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JMIR Mental Health Jun 2024Due to recent advances in artificial intelligence (AI), large language models (LLMs) have emerged as a powerful tool for a variety of language related tasks, including...
BACKGROUND
Due to recent advances in artificial intelligence (AI), large language models (LLMs) have emerged as a powerful tool for a variety of language related tasks, including sentiment analysis, and summarization of provider-patient interactions. However, there is limited research on these models in the area of crisis prediction.
OBJECTIVE
This study aimed to evaluate the performance of LLMs, specifically OpenAI's GPT-4, in predicting current and future mental health crisis episodes using patient provided information at intake among users of a national telemental health platform.
METHODS
De-identified patient provided data was pulled from specific intake questions of the Brightside telehealth platform, including the chief complaint, for 140 patients who indicated suicidal ideation (SI), and another 120 patients who later indicated SI with a plan during the course of treatment. Similar data was pulled for 200 randomly selected patients treated during the same time period who never endorsed SI. Six senior Brightside clinicians (three psychologists and three psychiatrists) were shown patients' self-reported chief complaint and self-reported suicide attempt history but were blinded to the future course of treatment and other reported symptoms including SI. They were asked a simple yes/no question regarding their prediction of endorsement of SI with plan along with their confidence level about the prediction. GPT-4 was provided similar information and asked to answer the same questions, enabling us to directly compare the performance of AI and clinicians.
RESULTS
Overall, clinicians' average precision (0.698) was higher than GPT-4 (0.596) in identifying SI with plan at intake (n=140) vs. no SI (n=200) when using chief complaint alone, while sensitivity was higher for GPT-4 (0.621) than clinicians' average (0.529). The addition of suicide attempt history increased clinicians' average sensitivity (0.590) and precision (0.765), while increasing GPT-4 sensitivity (0.590) but decreasing GPT-4 precision (0.544). Performance decreased comparatively when predicting future SI with plan (n=120) vs no SI (n=200) with chief complaint only for clinicians (average sensitivity=0.399; average precision=0.594) and GPT-4 (sensitivity=0.458; precision=0.482). The addition of suicide attempt history increased performance comparatively for clinicians (average sensitivity=0.457; average precision=0.687) and GPT-4 (sensitivity=0.742; precision=0.476).
CONCLUSIONS
GPT-4 with a simple prompt design produced results on some metrics that approached that of a trained clinician. Additional work must be done before such a model could be piloted in a clinical setting. The model should undergo safety checks for bias given evidence that LLMs can perpetuate the biases of the underlying data they are trained upon. We believe that LLMs hold promise to augment identification of higher risk patients at intake and potentially deliver more timely care to patients.
PubMed: 38876484
DOI: 10.2196/58129 -
Psychiatry Research May 2024Depression was already a public health issue before the Covid-19 pandemic. Use of service and treatment adequacy in medical students was poorly known. A 2021 French...
Depression was already a public health issue before the Covid-19 pandemic. Use of service and treatment adequacy in medical students was poorly known. A 2021 French national study found the prevalence of 12-month major depressive disorder (MDD) was 25 % in medical school students and residents (MSSR). The main objective of our study was to measure the prevalence of service use and adequate treatment (therapy and/or recommended pharmacotherapy) and their associated factors. A national online survey was conducted in 2021. The Composite International Diagnostic Interview Short-Form questionnaire was used to assess MDD; 12-months service use and pharmacotherapy were assessed. Univariate and multivariate logistic regressions were performed between students' demographic characteristics, use of services, and treatment adequacy. Among included MSSR who experienced MDD in the last 12 months, only 32 % received adequate treatment, including 20 % with recommended pharmacotherapy. Being more advanced in medical studies and being treated both by a general practitioner and a psychiatrist were associated with receiving recommended pharmacotherapy. To our knowledge, our study is the largest to assess use of service and treatment adequacy in MSSR. Given the low percentage of depressed students receiving recommended treatment, it seems important to develop new interventions to better detect and treat MDD in MSSR.
