A framework for a brain-derived nosology of psychiatric disorders.

Current psychiatric diagnoses are not defined by neurobiological measures which hinders the development of therapies targeting mechanisms underlying mental illness 1,2 . Research confined to diagnostic boundaries yields heterogeneous biological results, whereas transdiagnostic studies often investigate individual symptoms in isolation. There is currently no paradigm available to comprehensively investigate the relationship between different clinical symptoms, individual disorders, and the underlying neurobiological mechanisms. Here, we propose a framework that groups clinical symptoms derived from ICD-10/DSM-V according to shared brain mechanisms defined by brain structure, function, and connectivity. The reassembly of existing ICD-10/DSM-5 symptoms reveal six cross-diagnostic psychopathology scores related to mania symptoms, depressive symptoms, anxiety symptoms, stress symptoms, eating pathology, and fear symptoms. They were consistently associated with multimodal neuroimaging components in the training sample of young adults aged 23, the independent test sample aged 23, participants aged 14 and 19 years, and in psychiatric patients. The identification of symptom groups of mental illness robustly defined by precisely characterized brain mechanisms enables the development of a psychiatric nosology based upon quantifiable neurobiological measures. As the identified symptom groups align well with existing diagnostic categories, our framework is directly applicable to clinical research and patient care.

Practitioner Review: Assessment and treatment of body dysmorphic disorder in young people.

Body dysmorphic disorder (BDD) is a relatively common and highly impairing mental disorder that is strikingly underdiagnosed and undertreated in Child and Adolescent Mental Health Services (CAMHS). The only clinical guidelines for the management of BDD in youth were published nearly 20 years ago, when empirical knowledge was sparse. Fortunately, there has been a surge in research into BDD over the last 10 years, shedding important insights into the phenomenology, epidemiology, assessment and treatment of the disorder in young people. This review aimed to provide an overview of recent research developments of relevance to clinicians and healthcare policymakers. We summarise key findings regarding the epidemiology of BDD in youth, which indicate that the disorder usually develops during teenage years and affects approximately 2% of adolescents at any one point in time. We provide an overview of aetiological research, highlighting that BDD arises from an interplay between genetic and environmental influences. We then focus on screening and assessment strategies, arguing that these are crucial to promote detection and diagnosis of this under-recognised condition. Additionally, we summarise the recommended treatment approaches for BDD in youth, namely cognitive behaviour therapy with or without selective serotonin reuptake inhibitors. The review concludes by highlighting key knowledge gaps and priorities for future research including, but not limited to, better understanding aetiological factors, long-term consequences and treatment.

Distinct personality profiles associated with disease risk and diagnostic status in eating disorders.

BACKGROUND: Personality traits have been associated with eating disorders (EDs) and comorbidities. However, it is unclear which personality profiles are premorbid risk rather than diagnostic markers. METHODS: We explored associations between personality and ED-related mental health symptoms using canonical correlation analyses. We investigated personality risk profiles in a longitudinal sample, associating personality at age 14 with onset of mental health symptoms at ages 16 or 19. Diagnostic markers were identified in a sample of young adults with anorexia nervosa (AN, n = 58) or bulimia nervosa (BN, n = 63) and healthy controls (n = 47). RESULTS: Two significant premorbid risk profiles were identified, successively explaining 7.93 % and 5.60 % of shared variance (Rc2). The first combined neuroticism (canonical loading, rs = 0.68), openness (rs = 0.32), impulsivity (rs = 0.29), and conscientiousness (rs = 0.27), with future onset of anxiety symptoms (rs = 0.87) and dieting (rs = 0.58). The other, combined lower agreeableness (rs = -0.60) and lower anxiety sensitivity (rs = -0.47), with future deliberate self-harm (rs = 0.76) and purging (rs = 0.55). Personality profiles associated with "core psychopathology" in both AN (Rc2 = 80.56 %) and BN diagnoses (Rc2 = 64.38 %) comprised hopelessness (rs = 0.95, 0.87) and neuroticism (rs = 0.93, 0.94). For BN, this profile also included impulsivity (rs = 0.60). Additionally, extraversion (rs = 0.41) was associated with lower depressive risk in BN. LIMITATIONS: The samples were not ethnically diverse. The clinical cohort included only females. There was non-random attrition in the longitudinal sample. CONCLUSIONS: The results suggest neuroticism and impulsivity as risk and diagnostic markers for EDs, with neuroticism and hopelessness as shared diagnostic markers. They may inform the design of more personalised prevention and intervention strategies.

