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1.
J Spec Oper Med ; 22(1): 115-120, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35278327

RESUMO

The Department of Defense (DoD) continues to emphasize operational readiness, lethality, and optimal performance. Performance psychology is a critical aspect of and central dimension to human performance optimization in support of Preservation of the Force and Family (POTFF) and Total Force Fitness (TFF). The delivery of performance psychology services must continue to evolve to maximize its potential for enhancing combat performance and supporting psychological readiness in warfighters across all branches of service. The authors (1) provide a brief history of the evolution of military psychology; (2) explore how performance psychology complements and broadens approaches to support warfighter health and readiness; and (3) present a set of strategies to advance performance psychology services toward an aspirational model. Such strategies will more effectively promote best practices to better target operational performance, complement existing health and medical service delivery, and encompass a systems approach to sustainable training. Moreover, these strategies aim to increase return on investment of psychological readiness efforts for warfighters across all branches of service.


Assuntos
Militares , Psicologia Militar , Exercício Físico , Humanos , Militares/educação
2.
World Psychiatry ; 21(1): 26-54, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35015357

RESUMO

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative nosological system that addresses shortcomings of traditional mental disorder diagnoses, including arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, substantial heterogeneity within disorders, and diagnostic unreliability over time and across clinicians. This paper reviews evidence on the validity and utility of the internalizing and somatoform spectra of HiTOP, which together provide support for an emotional dysfunction superspectrum. These spectra are composed of homogeneous symptom and maladaptive trait dimensions currently subsumed within multiple diagnostic classes, including depressive, anxiety, trauma-related, eating, bipolar, and somatic symptom disorders, as well as sexual dysfunction and aspects of personality disorders. Dimensions falling within the emotional dysfunction superspectrum are broadly linked to individual differences in negative affect/neuroticism. Extensive evidence establishes that dimensions falling within the superspectrum share genetic diatheses, environmental risk factors, cognitive and affective difficulties, neural substrates and biomarkers, childhood temperamental antecedents, and treatment response. The structure of these validators mirrors the quantitative structure of the superspectrum, with some correlates more specific to internalizing or somatoform conditions, and others common to both, thereby underlining the hierarchical structure of the domain. Compared to traditional diagnoses, the internalizing and somatoform spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and greater clinical applicability. Validated measures are currently available to implement the HiTOP system in practice, which can make diagnostic classification more useful, both in research and in the clinic.

3.
Sleep ; 45(2)2022 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-34432067

RESUMO

STUDY OBJECTIVES: Within-subject stability of certain sleep features across multiple nights is thought to reflect the trait-like behavior of sleep. However, to be considered a trait, a parameter must be both stable and robust. Here, we examined the stability (i.e. across the same sleep opportunity periods) and robustness (i.e. across sleep opportunity periods that varied in duration and timing) of different sleep parameters. METHODS: Sixty-eight military personnel (14 W) spent 5 nights in the sleep laboratory during a simulated military operational stress protocol. After an adaptation night, participants had an 8-hour sleep opportunity (23:00-07:00) followed by 2 consecutive nights of sleep restriction and disruption which included two 2-hour sleep opportunities (01:00-03:00; 05:00-07:00) and, lastly, another 8-hour sleep opportunity (23:00-07:00). Intra-class correlation coefficients were calculated to examine differences in stability and robustness across different sleep parameters. RESULTS: Sleep architecture parameters were less stable and robust than absolute and relative spectral activity parameters. Further, relative spectral activity parameters were less robust than absolute spectral activity. Absolute alpha and sigma activity demonstrated the highest levels of stability that were also robust across sleep opportunities of varying duration and timing. CONCLUSIONS: Stability and robustness varied across different sleep parameters, but absolute NREM alpha and sigma activity demonstrated robust trait-like behavior across variable sleep opportunities. Reduced stability of other sleep architecture and spectral parameters during shorter sleep episodes as well as across different sleep opportunities has important implications for study design and interpretation.


