BMC Psychiatry

Journal: BMC Psychiatry

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BioMed Central

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1471-244X

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Publications 1 - 10 of 12

Leveraging multigenerational health data to enhance mental disorder risk prediction: a population-based cohort study
Hamad , Amani F.; Monchka , Barret A.; Bolton , James M.; et al. (2025)
BMC Psychiatry
Background: Mental disorders are highly prevalent, and comorbidities between physical and mental health conditions are common. Physical comorbidities and family health histories may improve the accuracy of mental disorder risk prediction. We developed prediction models for mental disorder risk using comprehensive individual and family mental and physical health histories. Methods: We conducted a population-based cohort study using administrative Health data in Manitoba, Canada, and included adults between 1977 and 2020 with linkages to at least one parent and one grandparent. Mental disorders (mood and anxiety, substance use and psychotic disorders) for individuals, parents and grandparents were identified in inpatient and outpatient Health records. Predictors included demographics, family history of mental disorders and 130 health conditions in individuals, parents and grandparents. We used the Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression to build prediction models that sequentially included health conditions in individuals, parents and grandparents. Predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value and Brier score. Results: Of 125 070 individuals identified, 109 359 had no preexisting mental disorder. 52.9% were males and 52.8% were urban residents. 39 651 (36.3%) had a recorded diagnosis of mental disorders during follow-up. Predictive models incorporating Health histories of individuals, parents, and grandparents achieved the best predictive performance. Amongst all mental disorders, psychotic and substance use disorders had the highest AUCs of 0.78 (95% confidence interval (CI) 0.75–0.81) and 0.75 (95% CI 0.73–0.76), respectively. Key predictors included comorbid mental disorders, gastrointestinal conditions, female infertility and family history of dementia, gastrointestinal and metabolic conditions. Conclusions: Individual and family histories of physical and mental conditions improved mental disorder risk prediction, though accuracy was only moderate, highlighting the need for further refinement of risk prediction.
Personalized at-home neurofeedback compared with long-acting methylphenidate in an european non-inferiority randomized trial in children with ADHD
Bioulac, Stephanie; Purper Ouakil, Diane; Ross, Tomas; et al. (2019)
BMC Psychiatry
Background Neurofeedback (NF) has gained increasing interest among non-pharmacological treatments for Attention Deficit Hyperactivity Disorder (ADHD). NF training aims to enhance self-regulation of brain activities. The goal of the NEWROFEED study is to assess the efficacy of a new personalized NF training device, using two different protocols according to each child’s electroencephalographic pattern, and designed for use at home. This study is a non-inferiority trial comparing NF to methylphenidate. Methods The study is a prospective, multicentre, randomized, reference drug-controlled trial. One hundred seventy-nine children with ADHD, aged 7 to 13 years will be recruited in 13 clinical centres from 5 European countries. Subjects will be randomized to two groups: NF group (Neurofeedback Training Group) and MPH group (Methylphenidate group). Outcome measures include clinicians, parents and teachers’ assessments, attention measures and quantitative EEG (qEEG). Patients undergo eight visits over a three-month period: pre-inclusion visit, inclusion visit, 4 “discovery” (NF group) or titration visits (MPH group), an intermediate and a final visit. Patients will be randomized to either the MPH or NF group. Children in the NF group will undergo either an SMR or a Theta/Beta training protocol according to their baselineTheta/Beta Ratio obtained from the qEEG. Discussion This is the first non-inferiority study between a personalized NF device and pharmacological treatment. Innovative aspects of Mensia Koala™ include the personalization of the training protocol according to initial qEEG characteristics (SMR or Theta/Beta training protocols) and an improved accessibility of NF due to the opportunity to train at home with monitoring by the clinician through a dedicated web portal.
Stigma toward schizophrenia: do all psychiatrists behave the same? Latent profile analysis of a national sample of psychiatrists in Brazil
Andrade Loch, Alexandre; Bevilacqua Guarniero, Francisco; Lorea Lawson, Fabio; et al. (2013)
BMC Psychiatry
Background An important issue concerning the worldwide fight against stigma is the evaluation of psychiatrists’ beliefs and attitudes toward schizophrenia and mental illness in general. However, there is as yet no consensus on this matter in the literature, and results vary according to the stigma dimension assessed and to the cultural background of the sample. The aim of this investigation was to search for profiles of stigmatizing beliefs related to schizophrenia in a national sample of psychiatrists in Brazil. Methods A sample of 1414 psychiatrists were recruited from among those attending the 2009 Brazilian Congress of Psychiatry. A questionnaire was applied in face-to-face interviews. The questionnaire addressed four stigma dimensions, all in reference to individuals with schizophrenia: stereotypes, restrictions, perceived prejudice and social distance. Stigma item scores were included in latent profile analyses; the resulting profiles were entered into multinomial logistic