transurethral resection of the prostate (TURP) was 21.9 (6.8), and dropped to 6.38 (1.54) after TURP (P < 0.001), and the average difference was 15.52 (6.23), related to the drop from 4.5 (0.9) to 1.46 (0.48) in the QoL (P < 0.001). The IPSS-Tib has good reliability and validity in the diagnosis and symptom severity assessment of patients with BPH in Tibetan areas. It is an ideal assessment tool that can be used in Tibetan-speaking areas for patients with BPH and as a method for evaluating postoperative curative effect assessment of patients with BPH.

Symptom characteristics of health care workers seeking outpatient psychiatric care during the COVID-19 pandemic.

Though there is a growing body of research establishing a broad negative psychological impact of COVID-19 among healthcare workers (HCWs), there are comparably fewer studies evaluating symptom presentation and clinical diagnoses among treatment-seeking HCWs. The present report seeks to fill this gap in the literature by establishing the prevalence of anxiety, depression, post-traumatic stress, alcohol misuse, and well-being among treatment-seeking HCWs. Data were collected from 421 treatment-seeking HCWs in an outpatient hospital-based mental health setting. Both self-report measures and semi-structured interviews were utilized to assess symptom severity and render psychiatric diagnosis at intake. Adjustment disorders were the most prevalent diagnosis at 44.2%. Of the 347 who completed self-report measures, over 47% endorsed moderate-to-severe depressive symptoms, with 13% endorsing suicidal ideation (SI). Fifty-eight percent scored in the moderate-to-severe range for anxiety, and 19% screened positive for COVID-related post-traumatic stress disorder. Further analyses revealed that those in medical support roles endorsed significantly greater depression symptoms relative to other groups and also reported SI at greater frequency. Medical trainees also endorsed SI at higher frequencies. These findings are consistent with previous research on the adverse impact of COVID-19 stressors on HCWs' mental health. We further identified vulnerable groups that are underrepresented in the literature. These findings highlight the need for targeted outreach and intervention among overlooked HCWs populations.

Online structured dance/movement therapy reduces bodily detachment in depersonalization-derealization disorder

BackgroundDepersonalization-derealization disorder (DDD) is a dissociative disorder encompassing pronounced disconnections from the self and from external reality. As DDD is inherently tied to a detachment from the body, dance/movement therapy could provide an innovative treatment approach. Materials and methodsWe developed two online dance tasks to reduce detachment either by training body awareness (BA task) or enhancing the salience of bodily signals through dance exercise (DE task). Individuals with DDD (n = 31) and healthy controls (n = 29) performed both tasks individually in a cross-over design. We assessed symptom severity (Cambridge Depersonalization Scale), interoceptive awareness (Multidimensional Assessment of Interoceptive Awareness – II), mindfulness (Five Facet Mindfulness Questionnaire), and body vigilance (Body Vigilance Scale) before, during and after the tasks. ResultsAt baseline, individuals with DDD exhibited elevated depersonalization-derealization symptoms alongside lower levels of interoceptive awareness and mindfulness compared to controls. Both tasks reduced symptoms in the DDD group, though dance exercise was perceived as easier. The DE task increased mindfulness in those with DDD more than the BA task, whereas controls showed the opposite pattern. In the DDD group, within-subject correlations showed that lower levels of symptoms were associated with task-specific elevations in interoceptive awareness and mindfulness. ConclusionIndividual and structured dance/movement practice, performed at home without an instructor present, offers an effective tool to reduce symptoms in DDD and can be tailored to address specific cognitive components of a mindful engagement with the body.

Speech graph analysis in obsessive-compulsive disorder: The relevance of dream reports

Obsessive-compulsive disorder (OCD) is a distressing disorder characterized by the presence of intrusive thoughts, images or urges (obsessions) and/or behavioral efforts to reduce the anxiety (compulsions). OCD lifetime prevalence varies between 1% and 3% in the general population and there are no reliable markers that support the diagnosis. In order to fill this gap, Computational Psychiatry employs multiple types of quantitative analyses to improve the understanding, diagnosis, prediction, and treatment of mental illnesses including OCD. One of these computational tools is speech graphs analysis. A graph represents a network of nodes connected by edges: in non-semantic speech graphs, nodes correspond to words and edges correspond to the directed link between consecutive words. Using non-semantic speech graphs, we compared free speech samples from OCD patients and healthy controls (HC), to test whether speech graphs analysis can grasp structural differences in speech between these groups. To this end, 39 OCD patients and 37 HC were interviewed and recorded during six types of speech reports: yesterday, dream, old memory, positive image, negative image and neutral image. Also, the Obsessive-Compulsive Inventory-Revised (OCI-R) and the Yale Brown Obsessive-Compulsive Scale (Y-BOCS) were used to assess symptom severity. The graph-theoretical structural analysis of dream reports showed that OCD patients have significantly smaller lexical diversity, lower speech connectedness and a higher recurrence of words in comparison with HC. The other five report types failed to show differences between the groups, adding to the notion that dream reports are especially informative of speech structure in different psychiatric states. Further investigation is necessary to completely assess the potential of this tool in OCD.

Transdiagnostic psychiatry: Symptom profiles and their direct and indirect relationship with well-being

BackgroundHeterogeneity and comorbidity in psychiatric disorders are common, however, little is known about the impact on well-being and the role of functional limitations. We aimed to identify transdiagnostic psychiatric symptom profiles and to study their association with well-being and the mediating role of functional limitations in a naturalistic psychiatric patient group. MethodsWe used four disorder-specific questionnaires to assess symptom severity within a sample of 448 psychiatric patients with stress-related and/or neurodevelopmental disorders and 101 healthy controls. Using both exploratory and confirmatory factor analyses we identified transdiagnostic symptom profiles, which we entered into a linear regression analysis to assess their association with well-being and the mediating role of functional limitations in this association. ResultsWe identified eight transdiagnostic symptom profiles, covering mood, self-image, anxiety, agitation, empathy, non-social interest, hyperactivity and cognitive focus. Mood and self-image showed the strongest association with well-being in both patients and controls, while self-image also showed the highest transdiagnostic value. Functional limitations were significantly associated with well-being and fully mediated the relationship between cognitive focus and well-being. LimitationsThe participant sample consisted of a naturalistic group of out-patients. While this strengthens the ecological validity and transdiagnostic perspective of this study, the patients with a single neurodevelopmental disorder were underrepresented. ConclusionTransdiagnostic symptom profiles are valuable in understanding what reduces well-being in psychiatric populations, thereby opening new avenues for functionally meaningful interventions.