Assuntos
Militares , Eletroencefalografia/métodos , Humanos , Fenótipo , Polissonografia/métodos , Sono , Fases do Sono
4.
J Sport Health Sci ; 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34461327

RESUMO

PURPOSE: Recognizing sport-related concussion (SRC) is challenging and relies heavily on subjective symptom reports. An objective, biological marker could improve recognition and understanding of SRC. There is emerging evidence that salivary micro-ribonucleic acids (miRNAs) may serve as biomarkers of concussion; however, it remains unclear whether concussion-related miRNAs are impacted by exercise. We sought to determine whether 40 miRNAs previously implicated in concussion pathophysiology were affected by participation in a variety of contact and non-contact sports. Our goal was to refine a miRNA-based tool capable of identifying athletes with SRC without the confounding effects of exercise. METHODS: This case-control study harmonized data from concussed and non-concussed athletes recruited across 10 sites. Levels of salivary miRNAs within 455 samples from 314 individuals were measured with RNA sequencing. Within-subjects testing was used to identify and exclude miRNAs that changed with either: (a) a single episode of exercise (166 samples from 83 individuals) or (b) season-long participation in contact sports (212 samples from 106 individuals). The miRNAs that were not impacted by exercise were interrogated for SRC diagnostic utility using logistic regression (172 samples from 75 concussed and 97 non-concussed individuals). RESULTS: Two miRNAs (miR-532-5p, miR-182-5p) decreased (adjusted p < 0.05) after a single episode of exercise, and 1 miRNA (miR-4510) increased only after contact sports participation. Twenty-three miRNAs changed at the end of a contact sports season. Two of these miRNAs (miR-26b-3p, miR-29c-3p) were associated (R > 0.50; adjusted p < 0.05) with the number of head impacts sustained in a single football practice. Among the 15 miRNAs not confounded by exercise or season-long contact sports participation, 11 demonstrated a significant difference (adjusted p < 0.05) between concussed and non-concussed participants, and 6 displayed moderate ability (AUC > 0.70) to identify concussion. A single ratio (miR-27a-5p/miR-30a-3p) displayed the highest accuracy (AUC = 0.810, sensitivity = 82.4%, specificity = 73.3%) for differentiating concussed and non-concussed participants. Accuracy did not differ between participants with SRC and non-SRC (z = 0.5, p = 0.60). CONCLUSION: Salivary miRNA levels may accurately identify SRC when not confounded by exercise. Refinement of this approach in a large cohort of athletes could eventually lead to a non-invasive, sideline adjunct for SRC assessment.

5.
J Psychiatr Res ; 141: 301-308, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34304033

RESUMO

Posttraumatic stress disorder-related sleep disturbances may increase daytime sleepiness and compromise performance in individuals with posttraumatic stress disorder. We investigated nighttime sleep predictors of sleepiness in Veterans with and without posttraumatic stress disorder. Thirty-seven post-9/11 Veterans with posttraumatic stress disorder and 47 without posttraumatic stress disorder (Control) completed a 48-h lab stay. Nighttime quantitative EEG and sleep architecture parameters were collected with polysomnography. Data from daytime sleepiness batteries assessing subjective sleepiness (global vigor questionnaire), objective sleepiness (Multiple Sleep Latency Tests) and alertness (psychomotor vigilance task) were included in analyses. Independent samples t-tests and linear regressions were performed to identify group differences in sleepiness and nighttime sleep predictors of sleepiness in the overall sample and within each group. Participants with posttraumatic stress disorder had higher subjective sleepiness (t = 4.20; p < .001) and lower alertness (psychomotor vigilance task reaction time (t = -3.70; p < .001) and lapses: t = -2.13; p = .04) than the control group. Objective daytime sleepiness did not differ between groups (t = -0.79, p = .43). In the whole sample, higher rapid eye movement delta power predicted lower alertness quantified by psychomotor vigilance task reaction time (ß = 0.372, p = .013) and lapses (ß = 0.388, p = .013). More fragmented sleep predicted higher objective sleepiness in the posttraumatic stress disorder group (ß = -.467, p = .005) but no other nighttime sleep measures influenced the relationship between group and sleepiness. Objective measures of sleep and sleepiness were not associated with the increased subjective sleepiness and reduced alertness of the posttraumatic stress disorder group.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Atenção , Humanos , Desempenho Psicomotor , Sono , Sonolência , Transtornos de Estresse Pós-Traumáticos/complicações , Vigília
6.
World Psychiatry ; 20(2): 171-193, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34002506

