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Villacura-Herrera C, Pérez J, Jones PB, Núñez D. Internal consistency and temporal stability of the Community Assessment of Psychic Experiences (CAPE): A reliability generalization meta-analysis. Psychiatry Res 2024; 338:115988. [PMID: 38850889 DOI: 10.1016/j.psychres.2024.115988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/10/2024]
Abstract
Psychotic experiences (PE) are prevalent in general and clinical populations and can increase the risk for mental disorders in young people. The Community Assessment of Psychic Experiences (CAPE) is a widely used measure to assess PE in different populations and settings. However, the current knowledge on their overall reliability is limited. We examined the reliability of the CAPE-42 and later versions, testing the role of age, sex, test scores, and clinical status as moderators. A systematic search was conducted on the Scopus, Web of Science, PubMed, EBSCOhost, ProQuest, and GoogleScholar databases. Internal consistency and temporal stability indices were examined through reliability generalization meta-analysis (RGMA). Moderators were tested through meta-regression analysis. From a pool of 1,015 records, 90 independent samples were extracted from 71 studies. Four versions showed quantitative evidence for inclusion: CAPE-42, CAPE-20, CAPE-P15, and CAPE-P8. Internal consistency indices were good (α/ω≈.725-0.917). Temporal stability was only analyzed for the CAPE-P15, yielding a moderate but not-significant effect (r=0.672). The evidence for temporal stability is scant due to the limited literature, and definitive conclusions cannot be drawn. Further evidence on other potential moderators such as adverse experiences or psychosocial functioning is required.
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Affiliation(s)
- César Villacura-Herrera
- Centro de Investigación en Ciencias Cognitivas, Faculty of Psychology, Universidad de Talca, Chile
| | - Jesús Pérez
- Prevention and Early Intervention (PRINT) in Mental Health, Neuroscience Division, Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, Spain; Cambridgeshire and Peterborough NHS Foundation Trust, UK; Department of Psychiatry, University of Cambridge, UK
| | - Peter B Jones
- Cambridgeshire and Peterborough NHS Foundation Trust, UK; Department of Psychiatry, University of Cambridge, UK
| | - Daniel Núñez
- Centro de Investigación en Ciencias Cognitivas, Faculty of Psychology, Universidad de Talca, Chile; Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Chile.
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Wright AC, Palmer-Cooper E, Cella M, McGuire N, Montagnese M, Dlugunovych V, Liu CWJ, Wykes T, Cather C. Experiencing hallucinations in daily life: The role of metacognition. Schizophr Res 2024; 265:74-82. [PMID: 36623979 DOI: 10.1016/j.schres.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hallucinations have been linked to failures in metacognitive reflection suggesting an association between hallucinations and overestimation of performance, although the cross-sectional findings are inconsistent. This inconsistency may relate to the fluctuating hallucinatory experiences that are not captured in cross-sectional studies. Ecological Momentary Assessment (EMA) captures in-the-moment experiences over time so can identify causal relationships between variables such as the associations between metacognition and hallucinatory experience in daily life and overcome problems in cross-sectional designs. METHODS Participants (N = 41) experiencing daily hallucinations completed baseline questionnaires and smartphone surveys 7 times per day for 14 days. They were prompted to identify a task they would complete in the next 4 h and to make metacognitive predictions around the likelihood of completing the task, the difficulty of the task, and how well they would complete it (standard of completion). RESULTS 76 % finished the 14-days of assessment with an average of 42.2 % survey completion. Less accurate metacognition was associated with more hallucinations, but less accurate likelihood and standard of completion was associated with fewer hallucinations. Using a cross-lagged analysis, metacognitive predictions around the likelihood of completion (p < .001) and standard of completion (p = .01) predicted hallucination intensity at the following timepoint, and metacognitive predictions regarding likelihood of completion (p = .02) predicted hallucination control at the following timepoint. DISCUSSION Interventions that aim to improve metacognitive ability in-the-moment may serve to reduce the intensity and increase the control of hallucinations.
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Affiliation(s)
- Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Emma Palmer-Cooper
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, UK
| | - Matteo Cella
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Nicola McGuire
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Marcella Montagnese
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Chih-Wei Joshua Liu
- Physics of Living Systems Group, Department of Physics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Zarbo C, Zamparini M, Nielssen O, Casiraghi L, Rocchetti M, Starace F, de Girolamo G. Comparing Adherence to the Experience Sampling Method Among Patients With Schizophrenia Spectrum Disorder and Unaffected Individuals: Observational Study From the Multicentric DiAPAson Project. J Med Internet Res 2023; 25:e42093. [PMID: 37463030 PMCID: PMC10394602 DOI: 10.2196/42093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The Experience Sampling Method (ESM) is a valid method of remotely recording activities and mood, but the predictors of adherence to ESM in patients with Schizophrenia Spectrum Disorder (SSD) are not known. Studies on adherence are significant as they highlight the strengths and weaknesses of ESM-based study designs and allow the development of recommendations and practical guidelines for implementing future studies or treatment plans. OBJECTIVE The aim of this study was to compare the adherence to ESM in patients with SSD and unaffected control individuals, investigate their patterns, and report the predictors of adherence. METHODS In total, 131 patients with SSD (74 in residential facilities and 57 outpatients) and 115 unaffected control individuals were recruited at 10 different centers in Italy as part of the DiAPAson project. Demographic information, symptom severity, disability level, and level of function were recorded for the clinical sample. Participants were evaluated for daily time use and mood through a smartphone-based ESM 8 times a day for 7 consecutive days. Adherence was measured by the response rate to ESM notifications. Results were analyzed using the chi-square test, ANOVA, Kruskal-Wallis test, and Friedman test, and a logistic regression model. RESULTS The overall adherence rate in this study was 50% for residents, 59% for outpatients, and 78% for unaffected control individuals. Indeed, patients with SSD had a lower rate of adherence to ESM than the unaffected control group (P≤.001), independent of time slot, day of monitoring, or day of the week. No differences in adherence rates between weekdays and weekends were found among the 3 groups. The adherence rate was the lowest in the late evening time slot (8 PM to 12 AM) and days 6-7 of the study for both patients with SSD and unaffected control individuals. The adherence rate among patients with SSD was not predicted by sociodemographic characteristics, cognitive function, or other clinical features. A higher adherence rate (ie, ≥70%) among patients with SSD was predicted by higher collaboration skills (odds ratio [OR] 2.952; P=.046) and self-esteem (OR 3.394; P=.03), and lower positive symptom severity (OR 0.835; P=.04). CONCLUSIONS Adherence to ESM prompts for both patients with SSD and unaffected control individuals decreased during late evening and after 6 days of monitoring. Higher self-esteem and collaboration skills predicted higher adherence to ESM among patients with SSD, while higher positive symptom scores predicted lower adherence rates. This study provides important information to guide protocols for future studies using ESM. Future clinical or research studies should set ESM monitoring to waking hours, limit the number of days of monitoring, select patients with more collaborative skills and avoid those with marked positive symptoms, provide intensive training sessions, and improve participants' self-confidence with technologies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12888-020-02588-y.
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Affiliation(s)
- Cristina Zarbo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- Department of Psychology, University of Milano Bicocca, Milano, Italy
| | - Manuel Zamparini
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Olav Nielssen
- MindSpot Clinic, Macquarie University, Sydney, Australia
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Letizia Casiraghi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Matteo Rocchetti
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Fabrizio Starace
- Department of Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Martinelli A, D'Addazio M, Zamparini M, Thornicroft G, Torino G, Zarbo C, Rocchetti M, Starace F, Casiraghi L, Ruggeri M, de Girolamo G. Needs for care of residents with schizophrenia spectrum disorders and association with daily activities and mood monitored with experience sampling method: the DIAPASON study. Epidemiol Psychiatr Sci 2023; 32:e18. [PMID: 37039434 PMCID: PMC10130736 DOI: 10.1017/s2045796023000124] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/24/2023] [Accepted: 03/12/2023] [Indexed: 04/12/2023] Open
Abstract
AIMS Care needs represent an essential paradigm in planning residential facility (RF) interventions. However, possible disagreements between users and staff are critical issues in service delivery. The Experience Sampling Method (ESM) tracks experiences in the real world and real time. This study aimed to evaluate the care needs of patients with schizophrenia spectrum disorder (SSD) in RFs and its association with daily activities and mood monitored using the ESM. METHODS As part of the DIAPASON project, 313 residents with SSD were recruited from 99 Italian RFs. Sociodemographic and clinical characteristics were recorded. Care needs, the severity of symptomatology and negative symptoms were assessed. Fifty-six residents were also assessed for 7 consecutive days using the mobile ESM. Descriptive, agreement, predictor and moderator analyses were conducted. RESULTS The staff rated a higher number of total and met needs than service users (p < 0.001). Only a slight agreement between users and staff on unmet needs was found in self-care (k = 0.106) and information (k = 0.100) needs, while a moderate agreement was found in accommodation (k = 0.484), food (k = 0.406), childcare (k = 0.530), physical health (k = 0.470), telephone (k = 0.458) and transport (k = 0.425) needs. Older age (-0.15; p < 0.01), longer SSD diagnosis (-0.16; p < 0.01), higher collaboration (-0.16; p < 0.01) and lower symptomatology (-0.16; p < 0.01) decreased the number of unmet needs, while being a female (0.27; p < 0.05) and a shorter length of stay in an RF (0.54; p < 0.001) increased the number of unmet needs. A higher number of unmet needs was associated with a lower amount of time spent in leisure activities or reporting a positive mood: on the contrary, more unmet needs were associated with a greater amount of time spent in religious or non-productive activities. The associations between unmet needs rated by staff and users and momentary mood as assessed using the ESM were not moderated by the severity of symptomatology. CONCLUSIONS Although care needs are fundamental in planning residential activities aimed at recovery-oriented rehabilitation, RF interventions did not fully meet users' needs, and some disagreements on unmet needs between users and staff were reported. Further efforts are necessary to overcome Italian RF limits in delivering rehabilitative interventions defined by real users' needs to facilitate users' productivity and progress towards personal recovery.
