Personalized Models of Psychopathology Wright, Aidan G.C; Woods, William C
Annual review of clinical psychology,
05/2020, Volume:
16, Issue:
1
Journal Article
Peer reviewed
Open access
The personalized approach to psychopathology conceptualizes mental disorder as a complex system of contextualized dynamic processes that is nontrivially specific to each individual, and it seeks to ...develop formal idiographic statistical models to represent these individual processes. Although the personalized approach draws on long-standing influences in clinical psychology, there has been an explosion of research in recent years following the development of intensive longitudinal data capture and statistical techniques that facilitate modeling of the dynamic processes of each individual's pathology. Advances are also making idiographic analyses scalable and generalizable. We review emerging research using the personalized approach in descriptive psychopathology, precision assessment, and treatment selection and tailoring, and we identify future challenges and areas in need of additional research. The personalized approach to psychopathology holds promise to resolve thorny diagnostic issues, generate novel insights, and improve the timing and efficacy of interventions.
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CMK, FFLJ, NUK, UL, UM, UPUK
ABSTRACT
We investigate the occurrence of crystalline silicates in oxygen‐rich evolved stars across a range of metallicities and mass‐loss rates. It has been suggested that the crystalline silicate ...feature strength increases with increasing mass‐loss rate, implying a correlation between lattice structure and wind density. To test this, we analyse Spitzer Infrared Spectrograph and Infrared Space Observatory Short Wavelength Spectrometer spectra of 217 oxygen‐rich asymptotic giant branch and 98 red supergiants in the Milky Way, the Large and Small Magellanic Clouds, and Galactic globular clusters. These encompass a range of spectral morphologies from the spectrally rich which exhibit a wealth of crystalline and amorphous silicate features to ‘naked’ (dust‐free) stars. We combine spectroscopic and photometric observations with the grams grid of radiative transfer models to derive (dust) mass‐loss rates and temperature. We then measure the strength of the crystalline silicate bands at 23, 28 and 33 μm. We detect crystalline silicates in stars with dust mass‐loss rates which span over 3 dex, down to rates of ∼10−9 M⊙ yr−1. Detections of crystalline silicates are more prevalent in higher mass‐loss rate objects, though the highest mass‐loss rate objects do not show the 23‐μm feature, possibly due to the low temperature of the forsterite grains or it may indicate that the 23‐μm band is going into absorption due to high column density. Furthermore, we detect a change in the crystalline silicate mineralogy with metallicity, with enstatite seen increasingly at low metallicity.
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BFBNIB, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Ambulatory assessment (e.g., ecological momentary assessment) is now widely used in psychological research, yet key design decisions remain largely informed by methodological lore as opposed to ...systematic inquiry. The present study experimentally tested whether signal- (e.g., random prompt) and event- (e.g., complete a survey every time a target event occurs) contingent recording procedures of interpersonal behavior and affect in social situations yield equivalent quality and quantity of data. Participants (N = 286) completed baseline questionnaires, underwent cluster randomization to either a signal- or event-contingent condition, and then completed 1 week of ambulatory assessment, during which they answered questions about their social behavior and affect tied to their social interactions. Conditions were compared on response frequency, means and variances of interpersonal behavior and affect, correlations between interpersonal behavior and affect within-subject, and associations between momentary behavior and affect and baseline variables (e.g., Big Five traits). Results indicated that signal- and event-contingent recording techniques provided equivalent data quality, suggesting that researchers can use the 2 methodologies interchangeably to draw conclusions about means, variances, and associations when examining social interactions. However, results also showed that event-contingent recording returned, on average, a higher number of reported social interactions per individual, and this was true for most time periods of the day. Thus, event-contingent recording may hold advantages for studying frequency and timing of social interactions.
Public Significance Statement
This study compared two methods for administering surveys to measure social behavior and mood in daily life, using random prompts throughout the day or asking participants to report only when a social interaction occurs. Results suggest that both methods provide similar data quality, although having individuals report when they experience a social interaction may yield a higher quantity of data.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ, UPUK
Objective: Psychopathology research has relied on discrete diagnoses, which neglects the unique manifestations of each individual's pathology. Borderline personality disorder combines interpersonal, ...affective, and behavioral regulation impairments making it particularly ill-suited to a "one size fits all" diagnosis. Clinical assessment and case formulation involve understanding and developing a personalized model for each patient's contextualized dynamic processes, and research would benefit from a similar focus on the individual. Method: We use group iterative multiple model estimation, which estimates a model for each individual and identifies general or shared features across individuals, in both a mixed-diagnosis sample (N = 78) and a subsample with a single diagnosis (n = 24). Results: We found that individuals vary widely in their dynamic processes in affective and interpersonal domains both within and across diagnoses. However, there was some evidence that dynamic patterns relate to transdiagnostic baseline measures. We conclude with descriptions of 2 person-specific models as an example of the heterogeneity of dynamic processes. Conclusions: The idiographic models presented here join a growing literature showing that the individuals differ dramatically in the total patterning of these processes, even as key processes are shared across individuals. We argue that these processes are best estimated in the context of person-specific models, and that so doing may advance our understanding of the contextualized dynamic processes that could identify maintenance mechanisms and treatment targets.
