Psychiatric Symptom Clusters Research Articles

Development of a revised version of the transdiagnostic skills scale (T2S-R).

The transdiagnostic approach has been shown to offer promising prospects in psychopathology, based on the observation that common factors may be involved in different psychiatric disorders. The transdiagnostic skills scale (T2S) was developed recently to assess the skills that are disrupted in these disorders. However, studies have shown that the T2S has lower predictive power for externalizing than internalizing disorders. This may be due to the fact that the skills assessed do not include the control of urges and cravings. The aims of the current study are thus to develop a revised version of the T2S (T2S-R) integrating this dimension, and to assess its factor structure and invariance across employment status (workers vs. students) and the level of psychopathology. We recruited 1,298 French participants online through social media. They completed the revised version of the T2S and the symptomatic transdiagnostic test (S2T), which evaluates 11 clusters of psychiatric symptoms. We assessed the factor structure, internal consistency, invariance, and predictive validity of the revised T2S. We found a good fit for a bifactor exploratory structural equation modeling (B-ESEM) approach including a global skills factor and seven specific factors. The results also indicate that the new dimension (i.e., control of urges and cravings) has good predictive value, especially for externalizing problems. We also found total invariance of the scale across employment status and partial invariance across the level of psychopathology. The revised version of the T2S-R has good psychometric properties. It predicts better externalizing problems than the original version. However, the scale remains more correlated with internalizing than externalizing problems. We discuss the implications of the results on the transdiagnostic conceptualization and the interest of using a mixed approach combining transdiagnostic and diagnostic analyses.

Predictors of later COVID-19 test seeking.

Delays in COVID-19 testing may increase the risk of secondary household and community transmission. Little is known about what patient characteristics and symptom profiles are associated with delays in test seeking. We conducted a retrospective cohort study of all symptomatic patients diagnosed with COVID-19 and assessed in a COVID Expansion to Outpatients (COVIDEO) virtual care program between March 2020 and June 2021. The primary outcome was later test seeking more than 3 days from symptom onset. Multivariable logistic regression was used to examine predictors of later testing including patient characteristics and symptoms (30 individual symptoms or 7 symptom clusters). Of 5,363 COVIDEO patients, 4,607 were eligible and 2,155/4,607 (46.8%) underwent later testing. Older age was associated with increased odds of late testing (adjusted odds ratio [aOR] 1.007/year; 95% CI 1.00 to 1.01), as was history of recent travel (aOR 1.4; 95% CI 1.01 to 1.95). Health care workers had lower odds of late testing (aOR 0.50; 95% CI 0.39 to 0.62). Late testing was associated with symptoms in the cardiorespiratory (aOR 1.2; 95% CI 1.05, 1.36), gastrointestinal (aOR = 1.2; 95% CI 1.04, 1.4), neurological (aOR 1.1; 95% CI 1.003, 1.3) and psychiatric (aOR 1.3; 95% CI 1.1, 1.5) symptom clusters. Among individual symptoms, dyspnea, anosmia, dysgeusia, sputum, and anorexia were associated with late testing; pharyngitis, myalgia, and headache were associated with early testing. Certain patient characteristics and symptoms are associated with later testing, and warrant further efforts to encourage earlier testing to minimize transmission.

Exploring clusters of defence styles, psychiatric symptoms, and academic achievements among medical students in Saudi Arabia

Objective: This study aimed to identify clusters of defence mechanisms and their relationship with academic performance and mental health outcomes among medical students at five different universities in Saudi Arabia. Methods: This cross-sectional study was conducted using a self-administered online-based validated questionnaire. The questionnaire included sections on demographics, grades obtained in annual examinations, the Hospital Anxiety and Depression Scale (HADS), and the Defense Style Questionnaire-40 (DSQ-40). Results: A total of 997 medical students were included in the analysis, with 47.2% being male. Majority of the participants were in their 3rd and 6th year of college, and most were single. Among the participants, 16.8% reported being smokers. Based on academic achievements, 54.9% students were classified as low achievers, while 45.0% were classified as high achievers. The high achievers cluster was much larger than the low achievers cluster, with a ratio of sizes of 7.51. The low achievers cluster exhibited higher mean scores for traits such as immaturity, neuroticism, and suppression compared to the high achievers cluster. However, depression scores were similar in both clusters, while anxiety scores were significantly higher in the high achievers cluster. The high achievers cluster showed lower values for characteristics such as autistic fantasy, suppression, and anticipation. Conclusions: This study identified two distinct clusters of defence mechanisms among medical students in Saudi Arabia, which were associated with differences in academic performance and personality traits. High achievers demonstrated a higher proportion of mature defence mechanisms, while low achievers exhibited a higher prevalence of immature defence mechanisms.