regression models with sociodemographics, in order to identify significant correlates. Results Three profiles were identified. The “no stigma” subjects (n = 337) characterized individuals with schizophrenia in a positive light, disagreed with restrictions, and displayed a low level of social distance. The “unobtrusive stigma” subjects (n = 471) were significantly younger and displayed the lowest level of social distance, although most of them agreed with involuntary admission and demonstrated a high level of perceived prejudice. The “great stigma” subjects (n = 606) negatively stereotyped individuals with schizophrenia, agreed with restrictions and scored the highest on the perceived prejudice and social distance dimensions. In comparison with the first two profiles, this last profile comprised a significantly larger number of individuals who were in frequent contact with a family member suffering from a psychiatric disorder, as well as comprising more individuals who had no such family member. Conclusions Our study not only provides additional data related to an under-researched area but also reveals that psychiatrists are a heterogeneous group regarding stigma toward schizophrenia. The presence of different stigma profiles should be evaluated in further studies; this could enable anti-stigma initiatives to be specifically designed to effectively target the stigmatizing group.
Does psychopathology at admission predict the length of inpatient stay in psychiatry?
Warnke, Ingeborg; Rössler, Wulf; Herwig, Uwe (2011)
BMC Psychiatry
Background The debate on appropriate financing systems in inpatient psychiatry is ongoing. In this context, it is important to control resource use in terms of length of stay (LOS), which is the most costly factor in inpatient care and the one that can be influenced most easily. Previous studies have shown that psychiatric diagnoses provide only limited justification for explaining variation in LOS, and it has been suggested that measures such as psychopathology might be more appropriate to predict resource use. Therefore, we investigated the relationship between LOS and psychopathological syndromes or symptoms at admission as well as other characteristics such as sociodemographic and clinical variables. Methods We considered routine medical data of patients admitted to the Psychiatric University Hospital Zurich in the years 2008 and 2009. Complete data on psychopathology at hospital admission were available in 3,220 inpatient episodes. A subsample of 2,939 inpatient episodes was considered in final statistical models, including psychopathology as well as complete datasets of further measures (e.g. sociodemographic, clinical, treatment-related and psychosocial variables). We used multivariate linear as well as logistic regression analysis with forward selection procedure to determine the predictors of LOS. Results All but two syndrome scores (mania, hostility) were positively related to the length of stay. Final statistical models showed that syndromes or symptoms explained about 5% of the variation in length of stay. The inclusion of syndromes or symptoms as well as basic treatment variables and other factors led to an explained variation of up to 25%. Conclusions Psychopathological syndromes and symptoms at admission and further characteristics only explained a small proportion of the length of inpatient stay. Thus, according to our sample, psychopathology might not be suitable as a primary indicator for estimating LOS and contingent costs. This might be considered in the development of future costing systems in psychiatry.
Acceptability of palliative care approaches for patients with severe and persistent mental illness: a survey of psychiatrists in Switzerland
Trachsel, Manuel; Hodel, Martina A.; Irwin, Scott A.; et al. (2019)
BMC Psychiatry
Background Some patients develop severe and persistent mental illness (SPMI) which is therapy-refractory. The needs of these patients sometimes remain unmet by therapeutic interventions and they are at high risk of receiving care that is inconsistent with their life goals. Scholarly discourse has recently begun to address the suitability of palliative care approaches targeting at enhancing quality of life for these patients, but remains to be developed. Method A cross-sectional survey asked 1311 German-speaking psychiatrists in Switzerland (the total number of German-speaking members of the Swiss Society for Psychiatry and Psychotherapy) about the care of SPMI patients in general, and about palliative care approaches in particular. 457 (34.9%) returned the completed survey. In addition, participants were asked to evaluate three case vignettes of patients with SPMI. Results The reduction of suffering and maintaining daily life functioning of the patient were rated as considerably more important in the treatment of SPMI than impeding suicide and curing the underlying illness. There was broad agreement that SPMI can be terminal (93.7%), and that curative approaches may sometimes be futile (e.g. 72.4% for the anorexia nervosa case vignette). Furthermore, more than 75% of the participating psychiatrists were in favour of palliative care approaches for SPMI. Conclusions The results of the present study suggest that the participating psychiatrists in Switzerland regard certain forms of SPMI as posing high risk of death. Additionally, a majority of respondents consider palliative care approaches appropriate for this vulnerable group of patients. However, the generalizability of the results to all psychiatrists in Switzerland or other mental health professionals involved in the care of SPMI is limited. This limitation is important considering the reservations towards palliative care in the context of psychiatric illness, mainly because of the association with death and futility. Palliative care approaches, however, are applicable in conjunction with other therapies intended to prolong life. A next step could be to involve service users and develop a consensus of what palliative care might encompass in SPMI. A framework for identifying which patients might benefit from palliative care, should be explored for the future development of care for SPMI patients.
