Search

Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder. A key challenge associated with this condition is achieving an early diagnosis. The current study seeks to anticipate and delineate the assessments offered by both parents and teachers concerning a child’s behavior and overall functioning with the Behavior Rating Inventory of Executive Function-2 (BRIEF-2). Mothers, fathers, and teachers of 59 children diagnosed or in the process of being assessed for ADHD participated in this study. The responses provided by 59 mothers, 59 fathers, and 57 teachers to the BRIEF-2 questionnaire were collected. The performance of various feature selection techniques, including Lasso, decision trees, random forest, extreme gradient boosting, and forward stepwise regression, was evaluated. The results indicate that Lasso stands out as the optimal method for our dataset, striking an ideal balance between accuracy and interpretability. A repeated validation analysis reveals an average positive correlation exceeding 0.5 between the inattention/hyperactivity scores reported by informants (mother, father, or teacher) and the predictions derived from Lasso. This performance is achieved using only approximately 18% of the BRIEF-2 items. These findings underscore the usefulness of variable selection techniques in accurately characterizing a patient’s condition while employing a small subset of assessment items. This efficiency is particularly valuable in time-constrained settings and contributes to improving the comprehension of ADHD.

Abstract Background Three IL-10 gene promoter single nucleotide polymorphisms -1082G > A, -819C > T and -592C > A and the haplotypes they define in Caucasians, GCC, ACC, ATA, associated with different IL-10 production rates, have been linked to schizophrenia in some populations with conflicting results. On the basis of the evidence of the sex-dependent effect of certain genes in many complex diseases, we conducted a sex-stratified case-control association study to verify the linkage of the IL-10 gene promoter SNPs and haplotypes with schizophrenia and the possible sex-specific genetic effect in a Spanish schizophrenic population. Methods 241 DSM-IV diagnosed Spanish schizophrenic patients and 435 ethnically matched controls were genotyped for -1082G > A and -592C > A SNPs. Chi squared tests were performed to assess for genetic association of alleles, genotypes and haplotypes with the disease. Results The -1082A allele (p = 0.027), A/A (p = 0.008) and ATA/ATA (p = 0.003) genotypes were significantly associated with schizophrenia in females while neither allelic nor genotypic frequencies reached statistical significance in the male population. Conclusions Our results highlight the hypothesis of an imbalance towards an inflammatory syndrome as the immune abnormality of schizophrenia. Anyway, a better understanding of the involvement of the immune system would imply the search of immune abnormalities in endophenotypes in whose sex and ethnicity might be differential factors. It also reinforces the need of performing complex gene studies based on multiple cytokine SNPs, including anti and pro-inflammatory, to clarify the immune system abnormalities direction in the etiology of schizophrenia.

Introduction Spatial patterns of mortality could help us to focus research to achieve prevention. On the other hand, recent research has shown an association between unemployment and suicide, but the mediating factors in this relationship are still unknown. Objectives We investigated the provincial spatial patterns of suicide mortality in Spain, and the effect of unemployment and economic recession on suicide mortality rates in the Spanish region of Galicia that has high suicide rates. Method To describe regional suicide mortality in Spain and to assess its association with recession and unemployment in Galicia, we calculated age-standardized suicide rates in men and women throughout 1975–2012 by region and performed a time-trend Generalized Additive Model using mortality data provided by National Statistics Institute and employment data collected from Statistics Institute of Galicia. Results In Spain, during the study period, there were 105,134 suicides with an age-adjusted rate of 10.2 and 3.02 per 100,000 population in men and women, respectively. There is a high variability in mortality rates across Spanish provinces. Madrid had the lower rates and Asturias and Galicia the higher ones. In Galicia, suicide rates were 13.7 in men and 4.3 in women per 100,000 and we found that economic recession and unemployment interacted with regards to suicide rates ( P = 9.80E-4) and after stratifying by sex, the effect was confirmed only among men ( P = 8.70E-3). Conclusions In Spain, suicide mortality varies greatly by region and in Galicia that is one of Spanish regions with higher suicide rates, unemployment was related with suicide during economic recession periods. [ABSTRACT FROM AUTHOR]

Suicidal behavior and Non-Suicidal Self-Injuries (NSSIs) are a major health problem in the adolescent population. New technologies can contribute to the development of innovative interventions in suicide prevention. Here, we present the SmartCrisis-Teen study protocol. The study consists of a randomized clinical trial which aims to evaluate the effectiveness of a digital safety plan to prevent suicidal behavior and NSSIs in adolescents. This is a multicentric study which will be conducted among the adolescent population, both in clinical and student settings, with a target sample of 1080 participants. The intervention group will receive an Ecological Momentary Intervention (EMI) consisting of a digital safety plan on their mobile phone. All participants will receive their Treatment As Usual (TAU). Participants will be followed for six months, with weekly and monthly telephone visits and face-to-face visits at three and six months. Participants will be assessed using traditional questionnaires as well as Ecological Momentary Assessment (EMA) and Implicit Association Tests (IATs). With this intervention, we expect a reduction in NSSIs through the acquisition of coping strategies and a decrease in suicidal behavior over the course of follow-up. This study provides a novel, scalable digital intervention for preventing suicidal behavior and NSSIs in adolescents, which could contribute to improving adolescent mental health outcomes globally.

