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Characterizing the spectrum of irritability in preadolescence: Dimensional and pragmatic applications 青春期前易怒谱系的表征:维度和语用应用。
IF 3.1 3区 医学 Q2 PSYCHIATRY Pub Date : 2023-10-06 DOI: 10.1002/mpr.1988
Tasmia Alam, Nathan Kirk, Emily Hirsch, Margaret Briggs-Gowan, Lauren S. Wakschlag, Amy Krain Roy, Jillian Lee Wiggins

Objectives

Characterize the dimensional spectrum of preadolescent (PA) irritability, a robust transdiagnostic vulnerability marker, using the youth version of the Multidimensional Assessment Profiles Temper Loss (MAPS-TL-Youth) scale including common and with developmentally specific items. Based on this, derive and validate a clinically optimized irritability screener to flag psychopathology risk in preadolescents.

Methods

The normal:abnormal irritability spectrum was modeled using MAPS-TL-Youth data from the Multidimensional Assessment of Preschoolers Study (MAPS) Study PA wave (n = 340) via item response theory. Both cross-cutting core items from the MAPS scales and developmentally specific items were used to generate this dimension. Stepwise logistic regression was then used to optimize MAPS-TL-Youth irritability items in relation to Kiddie Schedule of Affective Disorders and Schizophrenia impairment to generate a clinically optimized irritability screener. Receiver operator characteristic analysis identified the irritability threshold for the screener. For the first time, youth self-report of their own irritability on the MAPS-TL was also modeled via the MAPS-TL-Youth-Self-Report (MAPS-TL-Youth-SR).

Results

Irritability was unidimensional and ranged from mild and common to severe and rare behaviors. Developmentally specific items allowed detection of more severe irritability. Items for the screener were identified in relation to concurrent impairment. These included low frustration tolerance and pathognomonic severe behaviors. The clinically optimized screener demonstrated very good sensitively (87%) and specificity (81%) in regard to concurrent irritability-related DSM disorders. Modeling of the MAPS-TL-Youth-SR yielded similar results.

Conclusion

Characterizing the normal: abnormal spectrum of irritability in preadolescence advances application of Research Domain Criteria methods to this developmental period. This foundational work yielded two developmentally specified tools for irritability characterization in preadolescence: a nuanced dimensional scale to precisely characterize the full normal-abnormal irritability spectrum, and a pragmatic, clinically optimized screener suitable for real world use. Future application in mechanistic and clinical studies will be important for establishing validity and incremental utility.

目的:使用青少年版的多维评估概况-脾气损失量表(MAPS-TL youth),包括常见项目和发育特异性项目,表征青春期前(PA)易怒的维度谱,这是一种强有力的跨诊断脆弱性标记。在此基础上,推导并验证了一种临床优化的易怒筛查器,以标记青春期前的精神病理学风险。方法:通过项目反应理论,使用来自学龄前儿童多维评估研究(MAPS)研究PA波(n=340)的MAPS TL青年数据,对正常:异常易怒谱进行建模。MAPS量表中的交叉核心项目和发展特定项目都用于生成该维度。然后使用逐步逻辑回归来优化与儿童情感障碍和精神分裂症障碍时间表相关的MAPS-TL青少年易怒项目,以生成临床优化的易怒筛查器。受试者-操作员特征分析确定了筛分机的易激惹阈值。首次通过MAPS-TL青少年自我报告(MAPS-TL youth SR)对青少年在MAPS-TL上的易怒自我报告进行建模。结果:易怒是一维的,从轻微和常见到严重和罕见的行为都有。发育特异性项目可以检测到更严重的易怒。筛选人员的项目已确定与同时发生的损害有关。其中包括低挫折容忍度和病态的严重行为。临床优化的筛查器对并发的易怒相关DSM障碍表现出非常好的敏感性(87%)和特异性(81%)。MAPS TL Youth SR的建模产生了类似的结果。结论:表征青春期前的正常:异常易怒谱,促进了研究领域标准方法在该发育时期的应用。这项基础性工作产生了两种专门用于青春期前易怒表征的开发工具:一种是精细的维度尺度,用于精确表征完全正常的异常易怒谱,另一种是适用于现实世界的实用、临床优化的筛查器。未来在机制和临床研究中的应用对于建立有效性和增量效用将非常重要。
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引用次数: 7
Young people's future thinking and mental health: The development and validation of the Adolescent Future Thinking Rating Scale 青少年未来思维与心理健康:青少年未来思维量表的开发和验证。
IF 3.1 3区 医学 Q2 PSYCHIATRY Pub Date : 2023-10-03 DOI: 10.1002/mpr.1994
Peiyao Tang, Edmund Sonuga-Barke, Katarzyna Kostyrka-Allchorne, Jacqueline Phillips-Owen

Objectives

We aimed to develop and validate a new scale of future thinking and adolescent mental health—the Adolescent Future Thinking Rating Scale (AFTRS).

