BMC Psychiatry最新文献

{"title":"The THINC-it tool: temporal sensitivity to change over time.","authors":"Na Zhu, Jia Huang, YouSong Su, JingFang Lu, XiaoHui Wu, Lu Yang, Jun Chen, YiRu Fang","doi":"10.1186/s12888-024-06170-8","DOIUrl":"10.1186/s12888-024-06170-8","url":null,"abstract":"<p><strong>Introduction: </strong>Cognitive dysfunction is believed to be among the core features of Bipolar Depression(BD-D). However, its evaluation and available treatments are limited. Here, we conducted a longitudinal follow-up clinical trial using the THINC-it tool to evaluate temporal sensitivity to change over time in cognitive function among patients with bipolar depression from a Chinese cohort. It is helpful to verify whether the scale can continuously and reliably measure cognitive function in different time points and reduce the measurement error caused by time factors. Hope our findings could provide insights into the significance of the THINC-it tool as an iterative clinical cognitive evaluation tool.</p><p><strong>Methods: </strong>A total of 120 patients with bipolar depression(40 males and 80 females, respectively) alongside 100 healthy controls(23 males and 77 females, respectively) were recruited in the study. All participants were interviewed for 8 weeks, using the 17-item Hamilton Depression Rating Scale (HAMD-17) and the Young Mania Rating Scale(YMRS). The primary dependent measure was the previously validated THINC-it tool, followed by psychometric analysis.</p><p><strong>Results: </strong>Repeated measures of the THINC-it tool at baseline, one-week, and eight-week periods were conducted after controlling for age, gender, and education effects. Results from the general linear model revealed no significant time differences in variances(P > 0.05). Similarly, adjusting for confounding factors (age, gender, education, and HAMD-17 scores), results from the longitudinal analysis showed that there were no significant differences in cognitive impairment over time(P > 0.05). However, we found significant differences between BD-D and Healthy Control(HC) groups with regards to Spotter, Codebreaker, Trails, Perceived Deficits Questionnaire for Depression-5-items(PDQ-5-D), and THINC-it Total composite(P < 0.05), but not in Symbol Check (p = 0.191).</p><p><strong>Conclusion: </strong>These findings indicate that the THINC-it tool effectively detects sensitivity to change in groups and maintains stability at times, indicating that it is a feasible and reliable instrument for evaluating cognitive dysfunction in Chinese patients with bipolar depression.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"24 1","pages":"749"},"PeriodicalIF":3.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychological resilience and post-traumatic stress disorder as chain mediators between personality traits and cognitive functioning in patients with breast cancer.","authors":"Xinmiao Zhang, Junyue Lu, Zhangyi Ding, Gaoxiang Zhong, Yan Qiao, XiChen Li, Huixia Cui","doi":"10.1186/s12888-024-06219-8","DOIUrl":"10.1186/s12888-024-06219-8","url":null,"abstract":"<p><strong>Background: </strong>Personality is a unique behavioral trait; cognition is how an individual knows and understands things. It is essential for everyday daily living. In patients with breast cancer, despite the growing body of research on personality and cognitive functioning, exploration of the underlying mechanisms is still relatively scarce. Therefore, this study aimed to investigate the impact of Big Five personality traits on cognitive functioning and the mediating role of psychological resilience and post-traumatic stress disorder(PTSD) between personality traits and cognitive functioning in patients with breast cancer.</p><p><strong>Methods: </strong>Convenience sampling was used, and a cross-sectional survey of 288 patients clinically diagnosed with breast cancer was conducted in the Department of Breast Surgery of the First Hospital of Jinzhou Medical University. The general information questionnaire, the Ten-Item Personality Inventory in China, the 10-item Connor-Davidson Resilience Scale, the Post-traumatic Stress Disorder Checklist-Civilian Version, and the Montreal Cognitive Assessment were used to measure the patient's general condition, personality traits, psychological resilience, PTSD, and cognitive function, respectively. Descriptive and correlation analyses were performed using SPSS 26.0 software, and mediation effect tests using SPSS PROCESS macro 3.3 software.