Prediction of Clinical Outcomes in Psychotic Disorders Using Artificial Intelligence Methods: A Scoping Review.

BACKGROUND: Psychotic disorders are major psychiatric disorders that can impact multiple domains including physical, social, and psychological functioning within individuals with these conditions. Being able to better predict the outcomes of psychotic disorders will allow clinicians to identify illness subgroups and optimize treatment strategies in a timely manner. OBJECTIVE: In this scoping review, we aimed to examine the accuracy of the use of artificial intelligence (AI) methods in predicting the clinical outcomes of patients with psychotic disorders as well as determine the relevant predictors of these outcomes. METHODS: This review was guided by the PRISMA Guidelines for Scoping Reviews. Seven electronic databases were searched for relevant published articles in English until 1 February 2024. RESULTS: Thirty articles were included in this review. These studies were mainly conducted in the West (63%) and Asia (37%) and published within the last 5 years (83.3%). The clinical outcomes included symptomatic improvements, illness course, and social functioning. The machine learning models utilized data from various sources including clinical, cognitive, and biological variables such as genetic, neuroimaging measures. In terms of main machine learning models used, the most common approaches were support vector machine, random forest, logistic regression, and linear regression models. No specific machine learning approach outperformed the other approaches consistently across the studies, and an overall range of predictive accuracy was observed with an AUC from 0.58 to 0.95. Specific predictors of clinical outcomes included demographic characteristics (gender, socioeconomic status, accommodation, education, and employment); social factors (activity level and interpersonal relationships); illness features (number of relapses, duration of relapses, hospitalization rates, cognitive impairments, and negative and disorganization symptoms); treatment (prescription of first-generation antipsychotics, high antipsychotic doses, clozapine, use of electroconvulsive therapy, and presence of metabolic syndrome); and structural and functional neuroimaging abnormalities, especially involving the temporal and frontal brain regions. CONCLUSIONS: The current review highlights the potential and need to further refine AI and machine learning models in parsing out the complex interplay of specific variables that contribute to the clinical outcome prediction of psychotic disorders.

Novel interventions significantly reduce falls with fractures: A meta-analysis and systematic review.

INTRODUCTION: Worldwide, falls lead to possible complications such as prolonged hospitalization, prolonged bed rest, pressure injuries, fractures and mortality. AIMS: The study aimed to evaluate the effectiveness of novel fall prevention strategies that utilized technology in preventing falls. METHODS: The meta-analysis and systematic review was guided by the Cochrane guidelines for systematic reviews of interventions. The authors searched databases for specified keywords. RESULTS: A total of 22 studies were included. Interventions included multi-modal fall prevention interventions, camera surveillance, motion sensors and bed/chair exit alarms. Video monitoring was equivocal in reducing fall rates. Exit alarms statistically significantly reduce falls between groups but not within groups. The interventions were not statistically significant in reducing falls with minor injuries but they were statistically significant in reducing falls with serious injuries including fractures. CONCLUSION: A comprehensive fall prevention care plan, rather than one specific intervention, is necessary to prevent falls effectively.

Effectiveness of Augmented and Virtual Reality-Based Interventions in Improving Knowledge, Attitudes, Empathy and Stigma Regarding People with Mental Illnesses-A Scoping Review.

Interventions adopting augmented and virtual reality (AR/VR) modalities allow participants to explore and experience realistic scenarios, making them useful psycho-educational tools for mental illnesses. This scoping review aims to evaluate the effectiveness of AR/VR interventions in improving (1) knowledge, (2) attitudes, (3) empathy and (4) stigma regarding people with mental illnesses. Literature on published studies in English up till April 2022 was searched within several databases. Sixteen articles were included. The majority of studies were conducted in the West (93.8%), within undergraduates (68.8%) but also amongst high school students, patients, caregivers, public including online community, and covered conditions including psychotic illnesses, dementia, anxiety and depression. A preponderance of these included studies which employed AR/VR based interventions observed improvements in knowledge (66.7%), attitudes (62.5%), empathy (100%) and reduction of stigma (71.4%) pertaining to people with mental illnesses. In the context of relatively limited studies, extant AR/VR based interventions could potentially improve knowledge, attitudes, empathy and decrease stigma regarding people with mental illness. Further research needs to be conducted in larger and more diverse samples to investigate the relatively beneficial effects of different AR/VR modalities and the durability of observed improvements of relevant outcomes of interests over time for different mental conditions.

Online HOPE intervention on help-seeking attitudes and intentions among young adults in Singapore: A randomized controlled trial and process evaluation.