RESUMO

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical effort to address limitations of traditional mental disorder diagnoses. These include arbitrary boundaries between disorder and normality, disorder co-occurrence in the modal case, heterogeneity of presentation within dis-orders, and instability of diagnosis within patients. This paper reviews the evidence on the validity and utility of the disinhibited externalizing and antagonistic externalizing spectra of HiTOP, which together constitute a broad externalizing superspectrum. These spectra are composed of elements subsumed within a variety of mental disorders described in recent DSM nosologies, including most notably substance use disorders and "Cluster B" personality disorders. The externalizing superspectrum ranges from normative levels of impulse control and self-assertion, to maladaptive disinhibition and antagonism, to extensive polysubstance involvement and personality psychopathology. A rich literature supports the validity of the externalizing superspectrum, and the disinhibited and antagonistic spectra. This evidence encompasses common genetic influences, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, and treatment response. The structure of these validators mirrors the structure of the phenotypic externalizing superspectrum, with some correlates more specific to disinhibited or antagonistic spectra, and others relevant to the entire externalizing superspectrum, underlining the hierarchical structure of the domain. Compared with traditional diagnostic categories, the externalizing superspectrum conceptualization shows improved utility, reliability, explanatory capacity, and clinical applicability. The externalizing superspectrum is one aspect of the general approach to psychopathology offered by HiTOP and can make diagnostic classification more useful in both research and the clinic.

7.
Suicide Life Threat Behav ; 51(2): 316-324, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33876487

RESUMO

OBJECTIVE: To evaluate the longitudinal relationships between unit cohesion, Army leader behaviors, and subordinate suicidal/death ideation. Recent cross-sectional research indicates that subordinates who perceive that their leaders instill a sense of purpose regarding military service demonstrate less frequent suicidal ideation. METHOD: Five hundred fifty-nine soldiers completed self-report measures of perceptions of leadership behaviors, unit cohesion, and suicidal/death ideation during deployment as well as one and three months following deployment. Latent change score modeling was conducted to evaluate the course and direction of study variables as well as the relationship between them. RESULTS: Although lower levels of suicidal/death ideation were related to leader-provided purpose, leader-provided meaning, and unit cohesion at baseline, only leader-provided purpose and unit cohesion prospectively predicted changes in suicidal/death ideation. CONCLUSIONS: Consistent with the goal of military leadership to augment effective clinical interventions that reduce suicide risk, prevention programs that reach a broader population of personnel should be considered. Enhanced leadership training may be an important primary prevention tool to reduce suicide risk that warrants further research.


Assuntos
Militares , Suicídio , Estudos Transversais , Humanos , Liderança , Fatores de Risco , Ideação Suicida , Suicídio/prevenção & controle
8.
J Head Trauma Rehabil ; 36(5): E345-E354, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33741827

RESUMO

OBJECTIVE: To evaluate trends in the extant literature on mild traumatic brain injury (mTBI) in military service members and veterans using network analysis based on a comprehensive search of original, peer-reviewed research articles involving human participants published between January 1, 2010, and December 31, 2019. Specifically, we employed network analysis to evaluate associations in the following areas: (1) peer-reviewed journals, (2) authors, (3) organizations/institutions, and (4) relevant key words. PARTICIPANTS: Included studies were published in peer-reviewed journals available on Web of Science database, using US military service members or veterans. DESIGN: Bibliometric network analytical review. MAIN MEASURES: Outcomes for each analysis included number of articles, citations, total link strength, and clusters. RESULTS: The top publishing journals were (1) Journal of Head Trauma and Rehabilitation, (2) Military Medicine, (3) Brain Injury, (4) Journal of Neurotrauma, and (5) Journal of Rehabilitation Research and Development. The top publishing authors were (1) French, (2) Lange, (3) Cooper, (4) Vanderploeg, and (5) Brickell. The top research institutions were (1) Defense and Veterans Brain Injury Center, (2) Uniformed Services University of the Health Sciences, (3) University of California San Diego, (4) Walter Reed National Military Medical Center, and (5) Boston University. The top co-occurring key words in this analysis were (1) posttraumatic stress disorder (PTSD), (2) persistent postconcussion symptoms (PPCS), (3) blast injury, (4) postconcussion syndrome (PCS), and (5) Alzheimer's disease. CONCLUSIONS: The results of this network analysis indicate a clear focus on veteran health, as well as investigations on chronic effects of mTBI. Research in civilian mTBI indicates that delaying treatment for symptoms and impairments related to mTBI may not be the most precise treatment strategy. Increasing the number of early, active, and targeted treatment trials in military personnel could translate to meaningful improvements in clinical practices for managing mTBI in this population.