</p><p><strong>Results: </strong>(1) Psychological resilience, PTSD, Big Five personality traits, and cognitive functioning were significantly correlated. (2) The effects of the Big Five personality traits (extraversion, conscientiousness, agreeableness, emotional stability, and openness) on cognitive functioning can be mediated through three indirect pathways: the separate mediating effects of psychological resilience and PTSD and the chain mediating effects of psychological resilience and PTSD, with a chain mediation effect of 0.014, 0.018, 0.014, 0.018, and 0.014, respectively. None of the 95% CI contained 0.</p><p><strong>Conclusion: </strong>Personality traits can indirectly influence cognitive functioning in patients with breast cancer through the separate mediating roles of psychological resilience and PTSD and their chained mediating roles. This result suggests we pay more comprehensive attention to patients' cognitive function. Workers can be guided to assess patients' personality, psychological, and spiritual characteristics promptly in their work and adopt personalized care to safeguard good cognitive functioning.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"24 1","pages":"750"},"PeriodicalIF":3.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketamine and chronic treatment-resistant depression: real-world practice and after relapse.","authors":"Sumaya Jobnah, Youssef Latifeh, Dina Al Kabani, Lama A Youssef","doi":"10.1186/s12888-024-06203-2","DOIUrl":"10.1186/s12888-024-06203-2","url":null,"abstract":"<p><strong>Background: </strong>Chronic treatment-resistant depression (TRD) poses a major challenge for clinicians. Ketamine has shown a rapid but short-lived antidepressant effect in several studies involving TRD patients with different demographic and clinical profiles. Our study aimed to assess the antidepressant effect of serial infusion sessions of ketamine in patients with chronic TRD and evaluate the severity of symptoms after relapse and the general psychiatric health of the responding patients.</p><p><strong>Methods: </strong>In this single arm open-label study, six infusions of ketamine at 0.5 mg/kg were administered to chronic TRD patients for approximately two weeks. Response and remission rates, side effects, adverse events and after-relapse symptoms were evaluated, and patients were followed for three months.</p><p><strong>Results: </strong>23 patients underwent at least one infusion session, and 18 patients completed the six sessions. Twelve (66.67%) patients responded to the treatment at some point, and 11 (61.11%) patients maintained response after the end of the treatment protocol. One infusion was not sufficient to achieve a response (P > 0.9999, z = 1.81), and more than half of the responders met the response criteria after the third infusion. Only one patient (5.56%) achieved remission at the end of the infusion phase. All but one ketamine responders relapsed within one month after the end of the treatment. There was no statistical difference between baseline and after-relapse MADRS scores (P = 0.7886, 95% CI=-5.512-4.312, R² = 0,008411). However, a high incidence of serious adverse events related to suicidality was evident; one of the non-responding patients attempted suicide and several attempts to sedate this patient with benzodiazepines failed. Two responding patients ended up with a suicidal attempt or severe suicidal thoughts.</p><p><strong>Conclusions: </strong>Introducing rapid-acting antidepressant to manage TRD patients in clinical practice demands further investigation, and the benefit-to-harm ratio should be assessed in the light of the increased risk of suicidality.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"24 1","pages":"745"},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The U-shaped association between serum direct bilirubin and incident mild cognitive impairment in hemodialysis patients: a multicenter study.","authors":"Yuqi Yang, Qian Li, Qian Zhang, Jing Yuan, Yan Zha","doi":"10.1186/s12888-024-06189-x","DOIUrl":"10.1186/s12888-024-06189-x","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have suggested an association between low serum bilirubin concentrations and increased risk of cognitive impairment. This study aimed to explore the association and dose-response relationship between serum direct bilirubin (DBIL) concentrations and mild cognitive impairment (MCI) among hemodialysis patients.