Transdiagnostic Associations between Anger Hostility and Chemokine Interferon-gamma Inducible Protein 10.

Many psychiatric disorders are linked to low grade systemic inflammation as measured by systemic cytokine levels. Exploration of cytokines and immune activity and their role in psychiatric symptoms may inform pathobiology and treatment opportunities. The aim of this study is to explore if there are associations between cytokines and psychiatric symptom clusters. Comparison between patients regularly using and those not using psychotropic medication is also conducted. This was a cross sectional naturalistic study with 132 participants from a general open inpatient psychiatric ward at the Nordland Hospital Trust, Norway. Serum levels of 28 different cytokines were assessed. Psychiatric symptoms the last week were assessed by a self-rating scale (Symptom check list, SCL-90-R) and grouped in defined clusters. Multiple linear regression model was used for statistical analyses of associations between levels of cytokines and symptoms, adjusting for possible confounding factors. We found a positive association (p = 0.009) between the chemokine interferon-gamma inducible protein 10 (CXCL 10; IP-10) and the anger hostility cluster. No associations were found between the other symptom clusters and cytokines. IP-10 and the anger hostility cluster were positively associated (p = 0.002) in the subgroup of patients using psychotropic medication, not in the subgroup not using psychotropic medication. Our analyses revealed a significant positive association between the symptom cluster anger hostility in SCL-90-R and the chemokine IP-10 in the subgroup of patients using psychotropic medications.

Social functioning mediates the relationship between psychiatric symptoms and recovery among veteran and community service users with serious mental illness.

Previous research has established the impact of psychiatric symptoms on social functioning, while there is a paucity of research examining how social functioning relates to personal recovery, an individual's self-assessment of their mental health recovery. This study examined the mediating effect of social engagement, interpersonal communication, and satisfaction with support in the relationship between distinct psychiatric symptom clusters and perceived mental health recovery. In a cross-sectional study, both patient self-report and provider assessment data were collected for 250 patients with serious mental illness (SMI) across four mental health service sites. Parallel mediation analytic models were used. Interpersonal communication partially mediated the relationship between positive and negative symptom clusters and personal recovery. Satisfaction with social supports partially mediated the relationship between excited symptoms and personal recovery. Both interpersonal communication and satisfaction with social supports partially mediated the relationship between general psychological distress and depressive symptoms and personal recovery. Collectively, social functioning mediators explained nearly half of the relationship between general psychological distress and excited symptoms and personal recovery and nearly all of the relationship between positive symptoms and personal recovery. Clinical providers working with persons with SMI should regularly assess social functioning in addition to assessing psychiatric symptoms and personal recovery factors and should incorporate social skills education into SMI group and individual treatments. Social functioning as a target of treatment may be especially beneficial for patients who are dissatisfied with other interventions or feel they have experienced the maximum benefit from treatment and are seeking additional methods to support personal recovery. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Clinical characterisation of patients in the post-acute stage of anti-NMDA receptor encephalitis: a prospective cohort study and comparison with patients with schizophrenia spectrum disorders (S22.006)

Clinical characterisation of patients in the post-acute stage of anti-NMDA receptor encephalitis: a prospective cohort study and comparison with patients with schizophrenia spectrum disorders (S22.006)

Self-injury and the embodiment of solitary confinement among adult men in Louisiana prisons

Solitary confinement is a harrowing human rights and public health problem that is currently inflicted as a routine punishment for a litany of prison rule violations, a reactionary tactic to quell resistance to prison conditions, and as a destination of last resort for people serious mental illnesses (SMI) who are especially vulnerable to its harms. An extensive body of research has documented clusters of psychiatric symptoms—emotional distress, cognitive deficits, social withdrawal, anxiety, paranoia, sleeplessness, and hallucinations—linked to solitary confinement that often manifest in decompensating behaviors, which include self-injury and suicide. This study summarizes the historical evolution of solitary confinement, recaps its linkages to self-injury and suicidality, and offers a theoretical framework grounded in ecosocial theory, and supplemented with concepts from theories of dehumanization and carceral geography. Findings bolster extant evidence on the harms of solitary confinement by focusing on whether and how exertions of power by prison staff to deploy mechanisms of dehumanization—as a pathway between SMI and self-injury among a cross section of adult men (n = 517) exposed to solitary confinement in Louisiana prisons in 2017. Findings reinforce the need for structural interventions that diffuse forms of carceral power and practices that continue to subject people to isolation, dehumanization, and violence.