Assuntos
Concussão Encefálica , Militares , Síndrome Pós-Concussão , Transtornos de Estresse Pós-Traumáticos , Veteranos , Concussão Encefálica/diagnóstico , Humanos
9.
Psychol Med ; : 1-8, 2020 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-33261701

RESUMO

BACKGROUND: For decades confirmatory factor analysis (CFA) has been the preeminent method to study the underlying structure of posttraumatic stress disorder (PTSD); however, methodological limitations of CFA have led to the emergence of other analytic approaches. In particular, network analysis has become a gold standard to investigate the structure and relationships between PTSD symptoms. A key methodological limitation, however, which has significant clinical implications, is the lack of data on the potential impact of item order effects on the conclusions reached through network analyses. METHODS: The current study, involving a large sample (N = 5055) of active duty army soldiers following deployment to Iraq, assessed the vulnerability of network analyses and prevalence rate to item order effects. This was done by comparing symptom networks of the DSM-IV PTSD checklist items to these same items distributed in random order. Half of the participants rated their symptoms on traditionally ordered items and half the participants rated the same items, but in random order and interspersed between items from other validated scales. Differences in prevalence rate and network composition were examined. RESULTS: The prevalence rate differed between the ordered and random item samples. Network analyses using the ordered survey closely replicated the conclusions reached in the existing network analyses literature. However, in the random item survey, network composition differed considerably. CONCLUSION: Order effects appear to have a significant impact on conclusions reached from PTSD network analysis. Prevalence rates were also impacted by order effects. These findings have important diagnostic and clinical treatment implications.

10.
Clin Transl Med ; 10(6): e197, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33135344

RESUMO

BACKGROUND: Early, accurate diagnosis of mild traumatic brain injury (mTBI) can improve clinical outcomes for patients, but mTBI remains difficult to diagnose because of reliance on subjective symptom reports. An objective biomarker could increase diagnostic accuracy and improve clinical outcomes. The aim of this study was to assess the ability of salivary noncoding RNA (ncRNA) to serve as a diagnostic adjunct to current clinical tools. We hypothesized that saliva ncRNA levels would demonstrate comparable accuracy for identifying mTBI as measures of symptom burden, neurocognition, and balance. METHODS: This case-control study involved 538 individuals. Participants included 251 individuals with mTBI, enrolled ≤14 days postinjury, from 11 clinical sites. Saliva samples (n = 679) were collected at five time points (≤3, 4-7, 8-14, 15-30, and 31-60 days post-mTBI). Levels of ncRNAs (microRNAs, small nucleolar RNAs, and piwi-interacting RNAs) were quantified within each sample using RNA sequencing. The first sample from each mTBI participant was compared to saliva samples from 287 controls. Samples were divided into testing (n = 430; mTBI = 201 and control = 239) and training sets (n = 108; mTBI = 50 and control = 58). The test set was used to identify ncRNA diagnostic candidates and create a diagnostic model. Model accuracy was assessed in the naïve test set. RESULTS: A model utilizing seven ncRNA ratios, along with participant age and chronic headache status, differentiated mTBI and control participants with a cross-validated area under the curve (AUC) of .857 in the training set (95% CI, .816-.903) and .823 in the naïve test set. In a subset of participants (n = 321; mTBI = 176 and control = 145) assessed for symptom burden (Post-Concussion Symptom Scale), as well as neurocognition and balance (ClearEdge System), these clinical measures yielded cross-validated AUC of .835 (95% CI, .782-.880) and .853 (95% CI, .803-.899), respectively. A model employing symptom burden and four neurocognitive measures identified mTBI participants with similar AUC (.888; CI, .845-.925) as symptom burden and four ncRNAs (.932; 95% CI, .890-.965). CONCLUSION: Salivary ncRNA levels represent a noninvasive, biologic measure that can aid objective, accurate diagnosis of mTBI.