The Precision in Psychiatry (PIP) study: Testing an internet-based methodology for accelerating research in treatment prediction and personalisation
Lee, Chi Tak; Palacios, Jorge; Richards, Derek; et al. (2023)
BMC Psychiatry
Background: Evidence-based treatments for depression exist but not all patients benefit from them. Efforts to develop predictive models that can assist clinicians in allocating treatments are ongoing, but there are major issues with acquiring the volume and breadth of data needed to train these models. We examined the feasibility, tolerability, patient characteristics, and data quality of a novel protocol for internet-based treatment research in psychiatry that may help advance this field. Methods: A fully internet-based protocol was used to gather repeated observational data from patient cohorts receiving internet-based cognitive behavioural therapy (iCBT) (N = 600) or antidepressant medication treatment (N = 110). At baseline, participants provided > 600 data points of self-report data, spanning socio-demographics, lifestyle, physical health, clinical and other psychological variables and completed 4 cognitive tests. They were followed weekly and completed another detailed clinical and cognitive assessment at week 4. In this paper, we describe our study design, the demographic and clinical characteristics of participants, their treatment adherence, study retention and compliance, the quality of the data gathered, and qualitative feedback from patients on study design and implementation. Results: Participant retention was 92% at week 3 and 84% for the final assessment. The relatively short study duration of 4 weeks was sufficient to reveal early treatment effects; there were significant reductions in 11 transdiagnostic psychiatric symptoms assessed, with the largest improvement seen for depression. Most participants (66%) reported being distracted at some point during the study, 11% failed 1 or more attention checks and 3% consumed an intoxicating substance. Data quality was nonetheless high, with near perfect 4-week test retest reliability for self-reported height (ICC = 0.97). Conclusions: An internet-based methodology can be used efficiently to gather large amounts of detailed patient data during iCBT and antidepressant treatment. Recruitment was rapid, retention was relatively high and data quality was good. This paper provides a template methodology for future internet-based treatment studies, showing that such an approach facilitates data collection at a scale required for machine learning and other data-intensive methods that hope to deliver algorithmic tools that can aid clinical decision-making in psychiatry.
The moderating effect of social resources on the link between study-related stressors and depressive symptoms among medical students in North Rhine-Westphalia, Germany – a cross-sectional study
Kappner, Nora; Lang, Jessica; Berthold, Anne; et al. (2022)
BMC Psychiatry
Background: Previous research has demonstrated the negative effects of study-related stressors on the mental health of medical students. It has been found that social resources such as social identity, dual identity and social support help buffer negative mental health outcomes. Notably, social status has been found to weaken the connection between stress and depressive symptoms. Based on these findings, the present study investigates how social resources (i.e., social identity, social support, dual identity and status) mitigate the impact of study-related stressors on the mental health of medical students who carry an inordinate stress burden. Methods: The data collection was based on a questionnaire (online and paper–pencil) which was distributed to medical students in North Rhine-Westphalia, Germany. The sample (224 participants) consisted of 77.2% female and 22.8% male medical students (36.2% human medicine students (HMS) and 63.8% dental medicine students (DMS)). The questionnaire included graphical scales and standardized questionnaires. We investigated demographic data, study-related stressors (i.e. academic performance, clinical practice, faculty relations) and depressive symptoms as outcomes, and social identity, social support, dual identity and status as moderators. The analyses were performed using SPSS 25 for Windows. Results: We found significant positive associations between study-related stressors and depressive symptoms. While dual identity as well as social support by fellow students emerged as buffers in these associations, the other social resources did not. As regards status, it was found to work as a buffer only in HMS, who typically enjoy a significantly higher status than dental medical students. Conclusion: It is only social resources such as support from fellow students and dual identity, but not other resource types, that can be effective buffers against depressive symptoms associated with study-related stressors. These findings can be used to promote students’ identities in relation to both fellow students and the faculty, or the university as a whole, enabling students to better cope with stress and, thus, suffer less from depressive symptoms. Furthermore, the HMS, who ascribe a relatively high status to themselves, can use their status as a buffering factor in stressful situations, in which little can be done from the outside.
Subgrouping suicidal ideations: an ecological momentary assessment study in psychiatric inpatients