Methods

A provisional AFTRS was developed from interviews with 19 adolescents. It was completed by three samples: exploratory (n = 161) aged 16–21 years, who also completed established measures of future thinking, cognitive risk factors, depression and anxiety; replication (n = 209) aged 16–25 years; and test-retest (n = 102) aged 17–23 years. The reliability, convergent, predictive, and discriminant validity were examined.

Results

Exploratory factor analyses identified the AFTRS-18 and AFTRS-12. Both had three sub-scales: (i) Concerns about Maladaptive Future Thinking, (ii) Future Positivity, and (iii) Ability to Visualise the Future. Established future thinking measures were combined into two factors: Negative Future Emotions (Cognitive Triad InventoryView of Future and Beck's Hopelessness Scale) and Immediacy Preference (Consideration of Future Consequences and Quick Delay Questionnaire). The AFTRS-18 and AFTRS-12 were similarly associated with both factors and with depression/anxiety. Internal consistency and test-retest reliability were high.

Conclusions

The AFTRS-12 and AFTRS-18 are reliable and valid measures of the three key dimensions of adolescent future thinking and mental health. The first subscale remained significant in predicting depression and anxiety after controlling for general cognitive risks.

目的:我们旨在开发和验证一种新的未来思维和青少年心理健康量表——青少年未来思维评定量表。它由三个样本完成:16-21岁的探索性(n=161),他们还完成了对未来思维、认知风险因素、抑郁和焦虑的既定测量;复制(n=209),年龄16-25岁;再测试(n=102),年龄17-23岁。检验了信度、收敛性、预测性和判别有效性。结果:探索性因素分析确定了AFTRS-18和AFTRS-12。两者都有三个子量表:(i)对适应不良的未来思维的担忧,(ii)未来积极性,以及(iii)对未来的视觉化能力。已建立的未来思维测量被组合为两个因素:消极的未来情绪(认知三元清单未来观和贝克绝望量表)和即时偏好(考虑未来后果和快速延迟问卷)。AFTRS-18和AFTRS-12同样与这两种因素以及抑郁/焦虑相关。内部一致性和重新测试的可靠性很高。结论:AFTRS-12和AFTRS-18是衡量青少年未来思维和心理健康三个关键维度的可靠有效的指标。在控制了一般认知风险后,第一个分量表在预测抑郁和焦虑方面仍然很重要。
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引用次数: 0
Ecological monitoring of emotional intensity, variability, and instability in individuals with schizophrenia spectrum disorders: Results of a multicentre study 精神分裂症谱系障碍患者情绪强度、变异性和不稳定性的生态监测:一项多中心研究的结果。
IF 3.1 3区 医学 Q2 PSYCHIATRY Pub Date : 2023-09-20 DOI: 10.1002/mpr.1992
Cristina Zarbo, Manuel Zamparini, Alessandra Patrono, Cosima Calini, Philip D. Harvey, Letizia Casiraghi, Massimo Clerici, Matteo Malvezzi, Matteo Rocchetti, Fabrizio Starace, Giovanni de Girolamo, DiAPAson Collaborators

Background

Evaluating emotional experiences in the life of people with Schizophrenia Spectrum Disorder (SSD) is fundamental for developing interventions aimed at promoting well-being in specific times and contexts. However, little is known about emotional variability in this population. In DiAPAson project, we evaluated between- and within-person differences in emotional intensity, variability, and instability between people with SSD and healthy controls, and the association with psychiatric severity and levels of functioning.

Methods

102 individuals diagnosed with SSD (57 residential patients, 46 outpatients) and 112 healthy controls were thoroughly evaluated. Daily emotions were prospectively assessed with Experience Sampling Method eight times a day for a week. Statistical analyses included ANOVA, correlations, and generalized linear models.

