Prediction of Suicide-Related Events by Analyzing Electronic Medical Records from PTSD Patients with Bipolar Disorder

Around 800,000 people worldwide die from suicide every year and it’s the 10th leading cause of death in the US. It is of great value to build a mathematic model that can accurately predict suicide especially in high-risk populations. Several different ML-based models were trained and evaluated using features obtained from electronic medical records (EMRs). The contribution of each feature was calculated to determine how it impacted the model predictions. The best-performing model was selected for analysis and decomposition. Random forest showed the best performance with true positive rates (TPR) and positive predictive values (PPV) of greater than 80%. The use of Aripiprazole, Levomilnacipran, Sertraline, Tramadol, Fentanyl, or Fluoxetine, a diagnosis of autistic disorder, schizophrenic disorder, or substance use disorder at the time of a diagnosis of both PTSD and bipolar disorder, were strong indicators for no SREs within one year. The use of Trazodone and Citalopram at baseline predicted the onset of SREs within one year. Additional features with potential protective or hazardous effects for SREs were identified by the model. We constructed an ML-based model that was successful in identifying patients in a subpopulation at high-risk for SREs within a year of diagnosis of both PTSD and bipolar disorder. The model also provides feature decompositions to guide mechanism studies. The validation of this model with additional EMR datasets will be of great value in resource allocation and clinical decision making

Applicability, Internal Structure, and basic Patterns of a Multicultural Brief Quality of Life Measure in a Sample of Psychiatric Patients with Comorbid Substance Use Disorders

Background: The measurement of quality of life as estimate of well being is assuming increasing importance in the evaluation of health and treatment efficacy. Objectives: The aim of this study is to evaluate the applicability, internal structure and clinical patterns of the Multicultural Quality of Life Index (MQLI), a brief, self-rated, culturally informed, quality of life scale, in patients experiencing comorbid psychiatric and substance use disorders. Methods: Sixty-two consecutively admitted outpatients completed the MQLI. With this data, the applicability, internal consistency, factorial structure, and prediction of treatment adherence over a three-month period were assessed. Results: It was found that the MQLI was easy to administer. It had good internal consistency (Cronbach’s alpha 0.89). Factor analysis revealed that the first factor explained 53% of the variance, indicating the unidimensionality of the instrument around quality of life. Two MQLI items, interpersonal functioning and the availability of supports, significantly predicted treatment adherence. Conclusions: The MQLI is easy to use, it has a coherent structure, and is clinically useful in psychiatric patients with comorbid substance use disorders

Impact of DSM-III Axis III on the Diagnosis of Physical Disorders in Ambulatory Psychiatric Patients

In the present study, the effectiveness and utility of DSM-III axis III in terms of adequate identification of physical disorders in psychiatric outpatients is appraised empirically. To this effect, the presence of physical disorders in diagnostic statements recorded in clinical charts is compared in a large medical center for two psychiatric outpatient samples, one from the nonmultiaxial DSM-II era and one after the implementation of the multiaxial DSM-III. In the earlier sample, 11% of the patients were diagnosed as having physical disorders. In the DSM-III sample, 42% of the patients were so diagnosed. The latter figure is consistent with the 40% average prevalence of physical disorders reported in careful studies of the physical condition of ambulatory psychiatric patients.—J Nerv Ment Dis 183:711–714, 199

Monte carlo studies in item response theory

Monte carlo studies are being used in item response theory (IRT) to provide information about how validly these methods can be applied to realistic datasets (e.g., small numbers of examinees and multidimensional data). This paper describes the conditions under which monte carlo studies are appropriate in IRT-based research, the kinds of problems these techniques have been applied to, available computer programs for generating item responses and estimating item and examinee parameters, and the importance of conceptualizing these studies as statistical sampling experiments that should be subject to the same principles of experimental design and data analysis that pertain to empirical studies. The number of replications that should be used in these studies is also addressed. Index terms: analysis of variance, experimental design, item response theory, monte carlo techniques, multiple regression

