Predicting non-response to multimodal day clinic treatment in severely impaired depressed patients: a machine learning approach.

A considerable number of depressed patients do not respond to treatment. Accurate prediction of non-response to routine clinical care may help in treatment planning and improve results. A longitudinal sample of N = 239 depressed patients was assessed at admission to multi-modal day clinic treatment, after six weeks, and at discharge. First, patient's treatment response was modelled by identifying longitudinal trajectories using the Hamilton Depression Rating Scale (HDRS-17). Then, individual items of the HDRS-17 at admission as well as individual patient characteristics were entered as predictors of response/non-response trajectories into the binary classification model (eXtremeGradient Boosting; XGBoost). The model was evaluated on a hold-out set and explained in human-interpretable form by SHapley Additive explanation (SHAP) values. The prediction model yielded a multi-class AUC = 0.80 in the hold-out set. The predictive power for the binary classification yielded an AUC = 0.83 (sensitivity = .80, specificity = .77). Most relevant predictors for non-response were insomnia symptoms, younger age, anxiety symptoms, depressed mood, being unemployed, suicidal ideation and somatic symptoms of depressive disorder. Non-responders to routine treatment for depression can be identified and screened for potential next-generation treatments. Such predictors may help personalize treatment and improve treatment response.

Sex differences in depressive symptoms and their networks in a treatment-seeking population - a cross-sectional study.

BACKGROUND: The higher prevalence of major depressive disorder (MDD) in females relative to males is well-established. Some authors have posited this difference arises to divergent symptom profiles in females vs. males. However, empirical tests of this hypothesis have yielded equivocal results. Here, we investigate sex differences in MDD of individual symptoms and symptom networks in a treatment-seeking sample. METHODS: We assessed depressive symptoms using Hamilton Depression Rating Scale (HDRS-17) in 590 treatment-seeking adults with MDD (300 females). We examined group differences in symptom endorsement. We investigated symptom networks and estimated Gaussian Graphical Models. Finally, we compared the female and male networks using the Network Comparison Test. RESULTS: Females scored significantly higher in psychological anxiety (p <0.001; rB = -0.155), somatic anxiety (p = .001; rB = -0.150) and feelings of guilt (p = .002; rB = -0.139). Male and female patients did not differ in depression sum scores. There were no sex differences in network structure or global strength. LIMITATIONS: Our study was sufficiently powered to detect only medium sized symptom differences. The generalizability of our study is limited to clinical samples and further studies are needed to investigate if findings also translate to outpatient samples. CONCLUSION: Females reported elevated anxiety symptoms and guilt. Clinicians should assess these symptom differences and tailor treatment to individual symptom profiles. No differences between sexes emerged in MDD network structures, indicating that features may be more similar than previously assumed. Sex differences in psychopathological features of MDD are important for future research and personalized treatment.

Diagnosis as dialogue: historical and current perspectives
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Ever since psychiatry emerged as a clinical discipline and field of scientific inquiry in the late 18th century, debates about diagnosis have been at its very heart. Considered by many a requirement for clinical communication as well as for systematic study, others have critiqued psychiatric diagnosis for being modeled on a medical conception of disease that is ill-suited to the specific nature of mental disorders. Based on a review of seminal positions in the conceptual history of psychiatry and an examination of their epistemological underpinnings, we propose to consider diagnosis as dialogue. Such understanding, we argue, can serve as a meta-framework that provides a conceptual and practical umbrella to encourage open-minded conversation across the diverse conceptual and experiential frameworks that are characteristic of psychiatry. In this perspective psychopathology will also reinforce the interpersonal realm as a necessary element of any clinical encounter, be it diagnostic in purpose or otherwise. Current challenges to traditional diagnostic systems like Research Domain Criteria (RDoC) and Hierarchical Taxonomy of Psychopathology (HiTOP) are discussed in light of these considerations.
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Desde finales del siglo XVIII, en que la psiquiatría surgió como disciplina clínica y campo de investigación científica, los debates acerca del diagnóstico han estado en su centro. Muchos lo han considerado como un requisito para la comunicación clínica, así como para el estudio sistemático, y otros han criticado el diagnóstico psiquiátrico por basarse en una concepción médica de la enfermedad, lo que no sería una buena adaptación a la naturaleza específica de los trastornos mentales. De acuerdo con una revisión de los planteamientos seminales en la historia conceptual de la psiquiatría y un examen de sus bases epistemológicas, se propone considerar el diagnóstico como un diálogo. Se argumenta que tal comprensión puede servir como un meta-marco que proporcione un paraguas conceptual y práctico para fomentar una conversación abierta a través de los diversos marcos conceptuales y experimentales que son característicos de la psiquiatría. De acuerdo con esta perspectiva, la psicopatología también reforzará el ámbito interpersonal como elemento necesario para cualquier encuentro clínico, ya sea de tipo diagnóstico u otro. A la luz de estas consideraciones, se discuten los desafíos actuales para los sistemas diagnósticos tradicionales como los Criterios de Dominio de Investigación (CDI) y la Taxonomía Jerárquica de la Psicopatología (TJP).

Le diagnostic en psychiatrie est au coeur de débats dans cette discipline devenue, à la fin du 18e siècle, à la fois clinique et domaine de recherche scientifique. Pour de nombreux médecins le diagnostic est aussi nécessaire à la communication qu'à la mise en œuvre d'études systématiques. D'autres en revanche ont critiqué cette conception médicale du diagnostic psychiatrique, inadaptée selon eux à la nature spécifique des troubles mentaux. Nous proposons d'envisager le diagnostic comme un dialogue, en examinant les positions fondamentales de l'histoire conceptuelle de la psychiatrie et leurs fondements épistémologiques. Selon nous, ce point de vue peut servir de méta-cadre pour un environnement conceptuel et pratique favorable à un échange ouvert au sein des divers contextes abstraits et expérientiels qui caractérisent la psychiatrie. Dans cette perspective, la psychopathologie renforcera également le domaine interpersonnel en tant qu'élément indispensable à toute rencontre clinique, que son but soit diagnostique ou non. Les méthodes de diagnostic traditionnelles, tels que les critères des domaines de recherche et la taxonomie hiérarchique de la psychopathologie, rencontrent aujourd'hui des difficultés examinées à la lumière de ces considérations.