Uncovering psychiatric phenotypes using unsupervised machine learning: A data-driven symptoms approach.

Current categorical classification systems of psychiatric diagnoses lead to heterogeneity of symptoms within disorders and common co-occurrence of disorders. We investigated the heterogeneous and overlapping nature of symptom endorsement in a population-based sample across three of the most common categories of psychiatric disorders: depressive disorders, anxiety disorders, and sleep-wake disorders using unsupervised machine learning approaches. We assessed a total of 43 symptoms in a discovery sample of 6,602 participants of the population-based Rotterdam Study between 2009 and 2013, and in a replication sample of 3,005 participants between 2016 and 2020. Symptoms were assessed using the Center for Epidemiologic Studies Depression Scale, the Hospital Anxiety and Depression Scale, and the Pittsburgh Sleep Quality Index. Hierarchical clustering analysis was applied on test items and participants to investigate common patterns of symptoms co-occurrence, and further quantitatively investigated with clustering methods to find groups that may represent similar psychiatric phenotypes. First, clustering analyses of the questionnaire items suggested a three-cluster solution representing clusters of "mixed" symptoms, "depressed affect and nervousness", and "troubled sleep and interpersonal problems". A highly similar clustering solution was independently established in the replication sample. Second, four groups of participants could be separated, and these groups scored differently on the item clusters. We identified three clusters of psychiatric symptoms that most commonly co-occur in a population-based sample. These symptoms clustered stable over samples, but across the topics of depression, anxiety, and poor sleep. We identified four groups of participants that share (sub)clinical symptoms and might benefit from similar prevention or treatment strategies, despite potentially diverging, or lack of, diagnoses.

Clinical characterisation of patients in the post-acute stage of anti-NMDA receptor encephalitis: a prospective cohort study and comparison with patients with schizophrenia spectrum disorders

Anti-NMDA receptor (NMDAR) encephalitis is associated with a post-acute stage that is not well known. We aimed to describe the clinical features of this stage, similarities with schizophrenia spectrum disorders, and the factors that predict cognitive-psychiatric outcomes and could serve as prognostic biomarkers. In this prospective cohort study, participants (aged 12-60 years) with anti-NMDAR encephalitis during the post-acute stage visited Hospital Clínic de Barcelona (Barcelona, Spain) on three occasions (at study entry [V1], at 6 months [V2], and at 12 months [V3]) and underwent comprehensive neuropsychiatric evaluations. Similar evaluations were done in a group of age-matched participants with schizophrenia spectrum disorders and a group of age-matched and sex-matched healthy participants also recruited from Hospital Clínic de Barcelona. We analysed differences between and within groups in the longitudinal follow-up using multilevel linear mixed-effect models, adjusting for group, age, sex, and socioeconomic status to control for possible confounding. Between Jan 1, 2017, and Sept 30, 2020, 82 participants were recruited, 28 (34%) with anti-NMDAR encephalitis, 27 (33%) with schizophrenia spectrum disorders, and 27 (33%) healthy participants. Although, by V1 (median 4 months [IQR 3-7] from disease onset), many acute-stage symptoms in participants with anti-NMDAR encephalitis had resolved (acute stage median modified Rankin Scale [mRS] score 5 [IQR 4-5] vs V1 mRS score 2 [1-2]; p<0·0001), 25 (89%) participants showed deficits in at least one cognitive domain. In this group, 15 (68%) of 22 cognitive domain variables were impaired at V1, whereas only eight (36%) were altered at V3 (p=0·016). In participants with schizophrenia spectrum disorders, 11 (50%) of 22 variables (all shared with participants with anti-NMDAR encephalitis) were impaired at V1, without changes at V3. Two acute-stage features of anti-NMDAR encephalitis (ie, decreased consciousness and no improvement within the first 4 weeks of treatment) predicted cognitive domain outcomes, and a visuospatial task (ie, serial biases) at V1 showed potential in predicting learning and memory outcomes. At V1, all psychiatric symptom clusters were similarly altered in participants with anti-NMDAR encephalitis and in those with schizophrenia spectrum disorders, but only those in individuals with anti-NMDAR encephalitis subsequently improved (p=0·031). The greatest cognitive-psychiatric improvement in participants with anti-NMDAR encephalitis occurred between V1 and V2. During this interval, four (14%) participants with anti-NMDAR encephalitis would have met the diagnostic criteria of schizophrenia if CSF antibody findings had not been investigated. The cognitive-psychiatric symptoms of anti-NMDAR encephalitis in the post-acute stage resembled those of stabilised schizophrenia, but only those in participants with anti-NMDAR encephalitis progressively improved, predominantly during V1-V2. These findings are important for clinical trials on anti-NMDAR encephalitis and suggest that prompt cognitive-psychosocial rehabilitation might be a valuable intervention. Instituto Salud Carlos III, NEURON Network of European Funding for Neuroscience Research, National Alliance for Research in Schizophrenia and Affective Disorders, and la Caixa Health-Research Foundation.

