Natural language processing to extract symptoms of severe mental illness from clinical text: the Clinical Record Interactive Search Comprehensive Data Extraction (CRIS-CODE) project.

OBJECTIVES: We sought to use natural language processing to develop a suite of language models to capture key symptoms of severe mental illness (SMI) from clinical text, to facilitate the secondary use of mental healthcare data in research. DESIGN: Development and validation of information extraction applications for ascertaining symptoms of SMI in routine mental health records using the Clinical Record Interactive Search (CRIS) data resource; description of their distribution in a corpus of discharge summaries. SETTING: Electronic records from a large mental healthcare provider serving a geographic catchment of 1.2 million residents in four boroughs of south London, UK. PARTICIPANTS: The distribution of derived symptoms was described in 23 128 discharge summaries from 7962 patients who had received an SMI diagnosis, and 13 496 discharge summaries from 7575 patients who had received a non-SMI diagnosis. OUTCOME MEASURES: Fifty SMI symptoms were identified by a team of psychiatrists for extraction based on salience and linguistic consistency in records, broadly categorised under positive, negative, disorganisation, manic and catatonic subgroups. Text models for each symptom were generated using the TextHunter tool and the CRIS database. RESULTS: We extracted data for 46 symptoms with a median F1 score of 0.88. Four symptom models performed poorly and were excluded. From the corpus of discharge summaries, it was possible to extract symptomatology in 87% of patients with SMI and 60% of patients with non-SMI diagnosis. CONCLUSIONS: This work demonstrates the possibility of automatically extracting a broad range of SMI symptoms from English text discharge summaries for patients with an SMI diagnosis. Descriptive data also indicated that most symptoms cut across diagnoses, rather than being restricted to particular groups

The Double-edged Sword: A Mixed Methods Study of the Interplay between Bipolar Disorder and Technology Use

Human behavior is increasingly reflected or acted out through technology. This is of particular salience when it comes to changes in behavior associated with serious mental illnesses including schizophrenia and bipolar disorder. Early detection is crucial for these conditions but presently very challenging to achieve. Potentially, characteristics of these conditions\u27 traits and symptoms, at both idiosyncratic and collective levels, may be detectable through technology use patterns. In bipolar disorder specifically, initial evidence associates changes in mood with changes in technology-mediated communication patterns. However much less is known about how people with bipolar disorder use technology more generally in their lives, how they view their technology use in relation to their illness, and, perhaps most crucially, the causal relationship (if any exists) between their technology use and their disease. To address these uncertainties, we conducted a survey of people with bipolar disorder (N = 84). Our results indicate that technology use varies markedly with changes in mood and that technology use broadly may have potential as an early warning signal of mood episodes. We also find that technology for many of these participants is a double-edged sword: acting as both a culprit that can trigger or exacerbate symptoms as well as a support mechanism for recovery. These findings have implications for the design of both early warning systems and technology-mediated interventions

Mobile early detection and connected intervention to coproduce better care in severe mental illness

Current approaches to the management of severe mentalillness have four major limitations: 1) symptom reporting isintermittent and subject to problems with reliability; 2) serviceusers report feelings of disengagement from their careplanning; 3) late detection of symptoms delay interventionsand increase the risk of relapse; and 4) care systems are heldback by the costs of unscheduled hospital admissions thatcould have been avoided with earlier detection andintervention. The ClinTouch system was developed to close theloop between service users and health professionals.ClinTouch is an end-to-end secure platform, providing avalidated mobile assessment technology, a web interface toview symptom data and a clinical algorithm to detect risk ofrelapse. ClinTouch integrates high-resolution, continuouslongitudinal symptom data into mental health care servicesand presents it in a form that is easy to use for targeting carewhere it is needed. The architecture and methodology can beeasily extended to other clinical domains, where the paradigmof targeted clinical interventions, triggered by the earlydetection of decline, can improve health outcomes

Psychological interventions for amotivation and possible selves in psychosis

Background This portfolio contains a systematic review and two empirical projects in the clinical field of psychosis. The aim of the systematic review was to narratively synthesise the effectiveness of psychological treatments for amotivation as a key negative symptom. The first empirical project aimed to explore possible selves theory with regards to individuals with psychosis and significant functional difficulties, as a possible motivational factor influencing functional recovery. The second empirical project aimed to explore whether Social Recovery Cognitive Behavioural Therapy (SRCBT) had an impact on possible selves and whether any change mediated functional recovery. Methods The systematic review included all psychological and psychosocial interventions for amotivation in psychosis, with focus on the most reliable measures of amotivation. The empirical projects included secondary analyses of data collected from the Improving Social Recovery in Psychosis project, where 77 individuals with psychosis and particularly low functioning were recruited. Results In the systematic review, conclusions regarding efficacy of interventions could not be drawn, due to the limited number of studies and mixed results. In the first empirical paper, Possible selves in people with psychosis and particularly poor functioning were found to have low specificity, balance and enmeshment, but relatively high optimism. Possible selves were not associated with functional outcomes in this population. Equally, in the second empirical paper, SRCBT was not found to have an impact on possible selves. Conclusions Ongoing research is required to explore novel treatments for amotivation in psychosis, particularly utilising outcome measures which give sufficient weight to amotivation as a construct. Whilst motivational theories suggest that possible selves were an important motivational construct impacting on functioning, perhaps change in possible selves is not necessary for behaviour change to occur. Future research is implicated with regards to whether possible selves are subject to change once behavioural changes are consolidated following therapy