Results

Participants with SSD, and especially residential patients, had a higher intensity of negative emotions when compared to controls. Moreover, all people with SSD reported a greater between-person-variability of both positive and negative emotions and greater intra-variability of negative emotions than healthy controls. In addition, the emotion variability in people with SSD does not follow a linear or quadratic trend but is more “chaotic” if compared to controls.

Conclusions

Adequate assessments of positive and negative emotional experiences and their time course in people with SSD can assist mental health professionals with well-being assessment, implementing targeted interventions through the identification of patterns, triggers, and potential predictors of emotional states.

背景:评估精神分裂症谱系障碍(SSD)患者生活中的情感体验是制定干预措施的基础,旨在促进特定时期和特定背景下的幸福感。然而,人们对这一人群的情绪变化知之甚少。在DiAPAson项目中,我们评估了SSD患者和健康对照组在情绪强度、可变性和不稳定性方面的人与人之间和人之间的差异,以及与精神疾病严重程度和功能水平的关系。方法:对102名SSD患者(57名住院患者,46名门诊患者)和112名健康对照进行全面评估。采用经验抽样法对日常情绪进行前瞻性评估,每天8次,为期一周。统计分析包括方差分析、相关性和广义线性模型。结果:与对照组相比,患有SSD的参与者,尤其是住院患者,负面情绪的强度更高。此外,与健康对照组相比,所有SSD患者的积极和消极情绪在人与人之间的变异性更大,消极情绪在体内的变异性也更大。此外,SSD患者的情绪变化并不遵循线性或二次趋势,但与对照组相比,情绪变化更“混乱”。结论:对SSD患者的积极和消极情绪体验及其时间过程进行充分评估,可以帮助心理健康专业人员进行幸福感评估,通过识别情绪状态的模式、触发因素和潜在预测因素来实施有针对性的干预措施。
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引用次数: 0
Prevalence, stability, and predictive utility of the Multidimensional Assessment of Preschoolers Scales clinically optimized irritability score: Pragmatic early assessment of mental disorder risk 学龄前儿童多维评估研究的患病率、稳定性和预测效用临床优化易怒评分:精神障碍风险的实用早期评估。
IF 3.1 3区 医学 Q2 PSYCHIATRY Pub Date : 2023-09-20 DOI: 10.1002/mpr.1991
Jillian Lee Wiggins, Ana Ureña Rosario, Leigha A. MacNeill, Sheila Krogh-Jespersen, Margaret Briggs-Gowan, Justin D. Smith, Lauren S. Wakschlag

Objectives

Characterizing the scope and import of early childhood irritability is essential for real-world actualization of this reliable indicator of transdiagnostic mental health risk. Thus, we utilize pragmatic assessment to establish prevalence, stability, and predictive utility of clinically significant early childhood irritability.

Methods

Data included two independent, diverse community samples of preschool age children (N = 1857; N = 1490), with a subset enriched for risk (N = 425) assessed longitudinally from early childhood through preadolescence (∼4–9 years old). A validated, brief (2-item) scale pragmatically assessed clinically significant irritability. In the longitudinal subsample, clinical interviews assessed internalizing/externalizing disorders.

Results

One in five preschool-age children had clinically significant irritability, which was independently replicated. Irritability was highly stable through preadolescence. Children with versus without clinically significant early childhood irritability had greater odds of early onset, persistent internalizing/externalizing disorders. The pragmatic assessment effectively screened out low-risk children and identified 2/3 of children with early-onset, persistent psychopathology.

Conclusions

Clinically significant early childhood irritability prevalence is akin to the pediatric obesity epidemic and may warrant similar universal screening/intervention. Also, irritability's stability demonstrates the common guidance “they'll grow out of it” to be false. Finally, pragmatic irritability assessment has transdiagnostic predictive power and addresses a need for feasible measures to flag risk.

