Measurement invariance is an understudied topic in much of psychopathology research, but its effects have far‐reaching consequences. It has rarely been examined with respect to hierarchical models of ...psychopathology. He & Li’s (2020) study represents one of the first attempts to bridge the gap between relatively narrow focused studies on the psychometric properties of specific assessments with broader research on the hierarchical structure of psychopathology. The results are promising, but more research is needed to understand the impact of culture, race, and ethnicity on the expression of psychopathology. Future research may determine whether dimensional and hierarchical models decrease the effect of cultural biases on assessment and help to further understand the etiology of epidemiological differences in rates of disorders. These models may also help to account for culture‐bound syndromes.
Traditional diagnostic systems went beyond empirical evidence on the structure of mental health. Consequently, these diagnoses do not depict psychopathology accurately, and their validity in research ...and utility in clinicalpractice are therefore limited. The Hierarchical Taxonomy of Psychopathology (HiTOP) consortium proposed a model based on structural evidence. It addresses problems of diagnostic heterogeneity, comorbidity, and unreliability. We review the HiTOP model, supporting evidence, and conceptualization of psychopathology in this hierarchical dimensional framework. The system is not yet comprehensive, and we describe the processes for improving and expanding it. We summarize data on the ability of HiTOP to predict and explain etiology (genetic, environmental, and neurobiological), risk factors, outcomes, and treatment response. We describe progress in the development of HiTOP-based measures and in clinical implementation of the system. Finally, we review outstanding challenges and the research agenda. HiTOP is of practical utility already, and its ongoing development will produce a transformative map of psychopathology.
IMPORTANCE: It remains uncertain whether people with psychotic disorders experience progressive cognitive decline or normal cognitive aging after first hospitalization. This information is essential ...for prognostication in clinical settings, deployment of cognitive remediation, and public health policy. OBJECTIVE: To examine long-term cognitive changes in individuals with psychotic disorders and to compare age-related differences in cognitive performance between people with psychotic disorders and matched control individuals (ie, individuals who had never had psychotic disorders). DESIGN, SETTING, AND PARTICIPANTS: The Suffolk County Mental Health Project is an inception cohort study of first-admission patients with psychosis. Cognitive functioning was assessed 2 and 20 years later. Patients were recruited from the 12 inpatient facilities of Suffolk County, New York. At year 20, the control group was recruited by random digit dialing and matched to the clinical cohort on zip code and demographics. Data were collected between September 1991 and July 2015. Analysis began January 2016. MAIN OUTCOMES AND MEASURES: Change in cognitive functioning in 6 domains: verbal knowledge (Wechsler Adult Intelligence Scale–Revised vocabulary test), verbal declarative memory (Verbal Paired Associates test I and II), visual declarative memory (Visual Reproduction test I and II), attention and processing speed (Symbol Digit Modalities Test–written and oral; Trail Making Test TMT–A), abstraction-executive function (Trenerry Stroop Color Word Test; TMT-B), and verbal fluency (Controlled Oral Word Association Test). RESULTS: A total of 705 participants were included in the analyses (mean SD age at year 20, 49.4 10.1 years): 445 individuals (63.1%) had psychotic disorders (211 with schizophrenia spectrum 138 (65%) male; 164 with affective psychoses 76 (46%) male; 70 with other psychoses 43 (61%) male); and 260 individuals (36.9%) in the control group (50.5 9.0 years; 134 51.5% male). Cognition in individuals with a psychotic disorder declined on all but 2 tests (average decline: d = 0.31; range, 0.17-0.54; all P < .001). Cognitive declines were associated with worsening vocational functioning (Visual Reproduction test II: r = 0.20; Symbol Digit Modalities Test–written: r = 0.25; Stroop: r = 0.24; P < .009) and worsening negative symptoms (avolition: Symbol Digit Modalities Test–written: r = −0.24; TMT-A: r = −0.21; Stroop: r = −0.21; all P < .009; inexpressivity: Stroop: r = −0.22; P < .009). Compared with control individuals, people with psychotic disrders showed age-dependent deficits in verbal knowledge, fluency, and abstraction-executive function (vocabulary: β = −0.32; Controlled Oral Word Association Test: β = −0.32; TMT-B: β = 0.23; all P < .05), with the largest gap among participants 50 years or older. CONCLUSIONS AND RELEVANCE: In individuals with psychotic disorders, most cognitive functions declined over 2 decades after first hospitalization. Observed declines were clinically significant. Some declines were larger than expected due to normal aging, suggesting that cognitive aging in some domains may be accelerated in this population. If confirmed, these findings would highlight cognition as an important target for research and treatment during later phases of psychotic illness.
