Current Psychiatry Research and Reviews - Volume 17, Issue 2, 2021

Background: The use of Machine Learning (ML) is witnessing exponential growth in the field of artificial intelligence (AI) and neuroscience, in particular in subdisciplines such as Systems Neuroscience (SN), as a viable alternative to the use of classical statistical techniques. The combination of this interconnection allows a more detailed study of algorithms and neural circuits that emulate core cognitive processes. ML toolbox includes algorithms that are suited to solving problems of classification, regression, clustering, and anomaly detection. Objective: The aim of the present opinion was to exemplify the contribution of ML in the field of SN in three different fields: 1) cognitive modelling; 2) neuroimaging; 3) analysis of clinical datasets. Methods: We gathered evidence from the relevant literature related to the interaction between neuroscience and AI and the impact of ML in SN. Results: ML is specifically suited to the analysis of large clinical neuroscience datasets. Experimental results in neuroscience are hard to replicate for a number of reasons, and ML may contribute to attenuating these replicability issues via the ubiquitous use of cross-validation procedures. While ML modelling is primarily focused on prediction accuracy, one of the drawbacks in ML is the opacity of various algorithms that resist intuitive understanding. Conclusion: Future avenues of research have already been traced and include increased interpretability of currently opaque ML models functioning and causal analysis. Causal analysis is intended to distinguish between spurious associations and cause-effect relationships and is a primary interest in both clinical medicine and basic neuroscience.

Background: Alcohol use disorders, defined as the maintenance of alcohol use for at least a 12-month period despite negative psychological, biological, behavioral, and social consequences, are frequently associated with psychotic symptoms. Objective: Our aim in this paper is to review alcohol-related clinical conditions that are accompanied by psychotic symptoms, alcohol-induced psychotic disorder, alcohol withdrawal delirium, Wernicke’s encephalopathy, Korsakoff’s dementia, comorbid schizophrenia, or delusional disorder. Methods: This is a non-systematic, narrative review based on the relevant literature indexed in PubMed and Google Scholar databases [2000-2020]. Results: Alcohol-induced psychotic disorder is characterized by the presence of auditory hallucinations or delusions. In the state of alcohol withdrawal, tactile, visual hallucinations and delusions are common. Wernicke-Korsakoff syndrome, caused by malnutrition secondary to chronic alcohol misuse, is characterized by the presence of ataxia, ophthalmoplegia, and a range of mental disturbances. The dual diagnosis of schizophrenia and alcohol use disorder rests on shared biological impairments, as shown by neuroendocrinological and brain imaging studies. The subtype of the delusional disorder called Othello’s syndrome, or delusional jealousy based on false beliefs of infidelity, is often seen in the context of alcohol alone or alcohol and neurological disorder. Treatment for alcoholic disorders with psychotic symptoms are dietary, psychological, and pharmacological. Conclusion: There are a number of alcohol-related psychotic syndromes, each requiring its own specific treatment approach.

Background: Despite the evidence and guidelines recommending otherwise, routine testing remains pervasive in the management of patients presenting to the Emergency Department (ED) for behavioral complaints under the guise of Medical Clearance (MC). The aim of this review is to highlight the evidence available concerning routine laboratory testing in psychiatry patients presenting to the ED, underline available guidelines, list possible reasons for over-testing, and propose a possible approach based on all the evidence and recommendations. Methods: Electronic database searches were carried out in Medline/PubMed and Google Scholar, with the period set from January 1, 1990, to March 1, 2021. The search process was focused on studies in which MC was evaluated in the management of patients presenting for psychiatric complaints to the ED. The references listed in each identified article were also screened and manually searched. Results: A total of 14 relevant studies were found. The majority of the studies evaluated the impact of routine laboratory testing on the management and disposition of adults in the ED presenting for an acute psychiatric condition. Two studies investigated the use of a screening tool to rule out the presence of acute medical illness. Conclusion: While ED physicians are faced with many challenges, such as litigation and fear of diagnostic uncertainty, few solutions have been proposed. A suggested approach relies on history taking, physical examination, and assessment of mentation to evaluate for the presence of an organic etiology requiring further testing. Adequate communication between the ED physician and psychiatrist, along with shared decision-making, are also the key to optimizing care.

