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Visual and auditory signs of patient functioning have long been used for clinical diagnosis, treatment selection, and prognosis. Direct measurement and quantification of these signals can aim to improve the consistency, sensitivity, and scalability of clinical assessment. Currently, we investigate if machine learning-based computer vision (CV), semantic, and acoustic analysis can capture clinical features from free speech responses to a brief interview 1 month post-trauma that accurately classify major depressive disorder (MDD) and posttraumatic stress disorder (PTSD).
N = 81 patients admitted to an emergency department (ED) of a Level-1 Trauma Unit following a life-threatening traumatic event participated in an open-ended qualitative interview with a para-professional about their experience 1 month following admission. A deep neural network was utilized to extract facial features of emotion and their intensity, movement parameters, speech prosody, and natural language content. These features were utilized as inputs to classify PTSD and MDD cross-sectionally.
Both video- and audio-based markers contributed to good discriminatory classification accuracy. The algorithm discriminates PTSD status at 1 month after ED admission with an AUC of 0.90 (weighted average precision = 0.83, recall = 0.84, and f1-score = 0.83) as well as depression status at 1 month after ED admission with an AUC of 0.86 (weighted average precision = 0.83, recall = 0.82, and f1-score = 0.82).
Direct clinical observation during post-trauma free speech using deep learning identifies digital markers that can be utilized to classify MDD and PTSD status.
Despite its high prevalence, the validated treatment for ADHD is chronic administration of psychostimulants, which is associated with side effects and occasionally not tolerated. Deep TMS using special coil designs for targeting neural networks linked with neuropsychiatric disorders, may become a viable alternative.
Comparison of rTMS treatment using deep, figure-8 and sham coils on ADHD symptoms.
In the current randomized, sham-controlled study, adult ADHD patients received 15 daily sessions of high-frequency rTMS directed to the right prefrontal cortex (rPFC), using either deep, figure-8, or a sham coil. ADHD symptoms and cognitive alterations were assessed using the CAARS-INV, self–report questionnaires and performance tests. Additionally, the stop signal task (SST) combined with EEG measures was used to asses behavioural inhibition and ERPs. EEG responses to an inhibitory protocol of paired TMS pulses over the rPFC were measured before and after treatments. A healthy control group was evaluated at baseline for comparison.
Several ADHD symptoms were improved in patients that received dTMS but not standard figure-8 or sham treatment (p=0.007, CAARS; p=0.014, SST). Differences between ADHD patients and healthy controls were demonstrated in ERPs during the SST, and in response to single and paired TMS pulses. The lower amplitudes of ERPs in patients correlated with ADHD symptoms and behavioural inhibition measures.
Repeated stimulation of deep areas in the rPFC has therapeutic potential, where rPFC excitability is impaired in ADHD patients. Ongoing analysis attempts to establish the neurophysiological measures as predictors and biomarkers for effectiveness of dTMS treatment.
PTSD patients display abnormal emotional processing and bias towards negative emotion. Long latency eventrelated potentials (ERP’s) are composed of the P300 and subsequent slow wave activity. These ERP’s are hypothesized to be relevant for attentional and initial memory storage events as well as emotional processing. objectives: This study tested the hypothesis that abnormal emotional processing in PTSD is reflected in altered brain activity, as measured via ERP’s.
Detect differences in cortical activity and emotional processing in PTSD patients as compared to controls.
ERP’s were recorded from 14 PTSD and 14 control subjects while viewing emotion-laden pictures. Subjects were instructed to press a button depending on the presence of a person or human part in the picture and response time was recorded.
Long latency ERP data (300-1035 msec) showed valence dependent activity in control subjects distinguishing negative vs. positive and neutral pictures. PTSD patients, however, lacked differential activation and had similar brain activity across all picture valances, which resembled the pattern observed in controls only for negative stimuli.
[Late ERP’s 980-1035msec]
PTSD patients also exhibited longer response time.