11.
Int J Mol Sci ; 21(20)2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-33092191

RESUMO

Recurrent concussions increase risk for persistent post-concussion symptoms, and may lead to chronic neurocognitive deficits. Little is known about the molecular pathways that contribute to persistent concussion symptoms. We hypothesized that salivary measurement of microribonucleic acids (miRNAs), a class of epitranscriptional molecules implicated in concussion pathophysiology, would provide insights about the molecular cascade resulting from recurrent concussions. This hypothesis was tested in a case-control study involving 13 former professional football athletes with a history of recurrent concussion, and 18 age/sex-matched peers. Molecules of interest were further validated in a cross-sectional study of 310 younger individuals with a history of no concussion (n = 230), a single concussion (n = 56), or recurrent concussions (n = 24). There was no difference in neurocognitive performance between the former professional athletes and their peers, or among younger individuals with varying concussion exposures. However, younger individuals without prior concussion outperformed peers with prior concussion on three balance assessments. Twenty salivary miRNAs differed (adj. p < 0.05) between former professional athletes and their peers. Two of these (miR-28-3p and miR-339-3p) demonstrated relationships (p < 0.05) with the number of prior concussions reported by younger individuals. miR-28-3p and miR-339-5p may play a role in the pathophysiologic mechanism involved in cumulative concussion effects.


Assuntos
Biomarcadores/metabolismo , Concussão Encefálica/genética , MicroRNAs/genética , Saliva/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atletas/estatística & dados numéricos , Estudos de Casos e Controles , Criança , Estudos Transversais , Futebol Americano , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Psychiatry ; 83(4): 358-374, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32924845

RESUMO

Objective: Rates of behavioral health disorders and potential protective factors in U.S. Special Operations Forces (SOF) have not been well studied, including differences between Operators and Support personnel, despite very high levels of combat exposure in these military personnel. The present study examined the prevalence of endorsed behavioral health problems and protective factors within a large sample of SOF personnel. Method: Anonymized data from 16,284 active duty SOF Service members from the 2016 Preservation of the Force and Family (POTFF) needs survey were analyzed. Results: Overall, the prevalence of PTSD (7.6%), depression (8.4%), alcohol misuse (12.8%), and nicotine use (28%) were comparable or lower than reported in conventional military populations. There were significant differences between Operators and Support personnel in a number of demographic and service-related variables. Operators also endorsed more direct combat exposure and scored higher on resilience and social support, and reported better quality and quantity of sleep. There were no significant group differences in rates of PTSD and depression, except lower odds (adjusted OR = 0.81) for alcohol problems in Support personnel (11.6%) compared to Operators (14.0%), p <.001, 95% CI [0.72, 0.91]. Conclusions: SOF personnel experience considerably higher exposure to combat deployments than conventional forces, yet the data from this study showed comparable or lower levels of behavioral health conditions. Although Operators were somewhat more likely than Support personnel to experience alcohol problems, they showed enhanced resilience, social support, and sleep health. Alcohol misuse is one potential target for preventive health efforts.


Assuntos
Comportamentos de Risco à Saúde , Militares/estatística & dados numéricos , Adolescente , Adulto , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Depressão/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Transtornos de Estresse Pós-Traumáticos , Uso de Tabaco/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
13.
Dialogues Clin Neurosci ; 22(1): 51-63, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32699505

RESUMO

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirical structural model of psychological symptoms formulated to improve the reliability and validity of clinical assessment. Neurobiology can inform assessments of early risk and intervention strategies, and the HiTOP model has greater potential to interface with neurobiological measures than traditional categorical diagnoses given its enhanced reliability. However, one complication is that observed biological correlates of clinical symptoms can reflect various factors, ranging from dispositional risk to consequences of psychopathology. In this paper, we argue that the HiTOP model provides an optimized framework for conducting research on the biological correlates of psychopathology from an ontogenetic perspective that distinguishes among indicators of liability, current symptoms, and consequences of illness. Through this approach, neurobiological research can contribute more effectively to identifying individuals at high dispositional risk, indexing treatment-related gains, and monitoring the consequences of mental illness, consistent with the aims of the HiTOP framework.
.


La taxonomía jerárquica de la psicopatología (TJP) es un modelo estructural empírico de síntomas psicológicos propuesto para mejorar la confiabilidad y la validez de la evaluación clínica. La neurobiología puede dar cuenta de las evaluaciones de riesgo precoz y estrategias de intervención, y el modelo de TJP tiene un mayor potencial para interactuar con las mediciones neurobiológicas que los diagnósticos categoriales tradicionales dada su mayor confiabilidad. Sin embargo, una complicación es que los correlatos biológicos observados de los síntomas clínicos pueden reflejar varios factores, que van desde el riesgo de la disposición hasta las consecuencias de la psicopatología. En este artículo, se argumenta que el modelo TJP proporciona un marco optimizado para realizar investigaciones sobre los correlatos biológicos de la psicopatología desde una perspectiva ontogenética que distingue entre indicadores de responsabilidad, síntomas actuales y consecuencias de la enfermedad. A través de este enfoque, la investigación neurobiológica puede contribuir de manera más efectiva con la identificación de individuos con un alto riesgo de disposición, el registro de los beneficios del tratamiento y el monitoreo de las consecuencias de la enfermedad mental, de acuerdo con los objetivos del marco de referencia de la TJP.