Risk for PTSD symptom worsening during new PTSD treatment episode in a nationally representative sample of treatment-seeking U.S. veterans with subthreshold PTSD

Previous research has examined risk factors associated with poorer treatment outcomes for military Veterans with PTSD. However, work has not examined risk for symptom worsening among Veterans with subthreshold PTSD. The aim of this study was to examine demographic, psychiatric, physical health, and pre-treatment PTSD symptom clusters associated with clinically significant worsening of PTSD among a nationally representative sample of United States (U.S.) Veterans with subthreshold PTSD. Participants were Veterans (weighted N = 3162; unweighted N = 236) with subthreshold PTSD entering a new episode of treatment at U.S. Veterans Affairs PTSD specialty clinics during fiscal years 2018 and 2019. Data was collected as part of the Veterans Outcome Assessment, a yearly baseline and 3-month follow-up telephone survey. Analyses used weighted calculations to support the use of VOA data to draw inferences about all eligible Veterans, and binary logistic regression was used to examine risk factors for symptom worsening. Over 1/3 (37.7%) of Veterans with subthreshold PTSD experienced clinically significant symptom worsening from baseline to follow-up. Adjusted analyses revealed several risk factors for symptom worsening, including demographic (e.g., male sex, White race), psychiatric (personality and anxiety disorders), health care utilization (e.g., more primary care encounters in the previous year), physical health disability, and specific baseline PTSD symptom clusters (negative affect and anxious arousal). Findings suggest that Veterans with subthreshold symptoms seeking treatment for PTSD are at risk for symptom worsening, and highlight the importance of assessment, prevention, and treatment in targeting veterans with PTSD symptoms below the diagnostic threshold.

Depression complexity prevalence and outcomes among veterans affairs patients in integrated primary care.

The Veterans Health Administration (VA) Primary Care-Mental Health Integration (PC-MHI) initiative targets depression (MDD), anxiety/posttraumatic stress disorder (PTSD) and alcohol misuse (AM) for care improvement. In primary care, case finding often relies on depression screening. Whereas clinical practice guidelines solely inform management of depression, minimal information exists to guide treatment when psychiatric symptom clusters coexist. We provide descriptive clinical information for care planners about VA PC patients with depression alone, depression plus alcohol misuse, and depression with complex psychiatric comorbidities (PTSD and/or probable bipolar disorder). We examined data from a VA study that used a visit-based sampling procedure to screen 10,929 VA PC patients for depression; 761 patients with probable major depression completed baseline measures of health and care engagement. Follow-up assessments were completed at 7 months. At baseline, 53% of patients evidenced mental health conditions in addition to depression; 10% had concurrent AM, and 43% had psychiatrically complex depression (either with or without AM). Compared with patients with depression alone or depression with AM, those with psychiatrically complex depression evinced longer standing and more severe mood disturbance, higher likelihood of suicidal ideation, higher unemployment, and higher levels of polypharmacy. Baseline depression complexity predicted worse mental health status and functioning at follow-up. A substantial proportion of VA primary care patients with depression presented with high medical multimorbidity and elevated safety concerns. Psychiatrically complex depression predicted lower treatment effectiveness, suggesting that PC-MHI interventions should co-ordinate and individualize care for these patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Validity and reliability study of coronavirus-related psychiatric symptom scale in children - parental form.

