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Gunlicks-Stoessel M, Liu Y, Parkhill C, Morrell N, Choy-Brown M, Mehus C, Hetler J, August G. Adolescent, parent, and provider attitudes toward a machine learning based clinical decision support system for selecting treatment for youth depression. BMC Med Inform Decis Mak 2024; 24:4. [PMID: 38167319 PMCID: PMC10759496 DOI: 10.1186/s12911-023-02410-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Machine learning based clinical decision support systems (CDSSs) have been proposed as a means of advancing personalized treatment planning for disorders, such as depression, that have a multifaceted etiology, course, and symptom profile. However, machine learning based models for treatment selection are rare in the field of psychiatry. They have also not yet been translated for use in clinical practice. Understanding key stakeholder attitudes toward machine learning based CDSSs is critical for developing plans for their implementation that promote uptake by both providers and families. METHODS In Study 1, a prototype machine learning based Clinical Decision Support System for Youth Depression (CDSS-YD) was demonstrated to focus groups of adolescents with a diagnosis of depression (n = 9), parents (n = 11), and behavioral health providers (n = 8). Qualitative analysis was used to assess their attitudes towards the CDSS-YD. In Study 2, behavioral health providers were trained in the use of the CDSS-YD and they utilized the CDSS-YD in a clinical encounter with 6 adolescents and their parents as part of their treatment planning discussion. Following the appointment, providers, parents, and adolescents completed a survey about their attitudes regarding the use of the CDSS-YD. RESULTS All stakeholder groups viewed the CDSS-YD as an easy to understand and useful tool for making personalized treatment decisions, and families and providers were able to successfully use the CDSS-YD in clinical encounters. Parents and adolescents viewed their providers as having a critical role in the use the CDSS-YD, and this had implications for the perceived trustworthiness of the CDSS-YD. Providers reported that clinic productivity metrics would be the primary barrier to CDSS-YD implementation, with the creation of protected time for training, preparation, and use as a key facilitator. CONCLUSIONS Machine learning based CDSSs, if proven effective, have the potential to be widely accepted tools for personalized treatment planning. Successful implementation will require addressing the system-level barrier of having sufficient time and energy to integrate it into practice.
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Affiliation(s)
- Meredith Gunlicks-Stoessel
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, 2025 E River Parkway, 55414, Minneapolis, MN, USA.
| | - Yangchenchen Liu
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Catherine Parkhill
- Department of Psychiatry & Behavioral Sciences, University of Minnesota, 2025 E River Parkway, 55414, Minneapolis, MN, USA
| | - Nicole Morrell
- Center for Applied Research and Educational Improvement, University of Minnesota, St. Paul, MN, USA
| | - Mimi Choy-Brown
- School of Social Work, University of Minnesota, St. Paul, MN, USA
| | - Christopher Mehus
- Center for Applied Research and Educational Improvement, University of Minnesota, St. Paul, MN, USA
- Department of Family Social Science, University of Minnesota, St. Paul, MN, USA
| | - Joel Hetler
- Department of Family Social Science, University of Minnesota, St. Paul, MN, USA
| | - Gerald August
- Department of Family Social Science, University of Minnesota, St. Paul, MN, USA
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Rost N, Binder EB, Brückl TM. Predicting treatment outcome in depression: an introduction into current concepts and challenges. Eur Arch Psychiatry Clin Neurosci 2023; 273:113-127. [PMID: 35587279 PMCID: PMC9957888 DOI: 10.1007/s00406-022-01418-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/11/2022] [Indexed: 12/19/2022]
Abstract
Improving response and remission rates in major depressive disorder (MDD) remains an important challenge. Matching patients to the treatment they will most likely respond to should be the ultimate goal. Even though numerous studies have investigated patient-specific indicators of treatment efficacy, no (bio)markers or empirical tests for use in clinical practice have resulted as of now. Therefore, clinical decisions regarding the treatment of MDD still have to be made on the basis of questionnaire- or interview-based assessments and general guidelines without the support of a (laboratory) test. We conducted a narrative review of current approaches to characterize and predict outcome to pharmacological treatments in MDD. We particularly focused on findings from newer computational studies using machine learning and on the resulting implementation into clinical decision support systems. The main issues seem to rest upon the unavailability of robust predictive variables and the lacking application of empirical findings and predictive models in clinical practice. We outline several challenges that need to be tackled on different stages of the translational process, from current concepts and definitions to generalizable prediction models and their successful implementation into digital support systems. By bridging the addressed gaps in translational psychiatric research, advances in data quantity and new technologies may enable the next steps toward precision psychiatry.
