Matthew P. Hyett

Next generation of self-management education: Web-based bipolar disorder program.

Objective: Education and self-management training assist patients with bipolar disorder to take control of their condition and to reduce disability, but the timeliness and availability of the education are important. A free Web-based bipolar education program has been recently developed to provide accessible evidence-based information for patients, carers and health professionals. The present paper describes the nine-module program, reports usage data and user profiles, and overviews the aims and methodology of a randomized controlled trial to measure its impact. Methods: Customized Web reports were developed to measure usage of the Web-based program, and to profile its users on a month-by-month basis. Data on the percentage of completers of each module were also collected. A randomized controlled trial evaluating the program in people with newly diagnosed bipolar disorder was also commenced. Results: More than 8000 visitors used the online program in its first 6 months. Users were predominantly female, of a broad cross-section of ages, 43.5% with bipolar disorder, and with the remainder describing themselves as health professionals, carers/family/friends of a person with bipolar disorder or members of the general public. The majority (76%) completed the sessions they commenced. Conclusions: The Web-based education program is attracting a steady stream of users and is exhibiting good completion rates. This preliminary support for the programs utility requires validation from our randomized controlled trial before definite conclusions can be drawn.

Disrupted Effective Connectivity of Cortical Systems Supporting Attention and Interoception in Melancholia

IMPORTANCE Patients with melancholia report a distinct and intrusive dysphoric state during internally generated thought. Melancholia has long been considered to have a strong biological component, but evidence for its specific neurobiological origins is limited. The distinct neurocognitive, psychomotor, and mood disturbances observed in melancholia do, however, suggest aberrant coordination of frontal-subcortical circuitry, which may best be captured through analysis of complex brain networks. OBJECTIVE To investigate the effective connectivity between spontaneous (resting-state) brain networks in melancholia, focusing on networks underlying attention and interoception. DESIGN, SETTING, AND PARTICIPANTS We performed a cross-sectional, observational, resting-state functional magnetic resonance imaging study of 16 participants with melancholia, 16 with nonmelancholic depression, and 16 individuals serving as controls at a hospital-based research institute between August 30, 2010, and June 27, 2012. We identified 5 canonical resting-state networks (default mode, executive control, left and right frontoparietal attention, and bilateral anterior insula) and inferred spontaneous interactions among these networks using dynamic causal modeling. MAIN OUTCOMES AND MEASURES Graph theoretic measures of brain connectivity, namely, in-degree and out-degree of each network and edge connectivity, between regions composed our principal between-group contrasts. RESULTS Melancholia was characterized by a pervasive disconnection involving anterior insula and attentional networks compared with participants in the control (Mann-Whitney, 189.00; z = 2.38; P = .02) and nonmelancholic depressive (Mann-Whitney, 203.00; z = 2.93; P = .004) groups. Decreased effective connectivity between the right frontoparietal and insula networks was present in participants with melancholic depression compared with those with nonmelancholic depression (χ2 = 8.13; P = .004). Reduced effective connectivity between the insula and executive networks was found in individuals with melancholia compared with healthy controls (χ2 = 8.96; P = .003). CONCLUSIONS AND RELEVANCE We observed reduced effective connectivity in resting-state functional magnetic resonance imaging between key networks involved in attention and interoception in melancholia. We propose that these abnormalities underlie the impoverished variety and affective quality of internally generated thought in this disorder.

Survival following an acute coronary syndrome: a pet theory put to the test

Objective:  The aim of this study was to revisit findings from previous studies reporting that pet ownership improves outcome following an admission for acute coronary syndrome (ACS).

An approach for automatically measuring facial activity in depressed subjects

This paper is motivated by Ellgrings work in non-verbal communication in depression to measure and compare the levels of facial activity, before and after treatment, of endogenous and neurotic depressives. Similar to that work, we loosely associate the measurements with action units (AU) groups from the facial action coding system (FACS). However, we use the neologism region units (RU) to describe regions of the face that encapsulate AUs. In contrast to Ell-grings approach, we automatically generate the measurements and provide both prototypical expression recognition and RU-specific activity measurements. Latency between expressions is also measured and the system is conducive to comparison across groups and individual subjects. By using active appearance models (AAM) to locate the fiduciary facial points, and multiboost to classify prototypical expressions and the RUs, we can provide a simple, objective, flexible and cost-effective means of automatically measuring facial activity.

The impact of differing anxiety disorders on outcome following an acute coronary syndrome: time to start worrying?†

Background: Both depression and anxiety have been implicated as influencing survival following an acute coronary syndrome (ACS). Studies evaluating the contribution of anxiety have produced varying results, perhaps reflecting the use of dimensional self‐report measures of state anxiety and failure to control for co‐morbid depression. We sought to assess the impact of anxiety on outcome in ACS patients using DSM‐IV diagnoses, in addition to self‐report measures, controlling for effects of concurrent depressive diagnosis as well as medical and socio‐demographic variables. Methods: Some 489 patients hospitalized with an ACS were assessed for lifetime and current DSM‐IV anxiety disorders using both Composite International Diagnostic Interview (CIDI) decisions and such decisions complemented by clinical judgments of impairment. Patients were re‐interviewed over the next 12 months to assess cardiac outcome (ACS readmission and cardiac mortality). Results: Univariate analyses revealed a trend for those with a lifetime history of agoraphobia to experience poorer cardiac outcome and for those with a lifetime diagnosis of generalized anxiety disorder (GAD) to experience a superior cardiac outcome. After controlling for post‐ACS depression and key medical and demographic covariates, agoraphobia was a significant predictor of poorer cardiac outcome while the trend for those with a history of GAD to experience a superior cardiac outcome remained. Conclusions: Any impact of “anxiety” on post‐ACS outcome appears to be influenced by the clinical sub‐type. The seemingly paradoxical finding that GAD might improve outcome may reflect “apprehensive worrying” being constructive, by improving self‐management of the individuals cardiac problems. Depression and Anxiety, 2010.

