1,721,157 research outputs found
Annual Research Review: Transdiagnostic neuroscience of child and adolescent mental disorders - differentiating decision making in attention-deficit/hyperactivity disorder, conduct disorder, depression, and anxiety
Full text linkBackgroundIneffective decision making is a major source of everyday functional impairment and reduced quality of life for young people with mental disorders. However, very little is known about what distinguishes decision making by individuals with different disorders or the neuropsychological processes or brain systems underlying these. This is the focus of the current review.Scope and methodologyWe first propose a neuroeconomic model of the decision-making process with separate stages for the prechoice evaluation of expected utility of future options; choice execution and postchoice management; the appraisal of outcome against expectation; and the updating of value estimates to guide future decisions. According to the proposed model, decision making is mediated by neuropsychological processes operating within three domains: (a) self-referential processes involved in autobiographical reflection on past, and prospection about future, experiences; (b) executive functions, such as working memory, inhibition, and planning, that regulate the implementation of decisions; and (c) processes involved in value estimation and outcome appraisal and learning. These processes are underpinned by the interplay of multiple brain networks, especially medial and lateralized cortical components of the default mode network, dorsal corticostriatal circuits underpinning higher order cognitive and behavioral control, and ventral frontostriatal circuits, connecting to brain regions implicated in emotion processing, that control valuation and learning processes.Findings and conclusionBased on clinical insights and considering each of the decision-making stages in turn, we outline disorder-specific hypotheses about impaired decision making in four childhood disorders: attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), depression, and anxiety. We hypothesize that decision making in ADHD is deficient (i.e. inefficient, insufficiently reflective, and inconsistent) and impulsive (biased toward immediate over delayed alternatives). In CD, it is reckless and insensitive to negative consequences. In depression, it is disengaged, perseverative, and pessimistic, while in anxiety, it is hesitant, risk-averse, and self-deprecating. A survey of current empirical indications related to these disorder-specific hypotheses highlights the limited and fragmentary nature of the evidence base and illustrates the need for a major research initiative in decision making in childhood disorders. The final section highlights a number of important additional general themes that need to be considered in future research
Anxiety onset in adolescents: a machine-learning prediction
No full textAbstract Recent longitudinal studies in youth have reported MRI correlates of prospective anxiety symptoms during adolescence, a vulnerable period for the onset of anxiety disorders. However, their predictive value has not been established. Individual prediction through machine-learning algorithms might help bridge the gap to clinical relevance. A voting classifier with Random Forest, Support Vector Machine and Logistic Regression algorithms was used to evaluate the predictive pertinence of gray matter volumes of interest and psychometric scores in the detection of prospective clinical anxiety. Participants with clinical anxiety at age 18–23 ( N = 156) were investigated at age 14 along with healthy controls ( N = 424). Shapley values were extracted for in-depth interpretation of feature importance. Prospective prediction of pooled anxiety disorders relied mostly on psychometric features and achieved moderate performance (area under the receiver operating curve = 0.68), while generalized anxiety disorder (GAD) prediction achieved similar performance. MRI regional volumes did not improve the prediction performance of prospective pooled anxiety disorders with respect to psychometric features alone, but they improved the prediction performance of GAD, with the caudate and pallidum volumes being among the most contributing features. To conclude, in non-anxious 14 year old adolescents, future clinical anxiety onset 4–8 years later could be individually predicted. Psychometric features such as neuroticism, hopelessness and emotional symptoms were the main contributors to pooled anxiety disorders prediction. Neuroanatomical data, such as caudate and pallidum volume, proved valuable for GAD and should be included in prospective clinical anxiety prediction in adolescents
Commentary: bipolar disorder in children and adolescents:good to have the evidence
No full textEmotions run high when it comes to bipolar disorder (BD) in children. At conferences in the recent past, I often had to speak in front of audiences that were divided into those who strongly favoured a wider use of the diagnosis of BD and those who fervently opposed it. For years, such diametrically opposed views have been held with equal vigour, despite the striking absence of much evidence either way. This is about to change as more empirical data on BD are accumulating. It is research like that conducted by Boris Birmaher's group that allows us to start having a more rational discussion on youth BD, and a debate that goes beyond anecdote and prejudices. In this Commentary I highlight the ground-breaking research in the US of studying the clinical course of BD and translate the impact of these findings for the diagnosis and treatment of children and adolescents on this side of the Atlantic
Editorial: mood disorders in families: ways to discovery.
No full textMedical discovery occasionally involves understanding the first causes of problems before solving them. Yet, solutions to complex medical problems often come about by looking not at the beginning but rather at the middle or the final parts of the causal chain. Five new papers in this issue of the Journal illustrate this much-needed approach in the field of mood disorders. They range from an in-depth review into possible intrauterine effects of maternal depression to an experimental intervention to elucidate the effects of sleep deprivation on young people's mood regulation
The Maudsley Reader in Phenomenological Psychiatry
Full text linkBrings together and interprets previously hard-to-find texts, new translations and passages detailing the interplay between philosophy and psychopathology
Trials and tribulations in child psychology and psychiatry:what is needed for evidence-based practice
No full textIf your child had leukaemia you would be distraught. Yet, there would also be hope. Most children with a diagnosis of leukaemia start their treatment as part of ongoing trials. The clinical teams looking after such children are motivated, knowledgeable and work in centres that specialise in the treatment of this lethal illness. The results speak for themselves. Not only have the trials helped oncologists learn more about which treatments work best. For years we have known that those who enter trials do better than those patients with similar characteristics who don't. We have recently also learnt that trials improve survival rates in those cancers population wide: the annual reduction between 1978-2005 in risk of death from childhood cancers ranged from 2.7% to 12.0%. This cancer trial culture is a splendid example of British health care delivery. What is happening in child psychiatry, though? If your child had, say, depression you would have every reason to be distraught too. The mortality rate is higher than in the general population and the burden of disease in the long run heavier than that of cardiovascular illness or cancer. Yet, your child would not have access to a trial. Instead, you would probably struggle to have your child's depression recognised in the first place. The care you would get would be determined by extreme regional variations and by what resources are available to local services and often the ideology or preferences of practitioners.</p
Irritable and Depressed Mood: Genetic Associations, Development Tranisitions and Hormonal Effects
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