The aim of this study is to develop a scale to assess the psychiatric symptoms that may emerge owing to the coronavirus disease 2019 (COVID-19) pandemic period in children and adolescents aged 4-18 years. To develop the scale, first, interviews with children, adolescents, and their parents were conducted, and the possible psychiatric symptom clusters were detected. The items were written with reference to the literature and reviewed by the experts. A 40-item scale form was shared as an online survey, and a factor analysis of the scale was carried out with data obtained from 441 participants. The test-retest reliability of the scale was carried out with data obtained from the 51 participants who filled the scale again after 14 days. According to the item-total correlations and factor analysis results with 40 items, 5 items with low correlation and factor load or loaded same under the two factors were removed from the scale. The final form had 35 items and had a two-factor structure. The internal consistency coefficient of the scale was calculated as 0.96, and the test-retest correlation coefficient was 0.98. Coronavirus-related psychiatric symptom scale in children - parental form is a valid and reliable scale for measuring perceived psychiatric symptoms associated with COVID-19pandemic in children aged 4-18 years by their parents.

DSM-5 Level 1 cross-cutting measure in an online sample: evaluating its latent dimensionality and utility detecting nonspecific psychological distress

Included in the most recent Diagnostic and Statistical Manual of Mental Disorders is the Level 1 Cross-Cutting Symptom Measure (CCSM), a self-report checklist with 23 items assessing 13 major psychiatric symptom clusters. To date, minimal literature has examined the factor structure of the CCSM and its utility identifying significant psychological distress, and existing studies pose notable limitations. Four hundred (400) American adults (M age = 34.13; 50.2% female) participated online via Amazon Mechanical Turk as part of a larger study, which included the CCSM. The sample was randomly split to conduct exploratory and confirmatory factor analyses (EFAs and CFAs). EFAs revealed structures with one (general psychopathology) and two (externalizing/serious mental illness and internalizing/affective) factors accounting for 67.3% and 73.7% of the variance, respectively. CFAs indicated good fit for both models, though statistical comparison of the models via χ2 difference test revealed the two-factor model provided significantly better fit. Areas under the receiver operating curve (AUCs) suggested that all CCSM variables of interest poorly differentiated those currently receiving mental health treatment from those who have never received mental health treatment (AUCs ranged from .57 to .68). Implications of these findings, various limitations, and recommendations for future lines of inquiry were discussed.

Depression and Anxiety Subgroups Across Alcohol Use Disorder and Substance Use in a National Epidemiologic Study

Objective: The high prevalence of alcohol/substance use among individuals with psychiatric disorders elucidates the import of investigations into associations between types and severity of psychiatric symptoms and alcohol/substance use. This study examined the likelihood of alcohol use disorder and substance use among individuals with varying depression and anxiety symptoms and severity thereof. Differences across sex were also examined.Methods: Using data from the National Epidemiological Survey on Alcohol and Related Conditions, a nationally representative sample from the United States (N = 43,093), separate logistic regressions estimated the odds of lifetime alcohol use disorder, depressant, stimulant, hallucinogen, and comorbid substance use across psychiatric symptom clusters controlling for age, sex, and ethnicity.Results: Symptom severity was a more important correlate of alcohol use disorder and substance use than symptom type. In particular, the odds ratio of lifetime use of depressants, stimulants, hallucinogens, or any combination of these types of substances were higher for individuals with either severe depression or severe depression and anxiety relative to a healthy control. Moreover, the odds of having a diagnosis of lifetime alcohol use disorder were higher for individuals with severe symptoms of depression, anxiety, and both depression and anxiety, relative to healthy individuals. Those with mild depression were more likely to engage in substance use than individuals with anxiety alone. Patterns of association among males and females were highly consistent.Conclusions: The findings highlight an enhanced risk of alcohol and substance use among individuals with severe depression and/or anxiety symptoms above what is seen among individuals with less severe symptomatology. In addition, this study shows a unique risk posed by the presence of depression on substance use. This study offers a framework for future studies to examine the causal mechanisms explaining the connection between psychiatric symptoms and alcohol/substance use.

Correlates of gun violence by criminal justice-involved adolescents.