Specificity of depression following an acute coronary syndrome to an adverse outcome extends over five years.

Many studies have demonstrated that depression is associated with a worse cardiovascular outcome and increased risk of death in those experiencing an acute coronary syndrome (ACS). Recent studies have suggested, however, that any association is strongly influenced by the timing of the depression, with post-ACS depression providing the greatest risk. Establishing any timing impact should assist etiological clarification. We initially recruited 489 subjects hospitalized for an ACS, assessed lifetime and current depression, and then - at 1 and 12 months - assessed subsequent depression. Subjects were followed for up to 5 years to assess cardiovascular outcome and the impact of depression at differing time points, with three defined poor outcome categories (i.e. cardiac admission and/or cardiac rehospitalization). While outcome was associated with a number of non-depression variables, a poor outcome was most clearly associated with depressive episodes emerging at the time of the ACS but with some risk affected by episodes that commenced prior to the ACS and being persistent. Neither lifetime depressive episodes nor transient depressive episodes occurring around the baseline ACS event appeared to provide any risk. Study findings indicate that any differential deleterious impact of post-ACS depression has both short-term and longer-term outcomes, and, by implicating the centrality of post-ACS depression, should assist studies seeking to identify causal explanations.

Out-of-sync: disrupted neural activity in emotional circuitry during film viewing in melancholic depression

While a rich body of research in controlled experiments has established changes in the neural circuitry of emotion in major depressive disorders, little is known as to how such alterations might translate into complex, naturalistic settings - namely involving dynamic multimodal stimuli with rich contexts, such as those provided by films. Neuroimaging paradigms employing dynamic natural stimuli alleviate the anxiety often associated with complex tasks and eschew the need for laboratory-style abstractions, hence providing an ecologically valid means of elucidating neural underpinnings of neuropsychiatric disorders. To probe the neurobiological signature of refined depression subtypes, we acquired functional neuroimaging data in patients with the melancholic subtype of major depressive disorder during free viewing of emotionally salient films. We found a marked disengagement of ventromedial prefrontal cortex during natural viewing of a film with negative emotional valence in patients with melancholia. This effect significantly correlated with depression severity. Such changes occurred on the background of diminished consistency of neural activity in visual and auditory sensory networks, as well as higher-order networks involved in emotion and attention, including bilateral intraparietal sulcus and right anterior insula. These findings may reflect a failure to re-allocate resources and diminished reactivity to external emotional stimuli in melancholia.

Management of Depression by General Practitioners: Impact of Physician Gender

Objective: The aim of the present study was to determine whether anecdotal claims of gender differences in the treatment of depression by general practitioners (GPs) existed in practice. Method: Referral letters from 100 GPs to a specialized psychiatric depression clinic were analysed by word count and gender of referrer. Second, a Web-based survey of 517 participants examined the impact of GP gender in terms of levels of management nuances. Results: The first study established that female GPs wrote distinctly longer referral letters. The second study identified that female GPs were seen as distinctly more caring over a range of parameters and identified the impact of some GP–patient gender differences. Conclusions: Reasons why female GPs are viewed as more caring – and any impact on the management of those with a depressive disorder – would benefit from refined investigation.

Can the highly cited psychiatric paper be predicted early

Objective: Predicting the impact of any research article on its scientific discipline is often viewed as requiring the passage of time. A recent BMJ article, however, reported that an articles citation rate at 2years could be predicted by data available 3weeks following publication. The question remains as to whether establishing a citation trajectory at an early stage holds for psychiatric publications, given the low percentage of psychiatric articles in their analysis. The aim of the current article was to critically examine this area of the scientific literature. Method: Data were collected from the Institute for Scientific Information on scientific papers published in January/February 2006, in the top 30 psychiatric journals. Analyses examined the comparative impact of early citation numbers and several predictors identified in the BMJ article. Results: Only two BMJ variables (a larger number of references per article and larger number of authors) predicted higher citations at 2years in the principal analysis. Citation counts at 1, 3, 6 and 12months predicted citations at 2years, with increasing success over time, and such citation counts were distinctly superior to the quantified variables in the previous study. Conclusions: It appears doubtful that data available at 3weeks after publication for psychiatric articles are useful in predicting citation counts at 2years. The trajectory of citation counts for a psychiatric article becomes more apparent with time.

Multimodal Depression Detection:Fusion Analysis of Paralinguistic, Head Pose and Eye Gaze Behaviors

An estimated 350 million people worldwide are affected by depression. Using affective sensing technology, our long-term goal is to develop an objective multimodal system that augments clinical opinion during the diagnosis and monitoring of clinical depression. This paper steps towards developing a classification system-oriented approach, where feature selection, classification and fusion-based experiments are conducted to infer which types of behaviour (verbal and nonverbal) and behaviour combinations can best discriminate between depression and non-depression. Using statistical features extracted from speaking behaviour, eye activity, and head pose, we characterise the behaviour associated with major depression and examine the performance of the classification of individual modalities and when fused. Using a real-world, clinically validated dataset of 30 severely depressed patients and 30 healthy control subjects, a Support Vector Machine is used for classification with several feature selection techniques. Given the statistical nature of the extracted features, feature selection based on T-tests performed better than other methods. Individual modality classification results were considerably higher than chance level (83 percent for speech, 73 percent for eye, and 63 percent for head). Fusing all modalities shows a remarkable improvement compared to unimodal systems, which demonstrates the complementary nature of the modalities. Among the different fusion approaches used here, feature fusion performed best with up to 88 percent average accuracy. We believe that is due to the compatible nature of the extracted statistical features.