Identifying non‐adult attention‐deficit/hyperactivity disorder individuals using a stacked machine learning algorithm using administrative data population registers in a universal healthcare system

Attention‐deficit hyperactive disorder; Comorbidity; Machine learningTrastorn per dèficit d'atenció amb hiperactivitat; Comorbilitat; Aprenentatge automàticTrastorno por déficit de atención e hiperactividad; Comorbilidad; Aprendizaje automáticoBackground.This research project aims to build a Machine Learning algorithm (ML) to predict first‐time ADHD diagnosis, given that it is the most frequent mental disorder for the non‐adult population.Methods.We used a stacked model combining 4 ML approaches to predict the presence of ADHD. The dataset contains data from population health care administrative registers in Catalonia comprising 1,225,406 non‐adult individuals for 2013–2017, linked to socioeconomic characteristics and dispensed drug consumption. We defined a measure of proper ADHD diagnoses based on medical factors.Results,We obtained an AUC of 79.6% with the stacked model. Significant variables that explain the ADHD presence are the dispersion across patients' visits to healthcare providers; the number of visits, diagnoses related to other mental disorders and drug consumption; age, and sex.Conclusions. ML techniques can help predict ADHD early diagnosis using administrative registers. We must continuously investigate the potential use of ADHD early detection strategies and intervention in the health system.Ministry of Science and Innovation, Grant/ Award Number: PID2021‐124067OB‐C2

El Esquema como organizador de la personalidad y sus trastornos: estudio psicométrico de la adaptación Española del Young Schema Questionnaire-Short Form

El Cuestionario de Esquemas de Young, en su versión reducida (Young Schema Questionnaire-Short Form. Young y Brown, 1999; CEY-VR) es una escala de formato autoinforme que evalúa una taxonomía de 15 esquemas. Está formada por 75 ítems, con 5 ítems para cada esquema que están ordenados de forma aleatoria para evitar el sesgo de tendencia de respuesta. El objetivo general de esta investigación fue el estudio de las propiedades psicométricas de la adaptación española del Cuestionario de Esquemas de Young-Versión Reducida (CEY-VR) en población clínica. La hipótesis general del trabajo fue que la versión española del CEY-VR, aplicada en población clínica, posee una adecuada fiabilidad y validez, equiparables a las diferentes adaptaciones a distintas lenguas. Para conseguir estos objetivos se ha analizado en una muestra de 610 pacientes con diagnóstico clínico de trastorno del Eje I, de trastorno del Eje II o con ambos tipos de trastornos: a) la fiabilidad del instrumento; b) la validez de constructo; c) la validez de criterio, con los criterios clínicos de presencia/ausencia de TP, con las puntuaciones en el inventario de trastornos de la personalidad PDQ-4+, la sensibilidad al cambio y la validez incremental, la validez convergente/discriminante con medidas de personalidad (KSP, SCSR, PANAS,BIS), con medidas de síntomas de psicopatología (BDI-I, SCL-90-R, EAD, ROS y EMCA), con medidas de funcionalismo (HoNOS, EEAG y EEALS), con variables sociodemográficas y con medidas clínicas. Los resultados obtenidos en este estudio son parecidos a los otros estudios publicados con el CEY-VR en muestras clínicas y similares a los de los estudios realizados en nuestro país que utilizan la misma versión aunque sin ordenación aleatoria de los ítems (Cid y Torrubia, 2002). Destacamos de la fiabilidad y validez de constructo que el CEY-VR, ha mostrado unos niveles adecuados de consistencia interna y de estabilidad temporal a las seis semanas. También muestra una estructura interna de 15 factores congruente con la estructura propuesta de 15 esquemas por Young (1990). Por lo que concierne a la estructura factorial de segundo orden, se valida la estructura factorial de cuatro factores propuesta por Lee, Dunn y Taylor (1999) para muestras clínicas. En la validez de criterio concurrente, las puntuaciones en las escalas del CEY-VR se han mostrado capaces de discriminar entre la presencia y la ausencia de un trastorno de la personalidad en muestras clínicas, altamente asociadas con la puntuación total en el PDQ-R+ y sensibles a los criterios de severidad de Tyrer de los TP. Además, proporcionan validez incremental en la clasificación de los trastornos de la personalidad más allá de las variables psicopatológicas (depresión y severidad de síntomas), de los rasgos de personalidad (PANAS) y de otras medidas de TP (PDQ-4+). También se han mostrado sensibles al cambio producido por las intervenciones psicológicas. En lo que concierne a la validez convergente y discriminante, las puntuaciones en el CEY-VR se muestran asociadas de forma elevada o moderada con depresión, síntomas psicopatológicos, actitudes disfuncionales, socialización (en negativo) y género. En cambio, muestran asociaciones bajas con el constructo como la autoestima, el deseo de consumir en pacientes con trastorno por uso de sustancias, la edad, el funcionamiento global y el impacto de los trastornos mentales. En relación a variables de temperamento y personalidad, las escalas del CEY-VR se muestran altamente asociadas con variables internalizantes y se muestran poco asociadas con variables externalizantes. Todo lo anterior nos permite afirmar que los esquemas precoces desadaptativos se perfilan como un constructo relevante y útil para el avance en el estudio y de los trastornos de la personalidad, y que la adaptación española del CEY-VR es un buen instrumento para evaluarlo en población clínica