La taxonomie hiérarchique de la psychopathologie (HiTOP, Hierarchical Taxonomy of Psychopathology) est un modèle empirique et structuré de symptômes psychologiques visant à améliorer la fiabilité et la validité de l'évaluation clinique. L'évaluation sur le risque précoce et les stratégies thérapeutiques peuvent bénéficier des apports de la neurobiologie ; le modèle HiTOP interagit mieux avec les mesures neurobiologiques que les diagnostics catégoriels classiques, en raison de sa plus grande fiabilité. Néanmoins, le fait que les corrélats biologiques observés des symptômes cliniques peuvent refléter différents facteurs qui vont du risque lié à la prédisposition aux conséquences de la pathologie, complique les choses. Dans cet article, nous soutenons que le cadre du modèle HiTOP est optimal pour la recherche sur les corrélats biologiques de la psychopathologie d'un point de vue ontogénétique qui distingue les indicateurs de responsabilité, les symptômes actuels et les conséquences de la maladie. Par cette approche, la recherche neurobiologique permet de mieux identifier les personnes à risque de prédisposition élevé, de mieux répertorier les bénéfices liés au traitement et de surveiller les conséquences de la maladie mentale, selon les objectifs du cadre de l'HiTOP.


Assuntos
Transtornos Mentais/classificação , Transtornos Mentais/genética , Neurobiologia/classificação , Psicopatologia/classificação , Classificação , Estudos Transversais , Humanos , Transtornos Mentais/fisiopatologia , Estudos Prospectivos , Reprodutibilidade dos Testes
14.
World Psychiatry ; 19(2): 151-172, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32394571

RESUMO

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a scientific effort to address shortcomings of traditional mental disorder diagnoses, which suffer from arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, heterogeneity within disorders, and diagnostic instability. This paper synthesizes evidence on the validity and utility of the thought disorder and detachment spectra of HiTOP. These spectra are composed of symptoms and maladaptive traits currently subsumed within schizophrenia, other psychotic disorders, and schizotypal, paranoid and schizoid personality disorders. Thought disorder ranges from normal reality testing, to maladaptive trait psychoticism, to hallucinations and delusions. Detachment ranges from introversion, to maladaptive detachment, to blunted affect and avolition. Extensive evidence supports the validity of thought disorder and detachment spectra, as each spectrum reflects common genetics, environmental risk factors, childhood antecedents, cognitive abnormalities, neural alterations, biomarkers, and treatment response. Some of these characteristics are specific to one spectrum and others are shared, suggesting the existence of an overarching psychosis superspectrum. Further research is needed to extend this model, such as clarifying whether mania and dissociation belong to thought disorder, and explicating processes that drive development of the spectra and their subdimensions. Compared to traditional diagnoses, the thought disorder and detachment spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and higher acceptability to clinicians. Validated measures are available to implement the system in practice. The more informative, reliable and valid characterization of psychosis-related psychopathology offered by HiTOP can make diagnosis more useful for research and clinical care.

15.
J Neurotrauma ; 37(19): 2102-2112, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32340548

RESUMO

Mild traumatic brain injury (mTBI) and post-traumatic stress disorder (PTSD) are common in military populations and share numerous symptoms. Functional graph theory studies demonstrate altered small-world brain networks in mTBI and PTSD, but little is known about structural covariance networks or the potentially distinct topology of mTBI-PTSD comorbidity. The purpose of this study was to compare brain structural covariance networks in healthy active duty military service members (CON) to those with PTSD, mTBI, and mTBI-PTSD. Seventy-six service members (31 CON, 14 PTSD, 12 mTBI, 19 mTBI-PTSD) completed clinical questionnaires and structural magnetic resonance imaging scans. Cortical thickness-derived adjacency matrices were used to determine structural covariance network topologies. Pairwise comparisons for characteristic path length, clustering coefficient, modularity (global), closeness centrality (nodal), and local efficiency were made across a range of network densities (5-35%) using non-parametric permutation tests. All clinical groups showed greater levels of arousal, stress, anxiety, and depression compared with CON. Global network analysis revealed greater clustering and local efficiency in PTSD compared with CON, whereas nodal analysis indicated altered path lengths and closeness centrality in fronto-limbic areas with mTBI-PTSD. Global and nodal graph outcomes suggest distinct pathophysiological manifestations of mTBI, PTSD, and mTBI-PTSD in structural brain networks. Greater network segregation and nodal differences in fronto-limbic areas may be tied to emotional fluctuations.