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Affiliation(s)
- Alessandra Martinelli
- Unit of Clinical Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Miriam D'Addazio
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Manuel Zamparini
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gabriele Torino
- Department of Psychology, Clinical Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Cristina Zarbo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Matteo Rocchetti
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Fabrizio Starace
- Department of Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Letizia Casiraghi
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Mirella Ruggeri
- Section of Psychiatry, Verona Hospital Trust, AOUI, Verona, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Haslbeck JMB, Ryan O. Recovering Within-Person Dynamics from Psychological Time Series. MULTIVARIATE BEHAVIORAL RESEARCH 2022; 57:735-766. [PMID: 34154483 DOI: 10.1080/00273171.2021.1896353] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Idiographic modeling is rapidly gaining popularity, promising to tap into the within-person dynamics underlying psychological phenomena. To gain theoretical understanding of these dynamics, we need to make inferences from time series models about the underlying system. Such inferences are subject to two challenges: first, time series models will arguably always be misspecified, meaning it is unclear how to make inferences to the underlying system; and second, the sampling frequency must be sufficient to capture the dynamics of interest. We discuss both problems with the following approach: we specify a toy model for emotion dynamics as the true system, generate time series data from it, and then try to recover that system with the most popular time series analysis tools. We show that making straightforward inferences from time series models about an underlying system is difficult. We also show that if the sampling frequency is insufficient, the dynamics of interest cannot be recovered. However, we also show that global characteristics of the system can be recovered reliably. We conclude by discussing the consequences of our findings for idiographic modeling and suggest a modeling methodology that goes beyond fitting time series models alone and puts formal theories at the center of theory development.
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Affiliation(s)
| | - Oisín Ryan
- Department of Methodology and Statistics, Utrecht University
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6
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Bergou N, Hammoud R, Smythe M, Gibbons J, Davidson N, Tognin S, Reeves G, Shepherd J, Mechelli A. The mental health benefits of visiting canals and rivers: An ecological momentary assessment study. PLoS One 2022; 17:e0271306. [PMID: 36044408 PMCID: PMC9432685 DOI: 10.1371/journal.pone.0271306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/27/2022] [Indexed: 11/19/2022] Open
Abstract
Existing evidence shows positive effects of being in nature on wellbeing, but we know little about the mental health benefits of spending time near canals and rivers specifically. This study investigates the association between visits to canals and rivers and mental wellbeing. We addressed the following questions: Are visits to canals and rivers associated with higher levels of mental wellbeing? Does this association depend on age and gender? Does this association vary between people with and without a diagnosis on mental illness? We used Urban Mind, a flexible smartphone application for examining the impact of different aspects of the built and social environment on mental wellbeing, a strong predictor of mental health. Participants were invited to complete an ecological momentary assessment three times a day for fourteen days. Each assessment included questions about their surrounding environment and mental wellbeing. A total of 7,975 assessments were completed by 299 participants including 87 with a diagnosis of mental illness. Multilevel regression models were used to analyse the data. We found positive associations between visits to canals and rivers and mental wellbeing (p < .05) when compared to being anywhere else and when compared to being in green spaces. Increases in mental wellbeing were still evident after the visit had taken place. These effects remained significant after adjusting for age, gender, ethnicity and education, and were consistent in people with and without a diagnosis of mental illness. Spending time near canals and rivers is associated with better mental wellbeing. These findings have potential implications for mental health as well as urban planning and policy. Visits to canals and rivers could become part of social prescribing schemes, playing a role in preventing mental health difficulties and complementing more traditional interventions.
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Affiliation(s)
- Nicol Bergou
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Ryan Hammoud
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | | | | | | | - Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | | | | | - Andrea Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- * E-mail:
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Rosen M, Betz LT, Montag C, Kannen C, Kambeitz J. Transdiagnostic Psychopathology in a Help-Seeking Population of an Early Recognition Center for Mental Disorders: Protocol for an Experience Sampling Study. JMIR Res Protoc 2022; 11:e35206. [PMID: 35916702 PMCID: PMC9379784 DOI: 10.2196/35206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Prevention in psychiatry provides a promising way to address the burden of mental illness. However, established approaches focus on specific diagnoses and do not address the heterogeneity and manifold potential outcomes of help-seeking populations that present at early recognition services. Conceptualizing the psychopathology manifested in help-seeking populations from a network perspective of interacting symptoms allows transdiagnostic investigations beyond binary disease categories. Furthermore, modern technologies such as smartphones facilitate the application of the Experience Sampling Method (ESM). OBJECTIVE This study is a combination of ESM with network analyses to provide valid insights beyond the established assessment instruments in a help-seeking population. METHODS We will examine 75 individuals (aged 18-40 years) of the help-seeking population of the Cologne early recognition center. For a maximally naturalistic sample, only minimal exclusion criteria will be applied. We will collect data for 14 days using a mobile app to assess 10 transdiagnostic symptoms (ie, depressive, anxious, and psychotic symptoms) as well as distress level 5 times a day. With these data, we will generate average group-level symptom networks and personalized symptom networks using a 2-step multilevel vector autoregressive model. Additionally, we will explore associations between symptom networks and sociodemographic, risk, and resilience factors, as well as psychosocial functioning. RESULTS The protocol was designed in February 2020 and approved by the Ethics Committee of the University Hospital Cologne in October 2020. The protocol was reviewed and funded by the Köln Fortune program in September 2020. Data collection began in November 2020 and was completed in November 2021. Of the 258 participants who were screened, 93 (36%) fulfilled the inclusion criteria and were willing to participate in the study. Of these 93 participants, 86 (92%) completed the study. The first results are expected to be published in 2022. CONCLUSIONS This study will provide insights about the feasibility and utility of the ESM in a help-seeking population of an early recognition center. Providing the first explorative phenotyping of transdiagnostic psychopathology in this population, our study will contribute to the innovation of early recognition in psychiatry. The results will help pave the way for prevention and targeted early intervention in a broader patient group, and thus, enable greater intended effects in alleviating the burden of psychiatric disorders. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/35206.
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Affiliation(s)
- Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Linda T Betz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Christian Montag
- Institute of Psychology and Education, Ulm University, Ulm, Germany
| | | | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
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Zarbo C, Agosta S, Casiraghi L, De Novellis A, Leuci E, Paulillo G, Rocchetti M, Starace F, Zamparini M, de Girolamo G. Assessing adherence to and usability of Experience Sampling Method (ESM) and actigraph in patients with Schizophrenia Spectrum Disorder: A mixed-method study. Psychiatry Res 2022; 314:114675. [PMID: 35751998 DOI: 10.1016/j.psychres.2022.114675] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 10/18/2022]
Abstract
The application of innovative technologies in psychiatry is promising, but the debate about its feasibility is not settled. Our aim was to investigate and compare adherence to and usability of 7-day monitoring with an Experience Sampling Method (ESM) and Actigraphy among a sample of individuals with a diagnosis of Schizophrenia Spectrum Disorders (SSD) and paired healthy controls. Twenty-two patients living in residential facilities (RFs), 20 outpatients and 26 controls were enrolled in this study as part of the DiAPAson project. Participants wore an actigraph and were evaluated for daily time use and mood with a smartphone-based ESM. Then, they completed questionnaires to assess the usability of the devices and were interviewed. Adherence was assessed as the percentage of time spent wearing actigraph and answering ESM notifications. Residential patients, compared to controls, showed significantly higher usability of the actigraph and lower adherence to both the actigraph and ESM. From the qualitative interviews, four high-order themes emerged: effects of monitoring, adherence and usability, emotions and mental states, and advice. Findings are promising for the application of these methodologies in such populations. The role of multidisciplinary staff in RFs is crucial for guaranteeing the realization of such projects.
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Affiliation(s)
- Cristina Zarbo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
| | - Sara Agosta
- Department of Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Letizia Casiraghi
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | | | | | | | - Matteo Rocchetti
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Fabrizio Starace
- Department of Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Manuel Zamparini
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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9
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Stress and emotional arousal in urban environments: A biosocial study with persons having experienced a first-episode of psychosis and persons at risk. Health Place 2022; 75:102762. [PMID: 35286900 DOI: 10.1016/j.healthplace.2022.102762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 11/22/2022]
Abstract
This article examines the entanglement between feelings of stress and discomfort, physiological arousal and urban experiences of persons living with early psychosis. It adopts a biosocial approach, using mixed methods combining ambulatory skin conductance monitoring, mobile interviews and contextual data, collected through GPS and video recordings. The study draws on and strives to cross-fertilize two recent strands of research. The first relates to the use of digital phenotyping in mental health research. The second explores stress and emotional arousal in cities using ambulatory physiological measures. Empirically, the paper is based on fieldwork in Basel, Switzerland, with nine participants recruited within the Basel Early Treatment Service (BEATS), and four controls. We focus on three salient elements in our results: visual perception of moving bodies, spatial transitions and openness and enclosure of the built environment. The analysis shows how these elements elicit physiological responses of arousal and expressed feelings of discomfort. In the concluding section we discuss the methodological implications of these results and suggest the notion of regime of attention as a focus for future biosocial research on urban mental health.