Capillary Filling at the Microscale : Control of Fluid Front Using Geometry

We propose an experimental and theoretical framework for the study of capillary filling at the micro-scale. Our methodology enables us to control the fluid flow regime so that we can characterise properties of Newtonian fluids such as their viscosity. In particular, we study a viscous, non-inertial, non-Washburn regime in which the position of the fluid front increases linearly with time for the whole duration of the experiment. The operating shear-rate range of our apparatus extends over nearly two orders of magnitude. Further, we analyse the advancement of a fluid front within a microcapillary in a system of two immiscible Newtonian liquids. We observe a non-Washburn regime in which the front can accelerate or decelerate depending on the viscosity contrast between the two liquids. We then propose a theoretical model which enables us to study and explain both non-Washburn regimes. Furthermore, our theoretical model allows us to put forward ways to control the emergence of these regimes by means of geometrical parameters of the experimental set-up. Our methodology allows us to design and calibrate a micro-viscosimetre which works at constant pressure

Heterogeneity in Response to MCT and Psychoeducation: A Feasibility Study Using Latent Class Mixed Models in First-Episode Psychosis

Primer episodi de psicosi; Cognició social; PsicoeducacióFirst episode psychosis; Social cognition; PsychoeducationPrimer episodio de psicosis; Cognición social; PsicoeducaciónMetacognitive training (MCT) is an effective treatment for psychosis. Longitudinal trajectories of treatment response are unknown but could point to strategies to maximize treatment efficacy during the first episodes. This work aims to explore the possible benefit of using latent class mixed models (LCMMs) to understand how treatment response differs between metacognitive training and psychoeducation. We conducted LCMMs in 28 patients that received MCT and 34 patients that received psychoeducation. We found that MCT is effective in improving cognitive insight in all patients but that these effects wane at follow-up. In contrast, psychoeducation does not improve cognitive insight, and may increase self-certainty in a group of patients. These results suggest that LCMMs are valuable tools that can aid in treatment prescription and in predicting response to specific treatmentsThis study was funded by the Instituto de Salud Carlos III, Spanish Government, (PI11/01347, PI14/00044 and PI18/00212); the Fondo Europeo de Desarrollo Regional (FEDER), Health Department of Catalonia, PERIS call (SLT006/17/00231); Progress and Health Foundation of the Andalusian Regional Ministry of Health (PI-0634/2011 and PI-0193/2014); Obra Social La Caixa (RecerCaixa call 2013), Obra Social Sant Joan de Déu, BML (RTI2018-100927-J-I00) administrated by Ministerio de Ciencia e Innovación (MCI, Spain), by the Agencia Estatal de Investigación (AEI, Spain), and by the European Regional Development Fund (FEDER, UE); Daniel Fernández has been supported by grant 2017 SGR 622 (GRBIO) administrated by the Departament d’Economia i Coneixement de la Generalitat de Catalunya (Spain) and by the Ministerio de Ciencia e Innovación (Spain) [PID2019-104830RB-I00/ DOI (AEI): 10.13039/501100011033]; and CIBER, Consorcio Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación

Standard comparison of local mental health care systems in eight European countries

Sistema de Salut Mental; Comparació d'atenció a la salut mentalMental Health System; Mental health care comparisonSistema de Salud Mental; Comparación de atención a la salud mentalAims: There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care in Europe) project. Methods: A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (≥18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS. Results: The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona - Italy and Girona - Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sør-Trøndelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care. Conclusions: There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.The REFINEMENT project has received funding from the European Commission under the Seventh Framework Programme (7FP) and lies within the Specific Programme ‘Cooperation’ – Theme ‘Health’: HEALTH.2010.3.2–1: Financing systems’ effect on quality of health care. Duration: 1 January 2011 to 31 December 2013. 7FP. Project number: 261459

Programa de col·laboració entre l’atenció a la salut mental i les addiccions, i l'atenció primària i comunitària

Salut mental; Addiccions; Atenció primàriaSalud mental; Adicciones; Atención primariaMental health; Addictions; Primary careAquest programa es basa, d’una banda, en el reforç i sistematització del treball conjunt entre els professionals de l’APiC i els de SMiA i, de l’altra, en el desplegament del model esglaonat d’atenció que consisteix en l’atribució de nivells assistencials diferenciats i procediments diagnòstics i terapèutics específics en funció de la gravetat clínica i la complexitat psicosocial de les persones ateses. Aquest model defineix què, qui i com s’atén en els diferents esglaons: promoció de la salut mental, prevenció de trastorns mentals en poblacions de risc, detecció precoç, diagnòstic àgil i tractament més eficient en cada cas

Cognitive insight in first-episode psychosis : changes during Metacognitive Training