Epidemiology of Body Dysmorphic Disorder and Appearance Preoccupation in Youth: Prevalence, Comorbidity and Psychosocial Impairment.

OBJECTIVE: Little is known about how common and impairing body dysmorphic disorder (BDD) is in the general population of youth. We evaluated the prevalence, comorbidity, and psychosocial impairment associated with BDD and more broadly defined appearance preoccupation in young people. METHOD: Data were drawn from the 2017 Mental Health of Children and Young People in England survey. BDD and psychiatric comorbidity were assessed in individuals 5 to 19 years of age (N = 7,654) according to DSM-5 criteria, using a clinician-rated standardized diagnostic assessment. Psychosocial impairment was measured with a quantitative scale and was indexed by reported self-harm and suicide attempts, as well as service use, assessed using structured interviews. RESULTS: The point prevalence of BDD was 1.0% (95% CI = 0.8%-1.3%). BDD was significantly more common among adolescents than children (1.9 vs 0.1%; OR = 22.5, p < .001), and among female than male participants (1.8% vs 0.3%; OR = 7.3, p < .001). Approximately 70% of young people with BDD had psychiatric comorbidity, most commonly internalizing disorders. BDD was associated with self- and parent-reported psychosocial impairment, self-harm and suicide attempts, and service utilization. Appearance preoccupation was more common than full-syndrome BDD, but showed similar age and sex effects, patterns of comorbidity, and associated impairment. CONCLUSION: BDD and appearance preoccupation are relatively common, especially among adolescent girls, and are associated with substantial co-occurring psychopathology, impairment, and risk. Improved screening is needed to increase detection and diagnosis of BDD, and to facilitate access to evidence-based treatment. STUDY PREREGISTRATION INFORMATION: The epidemiology of body dysmorphic disorder the youth: prevalence, comorbidity and psychosocial impact; https://osf.io/g83jy.

Irritability in Youths: A Critical Integrative Review.

Irritability, defined as proneness to anger that may impair an individual's functioning, is common in youths. There has been a recent upsurge in relevant research. The authors combine systematic and narrative review approaches to integrate the latest clinical and translational findings and provide suggestions for addressing research gaps. Clinicians and researchers should assess irritability routinely, and specific assessment tools are now available. Informant effects are prominent, are stable, and vary by age and gender. The prevalence of irritability is particularly high among individuals with attention deficit hyperactivity disorder, autism spectrum disorder, and mood and anxiety disorders. Irritability is associated with impairment and suicidality risk independent of co-occurring diagnoses. Developmental trajectories of irritability (which may begin early in life) have been identified and are differentially associated with clinical outcomes. Youth irritability is associated with increased risk of anxiety, depression, behavioral problems, and suicidality later in life. Irritability is moderately heritable, and genetic associations differ based on age and comorbid illnesses. Parent management training is effective for treating psychological problems related to irritability, but its efficacy in treating irritability should be tested rigorously, as should novel mechanism-informed interventions (e.g., those targeting exposure to frustration). Associations between irritability and suicidality and the impact of cultural context are important, underresearched topics. Analyses of large, diverse longitudinal samples that extend into adulthood are needed. Data from both animal and human research indicate that aberrant responses to frustration and threat are central to the pathophysiology of irritability, revealing important translational opportunities.

Machine learning models for diagnosis and risk prediction in eating disorders, depression, and alcohol use disorder.