目的:描述儿童早期易怒的范围和重要性对于现实世界中实现这一可靠的跨诊断心理健康风险指标至关重要。因此,我们利用实用评估来确定具有临床意义的幼儿易怒的患病率、稳定性和预测效用。方法:数据包括两个独立的、不同的学龄前儿童社区样本(N=1857;N=1490),其中一个子集的风险富集(N=425)从儿童早期到青春期前(~4-9岁)进行纵向评估。经验证的简短(2项)量表务实地评估了临床上显著的易怒。在纵向子样本中,临床访谈评估了内化/外化障碍。结果:五分之一的学龄前儿童有临床上显著的易怒,这是独立复制的。易激性在青春期前是高度稳定的。与没有临床意义的儿童早期易怒相比,儿童早期发作、持续的内化/外化障碍的几率更大。实用评估有效地筛选出了低风险儿童,并确定了2/3的儿童患有早发性、持续性精神病理学。结论:临床上显著的儿童早期易怒患病率类似于儿童肥胖流行,可能需要类似的普遍筛查/干预。此外,易怒的稳定性表明,“他们会长大”的普遍指导是错误的。最后,实用的易怒评估具有跨诊断的预测能力,并解决了对标记风险的可行措施的需求。
{"title":"Prevalence, stability, and predictive utility of the Multidimensional Assessment of Preschoolers Scales clinically optimized irritability score: Pragmatic early assessment of mental disorder risk","authors":"Jillian Lee Wiggins,&nbsp;Ana Ureña Rosario,&nbsp;Leigha A. MacNeill,&nbsp;Sheila Krogh-Jespersen,&nbsp;Margaret Briggs-Gowan,&nbsp;Justin D. Smith,&nbsp;Lauren S. Wakschlag","doi":"10.1002/mpr.1991","DOIUrl":"10.1002/mpr.1991","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Characterizing the scope and import of early childhood irritability is essential for real-world actualization of this reliable indicator of transdiagnostic mental health risk. Thus, we utilize pragmatic assessment to establish prevalence, stability, and predictive utility of clinically significant early childhood irritability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data included two independent, diverse community samples of preschool age children (<i>N</i> = 1857; <i>N</i> = 1490), with a subset enriched for risk (<i>N</i> = 425) assessed longitudinally from early childhood through preadolescence (∼4–9 years old). A validated, brief (2-item) scale pragmatically assessed clinically significant irritability. In the longitudinal subsample, clinical interviews assessed internalizing/externalizing disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One in five preschool-age children had clinically significant irritability, which was independently replicated. Irritability was highly stable through preadolescence. Children with versus without clinically significant early childhood irritability had greater odds of early onset, persistent internalizing/externalizing disorders. The pragmatic assessment effectively screened out low-risk children and identified 2/3 of children with early-onset, persistent psychopathology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Clinically significant early childhood irritability prevalence is akin to the pediatric obesity epidemic and may warrant similar universal screening/intervention. Also, irritability's stability demonstrates the common guidance “they'll grow out of it” to be false. Finally, pragmatic irritability assessment has transdiagnostic predictive power and addresses a need for feasible measures to flag risk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50310,"journal":{"name":"International Journal of Methods in Psychiatric Research","volume":"32 S1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/mpr.1991","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41164405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
Advancing earlier transdiagnostic identification of mental health risk: A pragmatic approach at the transition to toddlerhood 推进早期心理健康风险的跨诊断识别:在过渡到幼儿期的实用方法。
IF 3.1 3区 医学 Q2 PSYCHIATRY Pub Date : 2023-09-18 DOI: 10.1002/mpr.1989
Jillian Lee Wiggins, Ana Ureña Rosario, Yudong Zhang, Leigha MacNeill, Qiongru Yu, Elizabeth Norton, Justin D. Smith, Lauren S. Wakschlag

Objectives

In light of the youth mental health crisis, as 1 in 5 children have a mental disorder diagnosis by age 3, identification of transdiagnostic behavioral vulnerability prior to impairing psychopathology must occur at an earlier phase of the clinical sequence. Here, we lay the groundwork for a pragmatic irritability measure to identify at-risk infant-toddlers.

Methods

Data comprised N = 350 diverse infant-toddlers and their mothers assessed at ∼14 months old for irritability (Multidimensional Assessment Profiles- Temper Loss-Infant/Toddler (MAPS-TL-IT) and impairment (Early Childhood Irritability-Related Impairment Interview, E-CRI; and Family Life Impairment Scale (FLIS). Bimonthly follow-up surveys assessed impairment (FLIS) over the following year.

Results

Stepwise logistic regression indicated that 5 MAPS-TL-IT items were most informative for differentiating concurrent impairment on the FLIS: “frustrated about small things”; “hit, bite, or kick during tantrums”; “trouble cheering up when grumpy”; “grumpy during fun activities” and “tantrums in public”. With this summed score, Receiver Operating Characteristics analysis differentiating concurrent impairment on the E-CRI indicated good classification accuracy for (Area under the curve = 0.755, p < 0.05), with a cutoff of 5 maximizing sensitivity (71.4%) and specificity (70.6%). Elevated irritability on this MAPS-TL-IT clinically optimized screener increased likelihood of persistently elevated FLIS impairment trajectories over the following year more than fourfold (OR = 4.37; Confidence intervals = 2.40–7.97, p < 0.001).

