Social phobia is associated with suicide attempt history in bipolar inpatients

OBJECTIVES: In an attempt to reduce the phenotypical heterogeneity in an ongoing genetic study of suicidal behavior, we investigated the impact of comorbid anxiety disorders on suicidal behavior in bipolar disorder (BD) patients. METHODS: Anxiety disorders were compared in 406 BD I and BD II patients with or without lifetime history of suicide attempt. RESULTS: Among anxiety disorders, only social phobia (SP) was significantly associated with history of suicide attempt in BD [p<0.001, odds ratio 4.26 (2.284-7.946)]. Moreover, onset of SP was found to precede onset of BD. CONCLUSIONS: This result suggests that SP is an important risk factor for suicidal behavior in BD. Further studies are required to determine whether comorbid SP may help to identify a more homogeneous BD sub-group, especially when studies of suicidal behavior are conducted. A second question is whether SP identifies a sub-group of subjects with BD who have a more severe illness course and whether treatment of SP with selective serotonin reuptake inhibitor (SSRI) antidepressants is associated with improvement or worsening of the course of BD.     

Research on potential biomarker correlates for suicidal behavior: A review

Suicide is a world health priority. Studies over the last few decades have revealed the complexity underlying the neurobiological mechanisms of suicide. Researchers have found dysregulations in the serotonergic system, the stress system, neural plasticity, lipid metabolism, and cell signaling pathways in relation to suicidal behaviors. These findings have provided more insight into the final path leading to suicide, at which medical intervention should be applied to prevent the action. However, because these molecular mechanisms have been implicated in both depression and suicide, the specificity of the mechanisms has been obscured. In this review, we summarize the main findings of studies on molecular mechanisms of suicidal behavior from the last 2 decades, with particular emphasis on the potential, independent role of each mechanism that is not contingent upon an underlying psychopathology, such as depression. The act of suicide is multifactorial; no single molecular mechanism is sufficient to fully account for the act. Knowledge of the reciprocal interactions among these molecular mechanisms and studying them in the context of brain circuitry by using neuroimaging techniques will provide a better understanding of the neurobiology of suicide.     

Potential merits and flaws of large language models in epilepsy care: A critical review

The current pace of development and applications of large language models (LLMs) is unprecedented and will impact future medical care significantly. In this critical review, we provide the background to better understand these novel artificial intelligence (AI) models and how LLMs can be of future use in the daily care of people with epilepsy. Considering the importance of clinical history taking in diagnosing and monitoring epilepsy—combined with the established use of electronic health records—a great potential exists to integrate LLMs in epilepsy care. We present the current available LLM studies in epilepsy. Furthermore, we highlight and compare the most commonly used LLMs and elaborate on how these models can be applied in epilepsy. We further discuss important drawbacks and risks of LLMs, and we provide recommendations for overcoming these limitations.     

ICT-based applications to improve social health and social participation in older adults with dementia. A systematic literature review

ABSTRACT

Objectives: Information and communication technologies (ICT) developers, together with dementia experts have created several technological solutions to improve and facilitate social health and social participation and quality of life of older adults living with dementia. However, there is a need to carry out a systematic literature review that focuses on the validity and efficacy of these new technologies assessing their utility to promote ‘social health’ and ‘active ageing’ in people with dementia.

Method: Searches in electronic databases identified 3824 articles of which 6 met the inclusion criteria and were coded according to their methodological approach, sample sizes, type of outcomes and results.

Results: Six papers were identified reporting the use of 10 different interventions with people with dementia. Qualitative studies (four) showed a benefit of the use of technologies to foster social participation in people with dementia. At the same time, barriers to a widespread use of these technologies in this population were identified. A quantitative study and a mixed-method study with quantitative outcomes showed that ICT-based interventions promote more social behaviours than non-technology-based interventions.

Conclusions: In the last years, several technological devices for living independently and fostering social health and social participation in people with dementia have been developed. However, specific outcome measures to assess social health and social participation are needed. Even though the analysed studies provided some evidence-base for the use of technology in this field, there is an urge to develop high quality studies and specific outcome measures.     

Adherence According to Mary Poppins: Strategies to Make the Medicine Go Down

PURPOSE. This article reviews the prevalence, risk factors, and burden of nonadherence in mood and psychotic disorders, and presents evidence-based, disease-specific strategies shown to improve adherence. CONCLUSION. A comprehensive approach based on the goal of remission, designed around the patient's individual needs, facilitates adherence, leads to improved quality of life, and reduces disease burden. PRACTICE IMPLICATIONS. Adherence in mood and psychotic disorders can be improved when providers take time to build trusting relationships; identify risk factors; anticipate nonadherence; individualize treatment; and educate patients, families, and other healthcare providers.     