PubMed: 38875916
DOI: 10.1016/j.psychres.2024.115975 -
Australasian Psychiatry : Bulletin of... Jun 2024Increasing numbers of healthcare data breaches highlight the need for structured organisational responses to protect patients, trainees and psychiatrists against...
Increasing numbers of healthcare data breaches highlight the need for structured organisational responses to protect patients, trainees and psychiatrists against identity theft and blackmail. Evidence-based guidance that is informed by the COVID-19 pandemic response includes: timely and reliable information tailored to users' safety, encouragement to take protective action, and access to practical and psychological support. For healthcare organisations which have suffered a data breach, insurance essentially improves access to funded cyber security responses, risk communication and public relations. Patients, trainees and psychiatrists need specific advice on protective measures. Healthcare data security legislative reform is urgently needed.
PubMed: 38875170
DOI: 10.1177/10398562241261818 -
Tobacco Induced Diseases 2024Healthcare workers are integral to public smoking cessation; however, their own smoking behavior can create a significant obstacle to intervening in patients' cessation...
INTRODUCTION
Healthcare workers are integral to public smoking cessation; however, their own smoking behavior can create a significant obstacle to intervening in patients' cessation efforts. Conversely, their success in quitting can enhance their ability to support patients. Research on smoking behavior, particularly smoking cessation among Chinese psychiatric professionals is limited. This study addresses this gap by examining the factors associated with smoking cessation in this population, providing insights for targeted tobacco control policies.
METHODS
A cross-sectional survey was conducted, targeting psychiatric professionals including psychiatrists and psychiatric nurses, in 41 tertiary psychiatric hospitals in China. From January to March 2021, a WeChat-based questionnaire was distributed to collect demographic, occupational, and health-behaviors (including smoking) data. Statistical analyses, including the chi-squared test and adjusted binary logistic regression analysis, were conducted to identify the factors associated with smoking cessation.
RESULTS
Among the 12762 psychiatric professionals who participated in the survey, 11104 (87.0%) were non-smokers, 1196 (9.4%) were current smokers, and 462 (3.6%) were ex-smokers. Several factors were found to be associated with smoking cessation. Women had a higher prevalence of ex-smokers than men (AOR=1.88; 95% CI: 1.332-2.666, p<0.001). Compared to East China, the prevalence of ex-smokers among participants in Central and Northeast China was lower. Older age (≥50 years), higher level of education (Master's degree or higher), and non-drinkers, showed a higher likelihood of being ex-smokers. Notably, compared to current smokers, ex-smokers reported a lower prevalence of burnout (AOR=0.70; 95% CI: 0.552-0.892, p=0.004).
CONCLUSIONS
Smoking cessation interventions or health promotion programs should also focus on gender, age, education level, region, alcohol use, and burnout to effectively address smoking cessation within this specific professional group.
PubMed: 38873181
DOI: 10.18332/tid/189299 -
American Journal of Psychoanalysis Jun 2024Since its inception, psychiatry has undergone several periods of radical identity transformation. Initially limited to psychotherapy alone, the advent of medications...
Since its inception, psychiatry has undergone several periods of radical identity transformation. Initially limited to psychotherapy alone, the advent of medications stimulated an era of biological psychiatry. For years, medications served as the mainstay of biological treatments, paralleled by a rise in treatment resistance. Brain stimulation therapies are psychiatry's newest arm of intervention and represent an area ripe for exploration. These techniques offer new hope to treatment-resistant patients, but in a manner often dissociated from psychoanalytic conceptualization and the practice of psychotherapy. There is growing interest in bridging this divide. In this article, we continue the efforts at interweaving what may seem to be disparate approaches through the topic of treatment resistance. This article aims to engage interventional psychiatrists in considering psychosocial dimensions of their treatments and to provide education for psychoanalytic clinicians on the history, mechanism of action, and applications of brain stimulation technologies.
