107 research outputs found
Risk Assessment Tools and Data-Driven Approaches for Predicting and Preventing Suicidal Behavior
Risk assessment of suicidal behavior is a time-consuming but notoriously inaccurate activity for mental health services globally. In the last 50 years a large number of tools have
been designed for suicide risk assessment, and tested in a wide variety of populations, but studies show that these tools suffer from low positive predictive values. More recently, advances in research fields such as machine learning and natural language processing applied on large datasets have shown promising results for health care, and may enable an important shift in advancing precision medicine. In this conceptual review, we discuss established risk assessment tools and examples of novel data-driven approaches that have been used for identification of suicidal behavior and risk. We provide a perspective on the strengths and weaknesses of these applications to mental health-related data, and suggest research directions to enable improvement in clinical practice
Combining mobile-health (mHealth) and artificial intelligence (AI) methods to avoid suicide attempts: the Smartcrises study protocol
The screening of digital footprint for clinical purposes relies on the capacity of wearable technologies
to collect data and extract relevant informationâs for patient management. Artificial intelligence (AI) techniques
allow processing of real-time observational information and continuously learning from data to build
understanding. We designed a system able to get clinical sense from digital footprints based on the smartphoneâs
native sensors and advanced machine learning and signal processing techniques in order to identify suicide risk.
Method/design: The Smartcrisis study is a cross-national comparative study. The study goal is to determine the
relationship between suicide risk and changes in sleep quality and disturbed appetite. Outpatients from the
Hospital FundaciĂłn JimĂ©nez DĂaz Psychiatry Department (Madrid, Spain) and the University Hospital of Nimes
(France) will be proposed to participate to the study. Two smartphone applications and a wearable armband will
be used to capture the data. In the intervention group, a smartphone application (MEmind) will allow for the
ecological momentary assessment (EMA) data capture related with sleep, appetite and suicide ideations.
Discussion: Some concerns regarding data security might be raised. Our system complies with the highest level of
security regarding patientsâ data. Several important ethical considerations related to EMA method must also be
considered. EMA methods entails a non-negligible time commitment on behalf of the participants. EMA rely on
daily, or sometimes more frequent, Smartphone notifications. Furthermore, recording participantsâ daily experiences
in a continuous manner is an integral part of EMA. This approach may be significantly more than asking a
participant to complete a retrospective questionnaire but also more accurate in terms of symptoms monitoring.
Overall, we believe that Smartcrises could participate to a paradigm shift from the traditional identification of risks
factors to personalized prevention strategies tailored to characteristics for each patientThis study was partly funded by FundaciĂłn JimĂ©nez DĂaz Hospital, Instituto
de Salud Carlos III (PI16/01852), DelegaciĂłn del Gobierno para el Plan
Nacional de Drogas (20151073), American Foundation for Suicide Prevention
(AFSP) (LSRG-1-005-16), the Madrid Regional Government (B2017/BMD-3740
AGES-CM 2CM; Y2018/TCS-4705 PRACTICO-CM) and Structural Funds of the
European Union. MINECO/FEDER (âADVENTUREâ, id. TEC2015â69868-C2â1-R)
and MCIU Explora Grant âaMBITIONâ (id. TEC2017â92552-EXP), the French Embassy
in Madrid, Spain, The foundation de lâavenir, and the Fondation de
France. The work of D. RamĂrez and A. ArtĂ©s-RodrĂguez has been partly supported
by Ministerio de EconomĂa of Spain under projects: OTOSIS
(TEC2013â41718-R), AID (TEC2014â62194-EXP) and the COMONSENS Network
(TEC2015â69648-REDC), by the Ministerio de EconomĂa of Spain jointly with
the European Commission (ERDF) under projects ADVENTURE (TEC2015â
69868-C2â1-R) and CAIMAN (TEC2017â86921-C2â2-R), and by the Comunidad
de Madrid under project CASI-CAM-CM (S2013/ICE-2845). The work of P.
Moreno-Muñoz has been supported by FPI grant BES-2016-07762
Horror Vacui: Emptiness Might Distinguish between Major Suicide Repeaters and Nonmajor Suicide Repeaters: A Pilot Study
This Letter to the Editor is brought to you for free and open access by the Psychiatry at UKnowledge. It has been accepted for inclusion in Psychiatr
Coprophagia in a patient with borderline personality disorder
Background and Objectives: Human coprophagia is a rare phenomenon
with severe medical and social consequences. So far, coprophagia has mainly been associated
with severe mental retardation, schizophrenia, dementia, and depression. We report a case
of coprophagia in a 30-year-old woman with Borderline Personality Disorder (DSM-IV).
This case report illustrates the severity of symptoms and maladaptive social consequences of
severe personality disorders, comparable to those of patients with schizophrenia. Pharmacological
interventions and, particularly intensive psychotherapy might be effective for patients
diagnosed with borderline personality disorder displaying severe behavior disorders.