Schizophrenia is associated with major cognitive deficits and has been conceptualized as both a neurodevelopmental and a neurodegenerative disorder. However, when deficits develop and how they change ...over the course of illness is uncertain.
To trace cognition from elementary school to old age to test neurodevelopmental and neurodegenerative theories of psychotic disorders.
Data were taken from the Suffolk County Mental Health Project, a first-admission longitudinal cohort study of individuals with psychotic disorders. Participants were recruited from all 12 inpatient psychiatric facilities in Suffolk County, New York. This analysis concerns the 428 participants with at least 2 estimates of general cognitive ability. Data were collected between September 1989 and October 2019, and data were analyzed from January 2020 to October 2021.
Psychiatric hospitalization for psychosis.
Preadmission cognitive scores were extracted from school and medical records. Postonset cognitive scores were based on neuropsychological testing at 6-month, 24-month, 20-year, and 25-year follow-ups.
Of the 428 included individuals (212 with schizophrenia and 216 with other psychotic disorders), 254 (59.6%) were male, and the mean (SD) age at psychosis onset was 27 (9) years. Three phases of cognitive change were observed: normative, declining, and deteriorating. In the first phase, cognition was stable. Fourteen years before psychosis onset, those with schizophrenia began to experience cognitive decline at a rate of 0.35 intelligence quotient (IQ) points per year (95% CI, 0.29-0.42; P < .001), a significantly faster decline than those with other psychotic disorders (0.15 IQ points per year; 95% CI, 0.08-0.22, P < .001). At 22 years after onset, both groups declined at a rate of 0.59 IQ points per year (95% CI, 0.25-0.94; P < .001).
In this cohort study, cognitive trajectories in schizophrenia were consistent with both a neurodevelopmental and neurodegenerative pattern, resulting in a loss of 16 IQ points over the period of observation. Cognitive decline began long prior to psychosis onset, suggesting the window for primary prevention is earlier than previously thought. A window for secondary prevention emerges in the third decade of illness, when cognitive declines accelerate in individuals with schizophrenia and other psychotic disorders.
Posttraumatic stress disorder (PTSD) is common, debilitating, and associated with an increased risk of health problems, including cardiovascular disease. PTSD is related to poor autonomic function ...indicated by reduced heart rate variability (HRV). However, very little work has tested the timescale or direction of these effects, given that most evidence comes from cross-sectional studies. Documentation of when effects occur and in what direction can shed light on mechanisms of cardiovascular disease risk and inform treatment. The present study of 169 World Trade Center responders, oversampled for PTSD, tested how daily PTSD symptoms were associated with autonomic function as reflected through HRV.
Participants ( N = 169) completed surveys of PTSD symptoms three times a day at 5-hour intervals for 4 days while also wearing ambulatory monitors to record electrocardiograms to derive HRV (i.e., mean absolute value of successive differences between beat-to-beat intervals).
HRV did not predict PTSD symptoms. However, PTSD symptoms during a 5-hour interval predicted reduced HRV at the next 5-hour interval ( β = -0.09, 95% confidence interval = -0.16 to -0.02, p = .008). Results held adjusting for baseline age, current heart problems, and current PTSD diagnosis.
Findings underscore growing awareness that PTSD symptoms are not static. Even their short-term fluctuations may affect cardiovascular functioning, which could have more severe impacts if disruption accumulates over time. Research is needed to determine if momentary interventions can halt increases in PTSD symptoms or mitigate their impact on cardiovascular health.