Our results demonstrate abnormal cognitive-emotional processing in PTSD patients and may underlie overgeneralization processes that are part of this disorder.
Impairments in social behavior and cognition, such as the ability to identify others’ emotional state, are important features in schizophrenia. Arginine vasopressin (AVP) and oxytocin (OXT) and are nonapeptides that influence social cognition and behavior. Previous studies have shown that the administration of intranasal AVP or OXT may affect the ability to recognize facial emotions. The primary objective of this study was to investigate the effects of a single dose of AVP or OXT on social cognition in patients with schizophrenia. The secondary objective of the study was to test for sex-specific effects of intranasal AVP and OXT administration on social cognition.
In this double-blind, placebo-control, cross-over study, 34 patients diagnosed with schizophrenia or schizo-affective disorder, received a dose of AVP, OXT or placebo in three separate meetings. Forty-five minutes after administration, subjects performed facial emotion recognition tasks.
There were no significant main effects of hormone administration on the ability to recognize facial emotions between treatment conditions. However, AVP administration resulted in sex-specific differences in emotion recognition. Specifically, in men, AVP administration reduced the ability to recognize angry faces. In women, AVP administration reduced the ability to recognize sad faces and improved the ability to recognize fearful faces.
These findings indicate that intranasal AVP may affect the recognition of facial emotions differently in men and women. Thus, AVP may increase the differences between men and women on social cognition.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics.
This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3083). Each study included at least three assessments of the clinician-administered PTSD scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course.
Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (v. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (v. Remitting) trajectory.
The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.
Projected changes to post-traumatic stress disorder (PTSD) diagnostic criteria in the upcoming International Classification of Diseases (ICD)-11 may affect the prevalence and severity of identified cases. This study examined differences in rates, severity, and overlap of diagnoses using ICD-10 and ICD-11 PTSD diagnostic criteria during consecutive assessments of recent survivors of traumatic events.
The study sample comprised 3863 survivors of traumatic events, evaluated in 11 longitudinal studies of PTSD. ICD-10 and ICD-11 diagnostic rules were applied to the Clinician-Administered PTSD Scale (CAPS) to derive ICD-10 and ICD-11 diagnoses at different time intervals between trauma occurrence and 15 months.
The ICD-11 criteria identified fewer cases than the ICD-10 across assessment intervals (range −47.09% to −57.14%). Over 97% of ICD-11 PTSD cases met concurrent ICD-10 PTSD criteria. PTSD symptom severity of individuals identified by the ICD-11 criteria (CAPS total scores) was 31.38–36.49% higher than those identified by ICD-10 criteria alone. The latter, however, had CAPS scores indicative of moderate PTSD. ICD-11 was associated with similar or higher rates of comorbid mood and anxiety disorders. Individuals identified by either ICD-10 or ICD-11 shortly after traumatic events had similar longitudinal course.
This study indicates that significantly fewer individuals would be diagnosed with PTSD using the proposed ICD-11 criteria. Though ICD-11 criteria identify more severe cases, those meeting ICD-10 but not ICD-11 criteria remain in the moderate range of PTSD symptoms. Use of ICD-11 criteria will have critical implications for case identification in clinical practice, national reporting, and research.
Empirical data on the use of services due to mental health problems in older adults in Europe is lacking. The objective of this study is to identify factors associated with service utilization in the elderly.
As part of the MentDis_ICF65+ study, N = 3,142 people aged 65–84 living in the community in six European and associated countries were interviewed. Based on Andersen's behavioral model predisposing, enabling, and need factors were analyzed with logistic regression analyses.
Overall, 7% of elderly and 11% of those with a mental disorder had used a service due to mental health problems in the last 12 months. Factors significantly associated with underuse were male sex, lower education, living in the London catchment area, higher functional impairment and more comorbid mental disorders. The most frequently reported barrier to service use was personal beliefs, e.g. “I can deal with my problem on my own” (90%).
Underutilization of mental health services among older people in the European community is common and interventions are needed to achieve an adequate use of services.