Homan, Stephanie; Roman, Zachary; Ries, Anja; et al. (2025)
BMC Psychiatry
Background: Suicidal ideation (SI) is one of the strongest predictors of suicide attempts, yet reliable prediction models for suicide risk remain scarce. A key challenge is that SI can fluctuate over time, potentially reflecting different subgroups that may offer important insights for suicide risk prediction. This study aims to build upon previous approaches that averaged SI trajectories by adopting a method that respects the temporal nature of SI. Methods: First, we applied longitudinal clustering to ecological momentary assessment (EMA) data on SI, with five daily assessments over 28 days from 51 psychiatric patients (61% female, mean age = 35.26, SD = 12.54). We used the KmlShape algorithm, which takes raw SI scores and the measurement occasion index as input. Second, we regressed each identified subgroup against established clinical risk factors for SI, including a history of suicidal thoughts and behaviors, hopelessness, depression diagnosis, anxiety disorder diagnosis, and history of abuse. Results: Four distinct subgroups with unique SI patterns were identified: (1) “High SI, moderate variability” (high mean, medium variability, high maximum); (2) “Lowest SI, lowest variability” (lowest mean, lowest variability, lowest maximum); (3) “Low SI, moderate variability” (low mean, medium variability, high maximum); and (4) “Highest SI, highest variability” (highest mean, highest variability, highest maximum). Furthermore, these subgroups were significantly associated with clinical characteristics. For instance, the subgroup with the least severe SI (“lowest SI, lowest variability”) showed the lowest levels of hopelessness (beta = -0.95, 95% CI = -1.04, -0.86), whereas the subgroup with the most severe SI (“highest SI, highest variability”) exhibited the highest levels of hopelessness (beta = 0.84, 95% CI = 0.72, 0.95). Conclusion: Applying longitudinal clustering to EMA data from patients with SI enables the identification of well-defined and distinct SI subgroups with clearer clinical characteristics. This approach is a crucial step toward a deeper understanding of SI and serves as a foundation for enhancing prediction and prevention efforts. Trial registration: 10DL12_183251.
Glutamatergic deficits and parvalbumin-containing inhibitory neurons in the prefrontal cortex in schizophrenia
Bitanihirwe, Byron K.Y.; Lim, Maribel P.; Kelley, J.F.; et al. (2009)
BMC Psychiatry
Background We have previously reported that the expression of the messenger ribonucleic acid (mRNA) for the NR2A subunit of the N-methyl-D-aspartate (NMDA) class of glutamate receptor was decreased in a subset of inhibitory interneurons in the cerebral cortex in schizophrenia. In this study, we sought to determine whether a deficit in the expression of NR2A mRNA was present in the subset of interneurons that contain the calcium buffer parvalbumin (PV) and whether this deficit was associated with a reduction in glutamatergic inputs in the prefrontal cortex (PFC) in schizophrenia. Methods We examined the expression of NR2A mRNA, labeled with a 35S-tagged riboprobe, in neurons that expressed PV mRNA, visualized with a digoxigenin-labeled riboprobe via an immunoperoxidase reaction, in twenty schizophrenia and twenty matched normal control subjects. We also immunohistochemically labeled the glutamatergic axon terminals with an antibody against vGluT1. Results The density of the PV neurons that expressed NR2A mRNA was significantly decreased by 48-50% in layers 3 and 4 in the subjects with schizophrenia, but the cellular expression of NR2A mRNA in the PV neurons that exhibited a detectable level of this transcript was unchanged. In addition, the density of vGluT1-immunoreactive boutons was significantly decreased by 79% in layer 3, but was unchanged in layer 5 of the PFC in schizophrenia. Conclusion These findings suggest that glutamatergic neurotransmission via NR2A-containing NMDA receptors on PV neurons in the PFC may be deficient in schizophrenia. This may disinhibit the postsynaptic excitatory circuits, contributing to neuronal injury, aberrant information flow and PFC functional deficits in schizophrenia.
COMPULS: design of a multicenter phenotypic, cognitive, genetic, and magnetic resonance imaging study in children with compulsive syndromes
Naaijen, Jilly; Ruiter, Saskia de; Zwiers, Marcel P.; et al. (2016)
BMC Psychiatry
Background Compulsivity, the closely linked trait impulsivity and addictive behaviour are associated with several neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and obsessive compulsive disorder (OCD). All three disorders show impaired fronto-striatal functioning, which may be related to altered glutamatergic signalling. Genetic factors are also thought to play an important role in the aetiology of compulsivity-related disorders. Methods The COMPULS study is a multi-center study designed to investigate the relationship between the traits compulsivity, impulsivity, and, to a lesser extent, addictive behaviour within and across the neurodevelopmental disorders ADHD, ASD, and OCD. This will be done at the phenotypic, cognitive, neural, and genetic level. In total, 240 participants will take part in COMPULS across four different sites in Europe. Data collection will include diagnostic interviews, behavioural questionnaires, cognitive measures, structural, functional and spectral neuroimaging, and genome-wide genetic information. Discussion The COMPULS study will offer the unique opportunity to investigate several key aspects of compulsivity across a large cohort of ADHD, ASD and OCD patients.

Publications 1 - 10 of 12

Journal: BMC Psychiatry

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