Argyris Stringaris

• MD, PhD, FRCPsych
• Professor at University College London

Question: Should a young person receive psychotherapy or medication for their depression, and on what evidence do we base this decision? In this paper, we test whether the basic conditions required to draw valid inferences to answer this question are currently met. Study selection and analysis: We included 88 RCTs of psychotherapy and medication fo...

Background Most research on pediatric irritability focuses on children and/or relies on parent reports. We examined how self-reported irritability in adolescents influences the prevalence, sex distribution and correlates of irritability relative to children and parent reports. Methods Using data from Mental Health of Children and Young People Surv...

Introduction Adolescence is a critical period for the development of several emotional disorders, including body dysmorphic disorder (BDD), social anxiety disorder (SAD) and depression. It has been suggested that this may be partly due to developmental changes in self‐referential processing, including self‐focused attention (SFA). However, to date...

Background: Behavioral Activation (BA) as part of cognitive behavioral therapy effectively treats some individuals with major depressive disorder, and its putative mechanism is through targeting reward-related processes. Here we examine how BA may influence these processes in adolescents with depressive disorders.Method:We examined a total of 64 ad...

Background: It is unclear whether arts-based social prescribing is efficacious for people with mental illness. Methods: Three hundred and eighty two adults, mean age 52 years +/- 14 years, in the community with psychiatric diagnoses receiving care as usual (CAU) by their mental health care teams in Greece, were referred via a novel Arts on Prescrip...

Task-fMRI analyses typically focus on localized activation contrasts between stimuli, neglecting the dynamic hierarchy of the brain. We introduce Brain Diffusion Transformer (Brain-DiT), a deep generative model capturing recurrent processing underlying individualized neurocognitive state transitions via functional networks. Without prior assumption...

Background: It is unclear whether arts-based social prescribing is efficacious for people with mental illness. Methods: Three hundred and eighty two adults, mean age 52 years +/- 14 years, in the community with psychiatric diagnoses receiving care as usual (CAU) by their mental health care teams in Greece, were referred via a novel Arts on Prescrip...

The limited availability and high cost of 7 Tesla (7T) structural MRI hinder its widespread application despite its superior imaging quality. This study introduces a High Frequency-Generative Adversarial Network (HF-GAN) to predict three-dimensional 7T-equivalent (P7T) images from standard 3T structural MRI scans, offering a cost-effective alternat...

Background Depression is common, burdensome, and is frequently first diagnosed in adolescents. The popular Adolescent Brain Cognitive Development dataset (ABCD) provides an attractive opportunity to research depression in adolescents. The only continuous measure of depression, as defined by DSM‐5, in ABCD is the Child Behavior Checklist's DSM‐5‐Ori...

Objectives Should a young person receive psychotherapy or medication for their depression and on what evidence do we base this decision? In this paper, we test the factors across modalities that may influence comparability between medication and psychotherapy trials. Methods We included 92 randomised controlled trials (RCTs) of psychotherapy and m...

In this pre-registered study, we ask how people’s emotional responses under threat may be causally affected by what is available to them in the environment, i.e. environmental affordances. For this purpose, we introduce a novel behavioral paradigm using horror movie stimuli to simulate threats. The study illustrates that affordances, specifically i...

Background: It is unclear whether arts-based social prescribing is efficacious for people with mental illness. Methods: Three hundred and eighty two adults, mean age 52 years +/- 14 years, in the community with psychiatric diagnoses receiving care as usual (CAU) by their mental health care teams in Greece, were referred via a novel Arts on Prescrip...

Increasing awareness of mental health problems, including that of young people, is generally seenas positive and several interventions to increase awareness are underway internationally. Yet, aprincipled evaluation of benefits and harms of increasing awareness is still lacking.Here, we present a conceptual and mathematical framework for the evaluat...

Anyone reading this text has probably been a medical trainee once. What was your training like? More importantly, did anyone during your training ask you what your training was like? For example, did anyone ask you if you were satisfied with your training or if you worked a little or a lot? Probably not. The origin of medical specialty training is...

