Background: Conduct Disorder (CD) is associated with impairments in facial emotion recognition. However, it is unclear whether such deficits are explained by a failure to attend to emotionally informative face regions, such as the eyes, or by problems in the appraisal of emotional cues. Method: Male and female adolescents with CD and varying levels of callous-unemotional (CU) traits and age-and sex-matched typically developing (TD) controls (aged 13-18) categorised the emotion of dynamic and morphed static faces. Concurrent eye tracking was used to relate categorisation performance to participants' allocation of overt attention. Results: Adolescents with CD were worse at emotion recognition than TD controls, with deficits observed across static and dynamic expressions. In addition, the CD group fixated less on the eyes when viewing fearful and sad expressions. Across all participants, higher levels of CU traits were associated with fear recognition deficits and reduced attention to the eyes of surprised faces. Within the CD group, however, higher CU traits were associated with better fear recognition. Overall, males were worse at recognising emotions than females and displayed a reduced tendency to fixate the eyes. Discussion: Adolescents with CD, and particularly males, showed deficits in emotion recognition and fixated less on the eyes when viewing emotional faces. Individual differences in fixation behaviour predicted modest variations in emotion categorisation. However, group differences in fixation were small and did not explain the much larger group differences in categorisation performance, suggesting that CD-related deficits in emotion recognition were not mediated by abnormal fixation patterns.

Adolescents with disruptive behavior disorders are reported to show deficits in empathy and emotion recognition. However, prior studies have mainly used questionnaires to measure empathy or experimental paradigms that are lacking in ecological validity. We used an empathic accuracy (EA) task to study EA, emotion recognition, and affective empathy in 77 male adolescents aged 13–18 years: 37 with Conduct Disorder (CD) and 40 typically-developing controls. The CD sample was divided into higher callous-emotional traits (CD/CU+) and lower callous-unemotional traits (CD/CU-) subgroups using a median split. Participants watched films of actors recalling happy, sad, surprised, angry, disgusted or fearful autobiographical experiences and provided continuous ratings of emotional intensity (assessing EA), as well as naming the emotion (recognition) and reporting the emotion they experienced themselves (affective empathy). The CD and typically-developing groups did not significantly differ in EA and there were also no differences between the CD/CU+ and CD/CU- subgroups. Participants with CD were significantly less accurate than controls in recognizing sadness, fear, and disgust, all ps < 0.050, rs ≥ 0.30, whilst the CD/CU- and CD/CU+ subgroups did not differ in emotion recognition. Participants with CD also showed affective empathy deficits for sadness, fear, and disgust relative to controls, all ps < 0.010, rs ≥ 0.33, whereas the CD/CU+ and CD/CU- subgroups did not differ in affective empathy. These results extend prior research by demonstrating affective empathy and emotion recognition deficits in adolescents with CD using a more ecologically-valid task, and challenge the view that affective empathy deficits are specific to CD/CU+.Electronic supplementary materialThe online version of this article (doi:10.1007/s10802-016-0243-8) contains supplementary material, which is available to authorized users.

We found both similarities and differences between males and females in CD-cortical structure associations. This initial evidence that the pathophysiological basis of CD may be partly sex-specific highlights the need to consider sex in future neuroimaging studies and suggests that males and females may require different treatments.

The vast personal and economic burden of mood disorders is largely caused by their under- and misdiagnosis, which is associated with ineffective treatment and worsening of outcomes. Here, we aimed to develop a diagnostic algorithm, based on an online questionnaire and blood biomarker data, to reduce the misdiagnosis of bipolar disorder (BD) as major depressive disorder (MDD). Individuals with depressive symptoms (Patient Health Questionnaire-9 score ≥5) aged 18–45 years were recruited online. After completing a purpose-built online mental health questionnaire, eligible participants provided dried blood spot samples for biomarker analysis and underwent the World Health Organization World Mental Health Composite International Diagnostic Interview via telephone, to establish their mental health diagnosis. Extreme Gradient Boosting and nested cross-validation were used to train and validate diagnostic models differentiating BD from MDD in participants who self-reported a current MDD diagnosis. Mean test area under the receiver operating characteristic curve (AUROC) for separating participants with BD diagnosed as MDD (N = 126) from those with correct MDD diagnosis (N = 187) was 0.92 (95% CI: 0.86–0.97). Core predictors included elevated mood, grandiosity, talkativeness, recklessness and risky behaviour. Additional validation in participants with no previous mood disorder diagnosis showed AUROCs of 0.89 (0.86–0.91) and 0.90 (0.87–0.91) for separating newly diagnosed BD (N = 98) from MDD (N = 112) and subclinical low mood (N = 120), respectively. Validation in participants with a previous diagnosis of BD (N = 45) demonstrated sensitivity of 0.86 (0.57–0.96). The diagnostic algorithm accurately identified patients with BD in various clinical scenarios, and could help expedite accurate clinical diagnosis and treatment of BD.

