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In recent years, there has been tremendous support for working toward the RDoC goals of identifying the neurobiological mechanisms that cut across or are common to multiple psychiatric disorders. Identifying the pathophysiological mechanisms underlying transdiagnostic symptoms will improve the validity of disease classifications by grouping individuals based on multiple dimensions of behavior and biology. This could potentially account for heterogeneity and comorbidity observed among DSM diagnostic categories.
Depression has been associated with abnormalities in neural underpinnings of Reward Learning (RL). However, inconsistencies have emerged, possibly owing to medication effects. Additionally, it remains unclear how neural RL signals relate to real-life behaviour. The current study, therefore, examined neural RL signals in young, mildly to moderately depressed – but non-help-seeking and unmedicated – individuals and how these signals are associated with depressive symptoms and real-life motivated behaviour.
Individuals with symptoms along the depression continuum (n = 87) were recruited from the community. They performed an RL task during functional Magnetic Resonance Imaging and were assessed with the Experience Sampling Method (ESM), completing short questionnaires on emotions and behaviours up to 10 times/day for 15 days. Q-learning model-derived Reward Prediction Errors (RPEs) were examined in striatal areas, and subsequently associated with depressive symptoms and an ESM measure capturing (non-linearly) how anticipation of reward experience corresponds to actual reward experience later on.
Significant RPE signals were found in the striatum, insula, amygdala, hippocampus, frontal and occipital cortices. Region-of-interest analyses revealed a significant association between RPE signals and (a) self-reported depressive symptoms in the right nucleus accumbens (b = −0.017, p = 0.006) and putamen (b = −0.013, p = .012); and (b) the quadratic ESM variable in the left (b = 0.010, p = .010) and right (b = 0.026, p = 0.011) nucleus accumbens and right putamen (b = 0.047, p < 0.001).
Striatal RPE signals are disrupted along the depression continuum. Moreover, they are associated with reward-related behaviour in real-life, suggesting that real-life coupling of reward anticipation and engagement in rewarding activities might be a relevant target of psychological therapies for depression.
To evaluate the suitability of 80 patients referred for assertive outreach treatment (AOT) and their treatment outcomes, by comparing clinical and social data during the treatment period with data before treatment began. To control for service development across the board, patients on ordinary community treatment were identified and matched to patients undergoing AOT for age, gender, clinical diagnosis and duration, and data acquired for the same time period as the patients on AOT. This was a retrospective mirror-image evaluation with contemporaneous controls.
The patients referred for AOT were more socially disadvantaged and had used more clinical resources than the control patients. Overall, AOT reduced resource uptake markedly following referral, while resource uptake by control patients during the same period remained static or increased; AOT, however, did not lessen most aspects of social disadvantage.
The advantages of AOT include much reduced use of services but not the resolving of social exclusion. Some ordinary community provision may fail to afford the quality of AOT and thus suffer by comparison. The demise of AOT may be premature in such services.
Non-medical staff are eligible to assess trainee doctors through mandatory workplace-based assessments (WPBAs). An anonymous questionnaire was given out to non-medical staff working with trainees in community and in-patient settings at Royal Blackburn Hospital. Our aims were to look at their awareness of and familiarity with assessor guidance, trainee competencies, training needs and assessors' views on completing these assessments.
In total 118 of 150 (79%) individuals returned a questionnaire and 89 WPBAs had been carried out. Most assessors were Band 6 (or equivalent) or below (53%). Most assessors had neither read any assessor guidelines (75%) nor were familiar with the competencies required of a doctor (76%). Although 79% felt that non-medical staff should be assessing trainee doctors, only 44% felt comfortable doing this. None had been trained and 92% felt this would help. Twenty WPBAs (excluding mini-peer assisted tools) were carried out by staff at Band 6 or below.
No respondents received guidance or training on being an assessor. This highlights the need for urgent action and delivery of training. This can easily be adapted from training packages developed for medical staff.
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