Except for dementia and depression, little is known about common mental disorders in elderly people.
To estimate current, 12-month and lifetime prevalence rates of mental disorders in different European and associated countries using a standardised diagnostic interview adapted to measure the cognitive needs of elderly people.
The MentDis_ICF65+ study is based on an age-stratified, random sample of 3142 older men and women (65–84 years) living in selected catchment community areas of participating countries.
One in two individuals had experienced a mental disorder in their lifetime, one in three within the past year and nearly one in four currently had a mental disorder. The most prevalent disorders were anxiety disorders, followed by affective and substance-related disorders.
Compared with previous studies we found substantially higher prevalence rates for most mental disorders. These findings underscore the need for improving diagnostic assessments adapted to the cognitive capacity of elderly people. There is a need to raise awareness of psychosocial problems in elderly people and to deliver high-quality mental health services to these individuals.
be a finite almost simple group. It is well known that
can be generated by three elements, and in previous work we showed that 6 generators suffice for all maximal subgroups of
. In this paper, we consider subgroups at the next level of the subgroup lattice—the so-called second maximal subgroups. We prove that with the possible exception of some families of rank 1 groups of Lie type, the number of generators of every second maximal subgroup of
is bounded by an absolute constant. We also show that such a bound holds without any exceptions if and only if there are only finitely many primes
for which there is a prime power
is prime. The latter statement is a formidable open problem in Number Theory. Applications to random generation and polynomial growth are also given.
Two independent lines of inquiry suggest that growing up under conditions of contextual adversity (e.g., poverty and household chaos) accelerates aging and undermines long-term health. Whereas work addressing the developmental origins of health and disease highlights accelerated-aging effects of contextual adversity on telomere erosion, that informed by an evolutionary analysis of reproductive strategies highlights such effects with regard to pubertal development (in females). That both shorter telomeres early in life and earlier age of menarche are associated with poor health later in life raises the prospect, consistent with evolutionary life-history theory, that these two bodies of theory and research are tapping into the same evolutionary–developmental process whereby longer term health costs are traded off for increased probability of reproducing before dying via a process of accelerated aging. Here we make the case for such a claim, while highlighting biological processes responsible for these effects, as well as unknowns in the epigenetic equation that might instantiate these contextually regulated developmental processes.
We study the distribution of products of conjugacy classes in finite simple groups, obtaining effective two-step mixing results, which give rise to an approximation to a conjecture of Thompson.
Our results, combined with work of Gowers and Viola, also lead to the solution of recent conjectures they posed on interleaved products and related complexity lower bounds, extending their work on the groups SL(2, q) to all (non-abelian) finite simple groups.
In particular it follows that, if G is a finite simple group, and A, B ⊆ Gt for t ⩾ 2 are subsets of fixed positive densities, then, as a = (a1, . . ., at) ∈ A and b = (b1, . . ., bt) ∈ B are chosen uniformly, the interleaved product a • b:=a1b1 . . . atbt is almost uniform on G (with quantitative estimates) with respect to the ℓ∞-norm.
It also follows that the communication complexity of an old decision problem related to interleaved products of a, b ∈ Gt is at least Ω(t log |G|) when G is a finite simple group of Lie type of bounded rank, and at least Ω(t log log |G|) when G is any finite simple group. Both these bounds are best possible.
The Contracts (General Part) Law, 1973, is the fundamental statute in Israeli contract law, and will in the future serve as the basis for the codification of Israel civil law. The Law was enacted following a decade of meticulous preparatory work by a committee headed by Professor Tedeschi. Prof. Tedeschi was the leading intellectual force in this committee; his influence is apparent in the approaches, principles and concepts of the Law, as well as in its particular provisions. Prof. Tedeschi also devoted a part of his prolific writings to the realm of contracts law. This article, dealing with only two sections of the wide-ranging Contracts (General Part) Law, is dedicated with admiration to the father of Israeli modern contract law.
Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs.
General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure.
Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types – witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury – accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events.
Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.