Face Your Fears: Virtual reality-based cognitive behavioral therapy (VR-CBT) versus standard CBT for paranoid ideations in patients with schizophrenia spectrum disorders:a randomized clinical trial

Background: Schizophrenia spectrum disorders cause suffering for patients, relatives, and the surrounding society. Paranoid ideations, encompassing ideas of social reference and manifest persecutory delusions, are among the most frequent symptoms in this population and a cause of significant distress. Recent meta-analyses of cognitive behavioral therapy (CBT) for psychosis show small to moderate effect sizes in reducing paranoid ideations. Virtual reality-based CBT (VR-CBT) could improve therapy efficacy as exposure and behavioral experiments in VR can be optimized, individualized, and carried out in a safe environment. Few VR-CBT studies exist for paranoid ideations and there is a need for large-scale, methodologically rigorous trials. Methods: This study is a randomized, assessor-blinded parallel-groups multi-center superiority clinical trial, fulfilling the CONSORT criteria for non-pharmacological treatment. A total of 256 patients diagnosed with schizophrenia spectrum disorder, including schizotypal disorder (ICD-10 F20-29), will be allocated to either 10 sessions of symptom-specific CBT-VR plus treatment as usual-versus 10 sessions of standard symptom-specific CBT for paranoid ideations (CBT) plus treatment as usual. All participants will be assessed at baseline, treatment end (3 months post baseline), and then 9 months post baseline. A stratified block-randomization with concealed randomization sequence will be conducted. Independent assessors blinded to the treatment will evaluate the outcome. Analysis of outcome will be carried out with the intention to treat principles. The primary outcome is ideas of social reference measured with Green Paranoid Thought Scale Part A (GPTS-A) at the cessation of treatment at 3 months post baseline. Secondary outcomes are ideas of persecution (GPTS-B), Social Interaction Anxiety Scale (SIAS), Personal and Social Performance scale (PSP), Safety Behavior Questionnaire (SBQ), and CANTAB Emotion Recognition Task. Discussion: The trial will elucidate whether VR-CBT can enhance therapy efficacy for paranoid ideations. Additionally, Trial findings will provide evidence on the effectiveness and cost-effectiveness of VR-CBT for paranoid ideations that can guide the possible dissemination and implementation into clinical practice

Treatment in Schizophrenia: factors for adherence

Esta revisão narrativa analisa a atual evidência científica sobre os fatores relacionados com a adesão à terapêutica na esquizofrenia. Para a pesquisa bibliográfica foi utilizada a base de dados PubMed e selecionados artigos sobre preditores de adesão aos antipsicóticos na esquizofrenia, publicados entre 2009 e 2019 e escritos em inglês ou português. Os fatores de adesão têm sido subdivididos em 4 categorias: fatores relacionados com a doença, com o doente, com a medicação e com o contexto existencial. Fatores associados de forma consistente a má adesão à terapêutica incluem pobreza, elevada sintomatologia, níveis elevados de hostilidade, baixo insight, abuso de substâncias, atitudes negativas em relação à medicação e efeitos laterais dos antipsicóticos. Por outro lado, variáveis como disfunção neurocognitiva, tipo de antipsicótico utilizado, apoio social e parâmetros demográficos demonstraram resultados contraditórios. Variáveis que se associam de forma consistente a má adesão à terapêutica devem ser avaliadas na prática clínica e implementadas estratégias para as corrigir ou atenuar. Uma vez que foram encontrados resultados contraditórios em relação a múltiplas variáveis, investigação futura deve ter como objetivo identificar preditores de adesão que sejam úteis ao clínico, permitindo-lhe maximizar os benefícios do tratamento na sua população alvo.This narrative review analyzes the existing scientific evidence on factors related to medication adherence in schizophrenia. Using PubMed as the database, a research was conducted targeting articles published between 2009 and 2019, written in English or Portuguese, about predictors of antipsychotic compliance in schizophrenia. Factors affecting adherence have been generally subdivided into 4 categories: disease-related, patient-related, medication-related and environmental-related. Factors which were found to be consistently associated with poor adherence include poverty, high symptom burden, high levels of hostility, poor insight, presence of substance abuse, negative attitudes toward medication and antipsychotic side-effects. On the other hand, variables such as neurocognitive dysfunction, type of antipsychotic, social support and demographic parameters often yielded contradictory results. Variables consistently associated with non-adherence should be assessed in clinical practice and strategies put in place to correct them or dampen their effect. Since conflicting results are often found regarding several studied variables, future research should aim at identifying further predictors of adherence in order to better guide clinicians and maximize the patient's benefit of treatment