Conclusions

Our findings represent the first step toward a pragmatic tool for screening for transdiagnostic mental health risk in toddlers, optimized for feasibility in clinical care. This has potential to strengthen resilience pathways via earlier identification of mental health risk and corollary prevention in toddlers.

鉴于青少年心理健康危机,由于每5个儿童中就有1个在3岁时被诊断为精神障碍,因此必须在临床序列的早期阶段识别出在精神病理受损之前的跨诊断行为脆弱性。在这里,我们为一个实用的易怒措施奠定了基础,以确定在危险的婴幼儿。方法:数据包括N = 350个不同的婴幼儿及其母亲,在14个月大时进行易怒评估(多维评估档案-脾气丧失-婴幼儿(MAPS-TL-IT))和损害评估(早期儿童易怒相关损害访谈,E-CRI;家庭生活障碍量表(FLIS)。在接下来的一年里,每两个月的随访调查评估了损伤(FLIS)。结果:逐步logistic回归结果显示,5个map - tl - it项目对FLIS并发性损伤的鉴别信息量最大:“对小事感到沮丧”;“发脾气时打、咬或踢”;“烦恼时要高兴起来”;“在有趣的活动中脾气暴躁”和“在公共场合发脾气”。根据这一综合评分,接受者工作特征分析表明,区分E-CRI并发损伤的分类准确率很高(曲线下面积= 0.755,p)。结论:我们的研究结果代表了一种实用的工具,用于筛查幼儿的跨诊断精神健康风险,并优化了临床护理的可行性。这有可能通过早期识别幼儿的心理健康风险和相应的预防来加强恢复能力途径。
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引用次数: 7
Developmentally specified characterization of the irritability spectrum at early school age: Implications for pragmatic mental health screening 学龄期早期易怒谱的发育特异性特征:对实用心理健康筛查的影响。
IF 3.1 3区 医学 Q2 PSYCHIATRY Pub Date : 2023-09-15 DOI: 10.1002/mpr.1985
Emily Hirsch, Tasmia Alam, Nathan Kirk, Katherine B. Bevans, Margaret Briggs-Gowan, Lauren S. Wakschlag, Jillian L. Wiggins, Amy K. Roy

Objectives

Developmentally specified measures that identify clinically salient irritability are needed for early school-age youth to meaningfully capture this transdiagnostic risk factor for psychopathology. Thus, the current study modeled the normal:abnormal irritability spectrum and generated a clinically optimized screening tool for this population.

Methods

The irritability spectrum was modeled via the youth version of the Multidimensional Assessment Profile Scales—Temper Loss Scale (MAPS-TL-Youth) in children (n = 474; 6.0–8.9 years) using item response theory (IRT). Both cross-cutting core irritability items from the early childhood version and new developmentally specific items were included. Items uniquely associated with impairment were identified and used to derive a brief, clinically optimized irritability screener. Longitudinal data were then utilized to test the predictive utility of this clinically optimized screener in preadolescence (n = 348; 8.0–12.9 years).

Results

Most children exhibit irritability regularly, but daily occurrence was rare. Of the top 10 most severe items from the IRT analyses, 9 were from the developmentally specific items added for the MAPS-TL Youth version. Two items associated with concurrent impairment were identified for the clinically optimized irritability screener (“Become frustrated easily” and “Act irritable”). The MAPS-TL-Youth clinically optimized screener demonstrated good sensitivity (69%) and specificity (84%) in relation to concurrent DSM 5 irritability-related diagnoses. Youth with elevated scores on the screener at early school age (ESA) had more than 7x greater odds of irritability-related psychopathology at pre-adolescence.

Conclusions

The MAPS-TL-Youth characterized the developmental spectrum of irritability at ESA and a clinically optimized screener showed promise at predicting psychopathology risk. Rigorous testing of clinical applications is a critical next step.