The treatment of choice for coprophagia is aversive behavioral interventionThis study was funded in part by the National Alliance for Research on Schizophrenia
and Affective Disorders (NARSAD), Fondo de InvestigaciĂłn Sanitaria (FIS) [grant number
PI060092]; Fondo de InvestigaciĂłn Sanitaria FIS [grant number RD06/0011/0016]; ETES
[grant number PI07/90207]; the Conchita Rabago Foundation, the Harriet and Esteban
Vicente Foundation, the Spanish Ministry of Health, Instituto de Salud Carlos III, CIBERSAM (Intramural Project, P91B; Rio Hortega CM08/00170 âDr. Hilario Blasco-Fontecilla), the Alicia Koplowitz foundation, and the National Institutes of Health, USA [grant number K24MH072712
Can the Holmes-Rahe Social Readjustment Rating Scale (SRRS) Be Used as a Suicide Risk Scale? An Exploratory Study
The objective of this research was to examine whether the Holmes-Rahe Social Readjustment Rating Scale, a life event scale, can be used to identify suicide attempters. The Holmes-Rahe Social Readjustment Rating Scale\u27s ability to identify suicide attempters was tested in 1183 subjects (478 suicide attempters, 197 psychiatric inpatients, and 508 healthy controls) using the Fisher Linear Discriminant Analysis and traditional psychometric methods. The Fisher Linear Discriminant Analysis outperformed traditional psychometric approaches (area under the curve: 0.85 vs. 0.78; p \u3c 0.05) and indicated that this scale may be used to identify suicide attempters. The life events that better characterized suicide attempters were change in frequency of arguments, marital separation, and personal injury. The Holmes-Rahe Social Readjustment Rating Scale may help identify suicide attempters
Personality Disorders and Health Problems Distinguish Suicide Attempters from Completers in a Direct Comparison
Background
Whether suicide attempters and completers represent the same population evaluated at different points along a progression towards suicide death, overlapping populations, or completely different populations is a problem still unresolved.
Methods
446 Adult suicide attempters and knowledgeable collateral informants for 190 adult suicide probands were interviewed. Sociodemographic and clinical data was collected for both groups using semi-structured interviews and structured assessments. Univariate analyses and logistic regression models were conducted to explore the similarities and differences between suicide attempters and completers.
Results
Univariate analyses yielded significant differences in sociodemographics, recent life events, impulsivity, suicide intent, and distribution of Axis I and II disorders. A logistic regression model aimed at distinguishing suicide completers from attempters properly classified 90% of subjects. The most significant variables that distinguished suicide from attempted suicide were the presence of narcissistic personality disorder (OR=21.4; 95% CI=6.8â67.7), health problems (OR=20.6; 95% CI=5.6â75.9), male sex (OR=9.6; 95% CI=4.42â20.9), and alcohol abuse (OR=5.5; 95% CI=2.3â14.2).
Limitations
Our study shares the limitations of studies comparing suicide attempters and completers, namely that information from attempters can be obtained from the subject himself, whereas the assessment of completers depends on information from close family or friends. Furthermore, different semi-structured instruments assessed Axis I and Axis II disorders in suicide attempters and completers. Finally, we have no data on inter-rater reliability data.
Conclusions
Suicide completers are more likely to be male and suffer from alcohol abuse, health problems (e.g. somatic illness), and narcissistic personality disorder. The findings emphasize the importance of implementing suicide prevention programs tailored to suicide attempters and completers
Stability of childhood anxiety disorder diagnoses: a follow-up naturalistic study in psychiatric care
Few studies have examined the stability of major psychiatric disorders in pediatric psychiatric clinical populations. The objective of this study was to examine the long-term stability of anxiety diagnoses starting with pre-school age children through adolescence evaluated at multiple time points. Prospective cohort study was conducted of all children and adolescents receiving psychiatric care at all pediatric psychiatric clinics belonging to two catchment areas in Madrid, Spain, between 1 January, 1992 and 30 April, 2006. Patients were selected from among 24,163 children and adolescents who received psychiatric care. Patients had to have a diagnosis of an ICD-10 anxiety disorder during at least one of the consultations and had to have received psychiatric care for the anxiety disorder. We grouped anxiety disorder diagnoses according to the following categories: phobic disorders, social anxiety disorders, obsessiveâcompulsive disorder (OCD), stress-related disorders, and "other" anxiety disorders which, among others, included generalized anxiety disorder, and panic disorder. Complementary indices of diagnostic stability were calculated. As much as 1,869 subjects were included and had 27,945 psychiatric/ psychological consultations. The stability of all ICD-10 anxiety disorder categories studied was high regardless of the measure of diagnostic stability used. Phobic and social anxiety disorders showed the highest diagnostic stability, whereas OCD and "other" anxiety disorders showed the lowest diagnostic stability. No significant sex differences were observed on the diagnostic stability of the anxiety disorder categories studied. Diagnostic stability measures for phobic, social anxiety, and "other" anxiety disorder diagnoses varied depending on the age at first evaluation. In this clinical pediatric outpatient sample it appears that phobic, social anxiety, and stress-related disorder diagnoses in children and adolescents treated in community outpatient services may have high diagnostic stability
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Development of a Web-Based Clinical Decision Support System for Drug Prescription: ...