This study uses machine learning models to uncover diagnostic and risk prediction markers for eating disorders (EDs), major depressive disorder (MDD), and alcohol use disorder (AUD). Utilizing case-control samples (ages 18-25 years) and a longitudinal population-based sample (n=1,851), the models, incorporating diverse data domains, achieved high accuracy in classifying EDs, MDD, and AUD from healthy controls. The area under the receiver operating characteristic curves (AUC-ROC [95% CI]) reached 0.92 [0.86-0.97] for AN and 0.91 [0.85-0.96] for BN, without relying on body mass index as a predictor. The classification accuracies for MDD (0.91 [0.88-0.94]) and AUD (0.80 [0.74-0.85]) were also high. Each data domain emerged as accurate classifiers individually, with personality distinguishing AN, BN, and their controls with AUC-ROCs ranging from 0.77 to 0.89. The models demonstrated high transdiagnostic potential, as those trained for EDs were also accurate in classifying AUD and MDD from healthy controls, and vice versa (AUC-ROCs, 0.75-0.93). Shared predictors, such as neuroticism, hopelessness, and symptoms of attention-deficit/hyperactivity disorder, were identified as reliable classifiers. For risk prediction in the longitudinal population sample, the models exhibited moderate performance (AUC-ROCs, 0.64-0.71), highlighting the potential of combining multi-domain data for precise diagnostic and risk prediction applications in psychiatry.

Study Preregistration: Understanding the Etiology of Externalizing Problems in Young Children: The Roles of Callous-Unemotional Traits and Irritability.

Externalizing behavioral problems in young children are associated with later delinquency and crime,1 which can cause burdens at both personal and socialeconomic levels. The heterogeneity of externalizing problems emphasizes the importance of examining the etiological mechanisms that underlie externalizing problems and related behaviors. The present study focuses on 2 risk factors for externalizing behavioral problems in early childhood: callous-unemotional traits (CU), characterized as a lack of guilt and empathy,2 and irritability, a tendency to show anger and frustration.3 Behavioral genetic studies find that externalizing problems, CU, and irritability are heritable,4,5 raising the possibility of common genetic effects linking the 3 behaviors, but this has not been previously explored. Neurological evidence suggests distinct pathways from CU and irritability to externalizing problems,6 implying that the genetic and environmental factors linking externalizing problems and CU may differ from those linking externalizing problems and irritability. We predict that there will be common genetic influences operating across externalizing problems, CU, and irritability; but we also predict unique genetic and environmental influences representing distinctive risks shared between externalizing problems and CU, and between externalizing problems and irritability, respectively.

Evaluating the development and well-being assessment (DAWBA) in pediatric anxiety and depression.

Enhancing screening practices and developing scalable diagnostic tools are imperative in response to the increasing prevalence of youth mental health challenges. Structured lay psychiatric interviews have emerged as one such promising tool. However, there remains limited research evaluating structured psychiatric interviews, specifically their characterization of internalizing disorders in treatment-seeking youth. This study evaluates the relationship between the Development and Well-Being Assessment (DAWBA), a structured psychiatric interview, and established measures of pediatric anxiety and depression, including the Screen for Child Anxiety Related Disorders (SCARED), the Pediatric Anxiety Rating Scale (PARS), and the Mood and Feelings Questionnaire (MFQ). The study comprised two independent clinical samples of treatment-seeking youth: sample one included 55 youth with anxiety and 29 healthy volunteers (HV), while sample two included 127 youth with Major Depressive Disorder and 73 HVs. We examined the association between the DAWBA band scores, indicating predicted risk for diagnosis, the SCARED and PARS (sample one), and the MFQ (sample two). An exploratory analysis was conducted in a subset of participants to test whether DAWBA band scores predicted the change in anxiety symptoms (SCARED, PARS) across a 12-week course of cognitive behavioral therapy. The results revealed that the DAWBA significantly predicted the SCARED, PARS and MFQ measures at baseline; however, it did not predict changes in anxiety symptoms across treatment. These findings suggest that the DAWBA may be a helpful screening tool for indexing anxiety and depression in treatment-seeking youth but is not especially predictive of longitudinal trajectories in symptomatology across psychotherapy.

Distinct correlates of empathy and compassion with burnout and affective symptoms in health professionals and students

Objective: The causes of high rates of psychological distress among health professionals and students are largely unknown. Health professionals respond to those who are in distress with empathy (feeling what others feel) or compassion (caring about what others feel). This study aims to investigate whether empathy and compassion are distinct traits and how both traits are associated with negative affect (burnout, depression, anxiety and anger symptoms) in undergraduate students and professionals in medicine, psychology and nursing. Methods: A sample of 464 students and professionals filled out an online protocol with a sociodemographic data questionnaire and self-report questionnaires covering the variables of interest. Results: The findings indicate that empathy is associated with higher negative affect, while compassion is associate with lower negative affect, which suggests that they are different traits. Conclusion: Our findings provide new evidence that the well-being of health professionals might be affected differently depending on socioemotional traits relevant to emotional connection.