This study presents a prospective evaluation of the contribution of criminogenic factors, psychiatric symptomatology, and neighborhood-level factors to risk for self-reported gun violence by adolescents with criminal justice involvement. We hypothesized that elevated psychiatric symptom clusters would be associated with increased risk for gun violence after accounting for criminogenic factors and that neighborhood contextual variables would contribute independently to gun violence risk controlling for criminogenic and psychiatric factors. Data were drawn from the Pathways to Desistance study (Mulvey et al., 2004), a previously collected, longitudinal evaluation of 1,354 adolescents with felony or weapons-based misdemeanor convictions. Participants were located in Arizona and Pennsylvania and aged 14-18 at baseline. The majority identified as male (86.4%) and Black (41.4%) or Hispanic (33.5%). Participants completed interviews at baseline and follow-up over 7 years. This study drew indicators of criminogenic factors, psychiatric factors, ratings of neighborhood context, and self-reported offending. We used discrete time survival analysis to prospectively evaluate the contribution of independent variables to time to gun violence. The presence of self-reported threat control override symptoms represented a 56% increase in risk controlling for demographic and criminogenic factors, odds ratio = 1.56, 95% confidence interval [1.11, 2.18]. Ratings of higher neighborhood gun accessibility represented almost 2.5 times increased risk for self-reported gun violence controlling for demographic, criminogenic, and psychiatric factors, odds ratio = 2.48, 95% confidence interval [1.60, 3.85]. Results suggest that consideration of both environmental and individual-level factors hold importance for management of community risk and public safety for adolescents with criminal justice involvement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

COVID-19 Crisis: Early Observations on a Pandemic's Psychiatric Problems

We have recently observed several clusters of psychiatric symptoms in the context of COVID-19: (1) increased anxiety in psychiatric in- and outpatients with different diagnoses; (2) more cases of domestic violence often associated with increased drug- or alcohol-consumption in offenders and victims; (3) a nihilistic "apocalyptic" syndrome of elderly patients cut-off from their families; (4) visual and acoustic hallucinoses due to pneumonia and sepsis-related confusional states. Cases of chloroquine-related toxicity have been reported elsewhere, but have not been observed in our hospital so far. Mental issues related to COVID-19 reported from China and practical recommendations are briefly summarized. Many patients with serious mental disorders will suffer world-wide due to a reallocation of medical, social and financial ressources.

"Correlates of gun violence by criminal justice-involved adolescents": Retraction of Gonzales and McNiel (2019).

We hypothesized (a) elevated psychiatric symptom clusters would be associated with increased risk for gun violence after accounting for criminogenic factors; and (b) neighborhood contextual variables would contribute independently to gun violence risk controlling for criminogenic and psychiatric factors. Data were drawn from the Pathways to Desistance study (Mulvey et al., 2004), a previously collected, longitudinal evaluation of 1,354 adolescents with felony or weapons-based misdemeanor convictions. Participants were located in Arizona and Pennsylvania and aged 14-18 at baseline. The majority identified as male (86.4%) and Black (41.4%) or Hispanic (33.5%). Participants completed interviews at baseline and follow-up over 7 years. This study drew indicators of criminogenic factors, psychiatric factors, ratings of neighborhood context, and self-reported offending verified with criminal justice records. We used discrete time survival analysis to prospectively evaluate the contribution of independent variables to time to gun violence. The presence of self-reported threat control override symptoms represented a 56% increase in risk controlling for demographic and criminogenic factors, odds ratio (OR) = 1.56, 95% CI [1.11, 2.18]. Ratings of higher neighborhood gun accessibility represented almost 2.5 times increased risk for gun violence controlling for demographic, criminogenic, and psychiatric factors, OR = 2.48, 95% CI [1.60, 3.85]. Results suggest that consideration of environmental and individual-level factors hold importance for management of community risk and public safety for adolescents with criminal justice involvement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Double-Dissociation Studies in Psychiatric Research: A Scoping Review.

