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Risk Management and Healthcare Policy 2024
PubMed: 38894818
DOI: 10.2147/RMHP.S481040 -
Neuropsychopharmacology Reports Jun 2024The therapeutic potential of psychedelics for various mental disorders has gained significant interest. Previous studies have highlighted that psychedelics induce...
INTRODUCTION
The therapeutic potential of psychedelics for various mental disorders has gained significant interest. Previous studies have highlighted that psychedelics induce psychoactive effects, including challenging aspects of experiences. These experiences are assessed using the Challenging Experience Questionnaire (CEQ), yet its Japanese version has been unavailable. This study aimed to create a Japanese version of the CEQ.
METHODS
We followed the "Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation." Initially, two Japanese psychiatrists independently conducted the forward translations. These were then reconciled into a single version, which was back-translated into English. The original authors reviewed this back-translation for accuracy, leading to revisions through continuous dialogue until the original authors approved the final version.
RESULTS
The final, approved back-translated version of the CEQ is presented in the figure.
CONCLUSIONS
This study developed a Japanese version of the CEQ, enabling the assessment of challenging experiences during psychedelic-assisted therapy for Japanese speakers. Further studies are needed to assess the reliability and validity of this newly translated version.
PubMed: 38889223
DOI: 10.1002/npr2.12456 -
PloS One 2024Major depressive disorder (MDD) is a common and debilitating mental illness characterized by persistent feelings of sadness, hopelessness, and a lack of interest in...
BACKGROUND
Major depressive disorder (MDD) is a common and debilitating mental illness characterized by persistent feelings of sadness, hopelessness, and a lack of interest in daily activities. The objective of this study was to investigate whether levels of macrophage inflammatory protein-1β (MIP-1β) and macrophage chemoattractant protein-2 (MCP-2) in the blood were associated with the pathophysiology and development of MDD compared to healthy controls (HCs).
METHODS
This case-control study was conducted involving 50 MDD patients and 38 HCs. We performed a comprehensive assessment to match age, sex, BMI, and socio-demographic profile between the groups. The study excluded participants with chronic infection, inflammatory diseases, coexisting psychiatric disorder, history of liver and kidney diseases, and individuals who are under antipsychotic medications. A professional psychiatrist diagnosed MDD patients and evaluated HCs based on the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria. The severity of depression was assessed using the Hamilton Depression (Ham-D) rating scale. Commercially available enzyme-linked immunosorbent assay (ELISA) kits were used to quantify the serum MIP-1β and MCP-2 levels.
RESULTS
The results indicated elevated serum MIP-1β levels (207.73±24.24 pg/ml) in MDD patients compared to HCs (58.77±9.14 pg/ml). This difference in concentration is positively correlated with severity of disease symptoms (r = 0.451; p<0.001). Similarly, the levels of MCP-2 were found to be elevated in patients compared to controls (143.61±19.92 vs. 56.84±4.02 pg/ml; p = 0.003), with a positive correlation with the Ham-D scores (r = 0.373; p = 0.004).
CONCLUSION
According to this study, elevated levels of MIP-1β and MCP-2 may be associated with the pathophysiology and development of MDD. These increased serum MIP-1β and MCP-2 levels could be used as risk assessment tools for MDD. The present findings urge further research and the development of therapeutic and diagnostic approaches for depression.
Topics: Humans; Depressive Disorder, Major; Male; Female; Case-Control Studies; Adult; Chemokine CCL4; Chemokine CCL2; Middle Aged; Biomarkers
PubMed: 38889138
DOI: 10.1371/journal.pone.0305734 -
JMIR Formative Research Jun 2024Substance use disorder (SUD) is a major health issue in Indonesia, where several barriers to treatment exist, including inaccessibility to treatment services, stigma,...
BACKGROUND
Substance use disorder (SUD) is a major health issue in Indonesia, where several barriers to treatment exist, including inaccessibility to treatment services, stigma, and criminalization of drug issues. Peer involvement and the use of telemedicine to deliver psychotherapy are promising approaches to overcome these barriers.
OBJECTIVE
This study aims (1) to describe the development of a new group psychotherapy coprovided by a health care worker and a peer and (2) to evaluate the acceptability, practicality, and preliminary outcomes of the program delivered via videoconferencing in Indonesia.
METHODS
Building upon an established relapse prevention therapy in Japan, we developed a 3-month weekly group therapy module in the Indonesian language. Adjustments were made via focus group discussions with local stakeholders in terms of substance types, understandability, inclusive language, and cultural relevance. A pilot study was conducted to test the new module provided by a peer and a psychiatrist via videoconferencing, termed tele-Indonesia Drug Addiction Relapse Prevention Program (tele-Indo-DARPP), with a pre- and postcontrolled design. We analyzed data from semistructured feedback interviews and outcome measurements, including the number of days using substances and quality of life, and compared the intervention (tele-Indo-DARPP added to treatment as usual [TAU]) and control (TAU only) arms.