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10
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Paetzold I, Hermans KSFM, Schick A, Nelson B, Velthorst E, Schirmbeck F, van Os J, Morgan C, van der Gaag M, de Haan L, Valmaggia L, McGuire P, Kempton M, Myin-Germeys I, Reininghaus U. Momentary Manifestations of Negative Symptoms as Predictors of Clinical Outcomes in People at High Risk for Psychosis: Experience Sampling Study. JMIR Ment Health 2021; 8:e30309. [PMID: 34807831 PMCID: PMC8663470 DOI: 10.2196/30309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/02/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Negative symptoms occur in individuals at ultrahigh risk (UHR) for psychosis. Although there is evidence that observer ratings of negative symptoms are associated with level of functioning, the predictive value of subjective experience in daily life for individuals at UHR has not been studied yet. OBJECTIVE This study therefore aims to investigate the predictive value of momentary manifestations of negative symptoms for clinical outcomes in individuals at UHR. METHODS Experience sampling methodology was used to measure momentary manifestations of negative symptoms (blunted affective experience, lack of social drive, anhedonia, and social anhedonia) in the daily lives of 79 individuals at UHR. Clinical outcomes (level of functioning, illness severity, UHR status, and transition status) were assessed at baseline and at 1- and 2-year follow-ups. RESULTS Lack of social drive, operationalized as greater experienced pleasantness of being alone, was associated with poorer functioning at the 2-year follow-up (b=-4.62, P=.01). Higher levels of anhedonia were associated with poorer functioning at the 1-year follow-up (b=5.61, P=.02). Higher levels of social anhedonia were associated with poorer functioning (eg, disability subscale: b=6.36, P=.006) and greater illness severity (b=-0.38, P=.045) at the 1-year follow-up. In exploratory analyses, there was evidence that individuals with greater variability of positive affect (used as a measure of blunted affective experience) experienced a shorter time to remission from UHR status at follow-up (hazard ratio=4.93, P=.005). CONCLUSIONS Targeting negative symptoms in individuals at UHR may help to predict clinical outcomes and may be a promising target for interventions in the early stages of psychosis.
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Affiliation(s)
- Isabell Paetzold
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Karlijn S F M Hermans
- Department of Neuroscience, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Anita Schick
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Barnaby Nelson
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Frederike Schirmbeck
- Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands.,Arkin, Institute for Mental Health, Amsterdam, Netherlands
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- See Acknowledgments, Maastricht, Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom.,Department of Psychiatry, Brain Center Rudolf Magnus, Utrecht University Medical Centre, Utrecht, Netherlands
| | - Craig Morgan
- ESRC Centre for Society and Mental Health, King's College London, London, United Kingdom.,Department of Health Service and Population Research, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, School of Mental Health & Psychological Sciences, King's College London, London, United Kingdom
| | - Mark van der Gaag
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Lieuwe de Haan
- Department of Early Psychosis, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, London, United Kingdom
| | - Matthew Kempton
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Inez Myin-Germeys
- Department of Neuroscience, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,ESRC Centre for Society and Mental Health, King's College London, London, United Kingdom.,Department of Health Service and Population Research, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, School of Mental Health & Psychological Sciences, King's College London, London, United Kingdom
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11
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Wright AC, Browne J, Skiest H, Bhiku K, Baker JT, Cather C. The relationship between conventional clinical assessments and momentary assessments of symptoms and functioning in schizophrenia spectrum disorders: A systematic review. Schizophr Res 2021; 232:11-27. [PMID: 34004382 DOI: 10.1016/j.schres.2021.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/09/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Symptoms and functioning are critical dimensions in those with schizophrenia and are typically measured using validated conventional clinical assessments. Researchers and clinicians have begun to use real-time digital methods, such as ecological momentary assessment (EMA), to assess symptoms and functioning in the moment and outside of traditional hospital and laboratory settings, which may yield more naturalistic data. Although digital methods have advantages, it is unclear whether these momentary assessments capture core aspects of symptoms and functioning. OBJECTIVE This systematic literature review aimed to evaluate the association between conventional clinical and momentary-based assessments of functioning and symptoms in individuals with schizophrenia. METHODS Studies were included if they met the following criteria: (1) written or translated into English; (2) peer-reviewed; (3) included primary quantitative data; (4) 60% of the clinical sample included persons with schizophrenia spectrum disorders; (5) included a clinical assessment of functioning and/or symptoms; (6) included active momentary assessment and/or passive data; and (7) assessed the relationship between the momentary and conventional clinical assessments. RESULTS A total of 49 studies (87 analyses) were included. Conventional clinical assessments of functioning and positive, negative, and depressive symptoms were related to momentary assessments of these symptom domains. Passive data was beneficial for assessing negative symptoms, but research is warranted for other domains. CONCLUSIONS The reviewed studies highlight the utility of EMA methodologies to collect detailed data on symptoms and functioning. Such data is being used to develop more sophisticated models of schizophrenia to enhance our understanding of important mechanisms and develop targeted interventions.
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Affiliation(s)
- Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Hannah Skiest
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kamila Bhiku
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Justin T Baker
- Harvard Medical School, Boston, MA, USA; Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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12
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Daniëls NEM, Hochstenbach LMJ, van Zelst C, van Bokhoven MA, Delespaul PAEG, Beurskens AJHM. Factors That Influence the Use of Electronic Diaries in Health Care: Scoping Review. JMIR Mhealth Uhealth 2021; 9:e19536. [PMID: 34061036 PMCID: PMC8207255 DOI: 10.2196/19536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/30/2020] [Accepted: 02/25/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A large number of people suffer from psychosocial or physical problems. Adequate strategies to alleviate needs are scarce or lacking. Symptom variation can offer insights into personal profiles of coping and resilience (detailed functional analyses). Hence, diaries are used to report mood and behavior occurring in daily life. To reduce inaccuracies, biases, and noncompliance with paper diaries, a shift to electronic diaries has occurred. Although these diaries are increasingly used in health care, information is lacking about what determines their use. OBJECTIVE The aim of this study was to map the existing empirical knowledge and gaps concerning factors that influence the use of electronic diaries, defined as repeated recording of psychosocial or physical data lasting at least one week using a smartphone or a computer, in health care. METHODS A scoping review of the literature published between January 2000 and December 2018 was conducted using queries in PubMed and PsycInfo databases. English or Dutch publications based on empirical data about factors that influence the use of electronic diaries for psychosocial or physical purposes in health care were included. Both databases were screened, and findings were summarized using a directed content analysis organized by the Consolidated Framework for Implementation Research (CFIR). RESULTS Out of 3170 articles, 22 studies were selected for qualitative synthesis. Eleven themes were determined in the CFIR categories of intervention, user characteristics, and process. No information was found for the CFIR categories inner (eg, organizational resources, innovation climate) and outer (eg, external policies and incentives, pressure from competitors) settings. Reminders, attractive designs, tailored and clear data visualizations (intervention), smartphone experience, and intrinsic motivation to change behavior (user characteristics) could influence the use of electronic diaries. During the implementation process, attention should be paid to both theoretical and practical training. CONCLUSIONS Design aspects, user characteristics, and training and instructions determine the use of electronic diaries in health care. It is remarkable that there were no empirical data about factors related to embedding electronic diaries in daily clinical practice. More research is needed to better understand influencing factors for optimal electronic diary use.
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Affiliation(s)
- Naomi E M Daniëls
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Laura M J Hochstenbach
- Research Centre for Remote Health Care, Faculty of Health Care, Zuyd University of Applied Sciences, Heerlen, Netherlands
| | - Catherine van Zelst
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Marloes A van Bokhoven
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Philippe A E G Delespaul
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Mondriaan Mental Health Trust, Heerlen/Maastricht, Netherlands
| | - Anna J H M Beurskens
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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13
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Gomez-Sanchez-Lafuente C, Guzman-Parra J, Lopez-Zambrano MA, Moreno-Kustner B, Mayoral-Cleries F. Met and Unmet Needs in an Inpatient Psychiatry Setting in Spain. Neuropsychiatr Dis Treat 2021; 17:1859-1868. [PMID: 34135587 PMCID: PMC8197593 DOI: 10.2147/ndt.s307394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/14/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Patients with severe mental disorder have health and social needs that require care. The aim of the study was to determine the main areas of perceived needs among inpatients with severe mental disorders and to identify risk factors of the group of patients with the greatest unmet needs. PATIENTS AND METHODS A total of 150 patients with severe mental illness were assessed during admission prior to discharge from the hospital. Camberwell Assessment of Needs was used as evaluation measure, in addition to clinical status (The Brief Psychiatric Rating Scale), social functioning (Personal and Social Performance) and sociodemographic variables. A descriptive and a multivariate logistic regression analysis were used to analyse variables related to the group of patients with the highest number of unmet needs (≥3). RESULTS Mean number of needs was 7.93, being 4.61 the mean number of needs met and 3.32 the needs unmet. The highest proportion of unmet needs were intimate relationships (44.0%), company (40.7%) and daytime activities (38.7%). A relationship was also found between the presence of three or more unmet needs and the following variables: Brief Psychiatric Rating Scale score (p=0.004), Personal and Social Performance score (p = 0.013), marital status (p=0.018), employment status (p=0.009) and voluntary admission (p=0.032). The multivariate model explained 29.5% of the variance (Nagelkerke's R2: 0.295). CONCLUSION Treatments aimed at improving social relationships and daytime activities could be a good option for inpatients with many unmet needs.