Current psychiatric assessments oversimplify mental health phenomena. Ecological-Momentary-Assessment (EMA) captures richer dynamic interactions between psychological and contextual variables, but the resulting complexity currently hinders clinical translation. Here we propose an innovative approach to integrate dynamic data in clinical practice by...

Background Social anxiety disorder typically emerges in adolescence and its symptoms often co‐occur with depression and suicidal ideation. It is important to understand whether social anxiety symptoms precede depression and suicidal ideation in youth. This study aimed to investigate the temporal associations between baseline social anxiety and late...

Background: Personality traits have been associated with eating disorders (EDs) and comorbidities. However, it is unclear which personality profiles are premorbid risk rather than diagnostic markers. Methods: We explored associations between personality and ED-related mental health symptoms using canonical correlation analyses. We investigated p...

Question: Should a young person receive psychotherapy or medication for their depression, and on what evidence do we base this decision? In this paper, we test whether the basic conditions required to draw valid inferences to answer this question are currently met. Study selection and analysis: We included 88 RCTs of psychotherapy and medication fo...

Body dysmorphic disorder (BDD) is a relatively common and highly impairing mental disorder that is strikingly underdiagnosed and undertreated in Child and Adolescent Mental Health Services (CAMHS). The only clinical guidelines for the management of BDD in youth were published nearly 20 years ago, when empirical knowledge was sparse. Fortunately, th...

Current psychiatric diagnoses are not defined by neurobiological measures which hinders the development of therapies targeting mechanisms underlying mental illness 1,2. Research confined to diagnostic boundaries yields heterogeneous biological results, whereas transdiagnostic studies often investigate individual symptoms in isolation. There is curr...

Irritability, defined as proneness to anger that may impair an individual's functioning, is common in youths. There has been a recent upsurge in relevant research. The authors combine systematic and narrative review approaches to integrate the latest clinical and translational findings and provide suggestions for addressing research gaps. Clinician...

This study uses machine learning models to uncover diagnostic and risk prediction markers for eating disorders (EDs), major depressive disorder (MDD), and alcohol use disorder (AUD). Utilizing case-control samples (ages 18-25 years) and a longitudinal population-based sample (n=1,851), the models, incorporating diverse data domains, achieved high a...

Enhancing screening practices and developing scalable diagnostic tools are imperative in response to the increasing prevalence of youth mental health challenges. Structured lay psychiatric interviews have emerged as one such promising tool. However, there remains limited research evaluating structured psychiatric interviews, specifically their char...

Psychopharmacological treatment is an important component of the multimodal intervention approach to treating mental health conditions in children and adolescents. Currently, there are many unmet needs but also opportunities, alongside possible risks to consider, regarding the pharmacological treatment of mental health conditions in children and ad...

Background Identifying youths most at risk to COVID-19-related mental illness is essential for the development of effective targeted interventions. Aims To compare trajectories of mental health throughout the pandemic in youth with and without prior mental illness and identify those most at risk of COVID-19-related mental illness. Method Data wer...

Objective This paper aims to report our experience of developing, implementing, and evaluating myHealthE (MHE), a digital innovation for Child and Adolescents Mental Health Services (CAMHS), which automates the remote collection and reporting of Patient-Reported Outcome Measures (PROMs) into National Health Services (NHS) electronic healthcare reco...

There is growing evidence that universal school-based mental health interventions can lead to negative outcomes in young people. This is a critical ethical issue, especially when young people cannot easily opt-out of interventions run during school hours. To date, however, there is no guidance available about potential harms for researchers designi...

According to influential theories about mood, exposure to environments characterized by specific patterns of punishments and rewards could shape mood response to future stimuli. This raises the intriguing possibility that mood could be trained by exposure to controlled environments. The aim of the present study is to investigate experimental settin...

Objective: Little is known about the epidemiology of body dysmorphic disorder in youth. We evaluated the prevalence, comorbidity, and psychosocial impairment associated with BDD and more broadly defined appearance preoccupation in young people.Method: Data were drawn from the 2017 Mental Health of Children and Young People in England survey. BDD an...