目的:早期学龄青少年需要发展特定的措施来识别临床显著的易怒,以有意义地捕捉这种精神病理学的跨诊断风险因素。因此,目前的研究模拟了正常和异常的易怒谱,并为这一人群产生了临床优化的筛查工具。方法:采用青少年版多维评估量表-脾气损失量表(MAPS-TL-Youth)对儿童(n = 474;6.0-8.9岁),使用项目反应理论(IRT)。包括早期儿童版本的交叉核心易怒项目和新的发展特定项目。识别出与损伤唯一相关的项目,并用于得出一个简短的、临床优化的易怒筛选。然后利用纵向数据来检验这种临床优化的筛查方法在青春期前的预测效用(n = 348;8.0 - -12.9年)。结果:多数患儿有规律地表现出烦躁不安,但每日出现的少见。在IRT分析的前10个最严重的项目中,有9个是为MAPS-TL Youth版本添加的发展特定项目。在临床优化的易怒筛选中,确定了两个与并发损伤相关的项目(“容易沮丧”和“易怒”)。MAPS-TL-Youth临床优化筛选器在诊断DSM 5易怒相关症状时表现出良好的敏感性(69%)和特异性(84%)。在早期学龄(ESA)筛查中得分较高的青少年在青春期前出现易怒相关精神病理的几率要高出7倍以上。结论:map - tl - youth表征了ESA中易怒的发育谱,临床优化的筛选器在预测精神病理风险方面有希望。严格的临床应用测试是下一步的关键。
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引用次数: 7
MAPping affective dimensions of behavior: Methodologic and pragmatic advancement of the Multidimensional Assessment Profiles scales 映射行为的情感维度:多维评估档案量表的方法和实用进步。
IF 3.1 3区 医学 Q2 PSYCHIATRY Pub Date : 2023-09-13 DOI: 10.1002/mpr.1990
Jillian Lee Wiggins, Amy K. Roy, Lauren S. Wakschlag

Rigorous validation of the full developmentally sensitive normal:abnormal spectrum, including evaluating the incremental value of age-specific behaviors, is necessary for nuanced characterization of dimensional features of psychopathology. To maximize the clinical utility of transdiagnostic approaches to risk identification, derivation of psychometrically sound, pragmatic versions with empirically derived cutoffs is also key. This special section has a central focus on rigorous, developmentally-based measurement of irritability as an exemplar of this theory- and pragmatically-based approach. Elevated irritability is a robust transdiagnostic predictor of the common psychopathologies of childhood. The Multidimensional Assessment Profiles Temper Loss (MAPS-TL) Scales are the only irritability tool specifically designed to capture the normal:abnormal dimensional spectrum. These have been extensively investigated in preschool age but lack rigorous modeling at older and younger ages. In this special issue, (with three independent—and one longitudinal—set of samples), we test and improve measurement of irritability as a transdiagnostic phenotype of psychopathology risk as it unfolds across development, expanding the MAPS-TL scale in three important ways: (1) extending irritability dimensional modeling and the developmental specification approach to older ages, (2) advancing science to practice translation by generating pragmatic irritability screening tools across ages, and (3) extending the dimensional, developmental specification approach to other dimensions of behavior, that is, internalizing. Collectively, the special issue operationalizes and advances application of a neurodevelopmental, dimensional and transdiagnostic approach to psychopathology.

严格验证完整的发育敏感的正常:异常频谱,包括评估年龄特异性行为的增量价值,是细致入微的表征精神病理学维度特征的必要条件。为了最大限度地发挥跨诊断方法在风险识别方面的临床效用,推导出心理测量学上健全的、具有经验推导出的截止点的实用版本也是关键。这个特殊的部分集中在严格的,基于发展的易怒测量作为这个理论和实用为基础的方法的一个例子。高易怒是儿童常见精神病理的一个可靠的跨诊断预测因子。多维评估档案脾气损失量表(MAPS-TL)是唯一专门用于捕捉正常:异常维度谱的易怒工具。这些已经在学龄前进行了广泛的研究,但在老年人和年轻人中缺乏严格的模型。在这期特刊中,(有三个独立和一个纵向的样本集),我们测试和改进了易怒作为精神病理风险的跨诊断表型的测量,因为它在整个发展过程中展开,在三个重要方面扩展了MAPS-TL量表:(1)将易怒维度建模和发展规范方法扩展到老年人;(2)通过生成跨年龄的实用易怒筛查工具,推进科学到实践的翻译;(3)将维度、发展规范方法扩展到行为的其他维度,即内化。总的来说,该特刊将神经发育、维度和跨诊断方法应用于精神病理学进行操作和推进。
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引用次数: 4
A pragmatic, clinically optimized approach to characterizing adolescent irritability: Validation of parent- and adolescent reports on the Multidimensional Assessment Profile Scales—Temper Loss Scale 一种实用的、临床优化的方法来表征青少年易怒:父母和青少年关于多维评估档案量表-脾气损失量表的报告的验证。
IF 3.1 3区 医学 Q2 PSYCHIATRY Pub Date : 2023-09-13 DOI: 10.1002/mpr.1986
Nathan Kirk, Emily Hirsch, Tasmia Alam, Lauren S. Wakschlag, Jillian Lee Wiggins, Amy K. Roy

