Differences among Research Domain Criteria score trajectories by Diagnostic and Statistical Manual categorical diagnosis during inpatient hospitalization

Abstract

With brief psychiatric hospitalizations, the extent to which symptoms change is rarely characterized. We sought to understand symptomatic changes across Research Domain Criteria (RDoC) dimensions, and the extent to which such improvement might be associated with risk for readmission. We identified 3,634 individuals with 4,713 hospital admissions to the psychiatric inpatient unit of a large academic medical center between 2010 and 2015. We applied a natural language processing tool to extract estimates of the five RDoC domains to the admission note and discharge summary and calculated the change in each domain. We examined the extent to which symptom domains changed during admission, and their relationship to baseline clinical and sociodemographic features, using linear regression. Symptomatic worsening was rare in the negative valence (0.4%) and positive valence (5.1%) domains, but more common in cognition (25.8%). Most diagnoses exhibited improvement in negative valence, which was associated with significant reduction in readmission risk. Despite generally brief hospital stays, we detected reduction across multiple symptom domains, with greatest improvement in negative symptoms, and greatest probability of worsening in cognitive symptoms. This approach should facilitate investigations of other features or interventions which may influence pace of clinical improvement.

Mood Disorders and Outcomes of COVID-19 Hospitalizations

“…This method utilizes an expert-curated set of tokens associated with the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) domains, informed by the NIMH RDoC Workgroup statements and expanded to include synonyms commonly found in health care notes. These estimated RDoC domain scores have been validated against clinician review and shown to predict longitudinal outcomes in psychiatric and nonpsychiatric populations (17)(18)(19), from emergency department, admission, and discharge notes (20,21). For this study, we investigated negative valence (primarily anxiety and depressive symptoms), positive valence (substance use, impulsivity, and mania), and global cognition.…”

Characteristics of Dimensional Psychopathology in Suicidal Patients With Major Psychiatric Disorders and Its Association With the Length of Hospital Stay: Algorithm Validation Study

“…The depression group showed the highest negative valence scores among the disorder groups. Previous studies comparing the distribution of domains by diagnosis also showed differences in the negative valence scores for depression and bipolar disorder, and depression and schizophrenia [ 18 ]. Our findings not only confirm the previously established association between negative valence and suicide [ 19 ] but also suggest that negative valence is particularly associated with depression.…”

Dimensional clinical phenotyping using post‐mortem brain donor medical records: post‐mortem RDoC profiling is associated with Alzheimer's disease neuropathology

“…The domain‐specific symptom burden can be estimated from patient medical records using NLP 28,32,33 . RDoC symptom burdens estimated from medical records by NLP have been associated with genetic variants and clinical outcomes including suicide, hospital use, new dementia diagnosis, and progression from dementia diagnosis to death 34–36 …”

“…28,32,33 RDoC symptom burdens estimated from medical records by NLP have been associated with genetic variants and clinical outcomes including suicide, hospital use, new dementia diagnosis, and progression from dementia diagnosis to death. [34][35][36] We put forward that application of NLP-based methodologies to human brain post-mortem studies may represent a significant step toward a more current and translatable interpretation of molecular and cellular read-outs in the context of transdiagnostic clinical domains and symptom constructs. As a first step toward assessing the feasibility and validity of this approach, we focused on Alzheimer's disease (AD), a disease with distinct symptoms and well-established neuropatho- Neuritic plaques (NP), formed by Aβ plaques containing DNs, are considered a pathologic hallmark of AD.…”