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Affiliation(s)
- Carlos Gomez-Sanchez-Lafuente
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, 29010, Spain.,Universidad de Málaga, Andalucía Tech, Facultad de Psicología, Málaga, 29071, Spain
| | - Jose Guzman-Parra
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, 29010, Spain
| | - Maria Alejandra Lopez-Zambrano
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, 29010, Spain
| | - Berta Moreno-Kustner
- Universidad de Málaga, Andalucía Tech, Facultad de Psicología, Málaga, 29071, Spain
| | - Fermin Mayoral-Cleries
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, 29010, Spain
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14
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Alvarez EE, Pujji SD, Dinzeo TJ. Cognitive Failures and the Role of Emotion in Dimensional Schizotypy: A Replication and Extension. Psychopathology 2021; 54:325-334. [PMID: 34407538 PMCID: PMC9066366 DOI: 10.1159/000517795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/10/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cognitive failures are commonplace within the general population but may be particularly heightened in those with higher levels of schizotypy. This is especially salient in the context of enduring trait and momentary state negative emotion which often contributes to increases in daily impairments, leading to a more debilitating and distracted life. Particularly, individuals with elevated levels of schizotypy may be more likely to experience cognitive failures, especially in the presence of negative trait emotion such as depression, anxiety, and stress. However, little is known about the influence of state emotion and the distinct roles that state and trait emotion may have with cognitive failures and schizotypy. METHODS To replicate and extend previous findings, 306 (58% males) undergraduate students aged 18-50 years (M = 19.343; SD = 2.493) completed self-report measures of cognitive failures, trait and state emotion, and schizotypy. Mediation and moderation analyses were performed in SPSS to examine the potential effects of trait and state emotion on the relationship between schizotypy and cognitive failures. RESULTS Consistent with previous findings, mood symptomology, in addition to negative affect, mediated cognitive failures in those with higher levels of schizotypy. However, in our sample, positive affect did not appear to buffer against cognitive failures. CONCLUSION The findings of the present study suggest there may be a nuanced relationship between both negative trait and state emotions on the relationships between cognitive failures and schizotypy. Understanding the interaction of enduring versus momentary emotion on cognition as they relate to an elevated risk for developing schizophrenia-spectrum phenomena may be a point for earlier and more targeted interventions.
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Affiliation(s)
- Emmanuel E Alvarez
- Department of Neuroscience and Cell Biology, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA,
| | - Sherry D Pujji
- Department of Psychology, Rowan University, Glassboro, New Jersey, USA
| | - Thomas J Dinzeo
- Department of Psychology, Rowan University, Glassboro, New Jersey, USA
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15
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Geraets CNW, Snippe E, van Beilen M, Pot-Kolder RMCA, Wichers M, van der Gaag M, Veling W. Virtual reality based cognitive behavioral therapy for paranoia: Effects on mental states and the dynamics among them. Schizophr Res 2020; 222:227-234. [PMID: 32527676 DOI: 10.1016/j.schres.2020.05.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/31/2020] [Accepted: 05/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Negative affective processes may contribute to maintenance of paranoia in patients with psychosis, and vice versa. Successful treatment may break these pathological symptom networks. This study examined whether treatment with virtual reality based cognitive behavioral therapy (VR-CBT) for paranoia influences momentary affective states, and whether VR-CBT changes the adverse interplay between affective states and paranoia. METHODS Patients with a psychotic disorder (n = 91) were randomized to 16-session VR-CBT or treatment as usual (TAU). With the experience sampling method (structured diary technique) mental states were assessed for 6-10 days at baseline, posttreatment and 6-month follow-up. Multilevel analysis were performed to establish treatment effects and time-lagged associations between mental states, that were visualized with networks of mental states. RESULTS Average levels of paranoia (feeling suspicious [b = -032., p = .04], disliked [b = -49., p < .01] and hurt [b = -0.52, p < .01]) and negative affect (anxious [b = -0.37, p = .01], down [b = -0.33, p = .04] and insecure [b = -0.17, p = .03) improved more after VR-CBT than TAU, but positive affect did not. Baseline mental state networks had few significant connections, with most stable connections being autocorrelations of mental states. The interplay between affective states and paranoia did not change in response to treatment. A trend reduction in average intranode connections (autocorrelations) was found after VR-CBT (b = -0.07, p = .08), indicating that mental states reinforce themselves less after treatment. CONCLUSIONS VR-CBT reduced paranoid symptoms and lowered levels of negative affect in daily life, but did not affect the extent to which mental states influenced each other. Findings do suggest that as a result of treatment mental states regain flexibility.
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Affiliation(s)
- Chris N W Geraets
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, the Netherlands.
| | - Evelien Snippe
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), the Netherlands
| | - Marije van Beilen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, the Netherlands
| | - Roos M C A Pot-Kolder
- Parnassia Psychiatric Institute, The Hague, the Netherlands; VU University and Amsterdam Public Mental Health research institute, Department of Clinical Psychology, Amsterdam, the Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), the Netherlands
| | - Mark van der Gaag
- Parnassia Psychiatric Institute, The Hague, the Netherlands; VU University and Amsterdam Public Mental Health research institute, Department of Clinical Psychology, Amsterdam, the Netherlands
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, the Netherlands; Parnassia Psychiatric Institute, The Hague, the Netherlands; Maastricht University, Department of Psychiatry and Neuropsychology, Maastricht, the Netherlands
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16
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Fatori D, Argeu A, Brentani H, Chiesa A, Fracolli L, Matijasevich A, Miguel EC, Polanczyk G. Maternal Parenting Electronic Diary in the Context of a Home Visit Intervention for Adolescent Mothers in an Urban Deprived Area of São Paulo, Brazil: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e13686. [PMID: 32720906 PMCID: PMC7420524 DOI: 10.2196/13686] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 11/27/2019] [Accepted: 02/07/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Pregnancy during adolescence is prevalent in low- and middle-income countries (LMICs), which is associated with various adverse outcomes that can be prevented with home visiting programs. However, testing these interventions in LMICs can be challenging due to limited resources. The use of electronic data collection via smartphones can be an alternative and ideal low-cost method to measure outcomes in an environment with adverse conditions. OBJECTIVE Our study had two objectives: to test the efficacy of a nurse home visiting intervention on maternal parenting and well-being measured by an electronic daily diary (eDiary), and to investigate the compliance rate of the eDiary measurement method. METHODS We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse home visiting program, for adolescent mothers living in an urban deprived area of São Paulo, Brazil. A total of 169 pregnant adolescents were assessed for eligibility criteria, 80 of whom were included and randomized to the intervention (n=40) and control group (care as usual, n=40). Primeiros Laços is a home visiting intervention delivered by trained nurses tailored to first-time pregnant adolescents and their children, starting during the first 16 weeks of pregnancy until the child reaches 24 months of age. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and when the child was 3, 6, and 12 months of age. At 18 months, participants were assessed regarding maternal parenting and parental well-being using a 7-consecutive-day eDiary. The smartphone app was programmed to notify participants every day at 9:00 PM over a period of seven days. RESULTS We were able to contact 57/80 (71%) participants (29 from the intervention group and 28 from the control group) when the child was 18 months of age. Forty-eight of the 57 participants (84%) completed at least one day of the eDiary protocol. The daily compliance rate ranged from 49% to 70%. Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, 95% CI [0.06, 0.58], P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, 95% CI [1.20, 4.50], P=.01).Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, P=.01). CONCLUSIONS The Primeiros Laços intervention improved maternal parenting and parental well-being, demonstrating its promise for low-income adolescent mothers. The compliance rate of the eDiary assessment showed that it was generally accepted by adolescent mothers with limited resources. Future studies can implement ambulatory assessment in LMICs via smartphones to measure mother and child behaviors. TRIAL REGISTRATION ClinicalTrials.gov NCT02807818; https://clinicaltrials.gov/ct2/show/NCT02807818.