Objectives

Heightened irritability in adolescence is an impairing symptom that can lead to negative outcomes in adulthood, but effective screening tools are lacking. This study aimed to derive clinically-optimized cutoff scores using the Multidimensional Assessment Profile Scales–Temper Loss (MAPS-TL) to pragmatically identify adolescents with impairing irritability.

Methods

A diverse sample of 79 adolescents and their parents completed the MAPS-TL-Youth version. Stepwise logistic regression analyses were used to determine the items associated with impairment, and receiver operator characteristic (ROC) analyses were conducted to derive optimal cutoff scores.

Results

Three parent-report items (become frustrated easily, angry/irritable/grouchy throughout the day, difficulty calming down when angry) and two youth-report items (hit/shove/kick when lost temper, difficulty calming down when angry) were strongly associated with impairment. Optimal cutoff scores garnered very good sensitivity (91%, 73%) and specificity (77%, 75%) for the parent- and youth-report versions respectively. Scores above these cutoffs were associated with increased internalizing and externalizing problems and lower overall quality of life.

Conclusions

The MAPS-TL clinically optimized irritability scores show preliminary validity for implementation in practical settings to efficiently identify adolescents who need additional evaluation and/or intervention. Further research is important to validate these cutoff scores with larger population-based samples and real-world settings.

目的:青春期易怒是一种损害症状,可能导致成年后的负面结果,但缺乏有效的筛查工具。本研究旨在使用多维评估档案量表-回火损失量表(MAPS-TL)得出临床优化的临界分数,以务实地识别具有损害性易怒的青少年。方法:79名青少年及其父母的不同样本完成了MAPS TL青少年版。使用逐步逻辑回归分析来确定与损伤相关的项目,并进行受试者操作特征(ROC)分析来得出最佳截止分数。结果:三个家长报告项目(容易沮丧、整天生气/易怒/发脾气、生气时难以平静)和两个青少年报告项目(发脾气时打/推/踢、生气时难平静)与损伤密切相关。父母和青少年报告版本的最佳截止分数分别获得了非常好的敏感性(91%、73%)和特异性(77%、75%)。得分高于这些临界值与内化和外化问题的增加以及整体生活质量的降低有关。结论:MAPS-TL临床优化的易怒评分显示出在实际环境中实施的初步有效性,以有效识别需要额外评估和/或干预的青少年。进一步的研究对于用更大的基于人群的样本和真实世界的环境来验证这些临界分数很重要。
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引用次数: 7
Trial-based economic evaluation of mindfulness-based cognitive therapy compared to treatment as usual for bipolar disorder 基于试验的双相情感障碍认知疗法与常规治疗的经济评估。
IF 3.1 3区 医学 Q2 PSYCHIATRY Pub Date : 2023-09-12 DOI: 10.1002/mpr.1981
Ben Wijnen, Maud Jansen, Annelieke van Velthoven, Imke Hanssen, Marloes Huijbers, Silvia Evers, Anne Speckens

Objective

Aim of this study was to assess the cost-effectiveness and cost-utility of mindfulness-based cognitive therapy (MBCT) and treatment as usual (TAU) compared to TAU alone in adults with Bipolar disorder (BD).

Methods

An economic evaluation with a time horizon of 15 months was conducted from a societal perspective. Outcomes were expressed in costs per quality adjusted life years (QALYs) and costs per responder using the inventory of depressive symptomatology clinician rating score.

Results

People with BD (N = 144) were included in this study. From a societal perspective, the difference of total costs between MBCT + TAU and TAU was €615, with lower costs in the MBCT + TAU group. Only healthcare costs differed significantly between the two groups. A small difference in QALYs in favor of MBCT + TAU was found combined with lower costs (−€836; baseline adjusted) for MBCT + TAU compared to TAU, resulting in a dominant incremental cost-utility ratio. The probability that the MBCT + TAU was cost-effective was 65%. All sensitivity analyses attested to the robustness of the base case analyses.