Abstract Background A large body of research has focused on identifying the optimal number of dimensions—or spectra—to model individual differences in psychopathology. Recently, it has become ...increasingly clear that ostensibly competing models with varying numbers of spectra can be synthesized in empirically derived hierarchical structures. Methods and Materials. We examined the convergence between top-down (bass-ackwards or sequential principal components analysis) and bottom-up (hierarchical agglomerative cluster analysis) statistical methods for elucidating hierarchies to explicate the joint hierarchical structure of clinical and personality disorders. Analyses examined 24 clinical and personality disorders based on semi-structured clinical interviews in an outpatient psychiatric sample ( n = 2900). Results The two methods of hierarchical analysis converged on a three-tier joint hierarchy of psychopathology. At the lowest tier, there were seven spectra—disinhibition, antagonism, core thought disorder, detachment, core internalizing, somatoform, and compulsivity—that emerged in both methods. These spectra were nested under the same three higher-order superspectra in both methods: externalizing, broad thought dysfunction, and broad internalizing. In turn, these three superspectra were nested under a single general psychopathology spectrum, which represented the top tier of the hierarchical structure. Conclusions The hierarchical structure mirrors and extends upon past research, with the inclusion of a novel compulsivity spectrum, and the finding that psychopathology is organized in three superordinate domains. This hierarchy can thus be used as a flexible and integrative framework to facilitate psychopathology research with varying levels of specificity (i.e., focusing on the optimal level of detailed information, rather than the optimal number of factors).
Sleep disturbances are common in posttraumatic stress disorder (PTSD) and can have major impacts on workplace performance and functioning. Although effects between PTSD and sleep broadly have been ...documented, little work has tested their day-to-day temporal relationship particularly in those exposed to occupational trauma. The present study examined daily, bidirectional associations between PTSD symptoms and self-reported sleep duration and quality in World Trade Center (WTC) responders oversampled for PTSD. WTC responders (N = 202; 19.3% with current PTSD diagnosis) were recruited from the Long Island site of the WTC health program. Participants were administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; SCID; First, Spitzer, Gibbon, & Williams, 1997) and completed daily assessments of PTSD symptoms, sleep duration and sleep quality for 7 days. PTSD symptoms on a given day were prospectively associated with shorter sleep duration (β = −.13) and worse sleep quality (β = −.18) later that night. Reverse effects were also significant but smaller, with reduced sleep duration (not quality) predicting increased PTSD the next day (β = −.04). Effects of PTSD on sleep duration and quality were driven by numbing symptoms, whereas effects of sleep duration on PTSD were largely based on intrusion symptoms. PTSD symptoms and sleep have bidirectional associations that occur on a daily basis, representing potential targets to disrupt maintenance of each. Improving PTSD numbing symptoms may improve sleep, and increasing sleep duration may improve intrusion symptoms in individuals with exposure to work-related traumatic events.
COVID-19 public health proscriptions have created severe if temporary, barriers to accessing face-to-face psychotherapy across the world. As disruptive as these are, they come on top of more ...long-standing barriers to getting psychotherapy faced by millions in need. eHealth interventions offer an avenue for redressing both types of barriers, but evidence about their efficacy remains a concern. This review of reviews and meta-analyses outlines the strength of evidence and effect sizes for guided and unguided approaches to eHealth interventions targeting common problems in psychotherapy (i.e., depression, anxiety, substance abuse, and general well-being). After a comprehensive search, a total of 65 reviews and meta-analyses were identified and evaluated for treatment effects, moderators, acceptability, and attrition. Findings show eHealth is acceptable and effective at improving depression, anxiety, alcohol-related problems, and general mental health compared to waitlist, and can even offer benefit as an adjunct to traditional psychotherapy. Mixed evidence was found when comparing guided versus unguided interventions as well as the strength of benefit relative to active controls and the degree to which these approaches are associated with attrition. eHealth interventions have the potential to be an effective tool for redressing both new and old psychotherapy access barriers.
eHealth para remediar las barreras de acceso a la psicoterapia, tanto nuevas como antiguas: una reseña de reseña y metaanálisis
Las proscripciones de salud pública de COVID-19 han creado barreras severas, aunque temporales para
acceso a psicoterapia cara a cara en todo el mundo. Tan disruptivos como estos son, se suman a las barreras más antiguas para obtener psicoterapia a los que a millones en necesidad se enfrentan. Las intervenciones de eSalud ofrecen una vía para corregir ambos tipos de barreras, pero la evidencia sobre su eficacia sigue siendo motivo de preocupación. Esta reseña de reseñas y los metaanálisis describen la fuerza de la evidencia y los tamaños del efecto para guiados y enfoques no guiados para las intervenciones de eSalud dirigidas a problemas comunes en psicoterapia (es decir, depresión, ansiedad, abuso de sustancias, y bienestar general). Después de una búsqueda exhaustiva, se identificaron un total de 65 reseñas y metaanálisis y se evaluaron los efectos del tratamiento, moderadores, aceptabilidad y desgaste. Hallazgos muestran que la eSalud es aceptable y efectiva para mejorar la depresión, la ansiedad y el alcohol problemas y salud mental en general en comparación con la lista de espera, e incluso puede ofrecer beneficio como complemento de la psicoterapia tradicional. Se encontró evidencia mixta cuando comparar intervenciones guiadas versus no guiadas, así como la fuerza del beneficio en relación con los controles activos y el grado en que estos enfoques están asociados con desgaste. Las intervenciones de eSalud tienen el potencial de ser una herramienta efectiva para remediar las barreras de acceso a la psicoterapia nuevas y antiguas.