Objective To investigate the longitudinal associations between COVID-19 induced stress (related to COVID-19 restrictions/changes), attention-deficit/hyperactivity disorder (ADHD) symptoms, oppositional symptoms, and mental health outcomes (negative affect, anxiety, depression, and irritability) in children with ADHD during the COVID-19 pandemic. M...

Background: Resting state connectivity studies link ketamine's antidepressant effects with normalisation of the brain connectivity changes that are observed in depression. These changes, however, usually co-occur with improvement in depressive symptoms, making it difficult to attribute these changes to ketamine's effects per se. Aims: Our aim is...

Threatening situations can evoke anger and fear. Besides hedonic motivations, anger and fear can also be modulated by instrumental factors, potentially environmental affordances. In this pre-registered study, we use a novel behavioral paradigm simulating threats via the presentation of horror movies. With this paradigm, we show that affordances in...

Urban-living individuals are exposed to many environmental factors that may combine and interact to influence mental health. While individual factors of an urban environment have been investigated in isolation, no attempt has been made to model how complex, real-life exposure to living in the city relates to brain and mental health, and how this is...

Objective: To investigate longitudinal associations between changes in early childhood irritability, and depressive symptoms and self-harm at 14 years. Method: We used data from 7,225 children in a UK-based general population birth-cohort. Childhood irritability was measured at 3, 5 and 7 years using four items from two questionnaires (Children'...

Reporting of effect sizes is standard practice in psychology and psychiatry research. However, interpretation of these effect sizes can be meaningless or misleading – in particular, the evaluation of specific effect sizes as ‘small’, ‘medium’ and ‘large’ can be inaccurate depending on the research context. A real‐world example of this is research i...

Recent studies proposed a general psychopathology factor underlying common comorbidities among psychiatric disorders. However, its neurobiological mechanisms and generalizability remain elusive. In this study, we used a large longitudinal neuroimaging cohort from adolescence to young adulthood (IMAGEN) to define a neuropsychopathological (NP) facto...

Objective: The Affective Reactivity Index (ARI) is widely used to assess young people's irritability symptoms, but youth and caregivers often diverge in their assessments. Such informant discrepancy might be rooted in poor psychometric properties, the differential conceptualization of irritability across informants, or reflect sociodemographic and...

This meta-analysis investigated the effects of computerized cognitive training (CCT) on clinical, neuropsychological and academic outcomes in individuals with attention-deficit/hyperactivity disorder (ADHD). The authors searched PubMed, Ovid, and Web of Science until 19th January 2022 for parallel-arm randomized controlled trials (RCTs) using CCT i...

The pace of development and implementation of novel medications in child and adolescent psychiatry has remained slow. We systematically searched https://clinicaltrials.gov/ and https://www.clinicaltrialsregister.eu/ (from 01/01/2010 to 08/23/2022) for phase 2 or 3 randomized controlled trials (RCTs) of medications without regulatory approval in the...

In recent years, there have been extensive efforts in secondary schools to prevent, treat and raise awareness of adolescent mental health problems. For some adolescents, these efforts are essential and will lead to a reduction in clinical symptoms. However, it is also vital to assess whether, for others, the current approach might be causing iatrog...

Does our mood change as time passes? This question is central to behavioural and affective science, yet it remains largely unexamined. To investigate, we intermixed subjective momentary mood ratings into repetitive psychology paradigms. Here we demonstrate that task and rest periods lowered participants’ mood, an effect we call ‘Mood Drift Over Tim...

The COVID-19 pandemic led ADHD services to modify the clinical practice to reduce in-person contact as much as possible to minimise viral spread. This had far-reaching effects on day-to-day clinical practice as remote assessments were widely adopted. Despite the attenuation of the acute threat from COVID, many clinical services are retaining some r...

The Adolescent Brain Cognitive Development dataset (ABCD) is a popular source of data for research on children and adolescents, aged 9-11 at baseline. Depression is frequently first diagnosed in adolescents, is prevalent and carries heavy burden, thus ABCD provides an attractive opportunity to research depression in adolescents. The only continuous...