Cross-cultural adaptation and preliminary psychometric properties of the Affective Reactivity Index in Brazilian Youth: implications for DSM-5 measured irritability / Adaptação transcultural e propriedades psicométricas preliminares do Affective Reactivity Index em jovens brasileiros: implicações para a irritabilidade medida pelo DSM-5

Objective: To describe the cross-cultural adaptation of the Affective Reactivity Index (ARI) to Brazilian Portuguese and to investigate preliminary psychometric properties of the adapted version. Methods: Cross-cultural adaptation was based on the investigation of the theoretical and operational equivalences of the original ARI in the Brazilian context, followed by a process of translation, back-translation, and review by a committee of experts. Data analysis was carried out in a community sample of 133 schoolchildren aged 8 to 17 years to investigate the following characteristics of the ARI: 1) factor structure; 2) internal consistency; 3) construct validity comparing differential relationships between irritability and anxiety dimensions and impairment; and 4) item response theory (IRT) parameters. Results: A final Brazilian Portuguese version of the instrument was defined and is presented. Internal consistency was good, and our analysis supported the original single-factor structure of the ARI. Correlations of the ARI with distress-related anxiety dimensions were higher than with phobic-related anxiety dimensions, supporting its construct validity. In addition, higher ARI scores were associated with higher irritability-related impairment. IRT analysis underscored frequency of loss of temper as essential to inform about pathological states of irritability. Conclusion: The Brazilian Portuguese version of the ARI seems to be very similar to the original instrument in terms of conceptual, item, semantic, and operational equivalence. Our preliminary analysis replicates and extends previous evidence confirming promising psychometric properties for the ARI.

Objetivo: Descrever a adaptação transcultural do Affective Reactivity Index (ARI) para o português do Brasil e investigar propriedades psicométricas preliminares da versão adaptada. Método: A adaptação transcultural foi baseada na investigação das equivalências teórica e operacional da versão original do ARI no contexto brasileiro, seguida do processo de tradução, retrotradução e revisão por comitê de especialistas. A análise dos dados foi realizada em uma amostra comunitária de 133 escolares com idade entre 8 e 17 anos para investigar as seguintes características do ARI: 1) estrutura fatorial; 2) consistência interna; 3) validade do construto, comparando as relações diferenciais entre irritabilidade e as dimensões de ansiedade e prejuízo; e 4) parâmetros de teoria da resposta ao item (TRI). Resultados: Uma versão final em português do Brasil do instrumento foi definida e é apresentada. A consistência interna foi boa, e nossa análise confirmou a estrutura unifatorial original do ARI. As correlações do ARI com as dimensões de ansiedade relacionadas a sofrimento foram maiores do que com as dimensões de ansiedade relacionadas a fobias, reforçando a validade do construto. Além disso, escores mais altos no ARI foram associados a maior prejuízo relacionado à irritabilidade. A análise do TRI enfatizou a frequência de perda de controle como essencial para determinar estados patológicos de irritabilidade. Conclusão: A versão em português do Brasil do ARI parece ser muito semelhante ao instrumento original em termos de equivalência conceitual, de itens, semântica e operacional. Nossa análise preliminar reproduz e estende evidências anteriores que confirmam propriedades psicométricas promissoras para o ARI.

Irritability in children and adolescents: past concepts, current debates, and future opportunities

Irritability is defined as a low threshold to experience anger in response to frustration. It is one of the most common symptoms in youth and is part of the clinical presentation of several disorders. Irritability can present early in life and is a predictor of long-term psychopathology; yet, the diagnostic status of irritability is a matter of intense debate. In the present article, we address two main components of the debate regarding irritability in youth: the misdiagnosis of chronic irritability as pediatric bipolar disorder, and the proposal of a new diagnosis in the DSM-5, disruptive mood dysregulation disorder, whose defining symptoms are chronic irritability and temper outbursts.