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Affiliation(s)
- Daniel Fatori
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Adriana Argeu
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Helena Brentani
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Anna Chiesa
- Collective Health Nursing Department, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil
| | - Lislaine Fracolli
- Collective Health Nursing Department, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil
| | - Alicia Matijasevich
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Euripedes C Miguel
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Guilherme Polanczyk
- Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo, Brazil
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17
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Affect, motivation, temptation, and drinking among alcohol-dependent outpatients trying to maintain abstinence: An Ecological Momentary Assessment study. Drug Alcohol Depend 2020; 206:107626. [PMID: 31786398 DOI: 10.1016/j.drugalcdep.2019.107626] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Using Ecological Momentary Assessment we aimed to describe the time course of temptation episodes in alcohol-dependent outpatients in a real-life setting. We also examined whether affective and motivational variables were cross-sectionally and prospectively associated with temptation episodes. Additionally, we tested whether outpatients who drank against treatment goals (i.e., "lapsers") differed in craving, affect, and motivation from abstainers. METHODS Participants were 43 alcohol-dependent outpatients (13 female). Using personal digital assistants (PDAs), patients were signaled to complete three random assessments per day for 4 weeks. They were also instructed to complete a temptation assessment whenever they experienced the temptation to drink alcohol. RESULTS The number of temptation assessments declined over time and did not differ between lapsers and abstainers. Overall, craving was generally higher in lapsers (n = 14) than abstainers (n = 27). In lapsers, but not abstainers, abstinence motivation was lower at temptation assessments vs. random assessments. Across all patients, negative affect was prospectively associated with entry of temptation assessments later the same day. There were no significant effects for positive affect. CONCLUSIONS In alcohol-dependent outpatients attempting to remain abstinent, negative affect is cross-sectionally associated with entry of temptation assessments. There is more evidence that negative affect precipitates temptations than vice versa. Professionals should be watchful of outpatients who report generally high levels of craving, and who report more negative affect and lower abstinence motivation, when tempted.
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18
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van der Linden K, Simons C, van Amelsvoort T, Marcelis M. Lifetime and Momentary Psychotic Experiences in Adult Males and Females With an Autism Spectrum Disorder. Front Psychiatry 2020; 11:766. [PMID: 32848936 PMCID: PMC7416642 DOI: 10.3389/fpsyt.2020.00766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/20/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Existing research shows that adults with an autism spectrum disorder (ASD) are more vulnerable to develop overt psychosis. However, studies investigating (subclinical) psychotic experiences (PE) in ASD are scarce, and it is unknown if PE are accompanied with more distress in adults with ASD compared to the general population. This study examined lifetime PE and accompanying distress, momentary PE levels, and the impact of daily life stress and negative affect (NA) on momentary PE in males and females with ASD compared to controls. METHODS In 50 adults with ASD (males N= 26, females N= 24) and 51 adults without ASD (males N= 26, females N= 25), the Community Assessment of Psychic Experiences (CAPE) was used to analyze group differences in frequency and distress of lifetime subclinical positive, negative, and depressive symptoms. The Experience Sampling Method (ESM) was used to measure momentary PE, NA, and stress (activity-related, event-related, and social stress) for 10 days. Multilevel analyses were conducted to test whether stress and NA were associated with momentary PE and whether these associations were modified by group or sex. RESULTS Adults with ASD reported more lifetime CAPE negative and depressive symptoms, but similar levels of PE, than controls. Higher levels of accompanying distress were found in participants with ASD for each subscale. With respect to ESM momentary PE, higher levels were reported by adults with ASD and a stronger association between event-related stress and momentary PE was found compared to controls. This was not the case for NA, activity-related, and social stress. Overall, no significant differences between male and female outcomes were found. CONCLUSION Adults with ASD are more prone to encounter lifetime subclinical negative and depressive symptoms and accompanying distress compared to adults without ASD. Similar levels of lifetime PE in both groups were still accompanied with more distress in the ASD group. Furthermore, higher levels of ESM momentary PE were found in participants with ASD. Additionally, event-related stress may act as a risk factor for PE in both females and males with ASD, with a stronger risk-increasing effect than in their control counterparts.
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Affiliation(s)
- Kim van der Linden
- GGzE, Mental Healthcare Institution Eindhoven, Eindhoven, Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
| | - Claudia Simons
- GGzE, Mental Healthcare Institution Eindhoven, Eindhoven, Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
| | - Machteld Marcelis
- GGzE, Mental Healthcare Institution Eindhoven, Eindhoven, Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
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19
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Bell V, O'Driscoll C. The network structure of paranoia in the general population. Soc Psychiatry Psychiatr Epidemiol 2018; 53:737-744. [PMID: 29427197 PMCID: PMC6003969 DOI: 10.1007/s00127-018-1487-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 01/21/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Bebbington and colleagues' influential study on 'the structure of paranoia in the general population' used data from the British National Psychiatric Morbidity Survey and latent variable analysis methods. Network analysis is a relatively new approach in psychopathology research that considers mental disorders to be emergent phenomena from causal interactions among symptoms. This study re-analysed the British National Psychiatric Morbidity Survey data using network analysis to examine the network structure of paranoia in the general population. METHODS We used a Graphical Least Absolute Shrinkage and Selection Operator (glasso) method that estimated an optimal network structure based on the Extended Bayesian Information Criterion. Network sub-communities were identified by spinglass and EGA algorithms and centrality metrics were calculated per item and per sub-community. RESULTS We replicated Bebbington's four component structure of paranoia, identifying 'interpersonal sensitivities', 'mistrust', 'ideas of reference' and 'ideas of persecution' as sub-communities in the network. In line with previous experimental findings, worry was the most central item in the network. However, 'mistrust' and 'ideas of reference' were the most central sub-communities. CONCLUSIONS Rather than a strict hierarchy, we argue that the structure of paranoia is best thought of as a heterarchy, where the activation of high-centrality nodes and communities is most likely to lead to steady state paranoia. We also highlight the novel methodological approach used by this study: namely, using network analysis to re-examine a population structure of psychopathology previously identified by latent variable approaches.
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Affiliation(s)
- Vaughan Bell
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - Ciarán O'Driscoll
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- North East London NHS Foundation Trust, London, UK
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Pries LK, Guloksuz S, ten Have M, de Graaf R, van Dorsselaer S, Gunther N, Rauschenberg C, Reininghaus U, Radhakrishnan R, Bak M, Rutten BPF, van Os J. Evidence That Environmental and Familial Risks for Psychosis Additively Impact a Multidimensional Subthreshold Psychosis Syndrome. Schizophr Bull 2018; 44:710-719. [PMID: 29701807 PMCID: PMC6007403 DOI: 10.1093/schbul/sby051] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The observed link between positive psychotic experiences (PE) and psychosis spectrum disorder (PSD) may be stronger depending on concomitant presence of PE with other dimensions of psychopathology. We examined whether the effect of common risk factors for PSD on PE is additive and whether the impact of risk factors on the occurrence of PE depends on the co-occurrence of other symptom dimensions (affective dysregulation, negative symptoms, and cognitive alteration). METHOD Data from the Netherlands Mental Health Survey and Incidence Study 2 were used. Risk factors included childhood adversity, cannabis use, urbanicity, foreign born, hearing impairment, and family history of affective disorders. Logistic regression models were applied to test (1) the additive effect of risk factors (4 levels) on PE and (2) the moderating effects of symptom dimensions on the association between risk factors (present/absent) and PE, using additive interaction, expressed as the interaction contrast ratio. RESULTS Risk factors were additive: the greater the number of risk factors, the greater the odds of PE. Furthermore, concomitant presence of the other symptom dimensions all increased the impact of risk factors on PE. After controlling for age, sex, and education, only affective dysregulation and negative symptoms remained significant moderators; only affective dysregulation remained a significant moderator if all dimensions were adjusted for each other. CONCLUSIONS Risk factors may not be directly associated with PE but additively give rise to a multidimensional subthreshold state anticipating the multidimensional clinical syndrome. Early motivational and cognitive impairments in the context of PE may be reducible to affective dysregulation.
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Affiliation(s)
- Lotta-Katrin Pries
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands,Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Margreet ten Have
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Ron de Graaf
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Nicole Gunther
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands,School of Psychology, Open University, Heerlen, The Netherlands
| | - Christian Rauschenberg
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Ulrich Reininghaus
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands,Health Service and Population Research Department, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands,Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands,Department of Psychosis Studies, King’s College London, King’s Health Partners, Institute of Psychiatry, London, UK,To whom correspondence should be addressed; Department of Psychiatry, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands; tel: +31-88-75-560-25, fax: +31-88-75-560-27, e-mail:
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Holmes EA, Ghaderi A, Harmer CJ, Ramchandani PG, Cuijpers P, Morrison AP, Roiser JP, Bockting CLH, O'Connor RC, Shafran R, Moulds ML, Craske MG. The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science. Lancet Psychiatry 2018; 5:237-286. [PMID: 29482764 DOI: 10.1016/s2215-0366(17)30513-8] [Citation(s) in RCA: 323] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/10/2017] [Accepted: 11/24/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Emily A Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Trust Foundation, Warneford Hospital, Oxford, UK
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Heath Trust, Manchester, UK; School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Claudi L H Bockting
- Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands
| | - Rory C O'Connor
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Roz Shafran
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW, Sydney, NSW, Australia
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Hasmi L, Drukker M, Guloksuz S, Viechtbauer W, Thiery E, Derom C, van Os J. Genetic and Environmental Influences on the Affective Regulation Network: A Prospective Experience Sampling Analysis. Front Psychiatry 2018; 9:602. [PMID: 30546324 PMCID: PMC6279878 DOI: 10.3389/fpsyt.2018.00602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/29/2018] [Indexed: 12/18/2022] Open
Abstract
Background: The study of networks of affective mental states that play a role in psychopathology may help model the influence of genetic and environmental risks. The aim of the present paper was to examine networks of affective mental states (AMS: "cheerful," "insecure," "relaxed," "anxious," "irritated," and "down") over time, stratified by genetic liability for psychopathology and exposure to environmental risk, using momentary assessment technology. Methods: Momentary AMS, collected using the experience sampling method (ESM) as well as childhood trauma and genetic liability (based on the level of shared genes and psychopathology in the co-twin) were collected in a population-based sample of female-female twin pairs and sisters (585 individuals). Networks were generated using multilevel time-lagged regression analysis, and regression coefficients were compared across three strata of childhood trauma severity and three strata of genetic liability using permutation testing. Regression coefficients were presented as network connections. Results: Visual inspection of network graphs revealed some suggestive changes in the networks with more exposure to either childhood trauma or genetic liability (i.e., stronger reinforcing loops between the three negative AMS anxious, insecure, and down both under higher early environmental, and under higher genetic liability exposure, stronger negative association between AMS of different valences: i.e., between "anxious" at t-1 and "relaxed" at t, "relaxed" at t-1 and "down" at t, under intermediate genetic liability exposure when compared to both networks under low and high genetic liability). Yet, statistical evaluation of differences across exposure strata was inconclusive. Conclusions: Although suggestive of a difference in the emotional dynamic, there was no conclusive evidence that genetic and environmental factors may impact ESM network models of individual AMS.