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Affiliation(s)
- Nicolas Rost
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany. .,International Max Planck Research School for Translational Psychiatry, Munich, Germany.
| | - Elisabeth B. Binder
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, Germany
| | - Tanja M. Brückl
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, Germany
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Tutun S, Johnson ME, Ahmed A, Albizri A, Irgil S, Yesilkaya I, Ucar EN, Sengun T, Harfouche A. An AI-based Decision Support System for Predicting Mental Health Disorders. INFORMATION SYSTEMS FRONTIERS : A JOURNAL OF RESEARCH AND INNOVATION 2022; 25:1261-1276. [PMID: 35669335 PMCID: PMC9142346 DOI: 10.1007/s10796-022-10282-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 05/27/2023]
Abstract
Approximately one billion individuals suffer from mental health disorders, such as depression, bipolar disorder, schizophrenia, and anxiety. Mental health professionals use various assessment tools to detect and diagnose these disorders. However, these tools are complex, contain an excessive number of questions, and require a significant amount of time to administer, leading to low participation and completion rates. Additionally, the results obtained from these tools must be analyzed and interpreted manually by mental health professionals, which may yield inaccurate diagnoses. To this extent, this research utilizes advanced analytics and artificial intelligence to develop a decision support system (DSS) that can efficiently detect and diagnose various mental disorders. As part of the DSS development process, the Network Pattern Recognition (NEPAR) algorithm is first utilized to build the assessment tool and identify the questions that participants need to answer. Then, various machine learning models are trained using participants' answers to these questions and other historical data as inputs to predict the existence and the type of their mental disorder. The results show that the proposed DSS can automatically diagnose mental disorders using only 28 questions without any human input, to an accuracy level of 89%. Furthermore, the proposed mental disorder diagnostic tool has significantly fewer questions than its counterparts; hence, it provides higher participation and completion rates. Therefore, mental health professionals can use this proposed DSS and its accompanying assessment tool for improved clinical decision-making and diagnostic accuracy.
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Affiliation(s)
- Salih Tutun
- Washington University in St. Louis, St. Louis, MO USA
| | | | | | | | - Sedat Irgil
- Guven Private Health Laboratory, Guven, Turkey
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Schneider H. Artificial Intelligence in Schizophrenia. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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5
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Artificial Intelligence in Schizophrenia. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_214-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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6
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Chishti S, Jaggi KR, Saini A, Agarwal G, Ranjan A. Artificial Intelligence-Based Differential Diagnosis: Development and Validation of a Probabilistic Model to Address Lack of Large-Scale Clinical Datasets. J Med Internet Res 2020; 22:e17550. [PMID: 32343256 PMCID: PMC7218591 DOI: 10.2196/17550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/30/2020] [Accepted: 02/01/2020] [Indexed: 12/19/2022] Open
Abstract
Background Machine-learning or deep-learning algorithms for clinical diagnosis are inherently dependent on the availability of large-scale clinical datasets. Lack of such datasets and inherent problems such as overfitting often necessitate the development of innovative solutions. Probabilistic modeling closely mimics the rationale behind clinical diagnosis and represents a unique solution. Objective The aim of this study was to develop and validate a probabilistic model for differential diagnosis in different medical domains. Methods Numerical values of symptom-disease associations were utilized to mathematically represent medical domain knowledge. These values served as the core engine for the probabilistic model. For the given set of symptoms, the model was utilized to produce a ranked list of differential diagnoses, which was compared to the differential diagnosis constructed by a physician in a consult. Practicing medical specialists were integral in the development and validation of this model. Clinical vignettes (patient case studies) were utilized to compare the accuracy of doctors and the model against the assumed gold standard. The accuracy analysis was carried out over the following metrics: top 3 accuracy, precision, and recall. Results The model demonstrated a statistically significant improvement (P=.002) in diagnostic accuracy (85%) as compared to the doctors’ performance (67%). This advantage was retained across all three categories of clinical vignettes: 100% vs 82% (P<.001) for highly specific disease presentation, 83% vs 65% for moderately specific disease presentation (P=.005), and 72% vs 49% (P<.001) for nonspecific disease presentation. The model performed slightly better than the doctors’ average in precision (62% vs 60%, P=.43) but there was no improvement with respect to recall (53% vs 56%, P=.27). However, neither difference was statistically significant. Conclusions The present study demonstrates a drastic improvement over previously reported results that can be attributed to the development of a stable probabilistic framework utilizing symptom-disease associations to mathematically represent medical domain knowledge. The current iteration relies on static, manually curated values for calculating the degree of association. Shifting to real-world data–derived values represents the next step in model development.