</p><p><strong>Methods: </strong>This is a multicenter cross-sectional study with patients undergoing hemodialysis from 22 dialysis centers in Guizhou Province, China. The outcome was mild cognitive impairment (MCI), measured with a Mini-Mental State Examination. The association and dose-response relationship between serum DBIL and MCI incidence were examined using multivariate logistic regression analysis, restricted cubic spline, and subgroup analysis to explore the association of serum DBIL concentrations with MCI.</p><p><strong>Results: </strong>Of the 4223 enrolled patients (mean age 55.2 ± 15.3 years, 60.4% males), 1187 (28.1%) had MCI. Serum DBIL of 0.10-1.67umol/L [multivariable-adjusted odds ratios (OR) 1.32, 95% confidence interval (CI): 1.08-1.60, P = 0.005], 2.31-3.20umol/L (OR = 1.22, 95%CI: 1.00-1.49, P = 0.047), and > 3.21umol/L (OR = 1.32, 95%CI: 1.08-1.61, P = 0.006) had increased risk of MCI compared with 1.68-2.30umol/L. The dose-response analysis between serum DBIL and MCI showed a U-shaped relationship (P for non-linearity = 0.009), and the serum DBIL concentrations with the lowest risk of MCI was 2.01umol/L. As the serum DBIL concentrations were lower than the reference, the risk of MCI decreased by 49% per standard deviation (SD) increase in serum DBIL (OR = 0.51, 95%CI: 0.29-0.89, P < 0.001); when the concentration exceeds 2.01umol/L, a rise per SD increased the risk of MCI by 9% (OR = 1.09, 95%CI:1.01-1.17, P < 0.001).</p><p><strong>Conclusion: </strong>Our findings suggest a U-shaped association between serum DBIL and MCI among hemodialysis patients.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"24 1","pages":"744"},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-cultural adaptation and validation of the Chinese version of the Trauma Resiliency Scale (tRS-18).","authors":"Shihan Li, Chunyan Hao, Jiaxin Ren","doi":"10.1186/s12888-024-06166-4","DOIUrl":"10.1186/s12888-024-06166-4","url":null,"abstract":"<p><strong>Background: </strong>Trauma is a prevalent issue in public health, where individuals who experience physical injuries are also at risk of compromised mental health. Psychological resilience is considered a positive indicator that can predict the prognosis of trauma patients throughout their traumatic experiences. Currently, there is a lack of tools in China for measuring the psychological resilience of trauma patients. The aim of this study was to translate and cross-culturally adapt the Trauma Resiliency Scale (tRS-18) into Chinese and to test its reliability and validity in China.</p><p><strong>Methods: </strong>The Trauma Resiliency Scale (tRS-18) was translated into a Chinese version suitable for the Chinese language environment using the Brislin translation model. A convenience sampling method was used to select 588 trauma patients as study subjects. Reliability was assessed using Cronbach's alpha coefficient, 14-day test-retest reliability, and split-half reliability. Validity was examined through the content validity index, structural validity, and convergent validity. Structural validity was specifically evaluated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).</p><p><strong>Results: </strong>The total variance explained by the single-factor model in the exploratory factor analysis (EFA) of the Chinese version of the tRS-18 was 62.048%, and the factor loading of each item exceeded 0.4. The results of the CFA indicated that the model demonstrated a favorable fit index (X²/df = 1.620; RMSEA = 0.046; SRMR = 0.026; NFI = 0.945; CFI = 0.978; GFI = 0.927; TLI = 0.975; IFI = 0.978). The Cronbach's alpha coefficient of the reliability index was 0.963, the test-retest reliability was 0.970, and the split-half reliability was 0.964, which were all within the reference value range.</p><p><strong>Conclusion: </strong>The Chinese version of the tRS-18 has good validity and reliability and can be used as an assessment tool for trauma resilience in trauma patients.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"24 1","pages":"743"},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between benzodiazepine co-prescription, opioid agonist treatment and mortality: a systematic review.","authors":"Christine Hillestad Hestevik, Line Holtet Evensen, Hege Kornør, Ivar Skeie","doi":"10.1186/s12888-024-06191-3","DOIUrl":"10.1186/s12888-024-06191-3","url":null,"abstract":"<p><strong>Background: </strong>Opioid agonist treatment (OAT) is the preferred treatment for opioid dependence due to benefits such as treatment retention, reduced opioid use and mortality. Benzodiazepine co-dependence is common in OAT patients and has been linked to increased mortality. Prescribing benzodiazepines during OAT has been tried to reduce the harms of extra-medical benzodiazepine use. This systematic review examines association between benzodiazepine co-prescription during OAT and mortality.