Conclusion

Concludingly, MBCT + TAU seems to be cost-effective compared to TAU alone, indicated by a small or neglectable difference in effect, in favor of MBCT + TAU, while resulting in lower costs.

研究目的本研究旨在评估正念认知疗法(MBCT)和常规治疗(TAU)与单纯TAU治疗双相情感障碍(BD)成人患者的成本效益和成本效用:方法:从社会角度进行了一项时间跨度为 15 个月的经济评估。评估结果以每质量调整生命年(QALYs)的成本和使用抑郁症状清单临床医生评分的每位应答者的成本表示:本研究纳入了抑郁症患者(N = 144)。从社会角度来看,MBCT + TAU 和 TAU 的总成本相差 615 欧元,MBCT + TAU 组的成本更低。只有医疗成本在两组之间存在明显差异。与 TAU 相比,MBCT + TAU 的 QALYs 差异较小,而 MBCT + TAU 的成本较低(-836 欧元;基线调整),因此增量成本效用比占优势。MBCT + TAU 具有成本效益的概率为 65%。所有的敏感性分析都证明了基础案例分析的稳健性:总之,MBCT + TAU 与单用 TAU 相比似乎具有成本效益,其效果差异较小或可忽略不计,MBCT + TAU 更受青睐,同时成本更低。
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引用次数: 0
An exploration of actigraphy in the context of ketamine and treatment-resistant depression 在氯胺酮和难治性抑郁症的背景下探索动图。
IF 3.1 3区 医学 Q2 PSYCHIATRY Pub Date : 2023-09-05 DOI: 10.1002/mpr.1984
Claire Punturieri, Wallace C. Duncan Jr., Dede Greenstein, Gavi Shandler, Carlos A. Zarate Jr., Jennifer W. Evans

Objectives

This study explored the potential of non-parametric and complexity analysis metrics to detect changes in activity post-ketamine and their association with depressive symptomatology.

Methods

Individuals with treatment-resistant depression (TRD: n = 27, 16F, 35.9 ± 10.8 years) and healthy volunteers (HVs: n = 9, 4F, 36.4 ± 9.59 years) had their activity monitored during an inpatient, double-blind, crossover study where they received an infusion of ketamine or saline placebo. All participants were 18–65 years old, medication-free, and had a MADRS score ≥20. Non-parametric metrics averaged over each study day, metrics derived from complexity analysis, and traditionally calculated non-parametric metrics averaged over two weeks were calculated from the actigraphy time series. A separate analysis was conducted for a subsample (n = 17) to assess the utility of these metrics in a hospital setting.

Results

In HVs, lower intradaily variability was observed within daily rest/activity patterns post-ketamine versus post-placebo (F = 5.16(1,15), p = 0.04). No other significant effects of drug or drug-by-time or correlations between depressive symptomatology and activity were detected.

Conclusions

Weak associations between non-parametric variables and ketamine were found but were not consistent across actigraphy measures.

Clinical Trial registration

ClinicalTrials.gov, NCT00088699.

研究目的本研究探讨了非参数和复杂性分析指标检测氯胺酮后活动变化的潜力及其与抑郁症状的关联:在一项住院、双盲、交叉研究中,接受氯胺酮或生理盐水安慰剂输注的耐药抑郁症患者(TRD:n = 27,16F,35.9 ± 10.8 岁)和健康志愿者(HVs:n = 9,4F,36.4 ± 9.59 岁)接受了活动监测。所有参与者的年龄均为 18-65 岁,未服用药物,MADRS 评分≥20 分。从动电图时间序列中计算出了每个研究日的平均非参数指标、从复杂性分析中得出的指标以及传统计算的两周平均非参数指标。对一个子样本(n = 17)进行了单独分析,以评估这些指标在医院环境中的效用:在高危人群中,观察到氯胺酮后与安慰剂后相比,每日休息/活动模式的日内变异性较低(F = 5.16(1,15),P = 0.04)。没有发现药物或药物时间的其他明显影响,也没有发现抑郁症状与活动之间的相关性:结论:非参数变量与氯胺酮之间存在微弱的关联,但在各种动图测量中并不一致:临床试验注册:ClinicalTrials.gov,NCT00088699。
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引用次数: 0
期刊
International Journal of Methods in Psychiatric Research
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