Reporting of effect sizes is standard practice in psychology and psychiatry research. However, interpretation of these effect sizes can be meaningless or misleading – in particular, the evaluation of specific effect sizes as “small”, “medium” and “large” can be inaccurate depending on the research context. A real-world example of this is research i...

Recent longitudinal studies in youth have reported MRI correlates of prospective anxiety symptoms during adolescence, a vulnerable period for the onset of anxiety disorders. However, their predictive value has not been established. Individual prediction through machine-learning algorithms might help bridge the gap to clinical relevance. A voting cl...

Background Irritability is common in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD) and with anxiety/depressive disorders. Although youth irritability is linked with psychiatric morbidity, little is known regarding its non-pharmacological treatments. Developing non-pharmacological...

Importance The early childhood temperament of behavioral inhibition (BI), characterized by inhibited and fearful behaviors, has been associated with heightened risk for anxiety and depression across the lifespan. Although several neurocognitive correlates underlying vulnerability to the development of anxiety among inhibited children have been iden...

The test-retest reliability of fMRI functional connectivity is a key factor in the identification of reproducible biomarkers for psychiatric illness. Low reliability limits the observable effect size of brain-behavior associations. Despite this important connection to clinical applications of fMRI, few studies have explored reliability in populatio...

Background: Autistic traits are commonly viewed as dimensional in nature, and as continuously distributed in the general population. In this respect, the identification of predictive values of markers such as subtle autism-related alterations in brain morphology for parameter values of autistic traits could increase our understanding of this dimens...

Objective: The Affective Reactivity Index (ARI) is widely used to assess young people’s irritability symptoms, but youth and caregivers often diverge in their assessments. Such informant discrepancy might stem from poor reliability. However, evidence from genetic, imaging and treatment studies suggests that irritability may not be a unitary constru...

Capturing individual differences in cognition is central to human neuroscience. Yet our ability to estimate cognitive abilities via brain MRI is still poor in both prediction and reliability. Our study tested if this inability can be improved by integrating MRI signals across the whole brain and across modalities, including task-based functional MR...

Cognitive abilities are one of the major transdiagnostic domains in the National Institute of Mental Health's Research Domain Criteria (RDoC). Following RDoC's integrative approach, we aimed to develop brain-based predictive models for cognitive abilities that (a) are developmentally stable over years during adolescence and (b) account for the rela...

Despite its omnipresence in everyday interactions and its importance for mental health, mood and its neuronal underpinnings are poorly understood. Computational models can help identify parameters affecting self-reported mood during mood induction tasks. Here, we test if computationally modeled dynamics of self-reported mood during monetary gamblin...

Background The COVID-19 pandemic has affected all our lives, not only through the infection itself but also through the measures taken to control the spread of the virus (e.g. lockdown). Aims Here, we investigated how the COVID-19 pandemic and unprecedented lockdown affected the mental health of young adults in England and Wales. Method We compar...

Despite decades of costly research, we still cannot accurately predict individual differences in cognition from task-based functional magnetic resonance imaging (fMRI). Moreover, aiming for methods with higher prediction is not sufficient. To understand brain-cognition relationships, we need to explain how these methods draw brain information to ma...

Background Interest in internet‐based patient reported outcome measure (PROM) collection is increasing. The NHS myHealthE (MHE) web‐based monitoring system was developed to address the limitations of paper‐based PROM completion. MHE provides a simple and secure way for families accessing Child and Adolescent Mental Health Services to report clinica...

Since the onset of COVID-19 pandemic, concerns have been raised about the effects of the pandemic on youth with pre-existing mental health disorders. The present study aimed to explore change in emotional and behavioral symptoms (mood states) and daily behaviors during the lockdown in a clinical sample of children and adolescents in Greece. A cross...

Objective Adolescence is a critical period for circadian rhythm, with a strong shift towards eveningness around age 14. Also, eveningness in adolescence has been found to predict later onset of depressive symptomatology. However, no previous study has investigated structural variations associated with chronotype in early adolescence, and how this a...

