Sensitivity, specificity, and predictive power of the "Brief Risk-resilience Index for SCreening," a brief pan-diagnostic web screen for emotional health.
ABSTRACT FIntroduction: About 50% to 65% of brain related illnesses go unidentified and untreated in primary care. The ‘BRISC’ was developed as an efficient web-delivered questionnaire to identify these cases across populations and settings. Poor brain health on the BRISC is predicted by combination of genetic risk (5-HTT Short and COMT Met alleles), early life trauma, and hyper-reactivity of brainstem-amygdala-frontal circuitry for negative emotion.
Methods: We tested how well BRISC classified 1,079 people into ‘poor’ and ‘good’ brain health groups, compared to independent clinical determination. The poor brain health group comprised 6 diagnostic categories.
Results: ROC analyses showed optimal classification with 70 to 88% sensitivity, specificity and predictive power.
Discussion: Patients at risk of a brain health problem can be identified accurately using a brief web-delivered questionnaire, that reflects underlying brain function.
Full-textDOI: · Available from: Justine M Gatt, May 30, 2015
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ABSTRACT: A critical task for psychotherapy research is to create treatments that can be used by community clinicians. Streamlining of psychotherapies is a necessary first step for this purpose. We suggest that neurobiological knowledge has reached the point of providing biologically meaningful behavioral targets, thus guiding the development of effective, simplified psychotherapies. This view is supported by the Research Domain Criteria (RDoC) Project, which reflects the field's consensus and recognizes the readiness of neurobiology to guide research in treatment development. 'Engage' is an example of such a streamlined therapy. It targets behavioral domains of late-life depression grounded on RDoC constructs using efficacious behavioral strategies selected for their simplicity. 'Reward exposure' targeting the behavioral expression of positive valence systems' dysfunction is the principal therapeutic vehicle of 'Engage'. Its first three sessions consist of direct 'reward exposure', but the therapists search for barriers in three behavioral domains, that is, 'negativity bias' (negative valence), 'apathy' (arousal) and 'emotional dysregulation' (cognitive control), and add strategies targeting these domains when needed. The end result is a structured, stepped approach using neurobiological constructs as targets and as a guide to personalization. We argue that the 'reduction' process needed in order to arrive to simplified effective therapies can be achieved in three steps: (1) identify RDoC constructs driving the syndrome's psychopathology; (2) create a structured intervention utilizing behavioral and ecosystem modification techniques targeting behaviors related to these constructs; (3) examine whether the efficacy of the new intervention is mediated by change in behaviors related to the targeted RDoC constructs.Molecular Psychiatry advance online publication, 26 November 2013; doi:10.1038/mp.2013.150.Molecular Psychiatry 11/2013; 19(1). DOI:10.1038/mp.2013.150 · 15.15 Impact Factor
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ABSTRACT: BACKGROUND: Unaffected relatives (URs) of individuals with major depressive disorder (MDD) are biologically more vulnerable to depression. We compare healthy URs and controls at the level of phenotype (symptoms and functioning) and endophenotype (negative emotion bias), and further investigate the interrelation between these and the contribution of environmental early life stress. METHODS: URs (n=101), identified using Family History Screen interview methods and matched controls completed written and interview questions assessing symptoms of depression and anxiety, negative cognitive style, life functioning and early life stress. Biases in emotion processing were measured using a facial expression of emotion identification paradigm. RESULTS: Compared to controls, URs reported higher levels of depression and anxiety, a stronger negative cognitive bias, and poorer functioning and lower satisfaction with life. URs were slower to correctly identify fear and sad facial expressions. A slower response time to identify sad faces was correlated with lower quality of life in the social domain. Early life stress (ELS) did not contribute significantly to any outcome. LIMITATIONS: The methodology relies on accurate reporting of participants' own psychiatric history and that of their family members. The degree of vulnerability varies among URs. CONCLUSIONS: A family history of depression accounts for subtle differences in symptom levels and functioning without a necessary role of ELS. A negative emotion bias in processing emotion may be one vulnerability marker for MDD. Biological markers may affect functioning measures before symptoms at the level of experience.Journal of Affective Disorders 06/2013; 150(2). DOI:10.1016/j.jad.2013.04.042 · 3.71 Impact Factor