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1.
Alzheimers Dement ; 2024 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-39382098

RESUMO

INTRODUCTION: Early detection of both objective and subjective cognitive impairment is important. Subjective complaints in healthy individuals can precede objective deficits. However, the differential associations of objective and subjective cognition with modifiable dementia risk factors are unclear. METHODS: We gathered a large cross-sectional sample (N = 3327, age 18 to 84) via a smartphone app and quantified the associations of 13 risk factors with subjective memory problems and three objective measures of executive function (visual working memory, cognitive flexibility, model-based planning). RESULTS: Depression, socioeconomic status, hearing handicap, loneliness, education, smoking, tinnitus, little exercise, small social network, stroke, diabetes, and hypertension were all associated with impairments in at least one cognitive measure. Subjective memory had the strongest link to most factors; these associations persisted after controlling for depression. Age mostly did not moderate these associations. DISCUSSION: Subjective cognition was more sensitive to self-report risk factors than objective cognition. Smartphones could facilitate detecting the earliest cognitive impairments. HIGHLIGHTS: Smartphone assessments of cognition were sensitive to dementia risk factors. Subjective cognition had stronger links to most factors than did objective cognition. These associations were not fully explained by depression. These associations were largely consistent across the lifespan.

2.
BMC Psychiatry ; 23(1): 25, 2023 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-36627607

RESUMO

BACKGROUND: Evidence-based treatments for depression exist but not all patients benefit from them. Efforts to develop predictive models that can assist clinicians in allocating treatments are ongoing, but there are major issues with acquiring the volume and breadth of data needed to train these models. We examined the feasibility, tolerability, patient characteristics, and data quality of a novel protocol for internet-based treatment research in psychiatry that may help advance this field. METHODS: A fully internet-based protocol was used to gather repeated observational data from patient cohorts receiving internet-based cognitive behavioural therapy (iCBT) (N = 600) or antidepressant medication treatment (N = 110). At baseline, participants provided > 600 data points of self-report data, spanning socio-demographics, lifestyle, physical health, clinical and other psychological variables and completed 4 cognitive tests. They were followed weekly and completed another detailed clinical and cognitive assessment at week 4. In this paper, we describe our study design, the demographic and clinical characteristics of participants, their treatment adherence, study retention and compliance, the quality of the data gathered, and qualitative feedback from patients on study design and implementation. RESULTS: Participant retention was 92% at week 3 and 84% for the final assessment. The relatively short study duration of 4 weeks was sufficient to reveal early treatment effects; there were significant reductions in 11 transdiagnostic psychiatric symptoms assessed, with the largest improvement seen for depression. Most participants (66%) reported being distracted at some point during the study, 11% failed 1 or more attention checks and 3% consumed an intoxicating substance. Data quality was nonetheless high, with near perfect 4-week test retest reliability for self-reported height (ICC = 0.97). CONCLUSIONS: An internet-based methodology can be used efficiently to gather large amounts of detailed patient data during iCBT and antidepressant treatment. Recruitment was rapid, retention was relatively high and data quality was good. This paper provides a template methodology for future internet-based treatment studies, showing that such an approach facilitates data collection at a scale required for machine learning and other data-intensive methods that hope to deliver algorithmic tools that can aid clinical decision-making in psychiatry.


Assuntos
Terapia Cognitivo-Comportamental , Psiquiatria , Humanos , Reprodutibilidade dos Testes , Terapia Cognitivo-Comportamental/métodos , Autorrelato , Projetos de Pesquisa , Internet , Resultado do Tratamento , Depressão/terapia
3.
BMC Psychiatry ; 19(1): 290, 2019 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533676

RESUMO

BACKGROUND: Meta-analyses of randomised controlled trials suggest that psychological interventions to reduce children's risk of depression are effective. Nevertheless, these effects are modest and diminish over time. The Medical Research Council recommends a mixed-methods approach to the evaluation of complex interventions. By gaining a more thorough understanding of participants' perspectives, qualitative evaluations of preventive interventions could improve their efficacy, longevity and transfer into clinical practice. METHODS: 18 parents and 22 children who had received a 12-session family- and group-based cognitive-behavioural intervention to prevent youth depression as part of a randomised controlled trial took part in semi-structured interviews or a focus group about aspects which had been perceived as helpful, elements they were still using after the intervention had ended, and suggestions they had for improving the intervention. RESULTS: The chance to openly share and discuss their experiences of depression within and between families was considered helpful by both children and parents. Children benefitted the most from learning coping strategies for dealing with stress and many still used them in everyday life. Parents profited mostly from increasing positive family time, but noted that maintaining new routines after the end of the intervention proved difficult. Participants were generally content with the intervention but commented on how tiring and time consuming it was. CONCLUSIONS: Managing parents' expectations of family-based interventions in terms of their own mental health needs (versus those of their children) and leaving more room for open discussions may result in interventions which are more appealing to participating families. Increasing intervals between sessions may be one means of improving the longevity of interventions. TRIAL REGISTRATION: The original RCT this evaluation is a part of was registered under NCT02115880 .