The association of attempted suicide with genetic variants in the SLC6A4 and TPH genes depends on the definition of suicidal behavior: a systematic review and meta-analysis

The global prevalence of suicide has increased substantially over the last four decades. Suicidal behavior manifests owing to a combination of biological, behavioral and social factors; however, the etiology of suicidality remains elusive. Even though twin studies have reported a significant heritability of 30–50%, meta-analyses have not highlighted a common genetic variant associated with the spectrum of suicidal behavior. Here, we performed a systematic review of the literature (n=112) to assess the association between serotonergic and non-serotonergic genetic polymorphisms and suicidal behavior. Using an inverse variance random-effects model, we developed pooled odds ratios for the 10 most commonly studied genetic variants related to suicidal behavior, each with at least five independent studies that met our stringent inclusion criteria. Our pooled results indicate no significant correlation between genetic polymorphisms and overall suicidal behavior. However, subgroups of suicide attempts demonstrated actual significance with the serotonin transporter (SLC6A4) 5HTTLPR (OR=1.13 (95% confidence interval=1.05–1.21), P=0.001) and reached nominal significance with the tryptophan hydroxylase rs1800532 (1.22 (1.05–1.41), P=0.007) variant. Subgroups of suicidal behavior (completions and attempts) displayed reduced heterogeneity compared with the overall suicidal behavior spectrum. Our findings suggest that the 5HTTLPR and rs1800532 polymorphisms are significantly associated with suicide attempts, but not associated with completed suicides. The high degree of heterogeneity in past studies may be attributed to the lack of a phenotypic distinction between suicidal attempts and completions. Consequently, we have identified an important source of phenotypic heterogeneity that provides a rationale for the current lack of a common genetic variant associated with suicidal behavior.     

How culture shapes social cognition deficits in mental disorders: A review

Social cognitive skills are indispensable for successful communication with others. Substantial research has determined deficits in these abilities in patients with mental disorders. In neurobiological development and continuing into adulthood, cross-cultural differences in social cognition have been demonstrated. Moreover, symptomatic patterns in mental disorders may vary according to the cultural background of an individual. Cross-cultural studies can thus help in understanding underlying (biological) mechanisms and factors that influence behavior in health and disease. In addition, studies that apply novel paradigms assessing the impact of culture on cognition may benefit and advance neuroscience research. In this review, the authors give an overview of cross-cultural research in the field of social cognition in health and in mental disorders and provide an outlook on future research directions, taking a neuroscience perspective.     

Sharing suicidal thoughts in social networks: a multi-level perspective of disclosure among people with serious mental illness in India

Promoting disclosure about one’s suicidal thoughts is promising for risk management and recovery; however, almost nothing is known about it in India. In a sample of 25 adults with serious mental illness (Level 2) who nominated 333 social network members (Level 1), we adopted a multilevel perspective to assess patterns and correlates of disclosure. Most people had disclosed (72%; n?=?18) or were intent on doing so (92%; n?=?23). However, only 17% (n?=?58) of network members were identified as prior confidants and 20% (n?=?64) as intended confidants. Multilevel modeling results showed that relational factors and not individual factors were linked to disclosure intent. Network members who were prior confidants, emotionally close, and sources of social support were appealing as future confidants. This highlights the potential utility of network-based safety planning wherein these discerning attributes are used to efficiently recruit would-be confidants for training.     

Transforming epilepsy research: A systematic review on natural language processing applications

Despite improved ancillary investigations in epilepsy care, patients' narratives remain indispensable for diagnosing and treatment monitoring. This wealth of information is typically stored in electronic health records and accumulated in medical journals in an unstructured manner, thereby restricting complete utilization in clinical decision-making. To this end, clinical researchers increasing apply natural language processing (NLP)—a branch of artificial intelligence—as it removes ambiguity, derives context, and imbues standardized meaning from free-narrative clinical texts. This systematic review presents an overview of the current NLP applications in epilepsy and discusses the opportunities and drawbacks of NLP alongside its future implications. We searched the PubMed and Embase databases with a “natural language processing” and “epilepsy” query (March 4, 2022) and included original research articles describing the application of NLP techniques for textual analysis in epilepsy. Twenty-six studies were included. Fifty-eight percent of these studies used NLP to classify clinical records into predefined categories, improving patient identification and treatment decisions. Other applications of NLP had structured clinical information retrieval from electronic health records, scientific papers, and online posts of patients. Challenges and opportunities of NLP applications for enhancing epilepsy care and research are discussed. The field could further benefit from NLP by replicating successes in other health care domains, such as NLP-aided quality evaluation for clinical decision-making, outcome prediction, and clinical record summarization.     