INTRODUCTION: Despite the high prevalence of mental health disorders, professional help seeking was often unsought, worsening impairments in overall functioning among those who experienced them. AIM: This study aimed to evaluate the online HOPE intervention on help-seeking attitudes and intentions among young adults 18 to 24 years old in a University in Singapore. The study also described the process evaluation of the online HOPE intervention. METHOD: The study adopted a parallel two arms RCT. Outcome measurements measured at baseline, post-test and two-month follow-up were (1) recognition of depression, (2) barriers of help-seeking, (3) help-seeking intentions (4) attitudes about interventions, help sources, medications and (5) participants' perceptions about the intervention. RESULTS: At post-test, intervention group had significantly lower acknowledgement of depression as stress. At two months, control group was significantly more concerned about side effects of medications. There were no significant differences in all barriers of help-seeking between groups, pre and post intervention. The intervention group had greater acknowledgement of antidepressants, tranquilisers and antipsychotics. Thematic analysis revealed four main themes. DISCUSSION: There was high baseline recognition of depression. Improvements in help-seeking intentions were partially attributed to decreased help-seeking barriers. IMPLICATION FOR PRACTICE: The online HOPE intervention could be promptly implemented for young adults to enhance the identification of mental health disorders, early help-seeking and recovery. Nurses played an important role in patient education, and online interventions are especially crucial during this Covid period which mandated social distancing. [NCT04266119].

Effectiveness of Artificial Intelligence Methods in Personalized Aggression Risk Prediction within Inpatient Psychiatric Treatment Settings-A Systematic Review.

Aggression risk assessments are vital to prevent injuries and morbidities amongst patients and staff in psychiatric settings. More recent studies have harnessed artificial intelligence (AI) methods such as machine learning algorithms to determine factors associated with aggression in psychiatric treatment settings. In this review, using Cooper's five-stage review framework, we aimed to evaluate the: (1) predictive accuracy, and (2) clinical variables associated with AI-based aggression risk prediction amongst psychiatric inpatients. Databases including PubMed, Cochrane, Scopus, PsycINFO, CINAHL were searched for relevant articles until April 2022. The eight included studies were independently evaluated using critical appraisal tools for systematic review developed by Joanna Briggs Institute. Most of the studies (87.5%) examined health records in predicting aggression and reported acceptable to excellent accuracy with specific machine learning algorithms employed (area under curve range 0.75-0.87). No particular machine learning algorithm outperformed the others consistently across studies (area under curve range 0.61-0.87). Relevant factors identified with aggression related to demographic and social profile, past aggression, forensic history, other psychiatric history, psychopathology, challenging behaviors and management domains. The limited extant studies have highlighted a potential role for the use of AI methods to clarify factors associated with aggression in psychiatric inpatient treatment settings.

Impact of the HOPE Intervention on Mental Health Literacy, Psychological Well-Being and Stress Levels amongst University Undergraduates: A Randomised Controlled Trial.

Mental health literacy (MHL) promotes mental health among youths. We aimed to evaluate the effectiveness of the newly developed HOPE intervention in improving depression literacy, anxiety literacy, psychological well-being, and reducing personal stigma and stress levels amongst young adults at a university in Singapore. After two pilot studies, we conducted a randomised controlled trial (RCT) and recruited 174 participants aged 18-24 years old through social media platforms. The HOPE intervention group received four online sessions over two weeks and the control group received online inspirational quotes. Study outcomes were measured with self-reported questionnaires and they were assessed at baseline, post-intervention, and two-month follow-up (ClinicalTrials.gov: NCT04266119). Compared with the control arm, the intervention group was associated with increased depression and anxiety literacy levels at post-intervention and two-month follow-up. In addition, personal stigma for depression was reduced at the post-intervention juncture. However, there were no statistically significant changes in the ratings of psychological well-being and stress levels between the two groups. Longitudinal studies with larger sample sizes are warranted to replicate and extend the extant findings.

Brief contact interventions to reduce suicide among discharged patients with mental health disorders-A meta-analysis of RCTs.

BACKGROUND: Worldwide, about 1 million died from suicide in 2000. People with mental health disorders are at greater risk of suicide, and they are especially susceptible during 1-week period after discharge from the hospital. OBJECTIVE: This meta-analysis paper aims to evaluate the effectiveness of brief contact interventions in preventing (1) suicidal deaths, (2) suicidal attempts, and (3) suicidal ideations among mental health patients discharged from the hospital. METHODS: Search for published and unpublished articles were conducted using 10 databases: CINAHL, Cochrane Central Register of Controlled Trials, Embase, Scopus, Pubmed, PsycINFO, Web of Science, Randomised Control Trial Registry Website, ClinicalTrials.gov, and Proquest Dissertation and Theses Global, using the keywords "suicide" AND "discharged," AND "patients." All articles printed in English and published from the year 1995 to August 2019 were included. RESULTS: A total of 23 articles were included in the meta-analysis. Contact interventions significantly reduced suicidal attempts within (1) 12-14 months and (2) suicide ideations within 12 months. There were no significant findings on suicidal deaths. DISCUSSION: A new finding of this meta-analysis is that combining several brief contact interventions could potentially reduce suicidal attempts and ideations. This is important in preserving the lives of discharged patients.