What is the public health significance of this article?
This study highlights the importance of understanding psychopathology using individualized models. We demonstrate research techniques that can be used to develop personalized models of psychopathology as well as search for commonalities across individuals.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ, UPUK
Autosomal recessive primary microcephaly (MCPH) is a neurodevelopmental disorder. It is characterized by two principal features, microcephaly present at birth and nonprogressive mental retardation. ...The microcephaly is the consequence of a small but architecturally normal brain, and it is the cerebral cortex that shows the greatest size reduction. There are at least seven MCPH loci, and four of the genes have been identified:
MCPH1, encoding Microcephalin;
MCPH3, encoding CDK5RAP2;
MCPH5, encoding ASPM; and
MCPH6, encoding CENPJ. These findings are starting to have an impact on the clinical management of families affected with MCPH. Present data suggest that MCPH is the consequence of deficient neurogenesis within the neurogenic epithelium. Evolutionary interest in MCPH has been sparked by the suggestion that changes in the MCPH genes might also be responsible for the increase in brain size during human evolution. Indeed, evolutionary analyses of Microcephalin and ASPM reveal evidence for positive selection during human and great ape evolution. So an understanding of this rare genetic disorder may offer us significant insights into neurogenic mitosis and the evolution of the most striking differences between us and our closest living relatives: brain size and cognitive ability.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Personality and psychopathology are composed of dynamic and interactive processes among diverse psychological systems, manifesting over time and in response to an individual's natural environment. ...Ambulatory assessment techniques promise to revolutionize assessment practices by allowing access to the dynamic data necessary to study these processes directly. Assessing manifestations of personality and psychopathology naturalistically in an individual's own ecology allows for dynamic modeling of key behavioral processes. However, advances in dynamic data collection have highlighted the challenges of both fully understanding an individual (via idiographic models) and how s/he compares with others (as seen in nomothetic models). Methods are needed that can simultaneously model idiographic (i.e., person-specific) processes and nomothetic (i.e., general) structure from intensive longitudinal personality assessments. Here we present a method, group iterative multiple model estimation (GIMME) for simultaneously studying general, shared (i.e., in subgroups), and person-specific processes in intensive longitudinal behavioral data. We first provide an introduction to the GIMME method, followed by a demonstration of its use in a sample of individuals diagnosed with personality disorder who completed daily diaries over 100 consecutive days.
Public Significance Statement
Ambulatory assessment techniques (e.g., ecological momentary assessment) generate information that can be used to develop personalized models of an individual's behavior. Techniques are presented that allow for the simultaneous development of many personalized models and searches for shared features across models.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ, UPUK
Oropharyngeal squamous cell carcinoma (OPSCC) is often diagnosed at an advanced stage because the disease often causes minimal symptoms other than metastasis to neck lymph nodes. Better tools are ...required to assist with the early detection of OPSCC. MicroRNAs (miRNAs, miRs) are potential biomarkers for early head and neck squamous cell cancer diagnosis, prognosis, recurrence, and presence of metastatic disease. However, there is no widespread agreement on a panel of miRNAs with clinically meaningful utility for head and neck squamous cell cancers. This could be due to variations in the collection, storage, pre-processing, and isolation of RNA, but several reports have indicated that the selection and reproducibility of biomarkers has been widely affected by the methods used for data analysis. The primary analysis issues appear to be model overfitting and the incorrect application of statistical techniques. The purpose of this study was to develop a robust statistical approach to identify a miRNA signature that can distinguish controls and patients with inflammatory disease from patients with human papilloma virus positive (HPV +) OPSCC.
Small extracellular vesicles were harvested from the serum of 20 control patients, 20 patients with gastroesophageal reflux disease (GORD), and 40 patients with locally advanced HPV + OPSCC. MicroRNAs were purified, and expression profiled on OpenArray™. A novel cross validation method, using lasso regression, was developed to stabilise selection of miRNAs for inclusion in a prediction model. The method, named StaVarSel (for Stable Variable Selection), was used to derive a diagnostic biomarker signature.
A standard cross validation approach was unable to produce a biomarker signature with good cross validated predictive capacity. In contrast, StaVarSel produced a regression model containing 11 miRNA ratios with potential clinical utility. Sample permutations indicated that the estimated cross validated prediction accuracy of the 11-miR-ratio model was not due to chance alone.
We developed a novel method, StaVarSel, that was able to identify a panel of miRNAs, present in small extracellular vesicles derived from blood serum, that robustly cross validated as a biomarker for the detection of HPV + OPSCC. This approach could be used to derive diagnostic biomarkers of other head and neck cancers.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Greater understanding of international cancer survival differences is needed. We aimed to identify predictors and consequences of cancer diagnosis through emergency presentation in different ...international jurisdictions in six high-income countries.