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, Psych INFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and Epistemonikos for reports published from database inception to June 2021. The searches were updated in February 2024. We included studies comparing mortality rates in OAT patients with and without benzodiazepine co-prescription. Two reviewers independently screened, extracted data, and assessed risk of bias from eligible studies with the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. We combined the effect estimates in meta-analyses where possible. The certainty of the pooled effect estimates was assessed using the GRADE approach.</p><p><strong>Results: </strong>We included six observational studies (N = 84,452) conducted in Sweden, Scotland, Canada, England, and the USA. Moderate-certainty evidence linked benzodiazepine prescription to higher all-cause mortality on OAT (HR 1.83; 95% CI 1.59 to 2.11). Moderate-certainty evidence associated benzodiazepine prescription with higher non-drug-induced mortality during OAT and the whole observation period (HR 1.73; 95% CI 1.33 to 2.25) and HR 2.02; 95% CI 1.29 to 3.18). Low-certainty evidence suggested an association with higher drug-induced mortality on OAT (HR 2.36; 95% CI 1.38 to 4.0). Very low-certainty evidence linked benzodiazepine prescription to higher all-cause and drug-induced mortality throughout the observation period (HR 1.49; 95% CI 1.02 to 2.18 and HR 2.19; 95% CI 0.80 to 6.0).</p><p><strong>Conclusions: </strong>There is probably an association between prescribed benzodiazepine use and higher risk of all-cause mortality (on OAT) and mortality due to non-drug-induced causes (on OAT and on and off OAT). Benzodiazepine prescription may also be associated with higher all-cause mortality (on and off OAT) and drug-induced mortality (on OAT and on and off-OAT), but this is highly uncertain due to methodological issues and possible confounding.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"24 1","pages":"741"},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Neutrophil-Percentage-To-Albumin Ratio(NPAR) with depression symptoms in U.S. adults: a NHANES study from 2011 to 2018.","authors":"Yuting Zhu, Zhengchuang Fu","doi":"10.1186/s12888-024-06178-0","DOIUrl":"10.1186/s12888-024-06178-0","url":null,"abstract":"<p><strong>Background: </strong>Inflammation is crucial in the development of depression. This study aims to examine the potential association between the Neutrophil-Percentage-to-Albumin Ratio(NPAR) and depression symptoms.</p><p><strong>Methods: </strong>This study adopted a cross-sectional design, involving patients with depression symptoms and those without depression symptoms with comprehensive NPAR data originated from the National Health and Nutrition Examination Survey(NHANES) spanning 2011 to 2018. The research utilized weighted multivariate logistic regression models and multivariate linear regression to investigate the linear relationship between NPAR levels and depression symptoms and its severity scores. The characterization of nonlinear relationships was accomplished by employing fitted smoothing curves. Furthermore, subgroup analyses and interaction assessments were conducted to offer additional insights.</p><p><strong>Results: </strong>This study involved a total of 10,829 participants, and the prevalence of depression among them was found to be 15.08%. The multiple logistic regression analysis revealed a statistically significant positive association between the continuum of NPAR and depression symptoms[OR:1.03, 95% CI: (1.00, 1.05)], as well as depression severity scores[β: 0.08, 95% CI: (0.04,0.11)]. Stratifying NPAR into quartiles, we found that higher NPAR associated with increased odds of depression symptoms. Furthermore, in subgroup analysis, there were no significant differences in the relationship between NPAR levels and depression symptoms or its severity scores within populations with or without diabetes and cardiovascular diseases. Additionally, the use of a two-stage linear regression model uncovered a non-linear relationship between NPAR and depression symptoms.