Assuntos
Filho de Pais com Deficiência/psicologia , Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/prevenção & controle , Pais/psicologia , Adaptação Psicológica , Adolescente , Adulto , Criança , Filho de Pais com Deficiência/estatística & dados numéricos , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Estudos de Avaliação como Assunto , Feminino , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Resultado do Tratamento
4.
PLoS One ; 18(4): e0282259, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37027432

RESUMO

Cognitive models of social anxiety highlight the importance of different cognitive biases (e.g., attention bias, interpretation bias) and executive dysfunctions, which have, however, mostly been investigated in isolation. The present study explored their interplay using two statistical approaches: (1) network analysis to identify the unique associations between cognitive functions, and (2) cluster analysis to reveal how these associations (or combinations) are manifested in a population. Participants from the general population (N = 147) completed measures of attention control, attention bias, interpretation bias, and social anxiety symptoms. Network analysis showed an association between social anxiety symptoms and interpretation bias, although no other significant associations emerged. Cluster analysis identified a group of participants characterized by an adaptive cognitive pattern (i.e., low cognitive biases, good executive function); and a group exhibiting a more maladaptive pattern (i.e., high interpretation bias, good alerting but poor executive function). The maladaptive group showed higher levels of social anxiety than the adaptive group. Results highlight the strong association between social anxiety symptoms and interpretation bias, while challenging the putative role of attention bias. Attention control, particularly executive function, may limit the impact of cognitive bias on anxiety symptoms.


Assuntos
Ansiedade , Medo , Humanos , Ansiedade/psicologia , Cognição , Função Executiva , Viés
5.
Artigo em Inglês | MEDLINE | ID: mdl-32123572

RESUMO

BACKGROUND: Although there is good evidence to support the effectiveness of cognitive behavioral therapy (CBT) for the outpatient treatment of adolescent major depressive disorder (MDD), evidence-based manuals for the inpatient setting are lacking. This pilot study sought to (i) adapt an existing CBT manual (treatment of adolescent depression; TADS) to an inpatient setting (TADS-in), (ii) test its effectiveness at symptom reduction and remission of MDD in a pre-post design, and (iii) assess the strengths and limitations of the manual via a focus-group with clinicians. METHODS: Twenty nine adolescents aged 12-17 years with a primary ICD-10 diagnosis of MDD being treated as inpatients at a psychiatric clinic were included. Embedded in the regular inpatient treatment course (8 weeks), patients received 12 sessions of the TADS-in manual. Quantitative assessment of symptom reduction and remission of MDD was conducted using a non-controlled pre-post design. The quantitative results were supplemented by a focus group with participating psychotherapists. RESULTS: Of the 29 patients included in the study at the beginning, 19 (65.5%) remained in the study at week 8. Symptoms of depression were statistically significantly lower at the end of treatment than at baseline according to self- (d = 1.38; mean change = 19.88; 95% CI = 12.48-27.28) and other reports (d = 0.64, mean change = 0.35; 95% CI = 0.08-0.62). Clinicians ratings of improvement (CGI-I) suggested that at the end of treatment, 15.8% were very much improved, 68.4% much improved, and 15.8% were minimally improved. According to diagnostic interviews with patients conducted at the end of treatment, 73.3% were in remission. The qualitative analysis showed that on the whole, the TADS-in manual is suitable for the inpatient setting. However, clinicians believed the effectiveness of TADS-in was limited by patient comorbidity and the fact that the inpatients were unable to practice incorporating techniques learnt into everyday life. CONCLUSIONS: This study is the first to adapt the TADS manual to the inpatient setting. The sample of depressed adolescents showed reduced symptomology following treatment, although these findings require replicating in a randomized controlled trial before effects can be attributed to the TADS-in manual specifically. This pilot study informs further development of the manual as well as representing an important first step in the evaluation of the inpatient treatment of adolescent depression.The study was retrospectively registered (DRKS00017308) and received no external funding.

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