Assuntos
Concussão Encefálica/diagnóstico por imagem , Concussão Encefálica/psicologia , Militares , Transtornos de Estresse Pós-Traumáticos/diagnóstico por imagem , Transtornos de Estresse Pós-Traumáticos/etiologia , Adulto , Concussão Encefálica/fisiopatologia , Estudos de Casos e Controles , Conectoma , Estudos Transversais , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Inquéritos e Questionários , Estados Unidos
16.
J Sleep Res ; 29(4): e13026, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32166811

RESUMO

Adverse childhood experiences (ACEs) can have long-term impacts on a person's mental health, which extend into adulthood. There is a high prevalence of ACEs among service members. Further, service members also report frequently experiencing disrupted sleep. We hypothesized that disrupted sleep may serve a mechanistic function connecting ACEs to functional impairment and poorer mental health. In a cross-sectional sample (n = 759), we found evidence for an indirect effect of ACEs on mental health outcomes through disrupted sleep. In a different sample using two time-points (n = 410), we found evidence for an indirect effect of ACEs on changes in mental health outcomes and functional impairment during a reset period, through changes in disrupted sleep during the same period. Implications, limitations and future research directions are discussed.


Assuntos
Experiências Adversas da Infância/psicologia , Transtornos Mentais/etiologia , Saúde Mental/normas , Transtornos do Sono-Vigília/etiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Militares , Prevalência , Estados Unidos , Adulto Jovem
17.
Data Brief ; 29: 105213, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32090157

RESUMO

Resting-state functional Magnetic Resonance Imaging (rs-fMRI) has been extensively used for diagnostic classification because it does not require task compliance and is easier to pool data from multiple imaging sites, thereby increasing the sample size. A MATLAB-based toolbox called Machine Learning in NeuroImaging (MALINI) for feature extraction and disease classification is presented. The MALINI toolbox extracts functional and effective connectivity features from preprocessed rs-fMRI data and performs classification between healthy and disease groups using any of 18 popular and widely used machine learning algorithms that are based on diverse principles. A consensus classifier combining the power of multiple classifiers is also presented. The utility of the toolbox is illustrated by accompanying data consisting of resting-state functional connectivity features from healthy controls and subjects with various brain-based disorders: autism spectrum disorder from autism brain imaging data exchange (ABIDE), Alzheimer's disease and mild cognitive impairment from Alzheimer's disease neuroimaging initiative (ADNI), attention deficit hyperactivity disorder from ADHD-200, and post-traumatic stress disorder and post-concussion syndrome acquired in-house. Results of classification performed on the above datasets can be obtained from the main article titled "Supervised machine learning for diagnostic classification from large-scale neuroimaging datasets" [1]. The data was divided into homogeneous and heterogeneous splits, such that 80% could be used for training, model building and cross-validation, while the remaining 20% of the data could be used as a hold-out independent test data for replication of the classification performance, to ensure the robustness of the classifiers to population variance in image acquisition site and age of the sample.

18.
Mil Med ; 185(Suppl 1): 342-347, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-32074360

RESUMO

INTRODUCTION: The goal of the present study was to characterize behavioral health rates, behavioral health care utilization, loneliness, and perceived prejudice and support among sexual minority soldiers. MATERIALS AND METHODS: Cross-sectional survey data were obtained from 640 active-duty U.S. soldiers enrolled in an academic training institute who provided information on their sexual orientation. Survey topics included demographics, behavioral health, behavioral health care utilization, and mitigating factors (eg, perceived prejudice, perceived support, and loneliness). Chi-square analyses were utilized to determine any differences between groups for behavioral health rates and behavioral health care utilization. Robust regression was used for analysis of self-reported loneliness. RESULTS: A higher proportion of lesbian, gay, bisexual (LGB) soldiers than heterosexual soldiers screened positive for anxiety, post-traumatic stress disorder, and suicidality. No between-group differences in behavioral health care utilization were found; however, a higher proportion of LGB soldiers sought help from military family life counselors. No between-group differences for loneliness were found. Finally, perceived prejudice was higher for LGB soldiers and perceived support was lower. CONCLUSION: Organizational barriers, such as perceived prejudice and lack of support, appear to still exist for sexual minority soldiers. Increasing organizational support and implementing training and education for health care providers in order to better support the LGB soldier community may mitigate these barriers.