Background Web-based assessments of mental health concerns hold great potential for earlier, more cost-effective, and more accurate diagnoses of psychiatric conditions than that achieved with traditional interview-based methods. Objective The aim of this study was to assess the impact of a comprehensive web-based mental health assessment on the mental health and well-being of over 2000 individuals presenting with symptoms of depression. Methods Individuals presenting with depressive symptoms completed a web-based assessment that screened for mood and other psychiatric conditions. After completing the assessment, the study participants received a report containing their assessment results along with personalized psychoeducation. After 6 and 12 months, participants were asked to rate the usefulness of the web-based assessment on different mental health–related outcomes and to self-report on their recent help-seeking behavior, diagnoses, medication, and lifestyle changes. In addition, general mental well-being was assessed at baseline and both follow-ups using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS). Results Data from all participants who completed either the 6-month or the 12-month follow-up (N=2064) were analyzed. The majority of study participants rated the study as useful for their subjective mental well-being. This included talking more openly (1314/1939, 67.77%) and understanding one’s mental health problems better (1083/1939, 55.85%). Although most participants (1477/1939, 76.17%) found their assessment results useful, only a small proportion (302/2064, 14.63%) subsequently discussed them with a mental health professional, leading to only a small number of study participants receiving a new diagnosis (110/2064, 5.33%). Among those who were reviewed, new mood disorder diagnoses were predicted by the digital algorithm with high sensitivity (above 70%), and nearly half of the participants with new diagnoses also had a corresponding change in medication. Furthermore, participants’ subjective well-being significantly improved over 12 months (baseline WEMWBS score: mean 35.24, SD 8.11; 12-month WEMWBS score: mean 41.19, SD 10.59). Significant positive predictors of follow-up subjective well-being included talking more openly, exercising more, and having been reviewed by a psychiatrist. Conclusions Our results suggest that completing a web-based mental health assessment and receiving personalized psychoeducation are associated with subjective mental health improvements, facilitated by increased self-awareness and subsequent use of self-help interventions. Integrating web-based mental health assessments within primary and/or secondary care services could benefit patients further and expedite earlier diagnosis and effective treatment. International Registered Report Identifier (IRRID) RR2-10.2196/18453

The aim of this article is to review findings from the neurobiological, neuroimaging, and neuropsychological literature that have contributed to our understanding of the etiology and development of disruptive behavior disorders, with particular reference to conduct disorder. This review focuses on neurobiological systems such as the hypothalamic–pituitary–adrenal axis and neuroimaging evidence linking disruptive behavior disorders to changes in brain functioning or structure. Overall, this research suggests that brain areas involved in emotional processing and regulation are particularly compromised in children and adolescents with disruptive behavior disorder, which fits with evidence obtained from neuropsychological studies. This review highlights the importance of neuroscientific research in characterizing reliable brain‐based functional and structural biomarkers that may contribute to an increased understanding of, and the development of new treatments for, antisocial and aggressive behavior in children and adolescents.

Background Despite the rapidly growing number of digital assessment tools for screening and diagnosing mental health disorders, little is known about their diagnostic accuracy. Objective The purpose of this systematic review and meta-analysis is to establish the diagnostic accuracy of question- and answer-based digital assessment tools for diagnosing a range of highly prevalent psychiatric conditions in the adult population. Methods The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) will be used. The focus of the systematic review is guided by the population, intervention, comparator, and outcome framework (PICO). We will conduct a comprehensive systematic literature search of MEDLINE, PsychINFO, Embase, Web of Science Core Collection, Cochrane Library, Applied Social Sciences Index and Abstracts (ASSIA), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for appropriate articles published from January 1, 2005. Two authors will independently screen the titles and abstracts of identified references and select studies according to the eligibility criteria. Any inconsistencies will be discussed and resolved. The two authors will then extract data into a standardized form. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool, and a descriptive analysis and meta-analysis will summarize the diagnostic accuracy of the identified digital assessment tools. Results The systematic review and meta-analysis commenced in November 2020, with findings expected by May 2021. Conclusions This systematic review and meta-analysis will summarize the diagnostic accuracy of question- and answer-based digital assessment tools. It will identify implications for clinical practice, areas for improvement, and directions for future research. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020214724; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020214724. International Registered Report Identifier (IRRID) DERR1-10.2196/25382

Research on empathy in youth with Conduct Disorder (CD) has primarily focused on males, with the few studies that have investigated empathy in females relying on questionnaire measures. Our primary aim was to investigate whether females with CD show empathy deficits when using a more ecologically-valid task. We used an empathic accuracy (EA) paradigm that involved watching videos of actors recalling emotional experiences and providing continuous ratings of emotional intensity (assessing EA), naming the emotion expressed (emotion recognition), and reporting whether they shared the emotion expressed (affective empathy). We compared 23 females with CD and 29 typically-developing (TD) adolescents aged 13–18 years. The CD sample was divided into subgroups with higher (CD/CU+) versus lower (CD/CU−) levels of callous-unemotional traits. Females with CD did not differ from TD females in EA or emotion recognition but exhibited reduced affective empathy responses ( p s < 0.01, r s ≥ 0.39). The CD/CU+ and CD/CU− subgroups did not differ on any empathy measure. We also assessed for sex differences in CD-empathy associations by comparing the present data with archive data from males. CD adolescents exhibited impairments in EA relative to their TD counterparts overall ( p < 0.05, ηp 2 = 0.06), but there was no sex-by-diagnosis interaction. While females with CD were only impaired in affective empathy, males with CD exhibited emotion recognition and affective empathy deficits. This study demonstrates that females with CD show relatively specific impairments in affective empathy on an ecologically-valid task, whereas males with CD display more global empathic difficulties. Electronic supplementary material The online version of this article (10.1007/s10802-020-00659-y) contains supplementary material, which is available to authorized users.