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Foraging is risk sensitive if choices depend on the variability of returns from the options as well as their mean return. Risk‐sensitive foraging is important in behavioural ecology, psychology and neurophysiology. It has been explained both in terms of mechanisms and in terms of evolutionary advantage. We provide a critical review, evaluating both mechanistic and evolutionary accounts. Some derivations of risk sensitivity from mechanistic models based on psychophysics are not convincing because they depend on an inappropriate use of Jensen's inequality. Attempts have been made to link risk sensitivity to the ecology of a species, but again these are not convincing. The field of risk‐sensitive foraging has provided a focus for theoretical and empirical work and has yielded important insights, but we lack a simple and empirically defendable general account of it in either mechanistic or evolutionary terms. However, empirical analysis of choice sequences under theoretically motivated experimental designs and environmental settings appears a promising avenue for mapping the scope and relative merits of existing theories. Simply put, the devil is in the sequence. [ABSTRACT FROM AUTHOR]

Patients with depression often require inpatient treatment due to their high suicide risk. Ecological momentary assessment (EMA) studies have shown that suicidal ideation (SI) fluctuates over time. As affective instability and psychological pain (PP) are common experiences in borderline personality disorder (BPD), often comorbid with depression, we examined factors predicting short-term changes of SI in depressive inpatients with or without BPD. Psychiatric inpatients with depression with (N = 30) or without (N = 37) comorbid BPD assessed their anxiety, PP, severity of depression, SI, and hopelessness three times daily using visual analogue scales. Multilevel regression models were estimated. Altogether 4320 EMA observations, spanning on average 3.4 successive days, were collected. Only severity of depression (β = 0.19; [95 % CI = 0.06, 0.32]) and previous SI (β = 0.32; [95 % CI = 0.23, 0.41]) predicted near-future SI within several hours. PP predicted near-future SI in inpatients with depression and BPD (β = 0.28; [95 % CI = 0.11, 0.46]), but not in patients without BPD. The follow-up data represents only the first days of hospitalization. The context of the EMA is the acute psychiatric ward, affecting generalizability to outpatients. Short-terms changes in SI are predicted by changes in severity of depression and previous SI in depressed inpatients without BPD, and also by changes in PP in depressed inpatients with BPD. As SI and its risk factors may oscillate within a time scale of hours, frequent monitoring of momentary severity of depression, PP, and SI may be warranted in inpatient settings. • Suicidal ideation (SI) oscillates over time in patients with depression with and without borderline personality disorder (BPD) • Severity of depression and psychological pain (PP) are more temporally instable in depressed inpatients with BPD • Changes in depression in inpatients without BPD, and in PP in inpatients with BPD predict short-term changes of SI • Frequent monitoring of momentary severity of depression, PP, and SI may be warranted in inpatient settings [ABSTRACT FROM AUTHOR]

Background: Suicide risk is high in patients with major depressive disorder (MDD), bipolar disorder (BD) and borderline personality disorder (BPD). Whether risk levels of and risk factors for suicidal ideation (SI) and suicide attempts (SA) are similar or different in these disorders remains unclear, as few directly comparative studies exist. The relationship of short‐term changes in depression severity and SI is underinvestigated, and might differ across groups, for example, between BPD and non‐BPD patients. Methods: We followed, for 6 months, a cohort of treatment‐seeking, major depressive episode (MDE) patients in psychiatric care (original n = 124), stratified into MDE/MDD, MDE/BD and MDE/BPD subcohorts. We examined risks of suicide‐related outcomes and their risk factors prospectively. We examined the covariation of SI and depression over time with biweekly online modified Patient Health Questionnaire 9 surveys and analysed this relationship through multi‐level modelling. Results: Risk of SA in BPD (22.2%) was higher than non‐BPD (4.23%) patients. In regression models, BPD severity was correlated with risk of SA and clinically significant SI. During follow‐up, mean depression severity and changes in depression symptoms were associated with SI risk regardless of diagnosis. Conclusions: Concurrent BPD in depression seems predictive for high risk of SA. Severity of BPD features is relevant for assessing risk of SA and SI in MDE. Changes in depressive symptoms indicate concurrent changes in risk of SI. BPD status at intake can index risk for future SA, whereas depressive symptoms appear a useful continuously monitored risk index. [ABSTRACT FROM AUTHOR]

The push to systematically follow treatment outcomes in psychotherapies to improve health care is increasing worldwide. To manage psychotherapeutic services and facilitate tailoring of therapy according to feedback a comprehensive and feasible data system is needed. To describe the Finnish Psychotherapy Quality Register (FPQR), a comprehensive database on availability, quality, and outcomes of psychotherapies. We describe the development of the FPQR and outcome for outsourced psychotherapies for adults in Helsinki and Uusimaa hospital district (HUS). Symptom severity and functioning are measured with validated measures (e.g. CORE-OM, PHQ-9, OASIS, AUDIT, and SOFAS). Questionnaires on therapeutic alliance, risks, methods, and goals are gathered from patients and psychotherapist. During 2018–2021, the FPQR included baseline data for 7274 unique patients and 336 psychotherapists. Response rate of measures was 85–98%. The use of the register was mandatory for the outsourced therapist of the hospital districts, and the patients were strongly recommended to fulfill the questionnaires. We report outcome for three groups of patients (n = 1844) with final/midterm data. The effect sizes for long psychotherapy (Hedge's g = 0.65 of SOFAS) were smaller than those for short psychotherapy (g = 0.75–0.91). Within three months of referral, 26–60% entered treatment depending on short- or long-term therapy. The FPQR forms a novel rich database with commensurate data on availability and outcomes of outsourced psychotherapies. It may serve as a basis for a national comprehensive follow-up system of psychosocial treatments. The Finnish system seems to refer patients with milder symptoms to more intensive treatments and achieve poorer results compared to the IAPT model in UK, Norway, or Australia. [ABSTRACT FROM AUTHOR]