Assuntos
Programas de Rastreamento/métodos , Militares/psicologia , Minorias Sexuais e de Gênero/psicologia , Adolescente , Adulto , Ansiedade/diagnóstico , Ansiedade/psicologia , Estudos Transversais , Depressão/diagnóstico , Depressão/psicologia , Feminino , Humanos , Masculino , Programas de Rastreamento/instrumentação , Programas de Rastreamento/estatística & dados numéricos , Militares/estatística & dados numéricos , Comportamento Sexual/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários
19.
Psychiatry Res ; 285: 112722, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31822356

RESUMO

Suicide in U.S. Army Soldiers is of major concern as it is estimated that over 100 Soldiers die by suicide each year. Examining risk and protective factors is essential to develop both an understanding of Soldier suicide as well as inform systemic interventions to reduce suicide. One potential systemic approach is to embed preventive mechanisms within the structure of the military rather than the typical administration of primary intervention through mandatory training. To examine potential mechanisms of leader-based interventions, several leadership behaviors were assessed in a cross-sectional sample of n = 1,096 active duty Soldiers. Soldiers completed self-report measures of interpersonal predictors of suicide, suicidal ideation (SI), leadership behaviors, and unit cohesion. Logistic regression was used to identify leadership behaviors related to SI. Only the leader behavior attempting to foster a sense of purpose predicted SI. Leader provided purpose (LPP) was then entered into indirect effect analyses to evaluate the mechanisms of this relationship. Analyses revealed that LPP predicted SI through unit cohesion, thwarted belongingness, and perceived burdensomeness. Results demonstrate that specific aspects of military leadership such as fostering Soldier purpose may enhance resilience and reduce risk for SI.


Assuntos
Relações Interpessoais , Liderança , Saúde Mental , Militares/psicologia , Ideação Suicida , Adolescente , Adulto , Feminino , Humanos , Masculino , Exposição Ocupacional/efeitos adversos , Fatores de Risco , Autorrelato , Suicídio/prevenção & controle , Suicídio/psicologia , Adulto Jovem
20.
Brain Imaging Behav ; 14(6): 2378-2416, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31691160

RESUMO

There are growing concerns about the generalizability of machine learning classifiers in neuroimaging. In order to evaluate this aspect across relatively large heterogeneous populations, we investigated four disorders: Autism spectrum disorder (N = 988), Attention deficit hyperactivity disorder (N = 930), Post-traumatic stress disorder (N = 87) and Alzheimer's disease (N = 132). We applied 18 different machine learning classifiers (based on diverse principles) wherein the training/validation and the hold-out test data belonged to samples with the same diagnosis but differing in either the age range or the acquisition site. Our results indicate that overfitting can be a huge problem in heterogeneous datasets, especially with fewer samples, leading to inflated measures of accuracy that fail to generalize well to the general clinical population. Further, different classifiers tended to perform well on different datasets. In order to address this, we propose a consensus-classifier by combining the predictive power of all 18 classifiers. The consensus-classifier was less sensitive to unmatched training/validation and holdout test data. Finally, we combined feature importance scores obtained from all classifiers to infer the discriminative ability of connectivity features. The functional connectivity patterns thus identified were robust to the classification algorithm used, age and acquisition site differences, and had diagnostic predictive ability in addition to univariate statistically significant group differences between the groups. A MATLAB toolbox called Machine Learning in NeuroImaging (MALINI), which implements all the 18 different classifiers along with the consensus classifier is available from Lanka et al. (2019) The toolbox can also be found at the following URL: https://github.com/pradlanka/malini .


Assuntos
Transtorno do Espectro Autista , Transtorno do Espectro Autista/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Neuroimagem , Aprendizado de Máquina Supervisionado
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