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Affiliation(s)
- Laila Hasmi
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, Netherlands.,Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Evert Thiery
- Department of Neurology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Catherine Derom
- Centre of Human Genetics, University Hospitals Leuven, Leuven, Belgium.,Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Jim van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, Netherlands.,Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, King's Health Partners, London, United Kingdom
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Clark LA, Cuthbert B, Lewis-Fernández R, Narrow WE, Reed GM. Three Approaches to Understanding and Classifying Mental Disorder: ICD-11, DSM-5, and the National Institute of Mental Health’s Research Domain Criteria (RDoC). Psychol Sci Public Interest 2017; 18:72-145. [DOI: 10.1177/1529100617727266] [Citation(s) in RCA: 333] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The diagnosis of mental disorder initially appears relatively straightforward: Patients present with symptoms or visible signs of illness; health professionals make diagnoses based primarily on these symptoms and signs; and they prescribe medication, psychotherapy, or both, accordingly. However, despite a dramatic expansion of knowledge about mental disorders during the past half century, understanding of their components and processes remains rudimentary. We provide histories and descriptions of three systems with different purposes relevant to understanding and classifying mental disorder. Two major diagnostic manuals—the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders—provide classification systems relevant to public health, clinical diagnosis, service provision, and specific research applications, the former internationally and the latter primarily for the United States. In contrast, the National Institute of Mental Health’s Research Domain Criteria provides a framework that emphasizes integration of basic behavioral and neuroscience research to deepen the understanding of mental disorder. We identify four key issues that present challenges to understanding and classifying mental disorder: etiology, including the multiple causality of mental disorder; whether the relevant phenomena are discrete categories or dimensions; thresholds, which set the boundaries between disorder and nondisorder; and comorbidity, the fact that individuals with mental illness often meet diagnostic requirements for multiple conditions. We discuss how the three systems’ approaches to these key issues correspond or diverge as a result of their different histories, purposes, and constituencies. Although the systems have varying degrees of overlap and distinguishing features, they share the goal of reducing the burden of suffering due to mental disorder.
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Affiliation(s)
| | - Bruce Cuthbert
- Research Domain Criteria Unit, National Institute of Mental Health
| | | | - William E. Narrow
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine
| | - Geoffrey M. Reed
- Department of Mental Health and Substance Abuse, World Health Organization
- Global Mental Health Program, Columbia University Medical Center
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24
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Magallón-Neri E, Kirchner-Nebot T, Forns-Santacana M, Calderón C, Planellas I. Ecological Momentary Assessment with smartphones for measuring mental health problems in adolescents. World J Psychiatry 2016; 6:303-310. [PMID: 27679769 PMCID: PMC5031930 DOI: 10.5498/wjp.v6.i3.303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/11/2016] [Accepted: 08/29/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To analyze the viability of Ecological Momentary Assessment (EMA) for measuring the mental states associated with psychopathological problems in adolescents.
METHODS In a sample of 110 adolescents, a sociodemographic data survey and an EMA Smartphone application over a one-week period (five times each day), was developed to explore symptom profiles, everyday problems, coping strategies, and the contexts in which the events take place.
RESULTS The positive response was 68.6%. Over 2250 prompts about mental states were recorded. In 53% of situations the smartphone was answered at home, 25.5% of cases they were with their parents or with peers (20.3%). Associations were found with attention, affective and anxiety problems (P < 0.001) in the participants who took longer to respond to the EMA app. Anxious and depressive states were highly interrelated (rho = 0.51, P < 0.001), as well as oppositional defiant problems and conduct problems (rho = 0.56, P < 0.001). Only in 6.2% of the situations the subjects perceived they had problems, mainly associated with inter-relational aspects with family, peers, boyfriends or girlfriends (31.2%). We also found moderate-high reliability on scales of satisfaction level on the context, on positive emotionality, and on the discomfort index associated with mental health problems.
CONCLUSION EMA methodology using smartphones is a useful tool for understanding adolescents’ daily dynamics. It achieved moderate-high reliability and accurately identified psychopathological manifestations experienced by community adolescents in their natural context.
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Bak M, Drukker M, Hasmi L, van Os J. An n=1 Clinical Network Analysis of Symptoms and Treatment in Psychosis. PLoS One 2016; 11:e0162811. [PMID: 27643994 PMCID: PMC5028060 DOI: 10.1371/journal.pone.0162811] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/29/2016] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Dynamic relationships between the symptoms of psychosis can be shown in individual networks of psychopathology. In a single patient, data collected with the Experience Sampling Method (ESM-a method to construct intensive time series of experience and context) can be used to study lagged associations between symptoms in relation to illness severity and pharmacological treatment. METHOD The patient completed, over the course of 1 year, for 4 days per week, 10 daily assessments scheduled randomly between 10 minutes and 3 hours apart. Five a priori selected symptoms were analysed: 'hearing voices', 'down', 'relaxed', 'paranoia' and 'loss of control'. Regression analysis was performed including current level of one symptom as the dependent variable and all symptoms at the previous assessment (lag) as the independent variables. Resulting regression coefficients were printed in graphs representing a network of symptoms. Network graphs were generated for different levels of severity: stable, impending relapse and full relapse. RESULTS ESM data showed that symptoms varied intensely from moment to moment. Network representations showed meaningful relations between symptoms, e.g. 'down' and 'paranoia' fuelling each other, and 'paranoia' negatively impacting 'relaxed'. During relapse, symptom levels as well as the level of clustering between symptoms markedly increased, indicating qualitative changes in the network. While 'hearing voices' was the most prominent symptom subjectively, the data suggested that a strategic focus on 'paranoia', as the most central symptom, had the potential to bring about changes affecting the whole network. CONCLUSION Construction of intensive ESM time series in a single patient is feasible and informative, particularly if represented as a network, showing both quantitative and qualitative changes as a function of relapse.
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Affiliation(s)
- Maarten Bak
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- * E-mail:
| | - Marjan Drukker
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Laila Hasmi
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
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Guloksuz S, van Nierop M, Bak M, de Graaf R, ten Have M, van Dorsselaer S, Gunther N, Lieb R, van Winkel R, Wittchen HU, van Os J. Exposure to environmental factors increases connectivity between symptom domains in the psychopathology network. BMC Psychiatry 2016; 16:223. [PMID: 27391407 PMCID: PMC4939022 DOI: 10.1186/s12888-016-0935-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 06/17/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND We investigated to what degree environmental exposure (childhood trauma, urbanicity, cannabis use, and discrimination) impacts symptom connectivity using both continuous and categorical measures of psychopathology. METHODS Outcomes were continuous symptom dimensions of self-reported psychopathology using the Self-report Symptom Checklist-90-R in 3021 participants from The Early Developmental Stages of the Psychopathology (EDSP) study and binary DSM-III-R categories of mental disorders and a binary measure of psychotic symptoms in 7076 participants from The Netherlands Mental Health Survey and Incidence Study (NEMESIS-1). For each symptom dimension in the EDSP and mental disorder in the NEMESIS-1 as the dependent variable, regression analyses were carried out including each of the remaining symptom dimensions/mental disorders and its interaction with cumulative environmental risk load (the sum score of environmental exposures) as independent variables. RESULTS All symptom dimensions in the EDSP and related diagnostic categories in the NEMESIS-1 were strongly associated with each other, and environmental exposures increased the degree of symptom connectivity in the networks in both cohorts. CONCLUSIONS Our findings showing strong connectivity across symptom dimensions and related binary diagnostic constructs in two independent population cohorts provide further evidence for the conceptualization of psychopathology as a contextually sensitive network of mutually interacting symptoms.
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Affiliation(s)
- Sinan Guloksuz
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, P.O. BOX 616, 6200 MD Maastricht, The Netherlands ,Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Martine van Nierop
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, P.O. BOX 616, 6200 MD Maastricht, The Netherlands
| | - Maarten Bak
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, P.O. BOX 616, 6200 MD Maastricht, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Margreet ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | | | - Nicole Gunther
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, P.O. BOX 616, 6200 MD Maastricht, The Netherlands ,School of Psychology, Open University, Heerlen, The Netherlands
| | - Roselind Lieb
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Ruud van Winkel
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, P.O. BOX 616, 6200 MD Maastricht, The Netherlands ,University Psychiatric Center Katholieke Universiteit Leuven, campus Kortenberg, Leuvensesteenweg, Kortenberg, Belgium
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany ,Max Planck Institute of Psychiatry, Munich, Germany
| | - Jim van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, P.O. BOX 616, 6200 MD, Maastricht, The Netherlands. .,King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK.