Artificial intelligence and suicide prevention: A systematic review

BackgroundSuicide is one of the main preventable causes of death. Artificial intelligence (AI) could improve methods for assessing suicide risk. The objective of this review is to assess the potential of AI in identifying patients who are at risk of attempting suicide.MethodsA systematic review of the literature was conducted on PubMed, EMBASE, and SCOPUS databases, using relevant keywords.ResultsThanks to this research, 296 studies were identified. Seventeen studies, published between 2014 and 2020 and matching inclusion criteria, were selected as relevant. Included studies aimed at predicting individual suicide risk or identifying at-risk individuals in a specific population. The AI performance was overall good, although variable across different algorithms and application settings.ConclusionsAI appears to have a high potential for identifying patients at risk of suicide. The precise use of these algorithms in clinical situations, as well as the ethical issues it raises, remain to be clarified.     

Loneliness and social isolation among young and late middle-age adults: Associations with personal networks and social participation

Objective: Associations between social networks and loneliness or social isolation are well established among older adults. Yet, limited research examines personal networks and participation on perceived loneliness and social isolation as distinct experiences among younger adults. Accordingly, we explore relationships among objective and subjective measures of personal networks with loneliness and isolation, comparing a younger and older cohort.

Methods: The UC Berkeley Social Networks Study offers unique cohort data on young (21–30 years old, n = 472) and late middle-age adults’ (50–70 years old, n = 637) personal network characteristics, social participation, network satisfaction, relationship status, and days lonely and isolated via online survey or in-person interview. Negative binomial regression models were used to examine associations between social network characteristics, loneliness, and isolation by age group.

Results: Young adults reported twice as many days lonely and isolated than late middle-age adults, despite, paradoxically, having larger networks. For young adults, informal social participation and weekly religious attendance were associated with fewer days isolated. Among late middle-age adults, number of close kin and relationship status were associated with loneliness. Network satisfaction was associated with fewer days lonely or isolated among both age groups.

Conclusion: Distinct network characteristics were associated with either loneliness or isolation for each cohort, suggesting network factors are independently associated with each outcome, and may fluctuate over time. Network satisfaction was associated with either loneliness or isolation among both cohorts, suggesting perceptions of social networks may be equally important as objective measures, and remain salient for loneliness and isolation throughout the life course.     

Group-based social skills treatment: A methodological review

Group-based social skills training (SST) is a common treatment for children with autism spectrum disorders (ASD). There has been exponential growth in group-based SST in recent years. This review evaluated the SST literature published between 2000 and 2012 on a number of methodological variables. Key quality indicators included conducting a randomized controlled trial (RCT), having a well-characterized sample, using a manualized intervention, and using validated outcome measures. We identified a total of 48 studies. Thirteen studies (27%) were RCTs. Twenty-two studies (46%) had well-characterized samples, but only four (8%) explicitly allowed eligibility for individuals with intellectual disability. Eighteen (38%) had 10 or fewer participants in each active treatment condition. Most studies used or adapted a manual (71%), and had validated outcome measures (92%). Several rating scales and performance measures have seen widespread use. Methodological rigor has been improving as the field grows, especially with regard to the key quality indicators. We provide additional recommendations for future trials regarding study design, expanding participant characterization, statistical methods and analyses, and outcome measures.     

Social support and intellectual disabilities: a comparison between social networks of adults with intellectual disability and those with physical disability

Background   Social support has been identified as a major protective factor in preventing mental health problems and also as a major contributor to quality of life. People with intellectual disabilities (ID) have been identified as having limited social support structures. Interventions have been focused on promoting their social presence and integration. However, previous studies have shown that this does not always lead to the formation of social relationships. To date few studies have looked at how having an ID leads to impoverished social networks. This study aimed to do this by contrasting the social relationships of people with physical disabilities (PD) and people with ID.
Methods   Two groups of participants were recruited; 30 people with mild ID and 17 people with PD. Social and functional support networks were assessed, in addition to life experiences. Between and within group differences were then explored statistically.
Results   Adults with ID had more restricted social networks than PD, despite being involved in more activities. Social support for adults with ID was mainly provided by family and carers and few relationships with non-disabled people were identified. In contrast adults with PD had larger social networks than had been reported in the mainstream literature and had a balance of relationships with disabled and non-disabled people.
Conclusions   The results suggest that there are additional processes attached to having an ID, which lead to continued impoverished lifestyles. The findings also endorse other work that suggests being physically integrated and engaged in a wide range of activities does not guarantee good social and emotional support.