Many psychiatric conditions have been linked with deficits in cost-benefit reinforcement learning. However, previous results have been mixed, partly due to significant symptom heterogeneity within ...distinct psychiatric conditions and symptom overlap between them, making it difficult to disentangle whether alterations in cost-benefit reinforcement learning are condition- or symptom-specific. Here, we investigate whether transdiagnostic (sub-)clinical symptoms and risk factors for psychopathology are associated with reinforcement learning and cost-benefit integration. For this reason, we use an online cost-benefit reinforcement learning task in combination with self-rated measures of common transdiagnostic factors (perceived chronic stress, anhedonia, impulsivity, energy/fatigue) in 360 subjects (18–46 years old) with(out) a diagnosis of a psychiatric condition. Increased chronic stress and impulsivity were associated with poorer reinforcement learning, independent of whether participants were learning to minimize costs (physical effort) or maximize benefits (monetary rewards). These associations were selectively driven by a reduction in learning from positive and negative reinforcement, not punishment. The use of mobile phone (compared to laptop/PC) was also associated with lower performance accuracy. Data and scripts are available (https://osf.io/w3mvq/). Our work emphasizes the importance of chronic stress and impulsivity as potential drivers of altered motivation and goal-directed behavior beyond diagnostic labels, in addition to methodological challenges associated with data collection via online platforms.
●Chronic stress is negatively associated with learning from reinforcement, not punishment.●Impulsivity is negatively correlated with cost and benefit reinforcement learning.●Use of a single device type is recommended when conducting online research.
In this study, the feasibility and efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), ACT augmented with a daily life application, was investigated in 55 emerging adults (age 16 to ...25) with subthreshold depressive and/or psychotic complaints. Participants were randomized to ACT-DL (n = 27) or to active control (n = 28), with assessments completed at pre- and post-measurement and 6- and 12-months follow-up. It took up to five (ACT-DL) and 11 (control) months to start group-based interventions. Participants attended on average 4.32 out of 5 ACT-DL sessions. On the app, they filled in on average 69 (48%) of signal-contingent beep-questionnaires, agreed to 15 (41%) of offered beep-exercises, initiated 19 on-demand exercises, and rated ACT-DL metaphors moderately useful. Relative to active control, interviewer-rated depression scores decreased significantly in ACT-DL participants (p = .027). Decreases in self-reported depression, psychotic-related distress, anxiety, and general psychopathology did not differ between conditions. ACT-DL participants reported increased mean NA (p = .011), relative to active controls. Mean PA did not change in either group, nor did psychological flexibility. ACT-DL is a feasible intervention, although adaptations in future research may improve delivery of and compliance with the intervention. There were mixed findings for its efficacy in reducing subthreshold psychopathology in emerging adults. Dutch Trial Register no.: NTR3808.
•EMI-augmented ACT is a feasible intervention in non-help-seeking emerging adults.•Objective depressive symptoms reduce more in ACT-DL than in active control.•Self-reported psychopathology reduces equally in ACT-DL compared to active control.•Daily-life NA was increased in ACT-DL, compared to a decrease in active control.•ACT-DL did not have an effect on psychological flexibility, nor on daily life PA.
22q11.2 deletion syndrome (22q11DS) is the most frequently occurring microdeletion in humans. It is associated with a significant impact on brain structure, including prominent reductions in gray ...matter volume (GMV), and neuropsychiatric manifestations, including cognitive impairment and psychosis. It is unclear whether GMV alterations in 22q11DS occur according to distinct structural patterns. Then, 783 participants (470 with 22q11DS: 51% females, mean age SD 18.2 9.2; and 313 typically developing TD controls: 46% females, mean age 18.0 8.6) from 13 datasets were included in the present study. We segmented structural T1‐weighted brain MRI scans and extracted GMV images, which were then utilized in a novel source‐based morphometry (SBM) pipeline (SS‐Detect) to generate structural brain patterns (SBPs) that capture co‐varying GMV. We investigated the impact of the 22q11.2 deletion, deletion size, intelligence quotient, and psychosis on the SBPs. Seventeen GMV‐SBPs were derived, which provided spatial patterns of GMV covariance associated with a quantitative metric (i.e., loading score) for analysis. Patterns of topographically widespread differences in GMV covariance, including the cerebellum, discriminated individuals with 22q11DS from healthy controls. The spatial extents of the SBPs that revealed disparities between individuals with 22q11DS and controls were consistent with the findings of the univariate voxel‐based morphometry analysis. Larger deletion size was associated with significantly lower GMV in frontal and occipital SBPs; however, history of psychosis did not show a strong relationship with these covariance patterns. 22q11DS is associated with distinct structural abnormalities captured by topographical GMV covariance patterns that include the cerebellum. Findings indicate that structural anomalies in 22q11DS manifest in a nonrandom manner and in distinct covarying anatomical patterns, rather than a diffuse global process. These SBP abnormalities converge with previously reported cortical surface area abnormalities, suggesting disturbances of early neurodevelopment as the most likely underlying mechanism.