智慧醫療矯正使用心理治療的新舊障礙：回顧與後設分析之評論
在世界各地，COVID-19公共衛生禁令們創造了使用面對面心理治療的嚴重暫時性障礙。它們是如此的具有破壞性, 以至於超越了數百萬有需求的人在取得心理治療時面對的更長期存在的障礙。智慧醫療提供了一條路徑矯正這兩種類型的障礙, 但有關其功效的證據仍然值得關注。此針對文獻和後設分析之評論概述了智慧醫療針對心理治療常見問題 (即抑鬱症，焦慮症，藥物濫用和總體健康狀況) 的有指導和無指導的干預策略之證據強度和效應值。經過全面性的搜索, 共有65份回顧和後設分析被識別並評估治療效果, 調節因子, 可接受性和損耗。研究顯示智慧醫療在改善抑鬱症, 焦慮症, 酗酒相關方面問題以及相較於候補名單的一般心理健康是可接受且有效的; 作為傳統心理治療的附屬物, 其甚至可以提供效益。在比較有指導及無指導的干預、關於積極控制的受益強度, 以及這些方法與損耗的關聯程度時, 我們發現了混合的證據。智慧醫療干預有可能成為矯正新舊的心理治療使用障礙有效的工具。
Abstract Recent reports suggest bipolar disorder is not only under-diagnosed but may at times be over-diagnosed. Little is known about factors that increase the odds of such mistakes. The present ...work explores whether symptoms of borderline personality disorder increase the odds of a bipolar misdiagnosis. Psychiatric outpatients ( n = 610) presenting for treatment were administered the Structured Clinical Interview for DSM-IV (SCID) and the Structured Interview for DSM-IV Personality for DSM-IV axis II disorders (SIDP-IV), as well as a questionnaire asking if they had ever been diagnosed with bipolar disorder by a mental health care professional. Eighty-two patients who reported having been previously diagnosed with bipolar disorder but who did not have it according to the SCID were compared to 528 patients who had never been diagnosed with bipolar disorder. Patients with borderline personality disorder had significantly greater odds of a previous bipolar misdiagnosis, but no specific borderline criterion was unique in predicting this outcome. Patients with borderline personality disorder, regardless of how they meet criteria, may be at increased risk of being misdiagnosed with bipolar disorder.
Is bipolar disorder overdiagnosed? Zimmerman, Mark; Ruggero, Camilo J; Chelminski, Iwona ...
The journal of clinical psychiatry,
06/2008, Letnik:
69, Številka:
6
Journal Article
Recenzirano
Bipolar disorder, a serious illness resulting in significant psychosocial morbidity and excess mortality, has been reported to be frequently underdiagnosed. However, during the past few years we have ...observed the emergence of an opposite phenomenon--the overdiagnosis of bipolar disorder. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we empirically examined whether bipolar disorder is overdiagnosed.
Seven hundred psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV (SCID) and completed a self-administered questionnaire, which asked the patients whether they had been previously diagnosed with bipolar or manic-depressive disorder by a health care professional. Family history information was obtained from the patient regarding first-degree relatives. Diagnoses were blind to the results of the self-administered scale. The study was conducted from May 2001 to March 2005.
Fewer than half the patients who reported that they had been previously diagnosed with bipolar disorder received a diagnosis of bipolar disorder based on the SCID. Patients with SCID-diagnosed bipolar disorder had a significantly higher morbid risk of bipolar disorder than patients who self-reported a previous diagnosis of bipolar disorder that was not confirmed by the SCID (p < .02). Patients who self-reported a previous diagnosis of bipolar disorder that was not confirmed by the SCID did not have a significantly higher morbid risk for bipolar disorder than the patients who were negative for bipolar disorder by self-report and the SCID.
Not only is there a problem with underdiagnosis of bipolar disorder, but also an equal if not greater problem exists with overdiagnosis.
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