PubMed: 38871924
DOI: 10.1057/s11231-024-09444-y -
Journal of Psychiatric Research Jun 2024Schizophrenia (SCZ) is a severe psychiatric disorder with unclear pathophysiology. Moreover, there is no specific biological marker to help clinicians to define a... (Review)
Review
Schizophrenia (SCZ) is a severe psychiatric disorder with unclear pathophysiology. Moreover, there is no specific biological marker to help clinicians to define a diagnosis, and medication is decided according to the psychiatrist's experience. In this scenario, microRNAs (miRNAs), which are small noncoding RNA molecules that regulate several genes, emerge as potential peripheral biomarkers to help not only the evaluation of the disease state but also the treatment response. Here, we systematically reviewed indexed literature and evaluated follow-up studies investigating the changes in miRNA expression due to antipsychotic treatment. We also assessed target genes and performed pathway enrichment analysis of miRNAs listed in this systematic review. A total of 11 studies were selected according to research criteria, and we observed that 28 miRNAs play a relevant role in schizophrenia pathogenesis or response to antipsychotic treatment, seven of those of extreme interest as possible biomarkers either for condition or treatment. Predicted targets of the miRNAs reviewed here were previously associated with schizophrenia in genome-wide studies, and pathway analysis showed enrichment for genes related to neural processes. With this review, we expect to highlight the importance of miRNAs in schizophrenia pathogenesis and its treatment and point out interesting miRNAs to future studies.
PubMed: 38870782
DOI: 10.1016/j.jpsychires.2024.06.010 -
JAMA Network Open Jun 2024The use of evidence-based standardized outcome measures is increasingly recognized as key to guiding clinical decision-making in mental health. Implementation of these...
IMPORTANCE
The use of evidence-based standardized outcome measures is increasingly recognized as key to guiding clinical decision-making in mental health. Implementation of these measures into clinical practice has been hampered by lack of clarity on what to measure and how to do this in a reliable and standardized way.
OBJECTIVE
To develop a core set of outcome measures for specific neurodevelopmental disorders (NDDs), such as attention-deficit/hyperactivity disorder (ADHD), communication disorders, specific learning disorders, and motor disorders, that may be used across a range of geographic and cultural settings.
EVIDENCE REVIEW
An international working group composed of clinical and research experts and service users (n = 27) was convened to develop a standard core set of accessible, valid, and reliable outcome measures for children and adolescents with NDDs. The working group participated in 9 video conference calls and 8 surveys between March 1, 2021, and June 30, 2022. A modified Delphi approach defined the scope, outcomes, included measures, case-mix variables, and measurement time points. After development, the NDD set was distributed to professionals and service users for open review, feedback, and external validation.
FINDINGS
The final set recommends measuring 12 outcomes across 3 key domains: (1) core symptoms related to the diagnosis; (2) impact, functioning, and quality of life; and (3) common coexisting problems. The following 14 measures should be administered at least every 6 months to monitor these outcomes: ADHD Rating Scale 5, Vanderbilt ADHD Diagnostic Rating Scale, or Swanson, Nolan, and Pelham Rating Scale IV; Affective Reactivity Index; Children's Communication Checklist 2; Colorado Learning Disabilities Questionnaire; Children's Sleep Habits Questionnaire; Developmental-Disability Children's Global Assessment Scale; Developmental Coordination Disorder Questionnaire; Family Strain Index; Intelligibility in Context Scale; Vineland Adaptive Behavior Scale or Repetitive Behavior Scale-Revised and Social Responsiveness Scale; Revised Child Anxiety and Depression Scales; and Yale Global Tic Severity Scale. The external review survey was completed by 32 professionals and 40 service users. The NDD set items were endorsed by more than 70% of professionals and service users in the open review survey.
CONCLUSIONS AND RELEVANCE
The NDD set covers outcomes of most concern to patients and caregivers. Use of the NDD set has the potential to improve clinical practice and research.
Topics: Humans; Neurodevelopmental Disorders; Child; Consensus; Outcome Assessment, Health Care; Adolescent; Delphi Technique; Attention Deficit Disorder with Hyperactivity; Female
PubMed: 38869906
DOI: 10.1001/jamanetworkopen.2024.16760 -
Journal of Investigative Medicine : the... Jun 2024The prevalence of depression continues to rise,and it has a high death and disability rate.Life's Essential 8 (LE8) is an updated measurement of cardiovascular health...