Using a novel source‐based morphometry method called SS‐Detect, we identified 12 structural brain patterns (SBPs) that discriminated individuals with 22q11.2 deletion syndrome from healthy controls. We further demonstrated that deletion size was related to structural covariance patterns; however, history of psychosis did not show a strong relationship with these covariance patterns.
Highly accessible youth initiatives worldwide aim to prevent worsening of mental health problems, but research into outcomes over time is scarce.
This study aimed to evaluate outcomes and support use ...in 12- to 15-year-old visitors of the @ease mental health walk-in centres, a Dutch initiative offering free counselling by trained and supervised peers.
Data of 754 visitors, collected 2018-2022, included psychological distress (Clinical Outcomes in Routine Evaluation 10 (CORE-10)), social and occupational functioning (Social and Occupational Functioning Assessment Scale (SOFAS)), school absenteeism and support use, analysed with change indicators (first to last visit), and mixed models (first three visits).
Among return visitors, 50.5% were female, 79.4% were in tertiary education and 36.9% were born outside of The Netherlands (one-time visitors: 64.7%, 72.9% and 41.3%, respectively). Moreover, 29.9% of return visitors presented with suicidal ideations, 97.1% had clinical psychological distress levels, and 64.1% of the latter had no support in the previous 3 months (one-time visitors: 27.2%, 90.7% and 71.1%, respectively). From visit 1 to 3, psychological distress decreased (
= -3.79, 95% CI -5.41 to -2.18;
< 0.001) and social and occupational functioning improved (
= 3.93, 95% CI 0.51-7.36;
0.025). Over an average 3.9 visits, 39.6% improved reliably and 28.0% improved clinically significantly on the SOFAS, which was 28.4% and 8.8%, respectively, on the CORE-10, where 43.2% improved in clinical category. Counselling satisfaction was rated 4.5/5.
Reductions in psychological distress, improvements in functioning and high counselling satisfaction were found among @ease visitors, forming a basis for future research with a control group.
Aim
Young people around the age of 18 receiving mental health care usually face the transition from child and adolescent (CAMHS) to adult mental health services (AMHS) bringing the risk of disruption ...in continuity of care. Recognizing the importance of early intervention in this vulnerable life‐period, this study aims to emphasize the importance of a client‐centred approach and continuity of care for this age group. For a deeper understanding of the specific needs of this group, the working method of a Dutch youth mental health (YMH) team working in a secondary mental health care setting is described, including some clinical characteristics and treatment results of patients who accessed this service.
Methods
Data consist of a detailed description of the working method of the YMH team combined with clinical characteristics of all patients aged 15‐25 years accessing the services of the YMH team over a two‐year period.
Results
The YMH team incorporated suggestions of earlier research into a client centred treatment. Key elements were multidisciplinary meetings, transcending diagnosis, flexibility and collaboration with other care providers. Clinical records showed a complex patient population and significant treatment effect.
Conclusions
The group of emerging adults accessing the YMH team can be described as a patient group with a high diversity and complexity of disorders and problems. Continuity of care was met when patients turned 18, allowing treatments to be successfully performed by the same team of professionals using a client‐centred approach.
Background. Clinicians in Child and Adolescent Mental Healthcare Services (CAMHS) face the challenge to determine who is at risk of persistence of depressive problems into adulthood and requires ...continued treatment after reaching the CAMHS upper age limit of care-provision. We assessed whether risk factors for persistence were related to CAMHS clinicians’ transition recommendations. Methods. Within the wider MILESTONE cohort study, 203 CAMHS users were classified with unipolar depressive disorder by their clinician, and 185 reported clinical levels of depressive problems on the DSM-oriented Depressive Problems scale of the Achenbach Youth Self Report. Logistic regression models were fitted to both subsamples to assess the relationship between clinicians’ transition recommendations and risk factors for persistent depression. Results. Only clinician-rated severity of psychopathology was related to a recommendation to continue treatment for those classified with unipolar depressive disorder (N=203; OR=1.45, 95% CI (1.03–2.03), p=.044) and for those with self-reported depressive problems on the Achenbach DSM-oriented Depressive Problems scale (N=185; OR=1.62, 95% CI (1.12–2.34), p=.012). Conclusion. Transition recommendations and need for continued treatment are based on clinical expertise, rather than self-reported problems and needs.