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Affiliation(s)
| | | | - Anuj Saini
- 1mg Technologies Pvt Ltd, Gurgaon, India
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Malhotra S, Chakrabarti S, Shah R, Sharma M, Sharma KP, Malhotra A, Upadhyaya SK, Margoob MA, Maqbool D, Jassal GD. Telepsychiatry clinical decision support system used by non-psychiatrists in remote areas: Validity & reliabilityof diagnostic module. Indian J Med Res 2018; 146:196-204. [PMID: 29265020 PMCID: PMC5761029 DOI: 10.4103/ijmr.ijmr_757_15] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background & objectives: A knowledge-based, logically-linked online telepsychiatric decision support system for diagnosis and treatment of mental disorders was developed and validated. We evaluated diagnostic accuracy and reliability of the application at remote sites when used by non-psychiatrists who underwent a brief training in its use through video-conferencing. Methods: The study was conducted at a nodal telepsychiatry centre, and three geographically remote peripheral centres. The diagnostic tool of application had a screening followed by detailed criteria-wise diagnostic modules for 18 psychiatric disorders. A total of 100 consecutive consenting adult outpatients attending remote telepsychiatry centres were included. To assess inter-rater reliability, patients were interviewed face to face by non-specialists at remote sites using the application (active interviewer) and simultaneously on online application via video-conferencing by a passive assessor at nodal centre. Another interviewer at the nodal centre rated the patient using Mini-International Neuropsychiatric Interview (MINI) for diagnostic validation. Results: Screening sub-module had high sensitivity (80-100%), low positive predictive values (PPV) (0.10-0.71) but high negative predictive value (NPV) (0.97-1) for most disorders. For the diagnostic sub-modules, Cohen's kappa was >0.4 for all disorders, with kappa of 0.7-1.0 for most disorders. PPV and NPV were high for most disorders. Inter-rater agreement analysis revealed kappa >0.6 for all disorders. Interpretation & conclusions: Diagnostic tool showed acceptable to good validity and reliability when used by non-specialists at remote sites. Our findings show that diagnostic tool of the telepsychiatry application has potential to empower non-psychiatrist doctors and paramedics to diagnose psychiatric disorders accurately and reliably in remote sites.
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Affiliation(s)
- Savita Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ruchita Shah
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Minali Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kanu Priya Sharma
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Akanksha Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Suneet K Upadhyaya
- Department of Psychiatry, Hemwati Nandan Bahuguna Base Hospital, Srinagar, Uttarakhand, India
| | - Mushtaq A Margoob
- Department of Psychiatry, Institute of Mental Health & Neuro Sciences, Srinagar, Jammu & Kashmir, India
| | - Dar Maqbool
- Department of Psychiatry, Institute of Mental Health & Neuro Sciences, Srinagar, Jammu & Kashmir, India
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Design and implementation of a web-based fuzzy expert system for diagnosing depressive disorder. APPL INTELL 2017. [DOI: 10.1007/s10489-017-1068-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Koposov R, Fossum S, Frodl T, Nytrø Ø, Leventhal B, Sourander A, Quaglini S, Molteni M, de la Iglesia Vayá M, Prokosch HU, Barbarini N, Milham MP, Castellanos FX, Skokauskas N. Clinical decision support systems in child and adolescent psychiatry: a systematic review. Eur Child Adolesc Psychiatry 2017; 26:1309-1317. [PMID: 28455596 DOI: 10.1007/s00787-017-0992-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/20/2017] [Indexed: 11/30/2022]
Abstract
Psychiatric disorders are amongst the most prevalent and impairing conditions in childhood and adolescence. Unfortunately, it is well known that general practitioners (GPs) and other frontline health providers (i.e., child protection workers, public health nurses, and pediatricians) are not adequately trained to address these ubiquitous problems (Braddick et al. Child and Adolescent mental health in Europe: infrastructures, policy and programmes, European Communities, 2009; Levav et al. Eur Child Adolesc Psychiatry 13:395-401, 2004). Advances in technology may offer a solution to this problem with clinical decision support systems (CDSS) that are designed to help professionals make sound clinical decisions in real time. This paper offers a systematic review of currently available CDSS for child and adolescent mental health disorders prepared according to the PRISMA-Protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols). Applying strict eligibility criteria, the identified studies (n = 5048) were screened. Ten studies, describing eight original clinical decision support systems for child and adolescent psychiatric disorders, fulfilled inclusion criteria. Based on this systematic review, there appears to be a need for a new, readily available CDSS for child neuropsychiatric disorder which promotes evidence-based, best practices, while enabling consideration of national variation in practices by leveraging data-reuse to generate predictions regarding treatment outcome, addressing a broader cluster of clinical disorders, and targeting frontline practice environments.