Here we present the findings of the pilot phase of the SmartCrisis 2.0 Randomized Clinical Trial. This pilot study aimed to explore the feasibility and acceptability of a safety plan contained in a smartphone app. Our sample consisted patients with a history of recent suicidal behaviour who installed a smartphone-based safety plan. To explore the satisfaction with of the safety plan, two patient satisfaction surveys were conducted: one qualitative and one quantitative. To explore the objective use of the safety plan, we gained access to texts contained in the safety plans completed by the patients. Participation rate was 77%, while 48.9% patients completed both satisfaction surveys at the end of the pilot phase. N = 105 successfully installed the safety plan. In a scale from 1 to 10, users rated the usefulness of the security plan at 7.4, the usability at 8.9, the degree to which they would recommend it to others at 8.6 and the overall satisfaction with the project including evaluations at 9.6. The most widely completed tab was warning signs. Feeling sad or lonely was the warning sign most commonly reported by patients. The second most completed tab was internal coping strategies. Walking or practicing any other exercise was the strategy most commonly resorted to. Our smartphone-based safety plan appears to be a feasible intervention. Data obtained from this pilot study showed high participation rates and high acceptability by patients. This, together with the general satisfaction with the project, supports its implementation in the clinical practice., Competing Interests: Declaration of competing interest EBG has been a consultant to or has received honoraria or grants from Janssen Cilag, Lundbeck, Otsuka, Pziffer, Servier and Sanoffi. EBG and AAR designed the MEmind application. The other authors confirm they have no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: The prevalence of psychiatric disorders has not shifted widely through the COVID pandemic, except for some specific groups such as young people or women. Our objective is to examine prospectively the evolution of children and adolescents who consulted in a psychiatric emergency service during the COVID-19 confinements., Method: We collected prospective clinical information about 296 young people under 18 who visited a tertiary hospital for psychiatric reasons during the confinement periods in Spain. Clinical diagnoses, suicide attempts, hospital admissions, and pharmacological prescriptions were extracted from electronic health records through 2020, 2021, and 2022. Features of those who maintained psychiatric care and those who did not were compared., Results: Three out of four children and adolescents who visited the psychiatric emergency department during the confinements continued psychiatric care at the end of 2022. Those who did not showed better premorbid adjustment at baseline. During follow-up, diagnoses of neurodevelopmental disorders and eating disorders, as well as the dosage of psychotropic drug prescriptions, increased. The diagnoses of major depressive disorder and eating disorder at baseline were associated with attempting suicide during follow-up. Patients with internalizing symptoms were admitted earlier than those with externalizing symptoms but no differences were found in terms of suicide attempts., Conclusions: The continuity of psychiatric care after an initial emergency visit during the confinements implied greater clinical severity, as reflected by changes in clinical diagnoses and pharmacological regimens. Emergent symptoms of depression or eating disorders after social distancing or isolation could predict subsequent suicidal behavior in young populations., (© 2023. The Author(s).)

Objective: In this study, we combined ecological momentary assessment (EMA) with traditional clinical follow-up to explore correlates of suicidal relapse in patients with a history of suicidal behavior., Methods: Over 6 months, we followed up with 393 patients who completed baseline and follow-up interviews and were monitored through smartphone-based EMA via the MEmind app. Recruitment was conducted between February 2018 and March 2020. We recorded the occurrence of clinical suicidal events and EMA suicidal events, the latter defined as extreme scores on questions on passive suicide ideation., Results: Fifteen percent of participants had a new clinical suicidal event during follow-up (9.2% suicide attempt [SA]; 5.9% emergency referral for suicidal ideation [SI]). Of the 319 participants who installed the MEmind app, 20.7% presented with EMA suicidal events. EMA suicidal events were statistically significantly associated with clinical suicidal events at 2-month follow-up but not at 6-month follow-up. In the Cox multivariate regression model, 5 factors were independently associated with clinical suicidal events: number of previous SAs, SA in the past year, SA in the past month (risk factors), female gender, and age (protective factors)., Conclusions: Our study confirms some of the risk factors classically associated with risk of suicide reattempt, such as history of suicidal behavior, while questioning others, such as female gender. Risk factors associated with EMA events differed from risk factors associated with traditional clinical suicide events, supporting the existence of distinct suicidal phenotypes., (© Copyright 2022 Physicians Postgraduate Press, Inc.)