Certain pathogenic genetic variants impact neurodevelopment and cause deviations from typical cognitive trajectories. Understanding variant-specific cognitive trajectories is clinically important for ...informed monitoring and identifying patients at risk for comorbid conditions. Here, we demonstrate a variant-specific normative chart for cognitive development for individuals with 22q11.2 deletion syndrome (22q11DS). We used IQ data from 1365 individuals with 22q11DS to construct variant-specific normative charts for cognitive development (Full Scale, Verbal, and Performance IQ). This allowed us to calculate Z-scores for each IQ datapoint. Then, we calculated the change between first and last available IQ assessments (delta Z-IQ-scores) for each individual with longitudinal IQ data (n = 708). We subsequently investigated whether using the variant-specific IQ-Z-scores would decrease required sample size to detect an effect with schizophrenia risk, as compared to standard IQ-scores. The mean Z-IQ-scores for FSIQ, VIQ, and PIQ were close to 0, indicating that participants had IQ-scores as predicted by the normative chart. The mean delta-Z-IQ-scores were equally close to 0, demonstrating a good fit of the normative chart and indicating that, as a group, individuals with 22q11DS show a decline in IQ-scores as they grow into adulthood. Using variant-specific IQ-Z-scores resulted in 30% decrease of required sample size, as compared to the standard IQ-based approach, to detect the association between IQ-decline and schizophrenia (p < 0.01). Our findings suggest that using variant-specific normative IQ data significantly reduces required sample size in a research context, and may facilitate a more clinically informative interpretation of IQ data. This approach allows identification of individuals that deviate from their expected, variant-specific, trajectory. This group may be at increased risk for comorbid conditions, such as schizophrenia in the case of 22q11DS.
Much human behavior is driven by rewards. Preclinical neurophysiological and clinical positron emission tomography (PET) studies have implicated striatal phasic dopamine (DA) release as a primary ...modulator of reward processing. However, the relationship between experimental reward-induced striatal DA release and responsiveness to naturalistic rewards, and therefore functional relevance of these findings, has been elusive.
We therefore combined, for the first time, a DA D2/3 receptor 18Ffallypride PET during a probabilistic reinforcement learning (RL) task with a six day ecological momentary assessments (EMA) of reward-related behavior in the everyday life of 16 healthy volunteers. We detected significant reward-induced DA release in the bilateral putamen, caudate nucleus and ventral striatum, the extent of which was associated with better behavioral performance on the RL task across all regions. Furthermore, individual variability in the extent of reward-induced DA release in the right caudate nucleus and ventral striatum modulated the tendency to be actively engaged in a behavior if the active engagement was previously deemed enjoyable. This study suggests a link between striatal reward-related DA release and ecologically relevant reward-oriented behavior, suggesting an avenue for the inquiry into the DAergic basis of optimal and impaired motivational drive.
22q11 Deletion Syndrome (22q11DS) is associated with dysmorphology and a high prevalence of schizophrenia-like symptoms. Several genes located on chromosome 22q11 have been linked to schizophrenia. ...The deletion is thought to disrupt the expression of multiple genes involved in maturation and development of neurons and neuronal circuits, and neurotransmission. We investigated whole-genome gene expression of Peripheral Blood Mononuclear Cells (PBMC's) of 8 22q11DS patients and 8 age- and gender-matched controls, to (1) investigate the expression levels of 22q11 genes and (2) to investigate whether 22q11 genes participate in functional genetic networks relevant to schizophrenia. Functional relationships between genes differentially expressed in patients (as identified by Locally Adaptive Statistical procedure (LAP) or satisfying p<0.05 and fold-change >1.5) were investigated with the Ingenuity Pathways Analysis (IPA). 14 samples (7 patients, 7 controls) passed quality controls. LAP identified 29 deregulated genes. Pathway analysis showed 262 transcripts differentially expressed between patients and controls. Functional pathways most disturbed were cell death, cell morphology, cellular assembly and organization, and cell-to-cell signaling. In addition, 10 canonical pathways were identified, among which the signal pathways for Natural Killer-cells, neurotrophin/Trk, neuregulin, axonal guidance, and Huntington's disease. Our findings support the use of 22q11DS as a research model for schizophrenia. We identified decreased expression of several genes (among which COMT, Ufd1L, PCQAP, and GNB1L) previously linked to schizophrenia as well as involvement of signaling pathways relevant to schizophrenia, of which Neurotrophin/Trk and neuregulin signaling seems to be especially notable.
The Bivalent Shape Task (BST) tests the ability to suppress interfering information. The purpose of this study was to assess some psychometric properties of the BST in 5-11-year-old children, using ...multilevel analysis.
The present study was initiated in a Dutch primary school in October 2019. The BST was administered as part of a larger neuropsychological assessment. The outbreak of Covid-19 and the subsequential lockdown in the Netherlands led to a premature termination of the study in March 2020. Data of 38 children were available. This dataset was analyzed and labeled as pilot.
Significant main effects of age, time components, levels, correct answer, and several interactions were found on the reaction time in the predicted direction. Random effects could also be modeled. A final statistical combination model is described.
Despite the small study sample, it seems to be justified to conclude that the BST is a potentially valuable instrument to test interference suppression in 5-11-year-old children. In the analysis of the BST, multilevel analysis has proven to be very rewarding. Since the present study only examined a small part of reliability and validity aspects, further psychometric research is desired.
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