Altres ajuts: The project has been funded by the Instituto de Salud Carlos III (Spanish Government); by the Fondo Europeo de Desarrollo Regional (FEDER), Progress and Health Foundation of the Andalusian Regional Ministry of Health, grant PI-0634/2011; Obra Social La Caixa (RecerCaixa call 2013); and Obra Social Sant Joan de Déu (BML).Background: Metacognitive training (MCT) has demonstrated its efficacy in psychosis. However, the effect of each MCT session has not been studied. The aim of the study was to assess changes in cognitive insight after MCT: (a) between baseline, post-treatment, and follow-up; (b) after each session of the MCT controlled for intellectual quotient (IQ) and educational level. Method: A total of 65 patients with first-episode psychosis were included in the MCT group from nine centers of Spain. Patients were assessed at baseline, post-treatment, and 6 months follow-up, as well as after each session of MCT with the Beck Cognitive Insight Scale (BCIS). The BCIS contains two subscales: self-reflectiveness and self-certainty, and the Composite Index. Statistical analysis was performed using linear mixed models with repeated measures at different time points. Results: Self-certainty decreased significantly (p = 0.03) over time and the effect of IQ was negative and significant (p = 0.02). From session 4 to session 8, all sessions improved cognitive insight by significantly reducing self-certainty and the Composite Index. Conclusions: MCT intervention appears to have beneficial effects on cognitive insight by reducing self-certainty, especially after four sessions. Moreover, a minimum IQ is required to ensure benefits from MCT group intervention

Are There Gender Differences in Social Cognition in First-Episode Psychosis?

Altres ajuts: This research was funded by the Instituto de Salud Carlos III (Spanish Government, PI11/01347, PI14/00044, and PI18/00212) by the Fondo Europeo de Desarrollo Regional (FEDER), Health Department of Catalonia, PERIS call (SLT006/17/00231), Progress and Health Foundation of the Andalusian Regional Ministry of Health, grant PI-0634/2011 and PI-0193/ 2014, Obra Social La Caixa (RecerCaixa call 2013), CERCA Programme/Generalitat de Catalunya, Obra Social Sant Joan de Déu (BML) and by FI19/00062 (Ayudas para la contratación de personal predoctoral, Luciana Díaz-Cutraro is a beneficiary of a Predoctoral Training Grant in Health Research).The aim of this study was to explore gender differences in social cognition in a sample of first-episode psychosis (FEP). An observational descriptive study was performed with 191 individuals with FEP. Emotion perception was assessed using the Faces Test, theory of mind was assessed using the Hinting Task, and attributional style was assessed using the Internal, Personal and Situational Attributions Questionnaire. No gender differences were found in any of the social cognitive domains. Our results suggest that men and women with FEP achieve similar performances in social cognition. Therefore, targeting specific needs in social cognition regarding gender may not be required in early interventions for psychosis

Influence of Menstrual Cycle Length and Age at Menarche on Symptoms, Cognition, Social Cognition, and Metacognition in Patients with First-Episode Psychosis

Altres ajuts: PERIS call (grant no. SLT006/17/00231); the Progress and Health Foundation of the Andalusian Regional Ministry of Health (grant no. PI-0634/2011 and PI-0193/2014); Obra Social La Caixa (RecerCaixa call 2013); CERCA Programme/Generalitat de Catalunya; Obra Social Sant Joan de Déu (BML); and FI19/00062 (Ayudas para la Contratación de Personal Predoctoral).A protective effect has traditionally been attributed to estrogen in psychotic disorders. The aim of this study was to investigate cumulative lifetime estrogen by assessing the menstrual cycle length, age at menarche, and years of difference between the onset of psychotic symptoms and the age of menarche, measuring their effects on symptoms, cognition, social cognition, and metacognition. As it was not possible to directly measure cumulative estrogen levels over the lifetime of a patient, the study sample was composed of 42 women with first-episode psychosis; estrogen levels were inferred by the menstrual cycle length, age at menarche, and years of difference between the onset of psychotic symptoms and menarche. All patients were assessed with a battery of questionnaires using the BDI, PSYRATS, PANSS, STROOP, TAVEC, WSCT, IPSAQ, and BCIS questionnaires. The results related to menstrual cycle length showed a relationship with memory; specifically, shorter cycles with semantic strategies (p = 0.046) and longer cycles with serial strategies in the short term (p = 0.005) as well as in the long term (p = 0.031). The results also showed a relationship with perseverative errors (p = 0.035) and self-certainty (p = 0.049). Only personalized bias (p = 0.030) was found to be significant in relation to the age at menarche. When analyzing the differences in years of difference between the age at menarche and the onset of psychotic symptoms, the results indicated lower scores in women with a smaller difference between both events in memory (short-term (p = 0.050), long-term (p = 0.024), intrusions (p = 0.013), and recognition (p = 0.043)) and non-perseverative errors (p = 0.024). No relationship was found between symptoms and menstrual characteristics. The investigatory outcomes seem to indicate a relationship between estrogen cumulative effects and the memory domain. More in-depth investigations in the field are necessary in order to improve personalized treatment in women with psychosis