The interdependence of behavioral and somatic health: implications for conceptualizing health and measuring treatment outcomes

<b>Purpose:</b> The interdependence of behavioral and somatic aspects of various health conditions warrants greater emphasis on an integrated care approach.<br><br> <b>Theory:</b> We propose that integrated approaches to health and wellness require comprehensive and empirically-valid outcome measures to assess quality of care.<br><br> <b>Method:</b> We discuss the transition from independent to integrated treatment approaches and provide examples of new systems for integrated assessment of treatment outcome.<br><br> <b>Results:</b> Evidence suggests that support for an independent treatment approach is waning and momentum is building towards more integrated care. In addition, research evidence suggests integrated care improves health outcomes, and both physicians and patients have favorable impressions of integrated care.<br><br> <b>Conclusions:</b> As treatment goals in the integrated perspective expand to take into account the intimate relationships among mental illness, overall health, and quality of life, clinicians need to develop outcome measures that are similarly comprehensive. Discussion: Increased recognition, by researchers, providers, and insurers, of the interdependence between behavioral and physical health holds great promise for innovative treatments that could significantly improve patients' lives

Personality Measurement and Assessment in Large Panel Surveys

Personality tests are being added to large panel studies with increasing regularity, such as the Health and Retirement Study (HRS). To facilitate the inclusion and interpretation of these tests, we provide some general background on personality psychology, personality assessment, and the validity of personality tests. In this review, we provide background on definitions of personality, the strengths and weaknesses of the self-report approaches to personality testing typically used in large panel studies, and the validity of personality tests for three outcomes: genetics, income, and health. We conclude with recommendations on how to improve personality assessment in future panel studies

An examination of speech characteristics under conditions of affective reactivity and variable cognitive load as distinguishing feigned and genuine schizophrenia

Proper assessment of schizophrenia is complicated by the need for clinicians to be cognizant of the possibility of malingering, i.e., the intentional production of false or grossly exaggerated symptoms, motivated by external incentives. Current standardized schizophrenia malingering detection methods rely on endorsement of improbable or exaggerated, mainly positive, symptoms. However, these detection methods may be vulnerable to successful manipulation by sophisticated malingerers, particularly if coached regarding response style assessment strategies. This paper explored the utility of supplemental variables to examine in schizophrenia malingering detection by using a simulation study design to compare schizophrenia patients, a community participant sample instructed to feign schizophrenia symptoms, and an honest responder control group on behavioral speech characteristics indicative of thought disorganization (i.e., referential disturbances) and negative symptoms (i.e., alogia and flat affect) under experimentally-manipulated conditions of affective reactivity and cognitive load. Results indicated that the feigning group was distinguishable from the schizophrenia group based on differences in magnitude of speech disorganization during conditions of affective reactivity, due to feigners’ inability to mimic the schizophrenia group’s referential failures, and in magnitude of flat affect during conditions of affective reactivity and cognitive load, due to feigners’ excessively impaired use of formant inflection (i.e., vocal inflection related to tongue movement). Feigning and schizophrenia groups were also distinguishable due to feigners’ excessive impairment in cognitive task performance, observed both in group comparisons and differential patterns of change in cognitive task accuracy across cognitive load conditions

Depression and anxiety in cancer patients seeking psychosocial therapy

The prevalence of mental disorders (particularly depression and anxiety) in a sample of Canadian cancer patients who were referred to a psychosocial oncology program was investigated. Thirty-one cancer patients filled out both the Beck Depression Inventory-11 (BDI-II) and the Beck Anxiety Inventory (BAI) before seeing their psychosocial counselor who evaluated the patient according to Diagnostic and Statistical Manual of Mental Disorders — 4th Ed. diagnostic criteria. The prevalence of depression and anxiety disorders in cancer patients was found to be 13% and 6.45%, respectively. Total BDI-II and BAI scores remained constant over time and both instruments were found to be reliable measures of symptom severity. A number of demographic and cancer-related variables significantly correlated with BDI-II and BAI scores. Neither the BDIII nor the BAI appeared to be particularly good at predicting DSM-FV diagnosis

Mining social media data for biomedical signals and health-related behavior

Social media data has been increasingly used to study biomedical and health-related phenomena. From cohort level discussions of a condition to planetary level analyses of sentiment, social media has provided scientists with unprecedented amounts of data to study human behavior and response associated with a variety of health conditions and medical treatments. Here we review recent work in mining social media for biomedical, epidemiological, and social phenomena information relevant to the multilevel complexity of human health. We pay particular attention to topics where social media data analysis has shown the most progress, including pharmacovigilance, sentiment analysis especially for mental health, and other areas. We also discuss a variety of innovative uses of social media data for health-related applications and important limitations in social media data access and use.Comment: To appear in the Annual Review of Biomedical Data Scienc

Brain structure and function associated with emotion-cognition interactions: A multi-method investigation