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Affiliation(s)
- Roman Koposov
- Regional Centre for Children and Youth Mental Health and Welfare, Northern Norway, UiT The Arctic University of Norway, Hansine Hansens veg 18, 9019, Tromsø, Norway
| | - Sturla Fossum
- Regional Centre for Children and Youth Mental Health and Welfare, Northern Norway, UiT The Arctic University of Norway, Hansine Hansens veg 18, 9019, Tromsø, Norway
| | - Thomas Frodl
- Department of Psychiatry and Psychotherapy, Otto von Guericke University Magdeburg, Universitätsstr. 84, 93053, Magdeburg, Germany
| | - Øystein Nytrø
- Department of Computer and Information Science, Norwegian University of Science and Technology, Pb 8905, 7491, Trondheim, Norway
| | - Bennett Leventhal
- San Francisco School of Medicine, University of California, Parnassus Avenue 52, San Francisco, CA, 94143, USA
| | - Andre Sourander
- Department of Child Psychiatry, University of Turku and Turku University Hospital, Lemminkäisenkatu 3, 20014, Turku, Finland
| | - Silvana Quaglini
- Industrial and Information Engineering Department, Università degli Studi di Pavia, Via Ferrata 3, 27100, Pavia, Italy
| | - Massimo Molteni
- Child Psychopathology Unit, Hospital at Bosisio Parini, Via Alzate, 10, 22032, Albese Con Cassano, Italy
| | | | - Hans-Ulrich Prokosch
- Department of Medical Informatics, Friedrich-Alexander University, Schlossplatz 4, 91058, Erlangen, Germany
| | - Nicola Barbarini
- BIOMEdical Research Informatics Solutions, Via Ferrata 1, 27100, Pavia, Italy
| | - Michael Peter Milham
- Center for the Developing Brain, Child Mind Institute, 445 Park Avenue, New York, 10022, USA
| | | | - Norbert Skokauskas
- Regional Centre for Children and Youth Mental Health and Child Welfare - Central Norway, Norwegian University of Science and Technology, Pb 8905, 7491, Trondheim, Norway.
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Nurses' psychosocial barriers to suicide risk management. Nurs Res Pract 2011; 2011:650765. [PMID: 21994837 PMCID: PMC3169808 DOI: 10.1155/2011/650765] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 03/25/2011] [Indexed: 11/17/2022] Open
Abstract
Suicide remains a serious health care problem and a sentinel event tracked by The Joint Commission. Nurses are pivotal in evaluating risk and preventing suicide. Analysis of nurses' barriers to risk management may lead to interventions to improve management of suicidal patients. These data emerged from a random survey of 454 oncology nurses' attitudes, knowledge of suicide, and justifications for euthanasia. Instruments included a vignette of a suicidal patient and a suicide attitude questionnaire. Results. Psychological factors (emotions, unresolved grief, communication, and negative judgments about suicide) complicate the nurse's assessment and treatment of suicidal patients. Some nurses (n = 122) indicated that euthanasia was never justified and 11 were unsure of justifications and evaluated each case on its merits. Justifications for euthanasia included poor symptom control, poor quality of life, incurable illness or permanent disability, terminal illness, and terminal illness with inadequate symptom control or impending death, patient autonomy, and clinical organ death. The nurses indicated some confusion and misconceptions about definitions and examples of euthanasia, assisted suicide, and double effect. Strategies for interdisciplinary clinical intervention are suggested to identify and resolve these psychosocial barriers.
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