A randomised controlled trial of the clinical and cost-effectiveness of a contingency management intervention for reduction of cannabis use and of relapse in early psychosis (CIRCLE): a study protocol for a randomised controlled trial

Background: Around 35–45 % of people in contact with services for a first episode of psychosis are using cannabis. Cannabis use is associated with delays in remission, poorer clinical outcomes, significant increases in the risk of relapse, and lower engagement in work or education. While there is a clear need for effective interventions, so far only very limited benefits have been achieved from psychological interventions. Contingency management (CM) is a behavioural intervention in which specified desired behavioural change is reinforced through financial rewards. CM is now recognised to have a substantial evidence base in some contexts and its adoption in the UK is advocated by the National Institute for Health and Care Excellence (NICE) guidance as a treatment for substance or alcohol misuse. However, there is currently little published data testing its effectiveness for reducing cannabis use in early psychosis. Methods: CIRCLE is a two-arm, rater-blinded randomised controlled trial (RCT) investigating the clinical and cost-effectiveness of a CM intervention for reducing cannabis use among young people receiving treatment from UK Early Intervention in Psychosis (EIP) services. EIP service users (n = 544) with a recent history of cannabis use will be recruited. The experimental group will receive 12 once-weekly CM sessions, and a voucher reward if urinalysis shows that they have not used cannabis in the previous week. Both the experimental and the control groups will be offered an Optimised Treatment as Usual (OTAU) psychoeducational package targeting cannabis use. Assessment interviews will be performed at consent, at 3 months, and at 18 months. The primary outcome is time to relapse, defined as admission to an acute mental health service. Secondary outcomes include proportion of cannabis-free urine samples during the intervention period, severity of positive psychotic symptoms, quality-adjusted life years, and engagement in work or education. Discussion: CIRCLE is a RCT of CM for cannabis use in young people with a recent history of psychosis (EIP service users) and recent cannabis use. It is designed to investigate whether the intervention is a clinically and cost-effective treatment for cannabis use. It is intended to inform future treatment delivery, particularly in EIP settings

Assessing the effectiveness and cost-effectiveness of a solution-focused resource-orientated approach (DIALOG+) to improving the quality of life for people with psychosis in India and Pakistan—a cluster RCT

Background: Severe mental illness (SMI) presents a major challenge worldwide, affecting approximately 5–8% of the world’s population. It causes significant distress to affected people, families and wider communities, generating high costs through loss of productivity and ongoing healthcare use. Over 75% of patients with psychosis receive inadequate care and experience a negative financial impact and reduced quality of life (QoL). It is therefore a priority to reduce the treatment gap by providing low-cost, effective interventions for people with psychosis. Our research project, PIECEs, is designed to explore, adapt and test a low-cost, approach (DIALOG+) that makes use of existing resources to improve community-based care for patients with psychosis. The research will be conducted in two urban sites: Karachi, Pakistan and Chennai, India. DIALOG+ is a novel, technology-assisted and resource-oriented intervention, based on QoL research, concepts of patient-centred communication, IT developments and solution-focused therapy. However, the approach has not been rigorously tested within India and Pakistan. Our randomised controlled trial (RCT) aims to test the effectiveness and cost-effectiveness of DIALOG+ in improving the QoL and clinical outcomes for individuals with long-term psychosis being treated in the community in India and Pakistan. Methods: To assess the acceptability, feasibility, and cost effectiveness of DIALOG+, we will conduct a cluster RCT with 210 patients and 14 clinicians in each country. The intervention will be used during a routine interaction between a clinician and a patient. It consists of a patient-centred assessment (the DIALOG scale) whereby the clinician invites the patient to rate their satisfaction with different life domains and treatment aspects, which forms the active control group. The intervention group will follow this up with a four-step solution-focused approach to identify the patient’s resources and develop solutions to deal with the patient's concerns (DIALOG+). Discussion: If shown to be effective DIALOG+ has the potential to improve community-based care and the QoL for millions of people within India and Pakistan who experience psychosis. Trial registration: The trial was registered prospectively on the ISRCTN Registry: ISRCTN13022816 on 9 February 2022

Report on methods of safety signal generation in paediatrics from pharmacovigilance databases

This deliverable is based on the need to develop and test methods for safety signal detection in children. Signal detection is the mainstay of detecting safety issues, but so far very few groups have specifically looked at children. We developed reference sets for positive and negative drugevent combinations and vaccine-event combinations by a systematic literature review on all combinations. We retrieved the FDA AERS database, the CDC VAERS database and EUDRAVIGILANCE database. In order to analyse the datasets we had a stepwise approach from extraction of data, cleaning (e.g. mapping MedDRA and ATC codes) and transformation into a a common data model that we defined for the spontaneous reporting databases. A statistical analysis plan was created for the testing of methods and we provided some descriptive analyses of the FAERS data. Next steps will be to complete the analyses