Major Depression and Its Recurrences: Life Course Matters

Purpose In patients with ophthalmic disorders, psychosocial risk factors play an important role in morbidity and mortality. Proper and early psychiatric screening can result in prompt intervention and mitigate its impact. Because screening is resource intensive, we developed a framework for automating screening using an electronic health record (EHR)-derived artificial intelligence (AI) algorithm. Methods Subjects came from the Duke Ophthalmic Registry, a retrospective EHR database for the Duke Eye Center. Inclusion criteria included at least two encounters and a minimum of 1 year of follow-up. Presence of distress was defined at the encounter level using a computable phenotype. Risk factors included available EHR history. At each encounter, risk factors were used to discriminate psychiatric status. Model performance was evaluated using area under the receiver operating characteristic (ROC) curve and area under the precision–recall curve (PR AUC). Variable importance was presented using odds ratios (ORs). Results Our cohort included 358,135 encounters from 40,326 patients with an average of nine encounters per patient over 4 years. The ROC and PR AUC were 0.91 and 0.55, respectively. Of the top 25 predictors, the majority were related to existing distress, but some indicated stressful conditions, including chemotherapy (OR = 1.36), esophageal disorders (OR = 1.31), central pain syndrome (OR = 1.25), and headaches (OR = 1.24). Conclusions Psychiatric distress in ophthalmology patients can be monitored passively using an AI algorithm trained on existing EHR data. Translational Relevance When paired with an effective referral and treatment program, such algorithms may improve health outcomes in ophthalmology.

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“… 25 , 26 Distress was defined at the encounter level, because anxiety and depression are not permanent conditions and can be recurrent. 27 , 28 …”

Section: Methodsmentioning

confidence: 99%

A Framework for Automating Psychiatric Distress Screening in Ophthalmology Clinics Using an EHR-Derived AI Algorithm

Berchuck

Jammal

Page

et al. 2022

Trans. Vis. Sci. Tech.

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“…Moreover, the severity of each symptom can be different in each individual patient. Depression is broadly described in the literature with proposals of potential mechanisms and causes so we indicate only a couple of recently published comprehensive review articles as examples [ 65 , 66 ].…”

Section: Oxtr In Mental Disordersmentioning

confidence: 99%

Roles of the Oxytocin Receptor (OXTR) in Human Diseases

Pierzynowska

Gaffke

Żabińska

et al. 2023

IJMS

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The oxytocin receptor (OXTR), encoded by the OXTR gene, is responsible for the signal transduction after binding its ligand, oxytocin. Although this signaling is primarily involved in controlling maternal behavior, it was demonstrated that OXTR also plays a role in the development of the nervous system. Therefore, it is not a surprise that both the ligand and the receptor are involved in the modulation of behaviors, especially those related to sexual, social, and stress-induced activities. As in the case of every regulatory system, any disturbances in the structures or functions of oxytocin and OXTR may lead to the development or modulation of various diseases related to the regulated functions, which in this case include either mental problems (autism, depression, schizophrenia, obsessive-compulsive disorders) or those related to the functioning of reproductive organs (endometriosis, uterine adenomyosis, premature birth). Nevertheless, OXTR abnormalities are also connected to other diseases, including cancer, cardiac disorders, osteoporosis, and obesity. Recent reports indicated that the changes in the levels of OXTR and the formation of its aggregates may influence the course of some inherited metabolic diseases, such as mucopolysaccharidoses. In this review, the involvement of OXTR dysfunctions and OXTR polymorphisms in the development of different diseases is summarized and discussed. The analysis of published results led us to suggest that changes in OXTR expression and OXTR abundance and activity are not specific to individual diseases, but rather they influence processes (mostly related to behavioral changes) that might modulate the course of various disorders. Moreover, a possible explanation of the discrepancies in the published results of effects of the OXTR gene polymorphisms and methylation on different diseases is proposed.

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“…Depression shows affective, cognitive, motor and vegetative components [6]. The mood is depressed, there is a loss of interest or pleasure, slow thought processes, and feelings of worthlessness or inappropriate guilt are often evident [7]. The effect may be hopeless and despairing, with difficulty thinking, sadness and motor retardation.…”

Section: Masked Depressionmentioning

confidence: 99%

Evolution of Psychosomatic Diagnosis: From Masked Depression to Somatic Symptoms and Related Disorders

Prisco¹,

Donnarumma²,

Prisco³

2023

OBM Geriatr

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This paper discusses the history and the concept of somatization from masked depression to somatic symptoms and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Evaluating the evolution of these terms and concepts along the time course is very interesting. DSM 5 revision was intended to increase the relevance of these concepts in the primary care setting. “Masked depression” is a form of depression in which somatic symptoms or behavioral disturbances dominate the clinical picture. Primary care physicians often treat patients who show somatic symptoms without a biological substrate. These patients may receive unnecessary or invasive tests and procedures. An accurate psychiatric screening is essential to diagnose somatic symptoms disorder. As a result, it is very useful to establish a strong therapeutic alliance, and acknowledge and legitimize the patient’s symptoms. Cognitive behavioral therapy, mindfulness-based therapy, and pharmacotherapy are evidence-based therapies. In particular, selective serotonin reuptake inhibitors and tricyclic antidepressants have effectively alleviated somatic symptoms when there is a hidden psychological substrate.

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Major Depression and Its Recurrences: Life Course Matters

Cited by 166 publications

References 90 publications

A Framework for Automating Psychiatric Distress Screening in Ophthalmology Clinics Using an EHR-Derived AI Algorithm

A Framework for Automating Psychiatric Distress Screening in Ophthalmology Clinics Using an EHR-Derived AI Algorithm

Roles of the Oxytocin Receptor (OXTR) in Human Diseases

Evolution of Psychosomatic Diagnosis: From Masked Depression to Somatic Symptoms and Related Disorders

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