Predictors of Suicidal Behaviors during Hospitalization among Adolescents Admitted Due to Suicidal Behaviors: A 10-Year Retrospective Naturalistic Study.

Objectives: Suicidality during hospitalization is a common phenomenon with potential devastating consequences. We attempted to identify risk factors for in-hospital suicidality in a high risk group of adolescent inpatients hospitalized for suicidal behaviors (SB). Methods: The database of a tertiary adolescent psychiatric ward was screened for patients hospitalized consecutively for SB during 2001-2010. Data on documented demographic, clinical, and behavioral risk factors were collected. Suicidal events during hospitalization were classified according to the Columbia Classification Algorithm of Suicide Assessment. Results: The sample included 122 inpatients (53% female) aged 10-19 (Mean=15.77, Standard Deviation=2.89) years admitted for SB. Thirty-seven youth (30%) exhibited SB during the hospitalization period (the "suicidal group"), ten of which attempted suicide while hospitalized. There were no significant differences in demographic and clinical parameters between the suicidal and the non-suicidal groups. Younger age, history of drug use and a history of non-suicidal self-injury (NSSI) were independent predictors of a SA during hospitalization. A previous SA added significant risk to SA during hospitalization only in the group that had a history of NSSI. Conclusions: A high risk of SB exists among adolescents hospitalized for suicidality. The risk assessment for SA during hospitalization should include age, history of drug use and previous SA combined with a history of NSSI. Future studies should expand the efforts to identify potential risk factors of SB during hospitalization in this unique high-risk group.

Predicting Affect Classification in Mental Status Examination Using Machine Learning Face Action Recognition System: A Pilot Study in Schizophrenia Patients.

Classifying patients' affect is a pivotal part of the mental status examination. However, this common practice is often widely inconsistent between raters. Recent advances in the field of Facial Action Recognition (FAR) have enabled the development of tools that can act to identify facial expressions from videos. In this study, we aimed to explore the potential of using machine learning techniques on FAR features extracted from videotaped semi-structured psychiatric interviews of 25 male schizophrenia inpatients (mean age 41.2 years, STD = 11.4). Five senior psychiatrists rated patients' affect based on the videos. Then, a novel computer vision algorithm and a machine learning method were used to predict affect classification based on each psychiatrist affect rating. The algorithm is shown to have a significant predictive power for each of the human raters. We also found that the eyes facial area contributed the most to the psychiatrists' evaluation of the patients' affect. This study serves as a proof-of-concept for the potential of using the machine learning FAR system as a clinician-supporting tool, in an attempt to improve the consistency and reliability of mental status examination.

Vitamin D Supplementation in Chronic Schizophrenia Patients Treated with Clozapine: A Randomized, Double-Blind, Placebo-controlled Clinical Trial.

BACKGROUND: While accumulating evidence suggests that vitamin D deficiency may be involved in the risk to develop schizophrenia and its outcome, there are no studies on vitamin D supplementation in this context. We sought to assess the effect of vitamin D supplementation on psychiatric, cognitive and metabolic parameters in chronic clozapine-treated schizophrenia patients. METHODS: This eight-week, randomized, double-blind, placebo-controlled clinical trial, recruited schizophrenia patients who had been maintained on clozapine treatment for at least 18weeks and had low levels of vitamin D (<75nmol/l) and total PANSS scores >70 (to ascertain the presence of residual symptoms). Patients were randomly allocated to either weekly oral drops of vitamin D (14,000IU) or placebo and subsequently assessed at two-week intervals for psychosis severity, mood, cognition and metabolic profile. RESULTS: Twenty four patients were randomly assigned to vitamin D (aged 39.4±9.6years, 75% males) and the other 23 patients to the placebo arm (aged 42.5±11.2years, 60.9% males). After eight weeks, the vitamin D group exhibited a significant increase in vitamin D levels (31.4 vs -0.4nmol/l, p<0.0001). There was no significant effect of vitamin D on psychotic, depressive or metabolic parameters. However, in the vitamin D group, there was a trend towards improved cognition (effect size=0.17, significance lost following Bonferroni correction). CONCLUSIONS: Vitamin D supplementation was associated with a trend towards improved cognition, but did not affect psychosis, mood or metabolic status. It is possible that the robust decrease in the PANSS scores in both groups may have obscured an effect of vitamin D supplementation.