Using a federated analysis model, in this cross-sectional population-based study, we analysed cancer registration and linked hospital admissions data from 14 jurisdictions in six countries (Australia, Canada, Denmark, New Zealand, Norway, and the UK), including patients with primary diagnosis of invasive oesophageal, stomach, colon, rectal, liver, pancreatic, lung, or ovarian cancer during study periods from Jan 1, 2012, to Dec 31, 2017. Data were collected on cancer site, age group, sex, year of diagnosis, and stage at diagnosis. Emergency presentation was defined as diagnosis of cancer within 30 days after an emergency hospital admission. Using logistic regression, we examined variables associated with emergency presentation and associations between emergency presentation and short-term mortality. We meta-analysed estimates across jurisdictions and explored jurisdiction-level associations between cancer survival and the percentage of patients diagnosed as emergencies.
In 857 068 patients across 14 jurisdictions, considering all of the eight cancer sites together, the percentage of diagnoses through emergency presentation ranged from 24·0% (9165 of 38 212 patients) to 42·5% (12 238 of 28 794 patients). There was consistently large variation in the percentage of emergency presentations by cancer site across jurisdictions. Pancreatic cancer diagnoses had the highest percentage of emergency presentations on average overall (46·1% 30 972 of 67 173 patients), with the jurisdictional range being 34·1% (1083 of 3172 patients) to 60·4% (1317 of 2182 patients). Rectal cancer had the lowest percentage of emergency presentations on average overall (12·1% 10 051 of 83 325 patients), with a jurisdictional range of 9·1% (403 of 4438 patients) to 19·8% (643 of 3247 patients). Across the jurisdictions, older age (ie, 75–84 years and 85 years or older, compared with younger patients) and advanced stage at diagnosis compared with non-advanced stage were consistently associated with increased emergency presentation risk, with the percentage of emergency presentations being highest in the oldest age group (85 years or older) for 110 (98%) of 112 jurisdiction-cancer site strata, and in the most advanced (distant spread) stage category for 98 (97%) of 101 jurisdiction-cancer site strata with available information. Across the jurisdictions, and despite heterogeneity in association size (I2=93%), emergency presenters consistently had substantially greater risk of 12-month mortality than non-emergency presenters (odds ratio >1·9 for 112 100% of 112 jurisdiction-cancer site strata, with the minimum lower bound of the related 95% CIs being 1·26). There were negative associations between jurisdiction-level percentage of emergency presentations and jurisdiction-level 1-year survival for colon, stomach, lung, liver, pancreatic, and ovarian cancer, with a 10% increase in percentage of emergency presentations in a jurisdiction being associated with a decrease in 1-year net survival of between 2·5% (95% CI 0·28–4·7) and 7·0% (1·2–13·0).
Internationally, notable proportions of patients with cancer are diagnosed through emergency presentation. Specific types of cancer, older age, and advanced stage at diagnosis are consistently associated with an increased risk of emergency presentation, which strongly predicts worse prognosis and probably contributes to international differences in cancer survival. Monitoring emergency presentations, and identifying and acting on contributing behavioural and health-care factors, is a global priority for cancer control.
Canadian Partnership Against Cancer; Cancer Council Victoria; Cancer Institute New South Wales; Cancer Research UK; Danish Cancer Society; National Cancer Registry Ireland; The Cancer Society of New Zealand; National Health Service England; Norwegian Cancer Society; Public Health Agency Northern Ireland, on behalf of the Northern Ireland Cancer Registry; the Scottish Government; Western Australia Department of Health; and Wales Cancer Network.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Interpersonal theory organizes social behavior along dominant (vs. submissive) and warm (vs. cold) dimensions. There is a growing interest in assessing these behaviors in naturalistic settings to ...maximize ecological validity and to study dynamic social processes. Studies that have assessed interpersonal behavior in daily life have primarily relied on behavioral checklists. Although checklists have advantages, they are discrepant with techniques used to capture constructs typically assessed alongside warmth and dominance, such as affect, which typically rely on adjective descriptors. Further, these checklists are distinct from the methodologies used at the dispositional level, such as personality inventories, which rarely rely on behavioral checklists. The present study evaluates the psychometric performance of interpersonal adjectives presented on a visual analog scale in five different samples. Validity of the Visual Interpersonal Analog scale (VIAS) approach to momentary assessment was evaluated by comparing its performance with an interpersonal behavior checklist and by examining associations among the VIAS Warmth and Dominance scales and other momentary and dispositional constructs. Results were generally consistent with an existing interpersonal behavior checklist at the within-person level but diverged somewhat at the dispositional level. Across the five samples, the VIAS generally performed as hypothesized at both the within- and between-person levels.
Public Significance Statement
The present study reports on the development of a new method for measuring social behavior in ambulatory assessments. We find that the method performs as would be hypothesized based upon theory and existing empirical research on links between interpersonal behaviors and a variety of emotional and behavioral processes.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ, UPUK
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