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Willi TS, Honer WG, Thornton AE, Gicas K, Procyshyn RM, Vila-Rodriguez F, Panenka WJ, Aleksic A, Leonova O, Jones AA, MacEwan GW, Barr AM. Factors affecting severity of positive and negative symptoms of psychosis in a polysubstance using population with psychostimulant dependence. Psychiatry Res 2016; 240:336-342. [PMID: 27138828 DOI: 10.1016/j.psychres.2016.04.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/30/2016] [Accepted: 04/18/2016] [Indexed: 01/13/2023]
Abstract
Approximately half of psychostimulant users experience psychotic symptoms, which include both positive and negative symptoms. Prior reports have exclusively used positive symptoms to characterize psychostimulant associated psychosis. Symptoms vary dramatically in severity, though most investigations categorize psychosis as a dichotomous occurrence. To explore the association between different substances of abuse and the severity of psychotic symptoms, we investigated 171 individuals meeting DSM-IV-TR criteria for psychostimulant (cocaine or methamphetamine) dependence in an observational cross-sectional study. Participants were predominantly male (72.5%), recruited from a socially disadvantaged neighborhood in Vancouver, Canada, with a mean age of 45.5(±8.8) years. Of the total sample, 85% were dependent on cocaine, and 28.1% were dependent on methamphetamine. Participants had a median total PANSS score of 63, ranging from 37 to 111. Demographic information, current substance use and early substance exposure were used to predict positive and negative psychotic symptom severity in linear regression models. Increased severity of positive psychotic symptoms was significantly related to greater methamphetamine and marijuana use in the past 28 days, and methadone-abstinence. Negative symptom severity was related to increased opioid use in the past 28 days. There was no overlap between predictors of positive and negative symptom severity.
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Affiliation(s)
- Taylor S Willi
- Department of Psychiatry, University of British Columbia, Vancouver, B.C., Canada V6T 1Z3
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, B.C., Canada V6T 1Z3
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, B.C., Canada V5A 1S6
| | - Kristina Gicas
- Department of Psychology, Simon Fraser University, Burnaby, B.C., Canada V5A 1S6
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, B.C., Canada V6T 1Z3
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, B.C., Canada V6T 1Z3
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, B.C., Canada V6T 1Z3
| | - Ana Aleksic
- Department of Pharmacology, 2176 Health Sciences Mall, University of British Columbia, Vancouver, B.C., Canada V6T 1Z3
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, B.C., Canada V6T 1Z3
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, B.C., Canada V6T 1Z3
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, B.C., Canada V6T 1Z3
| | - Alasdair M Barr
- Department of Pharmacology, 2176 Health Sciences Mall, University of British Columbia, Vancouver, B.C., Canada V6T 1Z3.
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McBride O, Cheng HG, Slade T, Lynskey MT. The Role of Specific Alcohol-Related Problems in Predicting Depressive Experiences in a Cross-Sectional National Household Survey. Alcohol Alcohol 2016; 51:655-663. [PMID: 26956426 DOI: 10.1093/alcalc/agw010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 02/09/2016] [Indexed: 02/07/2023] Open
Abstract
AIMS This study examines the type of alcohol-related problems that commonly occur before the onset of depressive experiences to shed light on the mechanisms underlying the alcohol-depression comorbidity relationship. METHODS Data were from the 1992 USA National Longitudinal Alcohol Epidemiologic Survey. Analytical sample comprised of drinkers with a prior to past year (PPY) history of alcohol-related problems with or without any experiences of depressed mood in the past year (PY). The prevalence of PPY alcohol-related problems was examined, as well as the ability of specific alcohol problems to predict PY experiences of depressed mood. The type of depressed mood experienced by drinkers with PPY history of alcohol-related problems was compared to those without. RESULTS All but one alcohol-related problem PPY was more frequently endorsed among drinkers with PY experiences of depressed mood. Controlling for confounders, five alcohol-related problems experienced PPY were significantly predictive of depressed mood PY: tolerance, drinking longer than intended, inability to perform important social and occupational roles/obligations, as well as drinking in physically hazardous situations. Drinkers with alcohol-related problems PPY more frequently experienced difficulties with concentration, energy, and thoughts of death, than those without. CONCLUSIONS Alcohol-related problems are likely associated with depressive experiences through a complex network, whereby experiences of physical dependence and negative consequences increase the likelihood of negative affect. Novel study designs are necessary to fully understand the complex mechanisms underlying this comorbidity.
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Affiliation(s)
- Orla McBride
- Psychology Research Institute, Ulster University, Londonderry, Northern Ireland, UK
| | - Hui G Cheng
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Tim Slade
- National Drug and Alcohol Centre, University of New South Wales, Sydney, NSW, Australia
| | - Michael T Lynskey
- King's College, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Abstract
The concept of psychosis has been shaped by traditions in the concepts of mental disorders during the last 170 years. The term "psychosis" still lacks a unified definition, but denotes a clinical construct composed of several symptoms. Delusions, hallucinations, and thought disorders are the core clinical features. The search for a common denominator of psychotic symptoms points toward combinations of neuropsychological mechanisms resulting in reality distortion. To advance the elucidation of the causes and the pathophysiology of the symptoms of psychosis, a deconstruction of the term into its component symptoms is therefore warranted. Current research is dealing with the delineation from "normality", the genetic underpinnings, and the causes and pathophysiology of the symptoms of psychosis.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Jürgen Zielasek
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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Abstract
The National Institute of Mental Health is actively promoting Research Domain Criteria as a new model for the research on mental disorders. Research Domain Criteria approaches disorders through a matrix, linking units of analysis with domains, based on the assumption that psychopathology reflects abnormal connectivity in the brain. This review suggests that the Research Domain Criteria perspective is likely to fail to provide an adequate basis for clinical psychiatric theory and practice. First, it uses models from neuroscience that are insufficiently developed. Second, it is based on the premise that mental phenomena and mental disorders can be reduced to neural activity, without consideration of cognition, experience, and social interaction. Third, it downplays psychosocial factors in psychopathology and treatment. Research Domain Criteria may therefore prove inadequate for providing a neuroscientific basis for psychiatric nosology and treatment and needs to be supplemented with a broader view that incorporates insights from social sciences, psychology, and phenomenology.
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Badcock JC, Mahfouda S, Maybery MT. Hallucinations and inhibitory functioning in healthy young adults with high and low levels of hypomanic personality traits. Cogn Neuropsychiatry 2015; 20:254-69. [PMID: 25798816 DOI: 10.1080/13546805.2015.1021907] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Hallucinations in schizophrenia and hallucination proneness in healthy young adults are associated with a common cognitive mechanism, namely impaired inhibitory control. Hallucinatory-like experiences also seem related to hypomanic symptoms in non-clinical participants; however, the mechanisms involved are unknown. We sought to examine self-reported hallucinatory/anomalous perceptual experiences in students selected for high versus low levels of hypomanic personality traits, and whether hypomania is characterised by deficient inhibitory control. METHOD Undergraduate students with either high (n = 26) or low (n = 28) scores on the Hypomanic Personality Scale-Revised (HPS-20) were compared on: (1) the Launay Slade Hallucination Scale-Revised (LSHS-R), a measure of hallucination proneness, (2) the Cardiff Anomalous Perceptions Scale (CAPS) and (3) the Inhibition of Currently Irrelevant Memories (ICIM) task, an index of intentional inhibition. RESULTS The high HPS group had higher total scores, as well as higher frequency (on CAPS only), intrusiveness and distress (CAPS) scores compared to the low HPS group. They also produced significantly more false alarms on the second run of the ICIM task than the low hypomania traits group. CONCLUSIONS Frequent, intrusive and distressing perceptual anomalies and proneness to hallucinations tend to occur in healthy individuals with hypomanic personality traits and may be associated with transient difficulties with inhibitory control. Inhibitory control may be a cognitive marker of vulnerability to hallucinations across diagnostic boundaries.
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Affiliation(s)
- Johanna C Badcock
- a School of Psychology , University of Western Australia , 35 Stirling Highway, Crawley , WA 6010 , Australia
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Guloksuz S, van Nierop M, Lieb R, van Winkel R, Wittchen HU, van Os J. Evidence that the presence of psychosis in non-psychotic disorder is environment-dependent and mediated by severity of non-psychotic psychopathology. Psychol Med 2015; 45:2389-2401. [PMID: 25804288 DOI: 10.1017/s0033291715000380] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Evidence suggests that in affective, non-psychotic disorders: (i) environmental exposures increase risk of subthreshold psychotic experiences (PEs) and strengthen connectivity between domains of affective and subthreshold psychotic psychopathology; and (ii) PEs are a marker of illness severity. METHOD In 3021 adolescents from the Early Developmental Stages of Psychopathology cohort, we tested whether the association between PEs and presence of DSM-IV mood disorder (MD)/obsessive-compulsive disorder (OCD) would be moderated by risk factors for psychosis (cannabis use, childhood trauma and urbanicity), using the interaction contrast ratio (ICR) method. Furthermore, we analysed whether the interaction between environment and PEs was mediated by non-psychotic psychopathology. RESULTS The association between PEs and MD/OCD was moderated by urbanicity (ICR = 2.46, p = 0.005), cannabis use (ICR = 3.76, p = 0.010) and, suggestively, trauma (ICR = 1.91, p = 0.063). Exposure to more than one environmental risk factor increased the likelihood of co-expression of PEs in a dose-response fashion. Moderating effects of environmental exposures were largely mediated by the severity of general non-psychotic psychopathology (percentage explained 56-68%, all p < 0.001). Within individuals with MD/OCD, the association between PEs and help-seeking behaviour, as an index of severity, was moderated by trauma (ICR = 1.87, p = 0.009) and urbanicity (ICR = 1.48, p = 0.005), but not by cannabis use. CONCLUSIONS In non-psychotic disorder, environmental factors increase the likelihood of psychosis admixture and help-seeking behaviour through an increase in general psychopathology. The findings are compatible with a relational model of psychopathology in which more severe clinical states are the result of environment-induced disturbances spreading through a psychopathology network.