The prevalence of depression continues to rise,and it has a high death and disability rate.Life's Essential 8 (LE8) is an updated measurement of cardiovascular health (CVH),and the higher score of LE8 represents healthier CVH.Our study aimed to investigate the association between the LE8 and depression among adults.This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES).CVH was measured by using LE8 according to American Heart Association definitions.Depression was assessed by the 9-item Patient Health Questionnaire (PHQ-9).Weighted univariable and multivariable logistic analyses were performed to investigate the association of LE8 with depression.Subgroup analyses were also conducted in different groups based on age,gender,race,body mass index (BMI),smoking,arthritis,cardiovascular disease,and chronic kidney disease (CKD).A total of 22,149 participants were included from the database,with a mean LE8 score of 71.27.The prevalence of depression was 7.32%.The mean scores of LE8 in health behaviors and health factors were 73.28 and 69.26, respectively.After adjustment of potential confounders,a higher LE8 score was associated with a lower odd of depression (odds ratio=0.27, 95% confidence interval: 0.20 to 0.37).Similar association was observed in the subgroup analyses.Higher overall LE8 score and higher score for each component (diet, physical activity, nicotine exposure, sleep duration, BMI, blood lipids, blood glucose, and blood pressure) were associated with lower odds of depression.LE8 score might be a useful tool for both cardiologists and psychiatrists in screening for and monitoring physical and mental health.Primary care physicians also could better tailor care and interventions to address both physical and mental health needs.
PubMed: 38869164
DOI: 10.1177/10815589241261286 -
Noro Psikiyatri Arsivi 2024As a neurologist who has followed up countless Parkinson's patients over the last 32 years of my fifty-year career; I denied diagnosing myself with Parkinson's disease... (Review)
Review
As a neurologist who has followed up countless Parkinson's patients over the last 32 years of my fifty-year career; I denied diagnosing myself with Parkinson's disease (PD), although the seldom mild involuntary "twitches" that occurred in the thumb of my right hand over a two-year period, resembled Parkinson's disease tremor. However, when these involuntary contractions became persistent; considering its similarity to characteristic resting tremor in typical PD, the positive effect of dopaminergic medications, the development of levodopa-induced dyskinesias and other non-motor symptoms, it was clear that the PD diagnosis was accurate. This situation naturally caused me anxiety, and for a year and a half, I kept my diagnosis hidden from everyone except a few close relatives. However, with the encouragement of a psychiatrist friend, when I was able to share my condition with my loved ones, I felt a relative reduction in the burden I was carrying and consequently experienced emotional relief. I am still able to carry out my daily activities independently with a rather low dose of medication, and my PD symptoms do not attract noticeable attention.
PubMed: 38868853
DOI: 10.29399/npa.28634 -
Noro Psikiyatri Arsivi 2024The purpose of this study was to obtain information about the sexual behaviors, sexual functioning of "bondage-discipline, dominance-submission, sadism, masochism"...
INTRODUCTION
The purpose of this study was to obtain information about the sexual behaviors, sexual functioning of "bondage-discipline, dominance-submission, sadism, masochism" (BDSM) practitioners.
METHODS
The study group (n=141) consisted of 65 women and 76 men who defined themselves as BDSM practitioners included in the study with the snowball technique through websites that are accessible on online BDSM groups. A control group (n=167) who stated that they were not BDSM practitioners was also recruited through websites. Sociodemographic and Sexual Behavior Evaluation Form and Arizona Sexual Experience Scale (ASEX) were used online to gather data.
RESULTS
No significant difference was found between BDSM practitioners and controls with regard to ASEX scores. Yet, in women, the mean ASEX score was lower in BDSM practitioners than in the control group whereas in men, the mean ASEX score was higher in the BDSM practitioners.
CONCLUSION
Gender might be an important factor in terms of sexual functioning in cisgender BDSM practitioners. Awareness on problems of this sexual minority should be increased.
PubMed: 38868847
DOI: 10.29399/npa.28527