Purpose
The emergence of electronic prescribing devices with clinical decision support systems (CDSS) is able to significantly improve management pharmacological treatments. We developed a web application available on smartphones in order to help clinicians monitor prescription and further propose CDSS.
Method
A web application (www.MEmind.net) was developed to assess patients and collect data regarding gender, age, diagnosis and treatment. We analyzed antipsychotic prescriptions in 4345 patients attended in five Psychiatric Community Mental Health Centers from June 2014 to October 2014. The web-application reported average daily dose prescribed for antipsychotics, prescribed daily dose (PDD), and the PDD to defined daily dose (DDD) ratio.
Results
The MEmind web-application reported that antipsychotics were used in 1116 patients out of the total sample, mostly in 486 (44%) patients with schizophrenia related disorders but also in other diagnoses. Second generation antipsychotics (quetiapine, aripiprazole and long-acting paliperidone) were preferably employed. Low doses were more frequently used than high doses. Long acting paliperidone and ziprasidone however, were the only two antipsychotics used at excessive dosing. Antipsychotic polypharmacy was used in 287 (26%) patients with classic depot drugs, clotiapine, amisulpride and clozapine.
Conclusions
In this study we describe the first step of the development of a web application that is able to make polypharmacy, high dose usage and off label usage of antipsychotics visible to clinicians. Current development of the MEmind web application may help to improve prescription security via momentary feedback of prescription and clinical decision support system
Recommended from our members
Development of a Web-Based Clinical Decision Support System for Drug Prescription: ...
Purpose
The emergence of electronic prescribing devices with clinical decision support systems (CDSS) is able to significantly improve management pharmacological treatments. We developed a web application available on smartphones in order to help clinicians monitor prescription and further propose CDSS.
Method
A web application (www.MEmind.net) was developed to assess patients and collect data regarding gender, age, diagnosis and treatment. We analyzed antipsychotic prescriptions in 4345 patients attended in five Psychiatric Community Mental Health Centers from June 2014 to October 2014. The web-application reported average daily dose prescribed for antipsychotics, prescribed daily dose (PDD), and the PDD to defined daily dose (DDD) ratio.
Results
The MEmind web-application reported that antipsychotics were used in 1116 patients out of the total sample, mostly in 486 (44%) patients with schizophrenia related disorders but also in other diagnoses. Second generation antipsychotics (quetiapine, aripiprazole and long-acting paliperidone) were preferably employed. Low doses were more frequently used than high doses. Long acting paliperidone and ziprasidone however, were the only two antipsychotics used at excessive dosing. Antipsychotic polypharmacy was used in 287 (26%) patients with classic depot drugs, clotiapine, amisulpride and clozapine.
Conclusions
In this study we describe the first step of the development of a web application that is able to make polypharmacy, high dose usage and off label usage of antipsychotics visible to clinicians. Current development of the MEmind web application may help to improve prescription security via momentary feedback of prescription and clinical decision support system
Combining scales to assess suicide risk
Authors posting Accepted Author Manuscript online should later add a citation for the Published Journal Article indicating that the Article was subsequently published, and may mention the journal title provided they add the following text at the beginning of the document: âNOTICE: this is the authorâs version of a work that was accepted for publication in Journal of Cardiovascular Echography. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Psychiatric Research, [VOL#, ISSUE#, (DATE)] DOI#âA major interest in the assessment of suicide risk is to develop an accurate instrument, which could be easily adopted by clinicians. This article aims at identifying the most discriminative items from a collection of scales usually employed in the assessment of suicidal behavior. Methods: The answers to the Barrat Impulsiveness Scale, International Personality Disorder Evaluation Screening Questionnaire, BrowneGoodwin Lifetime History of Aggression, and Holmes & Rahe Social Readjustment Rating Scale provided by a group of 687 subjects (249 suicide attempters, 81 non-suicidal psychiatric inpatients, and 357 healthy controls) were used by the Lars-en algorithm to select the most discriminative items. Results: We achieved an average accuracy of 86.4%, a specificity of 89.6%, and a sensitivity of 80.8% in classifying suicide attempters using 27 out of the 154 items from the original scales. Conclusions: The 27 items reported here should be considered a preliminary step in the development of
a new scale evaluating suicidal risk in settings where time is scarce.This article was supported by the National Alliance for Research on Schizophrenia and Affective Disorders (NARSAD), Fondo de Investigacion Sanitaria (FIS) PI060092, Fondo de Investigacion Sanitaria FIS RD06/0011/0016, ETES (PI07/90207), the Conchita
Rabago Foundation, and the Spanish Ministry of Health, Instituto de Salud Carlos III, CIBERSAM (Intramural 521 Project, P91B; SCO/3410/2004)
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