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Affiliation(s)
- S Guloksuz
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, EURON,Maastricht,The Netherlands
| | - M van Nierop
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, EURON,Maastricht,The Netherlands
| | - R Lieb
- Epidemiology and Health Psychology, Institute of Psychology, University of Basel,Basel,Switzerland
| | - R van Winkel
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, EURON,Maastricht,The Netherlands
| | - H-U Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technical University Dresden,Dresden,Germany
| | - J van Os
- Department of Psychiatry and Psychology,Maastricht University Medical Centre, EURON,Maastricht,The Netherlands
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VAN Os J. The transdiagnostic dimension of psychosis: implications for psychiatric nosology and research. SHANGHAI ARCHIVES OF PSYCHIATRY 2015; 27:82-6. [PMID: 26120256 PMCID: PMC4466847 DOI: 10.11919/j.issn.1002-0829.215041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 04/07/2015] [Indexed: 12/29/2022]
Abstract
If psychosis is a transdiagnostic dimension, the expression of which is governed by a dynamic set of contextual and emotional factors that are amenable to treatment, current approaches in psychiatric nosology and therapeutic research may need to be revised. The dominant approach to date is to clinically and conceptually situate psychotic symptoms in the construct of schizophrenia. However, schizophrenia, which has a lifetime prevalence of 1%, only represents the poor outcome fraction of a much broader spectrum of psychotic disorders which have a lifetime prevalence of 3.5%. Therefore, research findings in schizophrenia may reflect mechanisms of prognosis rather than fundamental associations with psychosis and other symptom domains per se. Similarly, the discovery that up to 30% of individuals with non-psychotic common mental disorders have subthreshold psychotic symptoms that situate them on the transdiagnostic dimension of psychosis - and which impact clinical severity and treatment response - indicates that the rigid separation between 'psychotic' and 'non-psychotic' hampers both clinical practice and research. Diagnostic manuals in psychiatry would benefit from a system of transdiagnostic dimensions, including a transdiagnostic dimension of psychosis. Introduction of transdiagnostic dimensions allows for a system combining a nomothetic (i.e., group-specific) categorical diagnosis with an idiographic (i.e., person-specific) combination of dimensional scores. The advantage of such a system is that it encourages consideration of how symptoms dynamically interact with each other in a network of psychopathology, and of how this network is impacted by the social world.
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Affiliation(s)
- Jim VAN Os
- Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht, The Netherlands King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
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In this issue (April 2015). SHANGHAI ARCHIVES OF PSYCHIATRY 2015; 27. [PMCID: PMC4466845 DOI: 10.11919/j.issn.1002-0829.215047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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van Os J, Delespaul P, Barge D, Bakker RP. Testing an mHealth momentary assessment Routine Outcome Monitoring application: a focus on restoration of daily life positive mood states. PLoS One 2014; 9:e115254. [PMID: 25513813 PMCID: PMC4267819 DOI: 10.1371/journal.pone.0115254] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/18/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Routine Outcome Monitoring (ROM) is used as a means to enrich the process of treatment with feedback on patient outcomes, facilitating patient involvement and shared decision making. While traditional ROM measures focus on retrospective accounts of symptoms, novel mHealth technology makes it possible to collect real life, in-the-moment ambulatory data that allow for an ecologically valid assessment of personalized and contextualized emotional and behavioural adjustment in the flow daily life (mROM). METHOD In a sample of 34 patients with major depressive disorder, treated with antidepressants, the combined effect of treatment and natural course was examined over a period of 18 weeks with Ecological Momentary Assessment (EMA). EMA consisted of repeated, within-subject, mini-measurements of experience (eg positive affect, negative affect, medication side effects) and context (eg stressors, situations, activities) at 10 unselected semi-random moments per day, for a period of six days, repeated three times over the 18-week period (baseline, week 6 and week 18). RESULTS EMA measures of emotional and behavioural adjustment were sensitive to the effects of treatment and natural course over the 18-week period, particularly EMA measures focussing on positive mood states and the ability to use natural rewards (impact of positive events on positive mood states), with standardized effect sizes of 0.4-0.5. EMA measures of activities, social interaction, stress-sensitivity and negative mood states were also sensitive to change over time. CONCLUSION This study supports the use of mROM as a means to involve the patient in the process of needs assessment and treatment. EMA data are meaningful to the patient, as they reflect daily life circumstances. Assessment of treatment response with mROM data allows for an interpretation of the effect of treatment at the level of daily life emotional and social adjustment--as an index of health, obviating the need for an exclusive focus on traditional measures of 'sickness'.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands
- King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
| | - Philippe Delespaul
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands
| | - Daniela Barge
- Leiden University Medical Centre, Leiden, The Netherlands
| | - Roberto P. Bakker
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands
- Psychiatric Centre GGZ Centraal, Amersfoort, The Netherlands
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Goekoop R, Goekoop JG. A network view on psychiatric disorders: network clusters of symptoms as elementary syndromes of psychopathology. PLoS One 2014; 9:e112734. [PMID: 25427156 PMCID: PMC4245101 DOI: 10.1371/journal.pone.0112734] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 10/14/2014] [Indexed: 12/13/2022] Open
Abstract
Introduction The vast number of psychopathological syndromes that can be observed in clinical practice can be described in terms of a limited number of elementary syndromes that are differentially expressed. Previous attempts to identify elementary syndromes have shown limitations that have slowed progress in the taxonomy of psychiatric disorders. Aim To examine the ability of network community detection (NCD) to identify elementary syndromes of psychopathology and move beyond the limitations of current classification methods in psychiatry. Methods 192 patients with unselected mental disorders were tested on the Comprehensive Psychopathological Rating Scale (CPRS). Principal component analysis (PCA) was performed on the bootstrapped correlation matrix of symptom scores to extract the principal component structure (PCS). An undirected and weighted network graph was constructed from the same matrix. Network community structure (NCS) was optimized using a previously published technique. Results In the optimal network structure, network clusters showed a 89% match with principal components of psychopathology. Some 6 network clusters were found, including "DEPRESSION", "MANIA", “ANXIETY”, "PSYCHOSIS", "RETARDATION", and "BEHAVIORAL DISORGANIZATION". Network metrics were used to quantify the continuities between the elementary syndromes. Conclusion We present the first comprehensive network graph of psychopathology that is free from the biases of previous classifications: a ‘Psychopathology Web’. Clusters within this network represent elementary syndromes that are connected via a limited number of bridge symptoms. Many problems of previous classifications can be overcome by using a network approach to psychopathology.
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Affiliation(s)
- Rutger Goekoop
- Department of Mood Disorders, PsyQ Psychomedical Programs, The Hague, The Netherlands
- Parnassia Group, The Hague, The Netherlands
- * E-mail:
| | - Jaap G. Goekoop
- Department of Psychiatry, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
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Ambulatory assessment as a means of longitudinal phenotypes characterization in psychiatric disorders. Neurosci Res 2014; 102:13-21. [PMID: 25448546 DOI: 10.1016/j.neures.2014.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 10/28/2014] [Accepted: 10/31/2014] [Indexed: 12/27/2022]
Abstract
Ambulatory Assessment (AA) comprises the use of in-field methods to assess individuals' behavior, physiology, and the experience as they unfold in naturalistic settings. We propose that AA is favorable for the investigation of gene-environment interactions and for the search for endophenotypes, being able to assess the experienced environment and to track basic regulatory processes, such as stress reactivity, affective instability, and reward experience, which are potential common factors that underlie psychiatric disorders. In this article, we (a) first describe briefly the rationale of AA and summarize the key advantages of the approach, (b) highlight within-subject regulatory processes, such as stress reactivity, affective instability, and reward experience, (c) describe studies that used AA to examine genetic influences in psychiatric disorders, and (d) briefly review longitudinal studies that have investigated phenotypes of psychiatric disorders. The reported studies yielded promising, although sometimes inconclusive evidence for genetic effects on endophenotypes of psychiatric disorders. Moreover, most studies were twin or family studies, especially in stress-sensitivity research; thus, it is unclear which specific single nucleotide polymorphisms contribute to the endophenotypes of psychiatric disorders. We do hope that within-subject regulatory processes will enable us to clarify the fundamental psychological dimensions that cut across traditional disorders and link them to their genetic underpinnings.
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