RESULTS
In total, 8 people diagnosed with SUD participated in the pilot study with a mean age of 37 (SD 12.8) years. All were men, and 7 (88%) used sedatives as the primary substance. Collectively, they attended 44 of the 48 tele-Indo-DARPP sessions. A total of 3 out of 4 (75%) preferred telemedicine rather than in-person therapy. Positive acceptability and practicality were shown from qualitative feedback, in which the participants who joined the tele-Indo-DARPP reported that they liked the convenience of joining from home and that they were able to open up about personal matters, received helpful advice from peers, and received support from other participants. Providers reported that they feel the module was provider-friendly, and the session was convenient to join without diminishing rapport-building. Meanwhile, troubles with the internet connection and difficulty in comprehending some terminology in the workbook were reported. The intervention arm showed better improvements in psychological health and anxiety symptoms.
CONCLUSIONS
Group psychotherapy via videoconferencing coprovided by health care workers and peers was acceptable and practical for participants with SUD and service providers in this study. A large-scale study is warranted to examine the effectiveness of the newly developed module in Indonesia.
PubMed: 38888959
DOI: 10.2196/50452 -
Frontiers in Psychiatry 2024Diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) is based on clinical evaluation of symptoms by a psychiatrist, referencing results of psychological tests....
INTRODUCTION
Diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) is based on clinical evaluation of symptoms by a psychiatrist, referencing results of psychological tests. When diagnosing ADHD, the child's behavior and functionality in real-life situations are critical components. However, direct observation by a clinician is often not feasible in practice. Therefore, such information is typically gathered from primary caregivers or teachers, which can introduce subjective elements. To overcome these limitations, we developed AttnKare-D, an innovative digital diagnostic tool that could analyze children's behavioral data in Virtual Reality using Artificial Intelligence. The purpose of this study was to explore the utility and safety of AttnKare-D for clinical application.
METHOD
A total of 21 children aged between 6 and 12 years were recruited for this study. Among them, 15 were children diagnosed with ADHD, 5 were part of a normal control group, and 1 child was excluded due to withdrawal of consent. Psychological assessments, including K-WISC, Conners CPT, K-ARS, and K-CBCL, were conducted for participants and their primary caregivers. Diagnoses of ADHD were confirmed by child and adolescent psychiatrists based on comprehensive face-to-face evaluations and results of psychological assessments. Participants underwent VR diagnostic assessment by performing various cognitive and behavioral tasks in a VR environment. Collected data were analyzed using an AI model to assess ADHD diagnosis and the severity of symptoms.
RESULTS
AttnKare-D demonstrated diagnostic performance with an AUC of 0.893 when compared to diagnoses made by child and adolescent psychiatrist, showing a sensitivity of 0.8 and a specificity of 1.0 at a cut-off score of 18.44. AttnKare-D scores showed a high correlation with K-ARS scores rated by parents and experts, although the correlation was relatively low for inattention scores.
CONCLUSION
Results of this study suggest that AttnKare-D can be a useful tool for diagnosing ADHD in children. This approach has potential to overcome limitations of current diagnostic methods, enhancing the accuracy and objectivity of ADHD diagnoses. This study lays the groundwork for further improvement and research on diagnostic tools integrating VR and AI technologies. For future clinical applications, it is necessary to conduct clinical trials involving a sufficient number of participants to ensure reliable use.
PubMed: 38887727
DOI: 10.3389/fpsyt.2024.1383547 -
BMC Medical Education Jun 2024Clinical associates are a health professional cadre that could be utilised in mental health task sharing in South Africa but this is training dependent. The objectives...
BACKGROUND
Clinical associates are a health professional cadre that could be utilised in mental health task sharing in South Africa but this is training dependent. The objectives of the study were to identify the potential curricula content, training sites, and teaching modalities for undergraduate and potential postgraduate clinical associate mental health training and to identify the tasks that they should perform based on these curricula.
METHODS
We utilised the Delphi method to reach consensus on items with the panel comprising psychiatrists and family physicians. The first round questionnaire of the Delphi survey was developed based on a literature review and the results from earlier phases of the overall study. The survey was administered electronically and consisted of three rounds. Following both the first and second rounds, an updated questionnaire was constructed omitting the items on which consensus was reached. The questionnaire consisted primarily of nine-point scales with consensus based on 70% of participants rating 1,2,3 or 7,8,9.