Online HOPE intervention on mental health literacy among youths in Singapore: An RCT protocol.

AIMS: The study aims to examine the effectiveness of the online HOPE intervention to increase mental health literacy (MHL), psychological well-being (PWB); and in reducing stress among youths aged 18-24 living in Singapore. DESIGN: The study will be conducted in two phases. The first phase will adopt a single-group pre-post repeated quasi-experimental research design. The second phase adopts a two-group, parallel randomized control trial, with a pre-test, posttest and follow-up. METHODS: The study will be conducted in a University in Singapore, in 2019-2021. Participants will be recruited and randomly assigned into one of the two groups. Approval from the institutional review board has been obtained in August 2019. Research funding from National Youth Fund has been obtained in November 2019. Outcome measures will be measured using Depression Literacy Questionnaire, Anxiety literacy Questionnaire, validated depression vignette, Ryff's PWB Scale and Perceived Stress Scale, at baseline, postintervention and 2 months' follow-up. Participants' perceptions of the intervention will be measured qualitatively. DISCUSSION: The online HOPE intervention had been developed based on the principles of the Self-Efficacy Theory. IMPACT: There is no research about MHL intervention in Singapore. Low MHL prevents early help-seeking and delays treatment. Hence, this study highlights the importance of mental health public education as primary care. Increased MHL will enhance early help-seeking behaviours, promoting early recovery and enhancing the health of the young people worldwide.

A systematic review of the safety and efficacy of rapid titration of quetiapine running header: Rapid titration of Quetiapine- A systematic review.

Quetiapine is a second-generation antipsychotic that is most favoured for its low propensity for extrapyramidal side effects. However, Quetiapine requires slow titration, which is disadvantageous. The brief review discussed research that trialled rapid titration of Quetiapine The author searched PubMed, Proquest, Embase, Google Scholar and Google Web using the keyword 'rapid titration' and 'quetiapine'. A total of 18 articles were included. The process, safety and efficacy of rapid titration of Quetiapine was examined. In conclusion, preliminary results appear to show that there is minimal difference in efficacy, between the rapid and traditional titration of Quetiapine. Sedation tended to occur more frequently and earlier among experimental group, and this might render rapid titration of Quetiapine to be suitable for agitated patients. There is a need for more large-scale, multisite, randomized clinical trials to examine the safety and efficacy of rapid titration of Quetiapine.

Mental health literacy levels.

Globally, mental disorders affect 25% of the society. This discursive paper aims to illustrate the mental health literacy levels in the public. Mental health literacy (MHL) is the understanding of mental health conditions, which helps in their prevention, recognition and treatment. Unfortunately, the public has minimal understanding of mental disorders, leading to poor recognition and delay in treatment. There is a need to conduct good quality research to assess the MHL levels among public and tailor interventions to enhance MHL among the public. This will ensure early detection of mental disorders, leading to early recovery and greater quality of life among the society. Nurses have a great role to play in leading these public educations, and enhancing a healthy and happy nation.

Effectiveness of information and communication technologies interventions to increase mental health literacy: A systematic review.

AIM: Most mental health conditions affect adolescent and young adults. The onset of many mental disorders occurs in the young age. This is a critical period to implement interventions to enhance mental health literacy (MHL) and to prevent the occurrence of mental health problems. This systematic review examined the effectiveness of information and communication technologies interventions on MHL (recognition of conditions, stigma and help-seeking). METHODS: The authors searched for both published and unpublished studies. RESULTS: Nineteen studies were included with 9 randomized controlled trials and 10 quasi-experimental studies. Informational interventions were useful to enhance MHL of less-known disorders such as anxiety disorder and anorexia, but not depression. Interventions that were effective in enhancing depression MHL comprised active component such as videos or quizzes. Interventions that successfully elevated MHL also reduced stigma. Elevated MHL levels did not improve help-seeking, and reduction in stigma levels did not enhance help-seeking behaviours. CONCLUSIONS: Future good quality, large-scale, multi-sites randomized controlled trials are necessary to evaluate MHL interventions.

The ties that bind - A case report about restraining a mentally unwell family member at home for over a decade.

This is a case report describing a patient, with schizophrenia, who was physically chained by her mother in their house for more a decade. Illness factors, family dynamics, stigma, lack of mental health literacy and cultural roles contributed to her chaining. To our knowledge, this is the first case report that examines the prolonged use of physical restraints by family members on a patient in a developed urban setting and that explores the cultural and ethical issues surrounding this phenomenon. We have concluded that there remains a need for a national level approach to increase mental health literacy, reduce stigma and promote existing psychiatric community health services in a culturally sensitive manner.