Jane Eisen’s research while affiliated with McLean Hospital and other places

Background Outpatient psychotherapies are gold standard interventions for borderline personality disorder (BPD); however, in clinical reality, higher rates of psychiatric hospitalization and more severe symptoms, including suicidality and self-harm, occur for those with BPD compared to those with other psychiatric disorders in inpatient units. Methods This study aims to distinguish the clinical profile and outcomes of patients screening positive for a threshold of BPD traits in the inpatient psychiatric setting using the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), from those who do not. Results Compared to those screening negative on the MSI-BPD (MSI-BPD-), those who screen positive (MSI-BPD +) are younger, more likely to be female, and more likely to report a range of health and psychosocial risk factors such as unstable housing, reduced educational attainment, physical health problems, past trauma, and problematic drug and alcohol use. MSI-BPD + patients report significantly higher severity of anxiety, depression, suicidality, self-harm, and global symptoms on admission than MSI-BPD- patients. In terms of response to inpatient care, they also self-report significantly greater improvements and higher proportions of reliable change on measures of anxiety, depression, and general psychiatric severity. At discharge, MSI-BPD + patients no longer report significantly higher suicidality but do report greater levels of thoughts of self-harm. Conclusions These findings suggest that patients with self-reported BPD symptoms experience acute symptom relief during short-term inpatient hospitalization, including for suicidality-related symptoms. Our study also demonstrates the feasibility of utilizing the MSI-BPD screening tool within a large adult inpatient psychiatric population to identify individuals likely to have BPD with distinct clinical profiles.

Background: Psychiatric disorders are notoriously heterogenous, often rendering diagnostic efforts challenging, and leading to poor therapeutic outcomes. The growing emphasis on 'transdiagnostic' approaches in psychiatry aligns well with the National Institute of Health- devised Research Domain Criteria (RDoc) framework that seeks to enable precision psychiatry. Here, we sought to identify transdiagnostic subgroups, which share behavioral and neural abnormalities, in a large population of psychiatric inpatients treated at a tertiary psychiatric hospital. Methods: The sample included 1,571 patients across five units within the Depression & Anxiety Disorders Division at McLean Hospital who completed self-assessments as part of an ongoing quality-of-care improvement project. Self-assessments included validated measures of depression, anxiety, anhedonia, trauma, personality and substance misuse as well as broader screening questions. First, we identified naturally occurring transdiagnostic subgroups based on the self-reported questionnaires using consensus clustering to implement partition-around-medoids. In a subsample, we ascertained brain functional connectivity differences between the resultant subgroups using a multi-granular approach, i.e. whole-brain to connection-wise. Results: In a k=2 partitioning solution, the first transdiagnostic cluster; C1 (N=809) had consistently higher means across all questionnaires compared to the second cluster; C2 (N=762). QIDS total score (P<0.0001, effect size = 0.54) and BASIS-24 derived total score (P<0.0001, effect size = 0.53) showed the largest difference between the groups. In follow- up imaging analysis (N=26) functional connectivity (FC) differences were observed connection-wise (P<0.0001) and between functional networks (P<0.0001), with C1 showing stronger FC than C2. Cluster-by-sex analyses revealed that females had higher BASIS-24 derived depression/functioning (C1|C2; P<0.0001 | P<0.0001), and QIDS (C1|C2; P<0.0001 | P<0.0001) scores compared to males. This was coupled with greater intermodular FC in males than females in C1 (P<0.0001) and C2 (P<0.0005). Conclusions: These results suggest that inpatients with transdiagnostic symptoms show biobehavioral abnormalities, underpinned by sex differences. Behaviorally, this is a function of acuity, i.e., severity of psychopathological symptoms, and not diagnosis. Biologically, the dysfunction captured here may span across various brain networks, rather than a singular region.

Patient-reported measures are an important tool in personalizing care and monitoring clinical outcomes. This work presents results from the routine collection of self-report measures from individuals (n = 753) admitted to depression and anxiety inpatient units at McLean Hospital. 93.7% participated in the Clinical Measurement Initiative (CMI) between September 2020 and February 2022 on the most established unit. The average time between admission and discharge measures was 12.6 days and an attrition rate of 10.4% was observed on this unit. Missingness of discharge assessments was unrelated to symptom severity or comorbidities. We discuss the feasibility of deploying patient-reported measures as part of routine care in an inpatient psychiatric setting. Systematic evaluation of potential treatment modifiers (e.g., personality disorder, trauma history, and substance misuse) may be valuable in better serving those impacted by psychiatric illness.