Despite significant advances in cognitive neuroscience, comprehensive models of emotional functioning that include neuro-behavioral mechanisms and individual differences predicting vulnerability or resiliency to emotional challenges are scarce. At the level of brain structure, there has not been clear consensus on what the most appropriate tools and techniques are for investigating individual differences. At the level of brain function, the link between spatial (where) and temporal (when) aspects of the neural correlates of emotional processing remains unclear. Thus, there is a need to develop and capitalize on novel comprehensive approaches for the examination of emotional factors at multiple levels (i.e., brain structure, brain function, behavior, and individual differences), in order to elucidate the mechanisms of emotion-cognition interactions. These issues were investigated in a series of studies using an interdisciplinary multi-method approach involving structural and functional brain imaging (i.e., structural magnetic resonance imaging, MRI; functional MRI; event-related optical signal, EROS; electroencephalography/event-related potential, EEG/ERP), a cognitive task involving emotion-cognition interactions (i.e., the emotional oddball paradigm), and measures of individual differences (i.e., cognitive reappraisal, positive affectivity, optimism). Such a comprehensive approach is essential to elucidate mechanisms of emotional functioning, which will contribute to the development of novel theoretical frameworks and the design of assessment tools and interventions that promote emotional well-being

Improving the Methodology for Assessing Cognitive Impairment in People with Schizophrenia Spectrum Disorders

Cognitive dysfunctions in patients with schizophrenia disorders are common, have prognostic value, informs treatment planning and rehabilitation, and provide a basis for targeted cognitive remediation. Consequently, current Norwegian guidelines recommend that neuropsychological assessments should be conducted as soon as possible for all patients with psychotic symptoms. This recommendation warrants a neuropsychological method that can be used to assess large numbers of patients having a broad spectrum of cognitive functioning, which is efficient and cost effective without compromising the quality of the assessment, and that is not too taxing for the most severely afflicted patients. A method that meets these criteria is the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), primarily developed to detect and track cognitive decline over time in elderly people, and to identify neuropsychological deficits in acute care and rehabilitation settings. The main aim of this thesis is to examine the applicability and quality of the Norwegian version of the RBANS in assessing cognitive impairment in Norwegian young adults with schizophrenia spectrum disorders. The first paper investigated how different normative systems influenced the accuracy of identifying cognitive impairment in 315 Norwegian younger adults with a schizophrenia spectrum diagnosis. Applying U.S. normative data resulted in underestimation of cognitive impairment in one out of five patients compared to applying Scandinavian normative data. Patients with comorbid substance abuse disorders did not differ in overall test performance compared to those not abusing substances regardless of normative systems applied. There were significant effects of gender, educational levels, and intelligence on test performance for both normative systems. In the second paper, RBANS clinical normative tables for Norwegian patients with schizophrenia spectrum disorders were constructed, using a patient sample of 335 participants. Normative tables were stratified by educational attainment, by intelligence levels, and by gender. Normative tables were not stratified by substance abuse, as there were no significant differences between these patients’ test scores compared to those not abusing substances. The Norwegian clinical normative data did not differ from previous clinical norms derived from comparable patient groups in the U.S. and Canada. Tables of base rates of low scores on the RBANS indices were constructed, which facilitates interpretation of all five RBANS index scores simultaneously and can improve clinical judgement of patients’ cognitive impairment. The third paper investigated possible relationships between patients’ self-report of motivational and effort problems with several RBANS embedded performance validity tests (PVTs). Decreased motivation and interest are common symptoms in schizophrenia spectrum disorders and might adversely affect test performance. Thus, indicators of invalid test performance may correspond to symptoms of the disorder and not to purposeful underperformance. Of 250 patients, 51% reported severe problems with initiation, as measured with the self-report version of the Behavior Rating Inventory of Executive Function–Adult Version (BRIEF–A) Initiate Scale, compared to 6–28% having PVT scores indicating invalid RBANS test performance. However, RBANS PVTs did not explain a significant amount of variance in self-reported initiation problems but had moderate to high correlations with measures of cognitive impairment. Thus, the RBANS PVTs are probably not good indicators of avolition and likely reflects degree of cognitive impairment in this patient group. In sum, the findings from this thesis suggest that the Norwegian version of the RBANS is robust to effects of patients’ self-reported motivational problems on test performance, and reliably assesses cognitive impairment and functions in younger Norwegian patients with schizophrenia spectrum disorders. The clinical normative data and base rates of low RBANS Index scores for Norwegian patients with schizophrenia disorders facilitate clinicians’ judgment of patients’ cognitive functions, enhancing the RBANS’ clinical utility in assessing cognitive impairment in schizophrenia spectrum disorders.Doktorgradsavhandlin

Irritability in youth: A critical integrative review

Irritability, defined as proneness to anger that may reach an impairing extent, is common in youth. There has been a recent upsurge in relevant research. We combine systematic and narrative review approaches to integrate the latest clinical and translational findings and provide suggestions to address research gaps. Clinicians and researchers should assess irritability routinely; specific assessment tools are now available. Informant effects are prominent, stable, and vary by age and gender. The prevalence of irritability is particularly high in attention deficit hyperactivity disorder, autism spectrum disorder, and mood and anxiety disorders. Irritability is associated with impairment and suicidality risk independent of co-occurring diagnoses. Irritability trajectories have been identified that are differentially associated with clinical outcomes; some begin early in life. Youth irritability is associated with increased risk later in life for anxiety, depression, behavioral problems, and suicidality. Irritability is moderately heritable and genetic associations differ based on age and comorbid illnesses. Parent management training is effective for constructs related to irritability, but its efficacy in irritability should be tested rigorously, as should novel mechanism-informed interventions (e.g., those targeted to frustration exposure). Associations between irritability and suicidality and the impact of cultural context are important, under-researched topics. Large, diverse, longitudinal samples that extend into adulthood are needed. Data from both animal and human research indicate that aberrant responses to frustration and threat are central to the pathophysiology of irritability, thus affording important translational opportunities