Background: Smartphone-based ecological momentary assessment (EMA) is a promising methodology for mental health research. The objective of this study is to determine the feasibility of smartphone-based active and passive EMA in psychiatric outpatients and student controls., Methods: Two smartphone applications -MEmind and eB 2 - were developed for behavioral active and passive monitoring. The applications were tested in psychiatric patients with a history of suicidal thoughts and/or behaviors (STB), psychiatric patients without a history of STB, and student controls. Main outcome was feasibility, measured as response to recruitment, retention, and EMA compliance. Secondary outcomes were patterns of smartphone usage., Results: Response rate was 87.3% in patients with a history of STB, 85.1% in patients without a history of STB, and 75.0% in student controls. 457 participants installed the MEmind app (120 patients with a history of STB and 337 controls) and 1,708 installed the eB 2 app (139 patients with a history of STB, 1,224 patients with no history of STB and 346 controls). For the MEmind app, participants were followed-up for a median of 49.5, resulting in 22,622 person-days. For the eB 2 application, participants were followed-up for a median of 48.9 days, resulting in 83,521 person-days. EMA compliance rate was 65.00% in suicidal patients and 75.21% in student controls. At the end of the follow-up, over 60% of participants remained in the study., Limitations: Cases and controls were not matched by age and sex. Cases were patients who were receiving adequate psychopharmacological treatment and attending their appointments, which may result in an overstatement of clinical compliance., Conclusions: Smartphone-based active and passive monitoring are feasible methods in psychiatric patients in real-world settings. The development of applications with friendly interfaces and directly useful features can help increase engagement without using incentives. The MEmind and eB 2 applications are promising clinical tools that could contribute to the management of mental disorders. In the near future, these applications could serve as risk monitoring devices in the clinical practice., Competing Interests: Declaration of Competing Interest All the authors confirm they have no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: An expanding body of research suggests that childhood adverse experiences can lead to different negative health outcomes, including attempted suicide. Serotonergic genes such as the promoter region of the serotonin transporter gene (5-HTTLPR) have been associated both with impulsivity in suicide attempts and reactivity to environmental stress exposure. BDNF gene may play an epigenetic role., Methods: We studied the influence of childhood stressful events and 5-HTTLPR genotype on impulsivity measured by Barratt Impulsivity Scale (BIS-10) in a multicentre sample of 1,655 suicide attempters (69.4% women, 30.6% men; mean age 40.13 years). A co-dominant additive genetic model was used for the statistical analyses. Interaction between 5-HTTLPR genotype and early trauma exposure was tested using moderated and multiple regression techniques. Interaction plots were used to explore BDNF genotype modulation., Results: Mildly higher impulsivity scores were found in men with SS compared with SL or LL genotypes, and men with childhood emotional and physical abuse. Interaction analyses showed that combination of 5-HTTLPR-SS genotype and early trauma exposure increase impulsivity scores independently. Impulsivity scores were not affected by the modulation of BDNF genes., Conclusions: Childhood trauma and 5-HTTLPR genotype seem to be independently involved in suicide attempts, sharing a common pathway of increasing impulsivity.

Learning Objectives: After participating in this activity, learners should be better able to:• Evaluate diagnostic stability in bipolar disorder• Analyze the factors contributing to diagnostic stability OBJECTIVE: Diagnostic stability is the degree to which a diagnosis remains unchanged during follow-up. It is an important measure of predictive validity in bipolar disorder (BD). In this study, we review the literature concerning diagnostic stability in BD, analyze the factors contributing to diagnostic stability, and describe the implications of diagnostic boundaries and diagnostic delay., Methods: A comprehensive literature search of MEDLINE and EMBASE databases was conducted, including all studies published from 1980 to 2016, to evaluate the diagnostic stability of BD. Thirty-seven articles were included: 6 focusing mainly on BD, 18 on psychotic disorders, 10 on depression, and 3 on diagnostic stability in psychiatric disorders in general. Data analysis was performed in standardized fashion using a predefined form., Results: Despite a high variability of the methodological approaches taken, an acceptable degree of diagnostic stability was found. The most common criteria for evaluating diagnostic stability were prospective consistency and retrospective consistency. The mean prospective and retrospective consistencies were 77.4% and 67.6%, respectively. A large majority of studies were performed in Europe or in North America (67.5%), compared to 21.6% in Asia and only 10.8% in Africa, Oceania, and South America. Extreme ages, female gender, psychotic symptoms, changes to treatment, substance abuse, and family history of affective disorder have been related to diagnostic instability., Conclusions: Several factors appear to have a negative impact on the diagnostic stability, but the evidence is insufficient to draw any robust conclusions. Nevertheless, despite variable prospective and retrospective consistencies, the overall diagnostic stability is good. Standardized methods need to be used to obtain more accurate assessments of stability.

Bipolar disorder is associated with high risk for suicidal behavior. Lack of adherence to treatment is one factor that may be partly responsible for this common complication. We searched MEDLINE with the combination of the key words "compliance" or "adherence" with "suicide" and "bipolar", limited to English language papers published between 1990 and July 2008.We evaluate the existent literature studying the influence of treatment adherence on suicidality among these patients. Our findings show a limited number of studies addressing this issue, mostly conducted with patients enrolled in lithium clinics. Results suggest an association between non-adherence and an increased risk of suicidal behavior among bipolar patients. Whether non-adherence leads to increase risk of suicidality due to specific properties of interventions such as lithium treatment or simply is secondary to mood stabilization is still an open question., (Copyright © 2009 Sociedad Española de Psiquiatría and Sociedad Española de Psiquiatría Biológica. Published by Elsevier Espana. All rights reserved.)