Objective: Research in adolescent depression has found aberrant intrinsic functional connectivity (iFC) among the ventral striatum (VS) and several brain regions implicated in reward processing. The present study probes this question by taking advantage of the availability of data from a large youth cohort, the IMAGEN Consortium. Methods: iFC da...

Anhedonia reflects a reduced ability to engage in previously pleasurable activities and has been reported in children as young as 3 years of age. It manifests early and is a strong predictor of psychiatric disease onset and progression over the course of development and into adulthood. However, little is known about its mechanistic origins, particu...

The Affective Reactivity Index (ARI) is an irritability measure with good psychometric properties. However, there are no published studies in preschool children, an important population in which to differentiate normative from non-normative irritability. The goal of this study was to validate the ARI in preschoolers. Two samples were included: a sc...

Objective To investigate whether, compared to pre-pandemic levels, depressive and anxiety symptoms in adolescents with depression increased during the pandemic. Method We utilized data from National Institute of Mental Health Characterization and Treatment of Depression (NIMH CAT-D) cohort, a longitudinal case control study that started pre-pandem...

Adolescent depression is a serious and debilitating disorder associated with lifelong negative outcomes, including heightened risk for recurrence into adulthood, psychiatric comorbidities, and suicide. Among evidence-based treatments for adolescents, psychotherapies for depression have the smallest effect sizes of all psychiatric conditions studied...

Mood is a key factor that determines our well-being and a lot of effort goes into taming and regulating it. The role of positive and negative environmental stimuli on mood and whether they can promote mood resilience or susceptibility, remains relatively unexplored. The aim of the present study is to investigate whether mood could be trained to bec...

Objective Impairing emotional outbursts, defined by extreme anger or distress in response to relatively ordinary frustrations and disappointments, impact all mental health systems of care, emergency departments, schools and juvenile justice programs. However, the prevalence, outcome and impact of outbursts are difficult to quantify because they are...

Objective To examine the impact of COVID-19 restrictions among children with attention-deficit/hyperactivity disorder (ADHD). Methods Parents of 213 Australian children (5–17 years) with ADHD completed a survey in May 2020 when COVID-19 restrictions were in place (i.e., requiring citizens to stay at home except for essential reasons). Results Com...

The global spread of COVID-19 led the World Health Organization to declare a pandemic on 11 March 2020. To decelerate this spread, countries have taken strict measures that have affected the lifestyles and economies. Various studies have focused on the identification of COVID-19’s impact on the mental health of children and adolescents via traditio...

The global spread of COVID-19 led the World Health Organization to declare a pandemic on 11 March 2020. To decelerate this spread, countries have taken strict measures that affected the lifestyle and economy. Various studies have been focused on the identification of COVID-19 impact to mental health of children and adolescents via traditional stati...

Background Family history of depression (FHD) is a known risk factor for the new onset of depression. However, it is unclear if FHD is clinically useful for prognosis in adolescents with current, ongoing, or past depression. This preregistered study uses a longitudinal, multi‐informant design to examine whether a child’s FHD adds information about...

Capturing individual differences in cognitive abilities is central to human neuroscience. Yet our ability to estimate cognitive abilities via brain MRI is still poor in both prediction and reliability. Our study tested if this inability was partly due to the over-reliance on 1) non-task MRI modalities and 2) single modalities. We directly compared...

Background: Interest in internet-based patient reported outcome measure (PROM) collection is increasing. The NHS myHealthE (MHE) web-based monitoring system was developed to address the limitations of paper-based PROM completion. MHE provides a simple and secure way for families accessing Child and Adolescent Mental Health Services to report clinic...

The COVID-19 pandemic has impacted all our lives, not only through the infection itself, but also through the measures taken to control the virus spread (e.g., lockdown). Here we investigated how the COVID-19 pandemic and unprecedented lockdown affected the mental health of young adults in England and Wales. We compared the mental health symptoms o...