Understanding personalized dynamics to inform precision medicine: a dynamic time warp analysis of 255 depressed inpatients.

BACKGROUND: Major depressive disorder (MDD) shows large heterogeneity of symptoms between patients, but within patients, particular symptom clusters may show similar trajectories. While symptom clusters and networks have mostly been studied using cross-sectional designs, temporal dynamics of symptoms within patients may yield information that facilitates personalized medicine. Here, we aim to cluster depressive symptom dynamics through dynamic time warping (DTW) analysis. METHODS: The 17-item Hamilton Rating Scale for Depression (HRSD-17) was administered every 2 weeks for a median of 11 weeks in 255 depressed inpatients. The DTW analysis modeled the temporal dynamics of each pair of individual HRSD-17 items within each patient (i.e., 69,360 calculated "DTW distances"). Subsequently, hierarchical clustering and network models were estimated based on similarities in symptom dynamics both within each patient and at the group level. RESULTS: The sample had a mean age of 51 (SD 15.4), and 64.7% were female. Clusters and networks based on symptom dynamics markedly differed across patients. At the group level, five dynamic symptom clusters emerged, which differed from a previously published cross-sectional network. Patients who showed treatment response or remission had the shortest average DTW distance, indicating denser networks with more synchronous symptom trajectories. CONCLUSIONS: Symptom dynamics over time can be clustered and visualized using DTW. DTW represents a promising new approach for studying symptom dynamics with the potential to facilitate personalized psychiatric care.

Cognitive change after electroconvulsive therapy in mood disorders measured with the Montreal Cognitive Assessment.

OBJECTIVE: The Montreal Cognitive Assessment (MoCA) is a sensitive and clinically practical test but its usefulness in measuring long-term cognitive effects of ECT is unclear. Using the MoCA, we investigated short- and long-term global cognitive change in ECT-treated patients with a Major Depressive Episode (MDE). METHOD: We included 65 consecutive ECT-treated patients with MDE, in whom global cognitive functioning was assessed at baseline (T0); during ECT (before the third session; T1); and 1 week (T2), 3 months (T3), and 6 months (T4) after completion of the index course. Changes in MoCA (sub)scores were analyzed using linear mixed models and reliable change indices were computed to investigate individual changes in MoCA total scores. RESULTS: There was a significant effect of time on MoCA scores (F(4, 230.5) = 4.14, P = 0.003), with an improvement in global cognitive functioning from T3 compared to T1 and T2. At the individual level, 26% (n = 17) of patients showed a significantly worse cognitive functioning at T2 and 12% (n = 8) an improved cognitive functioning compared to T0. For T4, these percentages ameliorated to 8% and 18% respectively. CONCLUSION: No persistent global cognitive impairment induced by ECT was found at the group level using the MoCA. At the individual level, however, there was clear heterogeneity in the effects of ECT on cognitive functioning. The MoCA is a suitable tool to monitor short- and long-term global cognitive functioning in ECT-treated patients with MDE but in younger patients, potential ceiling effects must be taken into account.

[Training in psychiatry in Belgium through the eyes of the trainee]. / De opleiding psychiatrie in Vlaanderen door de ogen van de arts-specialist in opleiding.

BACKGROUND: In Belgium, psychiatry training is still organised by each university separately without a structured centralised funding plan for the financing of psychiatry trainees. Recently, the government has obliged trainers to integrate psychotherapy into psychiatry training.
AIM: An overview is provided of the current training in psychiatry in Belgium and the recent changes with regard to psychotherapy. Furthermore, the psychiatry trainees offer a critical appraisal of the existing programme.
METHOD: Results of a debate on 'The role of psychotherapy in the training in psychiatry' are presented. This debate was organised by the Flemish Association of Psychiatry Trainees for all Flemish trainees and psychiatrists. The Association also provide a critical appraisal of the current psychiatry training programme.
RESULTS: Participants in the debate agreed that the integration of psychotherapy into the psychiatry training programme is a good development. Nevertheless, there were some concerns about the practical implementation given the already existing hours of training, combined with a high workload and extracurricular training. The Association formulated three bottlenecks in the current psychiatry training programme: the preponderance of clinical work, lack of uniformity in the training, and the lack of formal supervision.
CONCLUSION: A better balance is required between clinical work and education, and the pressure on the supervisor and trainee has to be lowered. Additional funding and restructuring of the training programme is needed for this. Expanding the interuniversity training programme with high quality theoretical teaching, as well as training of skills, seems to be a good solution.