Conceptualization and Metrics in Person Centered Medicine

Since the inception of Person Centered Medicine (PCM) as a programmatic movement, one could find the articulation of science and humanism as a core concept. This revealed a prominent concern for conceptual clarity, illustratively to formulate humanism as the essence of medicine as well as to engage the scientific method as an essential tool. An ongoing scientific effort in PCM involves systematic conceptualization. Another one, reflecting concern for precision in description and prediction, looks at metrics and measurement in its various forms and levels. These two lines of work are outlined below

Multivariate comparison of male and female adolescent substance abusers with accompanying legal problems

Purpose The factors that distinguish adolescent male and female substance abusers with and without legal problems were investigated.Method Youths (N = 4,071) admitted for substance abuse treatment were administered the revised Drug Use Screening Inventory (DUSI-R) to measure severity of health, behavior, and social adjustment problems.Results Legal problems were more frequent among boys; however, severity of disturbance was greater in girls on 9 of 10 scales. Substance abusing girls and boys with legal problems reported more severe behavior, substance abuse, family adjustment, and peer relationship problems than substance abusing peers without legal problems. Quality of peer relationship mediated the association of family dysfunction, substance abuse and behavior problems with legal problems in boys only.Conclusions Gender and legal status both need to be taken into account to potentiate treatment prognosis of substance abusing youths.

Concurrent alcohol and cocaine dependence impact on physical health among psychiatric patients

The aim of this study was to examine the association between active, concomitant cocaine and alcohol dependence and the prevalence and patterns of comorbid physical disorders in a sample of substance abusing hospitalized psychiatric patients. Three groups of patients (concomitant cocaine and alcohol dependence (AD + CD) (N = 38), alcohol dependence (AD) only (N = 38), and cocaine dependence (CD) only (N = 25)) consecutively admitted to a psychiatric-substance abuse dual diagnosis unit were comparatively examined for the frequency of comorbid physical disorders diagnoses, including viral hepatitis, sexually transmitted diseases, and on liver function tests and electrocardiographic abnormalities. The results indicated that the concomitant alcohol and cocaine dependence group had higher rates of multiple physical disorders and also of multiple hepatitis infections than either the alcohol-only or the cocaine-only groups

Depressive and Anxiety Symptoms Predict Obsessive and Compulsive Cravings Among Depressed Alcoholics

OBJECTIVES:Alcohol craving is often associated with mood symptoms and predicts alcohol use in individuals with alcohol dependence. However, little is known about the impact of mood symptoms on alcohol craving in comorbid mood disorders and alcohol dependence. This study examines the predictive value of depressive and anxiety symptoms for obsessive and compulsive aspects of alcohol craving in adults with comorbid major depressive disorder (MDD) and alcohol dependence. MATERIALS AND METHODS:Fifty-five adults [47% female; mean age of 39.35 (SD=8.80)] with Diagnostic and Statistical Manual for Mental Disorders-4th edition diagnoses of comorbid MDD and alcohol dependence were prospectively assessed over a 6-month period. They completed the Hamilton Rating Scales for Depression and Anxiety, the Alcohol Timeline Followback, the Obsessive-Compulsive Drinking Scale (OCDS), the Alcohol Dependence Scale (ADS), and the Addiction Severity Index (ASI). The linear mixed model analyses for repeated measures was used to test whether depressive and anxiety symptoms predict OCDS subscale scores. RESULTS:Depressive and anxiety symptoms were strongly associated with obsessive and compulsive subscales of the OCDS. Baseline ASI-alcohol scores were associated with both the obsessive and compulsive and with the obsessive subscale scores in the predictive model including depressive symptoms, and that including anxiety symptoms, respectively. CONCLUSIONS:Results suggest that depressive and anxiety symptoms predict obsessive and compulsive aspects of alcohol craving in adults with comorbid MDD and alcohol dependence. Assessing the severity of depressive and anxiety symptoms and alcohol use in this population may identify those more likely to experience intense alcohol craving states and at increased risk of relapse