</p><p><strong>Conclusions: </strong>Our research indicates that NPAR levels were associated with depression symptoms. To corroborate our findings, larger prospective studies are warranted to elucidate nonlinear associations in greater detail.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"24 1","pages":"746"},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep learning approach to predict autism spectrum disorder: a systematic review and meta-analysis.","authors":"Yang Ding, Heng Zhang, Ting Qiu","doi":"10.1186/s12888-024-06116-0","DOIUrl":"10.1186/s12888-024-06116-0","url":null,"abstract":"<p><strong>Background: </strong>The use of the deep learning (DL) approach has been suggested or applied to identify childhood autism spectrum disorder (ASD). The capacity to predict ASD, however, differs across investigations. Our study's objective was to conduct a meta-analysis to determine the DL for ASD in children's classification accuracy.</p><p><strong>Methods: </strong>Eligibility criteria were designed according to the purpose of the meta-analysis; PubMed, EMBASE, Cochrane Library, and Web of Science Database were searched for articles published up to April 16, 2023, on the accuracy of DL methods for ASD classification. Using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) to assess the quality of the included studies. Sensitivity, specificity, areas under the curve (AUC), summary receiver operating characteristic (SROC), and corresponding 95% confidence intervals (CIs) were compiled by using the bivariate random-effects models.</p><p><strong>Results: </strong>A total of 11 predictive trials based on DL models were included, involving 9495 ASD patients from 6 different databases. According to bivariate random-effects models' results, the overall sensitivity, specificity, and AUC of the DL technique for ASD were, 0.95 (95% CI = 0.88-0.98), 0.93 (95% CI = 0.85-0.97), and 0.98 (95%CI: 0.97-0.99), respectively. Subgroup analysis results found that different datasets did not cause heterogeneity (meta-regression P = 0.55). The Kaggle dataset's sensitivity and specificity were 0.94 (95%CI: 0.82-1.00) and 0.91 (95%CI: 0.76-1.00), and with 0.97 (95%CI: 0.92-1.00) and 0.97 (95%CI: 0.92-1.00) for ABIDE dataset.</p><p><strong>Conclusions: </strong>DL techniques has satisfactory sensitivity, specificity, and AUC in ASD classification. However, the major heterogeneity of the included studies limited the effectiveness of this meta-analysis. Further trials need to be performed to demonstrate the clinical practicability of DL diagnosis.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"24 1","pages":"739"},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The development of early warning scores or alerting systems for the prediction of adverse events in psychiatric patients: a scoping review.","authors":"Valentina Tamayo Velasquez, Justine Chang, Andrea Waddell","doi":"10.1186/s12888-024-06052-z","DOIUrl":"10.1186/s12888-024-06052-z","url":null,"abstract":"<p><strong>Background: </strong>Adverse events in psychiatric settings present ongoing challenges for both patients and staff. Despite advances in psychiatric interventions and treatments, research on early warning scores and tools to predict patient deterioration is limited. This review provides a summary of the few tools that have been developed in a psychiatric setting, comparing machine learning (ML) and nonmachine learning/traditional methodologies. The outcomes of interest include the selected key variables that contribute to adverse events and the performance and validation measures of the predictive models.</p><p><strong>Methods: </strong>Three databases, Ovid MEDLINE, PsycINFO, and Embase, were searched between February 2023 and April 2023 to identify all relevant studies that included a combination of (and were not limited to) the following search terms: \"Early warning,\" \"Alerting tool,\" and \"Psychiatry\". Peer-reviewed primary research publications were included without imposing any date restrictions. A total of 1,193 studies were screened. A total of 9 studies met the inclusion and exclusion criteria and were included in this review. The PICOS model, the Joanna Briggs Institute (JBI) Reviewer's Manual, and PRISMA guidelines were applied.