Low adherence to antidepressants is associated with increased mortality in Parkinson disease patients.

INTRODUCTION: The purpose of this study was to evaluate the relationship between adherence to antidepressants (AD) and all-cause mortality in a population-based cohort of patients with Parkinson's Disease (PD). METHODS: From a database of more than 4 million people, 8553 patients with PD who purchased an AD at least once between the years 2008-2011 were retrospectively followed for all-cause mortality over 4-years. Adherence was measured as a ratio between dispensed and prescribed durations and was modeled as: non-adherence (<20%, n = 1566), poor (20%-50%, n = 1184), moderate (50%-80%, n = 1584), and good (>80%, n = 4219) adherence. Multivariable survival analyses adjusted for demographic and clinical variables including physical comorbidities known to influence mortality were conducted, however there was no adjustment for other psychiatric disorders and medications. RESULTS: Unadjusted mortality rates were 20.4%, 25.1%, 23.4% and 25.6% in those classified as non-adherent, poor, moderate and good adherence respectively (χ2 = 18.45, p < 0.0001). The non-adherent and poor adherence groups had significantly increased adjusted mortality hazard ratios (HR) of 1.43 (CI: 1.26-1.62) and 1.26 (CI: 1.1-1.44) respectively compared to the good adherence group. Using the same model, the adjusted HR for death among males was 1.49 [95% CI: 1.36-1.62] compared to females. People with PD and Charslon's Comorbidity Index score of 3-4 (HR 1.3, P < 0.001) and 5+ (HR 1.78, P < 0.001) were more likely to die than those with 0-2 comorbidities. CONCLUSIONS: Our findings suggest that poor adherence to AD is associated with increased all-cause mortality in people with PD. Given the high prevalence of depression and AD effectiveness, efforts to promote adherence should be prioritized in clinical practice.

Levels of depression and satisfaction with life as indicators of health services consumption.

OBJECTIVE: To evaluate the correlation between depression, satisfaction with life, and primary healthcare services consumption. METHODS: A random sample of primary healthcare clinic patients agreed to complete self-report questionnaires on demographics and physical activity, the Geriatric Depression Scale (GDS), Satisfaction with Life Scale and the Visual Analog Scale for Happiness. Treating physicians completed the Cumulative Illness Rating Scale (CIRS) for each patient. The relationships among psychometric, medical, the number of visits to health maintenance organization (HMO)-physicians during the previous year was assessed. RESULTS: Positive correlation was found between visits to HMO-physicians and depression severity, as assessed by GDS (p = .049), and between visits/year and illness severity, as measured by CIRS (p < .001). Correlation was also found between depression and number of chronic medications used (p = .005). Physical activity correlated inversely with depression severity (p = .014). Gender and income had no impact on frequency of visits to HMO-physicians, depression, or satisfaction with life. CONCLUSIONS: The results indicate that there is a correlation between depression and healthcare service consumption, as represented by number of HMO-physician visits and medication use. Thus, early detection of depression, using tools such as GDS, and early initiation of antidepressive treatment may help to lower the burden on the health system.

Pharmacological and behavioral management of some often-overlooked clozapine-induced side effects.

This article reviews four of the milder but still bothersome side effects of clozapine that are fairly frequent and may have a negative impact on patients' compliance with the treatment regime. We reviewed the available literature on the rate and management of four non-life-threatening side effects of clozapine, including hypersalivation, constipation, tachycardia, and nocturnal enuresis. We found a variety of pharmacological and behavioral strategies to manage these four side effects. There is, however, no consensus on a preferred strategy to control these distressing side effects and there are no guidelines. Psychiatrists should be aware of the relatively high rate of hypersalivation, constipation, tachycardia, and nocturnal enuresis in clozapine-treated patients, of the impact that these side effects may have on patients' quality of life, and should be able to suggest management strategies to the patients.