After participating in this activity, learners should be better able to:• Evaluate the double-dissociation approach to research in neuropsychology• Assess research aiming to provide evidence of double dissociation between neurobiological abnormalities and clinical presentations in psychiatry BACKGROUND: Psychiatric neuroscience research has grown exponentially, but it has not generated the desired breakthroughs in diagnosis, treatment development, or treatment selection. In many instances a given neurobiological abnormality is found in multiple clinical syndromes, and conversely, a clinical syndrome is associated with multiple neurobiological abnormalities. To the extent that neurobiology research is conducted to explain psychiatric manifestations, however, it should also provide insight into how certain brain abnormalities lead to one and not another specific clinical presentation-that is, "double-dissociation." We hypothesized that most psychiatric research studies are not designed to identify such double dissociations. We selected three leading psychiatric journals (American Journal of Psychiatry, JAMA Psychiatry, and Molecular Psychiatry) that are representative of high-quality psychiatry research and that also provided a sample size that was feasible to screen. We screened all original research manuscripts published over the course of one calendar year (2017) to identify those measuring brain function or biological parameters (which, collectively, we term neurobiological measures) in psychiatric disorders. We asked whether such biological research could provide evidence for a double dissociation of any kind. We found that only 7 of 403 articles published in three psychiatry journals, constituting approximately 2% of publications, examined the dissociation of neurobiological measures relating to two psychiatric disorders or symptom clusters. Of these 7 studies, 5 used imaging as research tool; 1 used genotype array; and 1 used polymerase chain reaction (PCR). Sample sizes of the 7 studies ranged from 100 to 2876. We report on a striking paucity of research aiming to provide evidence of double dissociation between neurobiological abnormalities and clinical presentations in psychiatry. We conclude that this paucity represents a missed opportunity for the field. Double-dissociation approaches have been used successfully in many studies in neurology and psychiatry in the past, and more widespread and explicit adoption of this design may improve the mechanistic insights obtained in psychiatry research.

Correlates of gun violence by criminal justice-involved adolescents.

We hypothesized (a) elevated psychiatric symptom clusters would be associated with increased risk for gun violence after accounting for criminogenic factors; and (b) neighborhood contextual variables would contribute independently to gun violence risk controlling for criminogenic and psychiatric factors. Data were drawn from the Pathways to Desistance study (Mulvey et al., 2004), a previously collected, longitudinal evaluation of 1,354 adolescents with felony or weapons-based misdemeanor convictions. Participants were located in Arizona and Pennsylvania and aged 14-18 at baseline. The majority identified as male (86.4%) and Black (41.4%) or Hispanic (33.5%). Participants completed interviews at baseline and follow-up over 7 years. This study drew indicators of criminogenic factors, psychiatric factors, ratings of neighborhood context, and self-reported offending verified with criminal justice records. We used discrete time survival analysis to prospectively evaluate the contribution of independent variables to time to gun violence. The presence of self-reported threat control override symptoms represented a 56% increase in risk controlling for demographic and criminogenic factors, odds ratio (OR) = 1.56, 95% CI [1.11, 2.18]. Ratings of higher neighborhood gun accessibility represented almost 2.5 times increased risk for gun violence controlling for demographic, criminogenic, and psychiatric factors, OR = 2.48, 95% CI [1.60, 3.85]. Results suggest that consideration of environmental and individual-level factors hold importance for management of community risk and public safety for adolescents with criminal justice involvement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Caregiver burden and caregiver appraisal of psychiatric symptoms are not modulated by subthalamic deep brain stimulation for Parkinson\u2019s disease

Subthalamic deep brain stimulation is an advanced therapy that typically improves quality of life for persons with Parkinson’s disease (PD). However, the effect on caregiver burden is unclear. We recruited 64 persons with PD and their caregivers from a movement disorders clinic during the assessment of eligibility for subthalamic DBS. We used clinician-, patient- and caregiver-rated instruments to follow the patient–caregiver dyad from pre- to postoperative status, sampling repeatedly in the postoperative period to ascertain fluctuations in phenotypic variables. We employed multivariate models to identify key drivers of burden. We clustered caregiver-rated variables into ‘high’ and ‘low’ symptom groups and examined whether postoperative cluster assignment could be predicted from baseline values. Psychiatric symptoms in the postoperative period made a substantial contribution to longitudinal caregiver burden. The development of stimulation-dependent mood changes was also associated with increased burden. However, caregiver burden and caregiver-rated psychiatric symptom clusters were temporally stable and thus predicted only by their baseline values. We confirmed this finding using frequentist and Bayesian statistics, concluding that in our sample, subthalamic DBS for PD did not significantly influence caregiver burden or caregiver-rated psychiatric symptoms. Specifically, patient–caregiver dyads with high burden and high levels of psychiatric symptoms at baseline were likely to maintain this profile during follow-up. These findings support the importance of assessing caregiver burden prior to functional neurosurgery. Furthermore, they suggest that interventions addressing caregiver burden in this population should target those with greater symptomatology at baseline and may usefully prioritise psychiatric symptoms reported by the caregiver.