</p><p><strong>Results: </strong>This review identified nine studies that developed predictive models for adverse events in psychiatric settings. Encompassing 41,566 participants across studies that used both ML and non-ML algorithmic approaches, performance metrics, primarily AUC ROC, varied among studies between 0.62 and 0.95. The best performing model that had also been validated was the random forest (RF) ML model, with a score of 0.87 and a high sensitivity of 74% and a specificity of 88%.</p><p><strong>Conclusion: </strong>Currently, few predictive models have been developed for adverse events and patient deterioration in psychiatric settings. The findings of this review suggest that the use of ML and non-ML algorithms show moderate to good performance in predicting adverse events at the hospitals/units where the tool was developed. Understanding these models and the methodology of the studies is crucial for enhancing patient care as well as staff and patient safety research. Further research on the development and implementation of predictive tools in psychiatry should be carried out to assess the feasibility and efficacy of the tool in psychiatric patients.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"24 1","pages":"742"},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relational institution: an ethnographic study of recovery orientation and relational engagement on a psychiatric rehabilitation ward in London.","authors":"Henry J Whittle, Ed Kiely, Isabel Millard, Sushrut Jadhav, Helen Killaspy","doi":"10.1186/s12888-024-06140-0","DOIUrl":"10.1186/s12888-024-06140-0","url":null,"abstract":"<p><strong>Background: </strong>In the UK, inpatient psychiatric rehabilitation services for complex psychosis aim to provide recovery-orientated treatment to patients, with the goal of supporting sustained stepdown into community living. The extent to which rehabilitation services uphold this recovery orientation is associated with better outcomes. However, few studies have been able to ascertain what promotes or prevents recovery orientation in inpatient settings.</p><p><strong>Methods: </strong>We conducted an ethnographic study of treatment on a National Health Service (NHS) psychiatric rehabilitation ward in London over six months during August 2022-February 2023. Data were collected through participant observation and semi-structured interviews with 9 patients and 14 staff members. Fieldnotes and interview transcripts were analysed using situational analysis.</p><p><strong>Results: </strong>Our analysis highlights the importance of what we term 'relational engagement' between staff and patients to nurture and sustain recovery-orientated treatment. This relational engagement was embodied through small acts of genuine human connection grounded in mutual acceptance and affective bonding; close attention to detail that communicated curiosity and respect; and recognition, appreciation, and encouragement of the slow and gradual progress that characterises recovery in complex psychosis. Yet, this relational engagement was often limited or foreclosed by the social environment of the ward and the wider institutional context. Limiting elements included the dominance of hospital logics geared towards high-throughput acute treatment and risk management; the presence of audit culture that led to a level of standardisation curtailing more genuine human connection; and staff demoralisation driven by events on and off the ward, including system-wide crises and more localised conflicts and disturbances. Some of these conflicts involved discrimination, most prominently anti-Black racism and homophobia, reflecting wider structural inequalities that characterise inpatient psychiatric populations and the healthcare workforce.</p><p><strong>Conclusion: </strong>Relationships, often under-prioritised in mental health services, were a key cornerstone of recovery-orientated treatment on a psychiatric rehabilitation ward. The shaping of therapeutic relationships amounted to an active process of relational engagement, which may be afforded or constrained by complex social elements requiring careful consideration in inpatient psychiatry. These social elements go beyond more surface-level factors such as staff training, knowledge, or attitudes and may require structural and system-level interventions.</p>","PeriodicalId":9029,"journal":{"name":"BMC Psychiatry","volume":"24 1","pages":"738"},"PeriodicalIF":3.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}