RESULTS
There were 26 participants in the first round with this number falling to 23 in later rounds. There was strong consensus on a training attachment to a mental health clinic at a community health centre (CHC) at undergraduate (96.2%) and postgraduate level (100%). Consensus was reached on the importance of training on the management of six categories of disorders at the undergraduate level and nine categories of disorders at the postgraduate level. Clerking patients as a teaching modality reached 100% consensus at both undergraduate and postgraduate levels. PHC clinics, CHCs and district hospitals reached consensus as appropriate settings for clinical associates to provide mental health services. In addition, GP practices and secondary hospitals reached consensus for those with postgraduate training. Consensus was reached on ten of the 21 listed tasks that could be performed based on undergraduate training and 20 of the 21 tasks based on a postgraduate qualification in mental health.
CONCLUSIONS
The Delphi panel's recommendations provide a clear roadmap for enhancing mental health curricula for clinical associates, enabling their utilisation in mental health service provision. A future postgraduate mental health qualification for clinical associates would allow for expanded task sharing.
Topics: South Africa; Delphi Technique; Humans; Curriculum; Psychiatry; Mental Health Services; Physicians, Family; Surveys and Questionnaires; Male; Mental Health; Female; Consensus; Education, Medical, Graduate; Education, Medical, Undergraduate; Psychiatrists
PubMed: 38886678
DOI: 10.1186/s12909-024-05637-2 -
Journal of Graduate Medical Education Jun 2024As medical education programs transition to competency-based medical education (CBME), experiences transitioning in the context of small subspecialty programs remain...
As medical education programs transition to competency-based medical education (CBME), experiences transitioning in the context of small subspecialty programs remain unknown, yet they are needed for effective implementation and continual improvements. To examine faculty and resident experiences transitioning to CBME in a small subspeciality program. Using a qualitative descriptive approach and constructivist lens, faculty and residents in McMaster University's geriatric psychiatry subspecialty program were interviewed about their transition experiences between November 2021 and February 2022, after the program's soft launch of CBME in 2020. Interviews were transcribed and data were analyzed using thematic analysis. Reflexive memo writing and investigator and data triangulation strategies were employed to ensure rigor and trustworthiness of the data. Ten of the 17 faculty members (59%) and 3 residents (100%) participated. Six themes were developed: (1) Both faculty and residents see themselves as somewhat knowledgeable about CBME, but sources of knowledge vary; (2) More frequent feedback is beneficial; (3) Aspects of CBME that are challenging for residents are beneficial for faculty; (4) Competence committees are perceived positively despite most participants' limited firsthand experience with them; (5) Small program size is both a barrier and facilitator to providing and receiving feedback; and (6) Suggestions for improvement are centered on helping manage faculty and resident workload imposed by CBME. Incongruent expectations surrounding entrustable professional activity management were highlighted as an area requiring support. Collegial relationships among faculty and residents made it difficult for faculty to provide constructive feedback but improved residents' perceptions of the feedback.
Topics: Humans; Competency-Based Education; Internship and Residency; Faculty, Medical; Clinical Competence; Education, Medical, Graduate; Qualitative Research
PubMed: 38882435
DOI: 10.4300/JGME-D-23-00643.1 -
Digital Health 2024Depression and anxiety are prevalent mental health issues addressed by online cognitive behavioral therapy (CBT) via mobile applications. This study introduces Sokoon, a...
BACKGROUND
Depression and anxiety are prevalent mental health issues addressed by online cognitive behavioral therapy (CBT) via mobile applications. This study introduces Sokoon, a gamified CBT app tailored for Arabic individuals, focusing on alleviating depression and anxiety symptoms (DASDs).
OBJECTIVES
The objectives of this study were to: Evaluate the effectiveness of Sokoon in reducing symptoms of depression and anxiety. Assess the usability of the intervention through user engagement and adherence to CBT skills.
METHODS
A single-group pre-post design evaluated Sokoon's impact on adults with DASDs. In consultation with psychiatrists, Sokoon integrates evidence-based skills such as relaxation, gratitude, behavioral activation, and cognitive restructuring, represented by planets. Its design incorporates Hexad theory and gamification, supported by a dynamic difficulty adjustment algorithm. The study involves 30 participants aged 18-35 (86.7% female), specifically those with mild to moderate depression and anxiety.
RESULTS
Based on a sample of 30 participants, Sokoon, a smartphone-based intervention, significantly reduced symptoms of depression and anxiety (d = 2.7, d = 3.6, < 0.001). Over a two-week trial, participants experienced a notable decrease in anxiety and depressive symptoms, indicating the effectiveness of the model. Sokoon shows potential as a valuable tool for addressing DASDs.
CONCLUSION
Sokoon, the gamified CBT application, offers an innovative approach to increasing CBT skills adherence and engagement. By leveraging Hexad theory and gamification, Sokoon provides an enjoyable and engaging user experience while maintaining the effectiveness of traditional CBT techniques. The study findings suggest that Sokoon has a positive impact on reducing symptoms of depression and anxiety.
PubMed: 38882250
DOI: 10.1177/20552076241263317 -
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 -
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