Background: The novel coronavirus (COVID-19) was first reported in Wuhan, China, and has since then spread worldwide, resulting in a large number of hospitalizations and deaths. To the best of our knowledge, the study about the mental health status (depression, anxiety, and stress) among high school students during COVID-19 has not been performed in Iran. Objective: This study was performed to investigate rates of anxiety, depression, and stress among high school students during the pandemic of COVID-19. Methods: This cross-sectional study was performed among high school students (12-18 years) from 30 April until 1 June 2020, in Hamadan City, west of Iran. In total, 2852 students contributed to the present study. Depression Anxiety and Stress Scale 21 (DASS-21) was used in this study. Statistical analyses were conducted in STATA 14 with a significant level of 0.05. Results: The present study showed that although stress status was normal among most high school students (70.3%), the status of anxiety and depression was high. The boys had reported a higher proportion of normal status of depression (51.62% vs. 44.97%), anxiety (31.71% vs. 26.91%), and stress (77.66% vs. 66.10%) compared to the girls. Also, students in grades 7-9 had reported a higher percentage of normal status in all three dimensions of stress, anxiety, and depression. Conclusion: These findings suggest that as rates of depression and anxiety are high, schoolage children may benefit from policymakers and other authorities’ active role.

Background: The published evidence supports the efficacy of dialectical behavioral therapy (DBT) to treat patients with borderline personality disorder and particular emphasis on emotion dysregulation as a psychopathological construct. Aim: To assess the efficacy of DBT for improving emotion dysregulation among patients with dual diagnosis of borderline personality disorder and substance use disorder. Methods: We recruited 40 patients meeting DSM-5 criteria for borderline personality disorder and substance use disorder and assigned them to one of two groups of 20 participants each. One group underwent DBT therapy and the other group followed a treatment-as-usual (TAU) protocol over one year. We used the scores of the difficulties in emotion regulation scale (DERS) at baseline, immediately after therapy, and 4 months after therapy to assess emotion dysregulation. Results: We found significant improvements (p<0.05) in the DBT group after therapy that were maintained at least for 4 months afterwards based on the DERS scores (including subscale scores). More patients dropped out of the treatment in the TAU group than in the DBT group. Conclusion: DBT is a potentially efficacious psychological intervention to treat emotion dysregulation in patients with borderline personality disorder and substance use disorder.

Background: Psoriasis is not merely an inflammatory skin disease but is commonly associated with systemic inflammation causing medical and psychiatric comorbidities. Objectives: To investigate several cognitive domains and detect Mild Cognitive Impairment (MCI) in psoriasis patients. Methods: 100 psoriasis patients, age 80 and sex-matched controls were recruited, dermatological and psychiatric assessments were done, psoriasis severity was assessed using the Psoriasis Area and Severity Index (PASI) score. Montreal Cognitive Assessment-Basic (MoCA-B) was used to assess the different cognitive domains and to screen for any possible MCI. Results: Cognitive functions were significantly worse in patients than in the healthy controls for the total score of MOCA-B (p <0.001), abstraction (p <0.001), delayed recall (p <0.001), visuospatial abilities (p= 0.013), naming (p=0.029) and attention (p <0.001). MCI was detected by the Arabic version of MoCA-B with a cut-off score of 21/22, and it was more in the psoriasis group (16 %) than in the controls (4%). No correlations were observed between disease characteristics (Psoriasis duration in months, PASI, BSA%,) and the MoCA scores in psoriasis patients. Conclusion: Psoriasis patients showed worse cognitive impairment when compared to the controls regardless of the psoriasis severity. Thus, the routine clinical examination of psoriasis patients should include the administration of a brief cognitive screening tool to reach the best management.

Background: Alzheimer’s disease is a multifactorial, neurodegenerative disease which is considered the most common cause of dementia. It is divided into two subtypes based on the age of onset: Early-Onset Alzheimer’s Disease (EOAD) and Late-Onset Alzheimer’s Disease (LOAD). Objective: In this study, we aimed to analyse the polymorphisms of APOE2/E3/E4, ACE I/D, PICALM rs3851179, which are thought to increase the risk of disease, and CYP2D6 rs1080985, that affects the therapy response. Methods: 102 early onset and 99 late onset Alzheimer's patients diagnosed according to DSM-IV and NINCDS-ADRDA diagnostic criteria were included in the study. MMSE test was applied at the time of diagnosis and the control examination was performed after 6 months. We analysed the polymorphisms of APOE2/E3/E4 by fragment analysis and ACE I/D, PICALM rs3851179, CYP2D6 rs1080985 by Real Time- PCR. The response of the therapy and effects on prognosis were compared between groups by Mini-Mental State Exam test scores. Results: The score differences of the women were significantly lower than men’s score differences. The score differences of the EOAD group were significantly lower than the LOAD group in women. Family history situation was higher in men compared to women. The score differences were higher at CC genotype for PICALM rs3851179 in the EOAD group; the score differences were higher at E3/E4 genotype than E2/E2 genotype in LOAD. Also, the score differences were significantly higher at PICALM rs3851179 in the acetylcholinesterase inhibitor+antidepressant therapy group. Conclusion: The relationship between the treatment groups and related gene regions was investigated extensively for the first time in the literature. As a result, it will be a guide in the clinic in light of the findings of the prognosis and pharmacogenetic interactions of the disease obtained from the study.