Showing papers by "Stephan F. Taylor published in 2022"

Modifying a cognitive behavioral suicide prevention treatment for adults with schizophrenia spectrum disorders in community mental health

Abstract: Suicide is among the leading causes of death for adults with schizophrenia spectrum disorders. Given a paucity of evidence-based interventions tailored for psychosis, we sought to modify a promising Cognitive-Behavioral Suicide Prevention for psychosis (CBSPp) treatment for adults in US community mental health (CMH) settings using community-based participatory research methods. This article presents our modification methodology, stakeholder data and scholarly expert input, and CBSPp adaptations prior to future intervention testing. Stakeholder data (n = 25) were collected from clients, providers, and peer advocates in a CMH setting in Michigan. Findings were subsequently presented to a panel of scholarly experts in the fields of suicide and psychosis research, intervention research, and implementation science for input. Emerging themes from stakeholders include logistic, perceptual, and clinical challenges in the process of introducing this treatment in a CMH setting. Consistent with literature, buy-in and support for the delivery of a new treatment emerged as important factors in modifying and implementing CBSPp. A final modification list is presented in this paper and collaborations among stakeholders, researchers, and scholarly experts are essential to navigate psychosocial treatment innovation barriers with an overall goal of improving access, feasibility, and quality of this suicide prevention treatment.

Mathematical modeling of risk-taking in bipolar disorder: Evidence of reduced behavioral consistency, with altered loss aversion specific to those with history of substance use disorder.

Abstract: Bipolar disorder (BD) is associated with excessive pleasure-seeking risk-taking behaviors that often characterize its clinical presentation. However, the mechanisms of risk-taking behavior are not well-understood in BD. Recent data suggest prior substance use disorder (SUD) in BD may represent certain trait-level vulnerabilities for risky behavior. This study examined the mechanisms of risk-taking and the role of SUD in BD via mathematical modeling of behavior on the Balloon Analogue Risk Task (BART). Three groups-18 euthymic BD with prior SUD (BD+), 15 euthymic BD without prior SUD (BD-), and 33 healthy comparisons (HC)-completed the BART. We modeled behavior using 4 competing hierarchical Bayesian models, and model comparison results favored the Exponential-Weight Mean-Variance (EWMV) model, which encompasses and delineates five cognitive components of risk-taking: prior belief, learning rate, risk preference, loss aversion, and behavioral consistency. Both BD groups, regardless of SUD history, showed lower behavioral consistency than HC. BD+ exhibited more pessimistic prior beliefs (relative to BD- and HC) and reduced loss aversion (relative to HC) during risk-taking on the BART. Traditional measures of risk-taking on the BART (adjusted pumps, total points, total pops) detected no group differences. These findings suggest that reduced behavioral consistency is a crucial feature of risky decision-making in BD and that SUD history in BD may signal additional trait vulnerabilities for risky behavior even when mood symptoms and substance use are in remission. This study also underscores the value of using mathematical modeling to understand behavior in research on complex disorders like BD.

Affective Dysregulation Precedes Emergence of Psychosis-Like Experiences in a Community Sample of Young Adults.

Abstract: Affective dysregulation (AD) among persons with schizophrenia spectrum disorders, involving the tendency to exhibit sensitivity to minor stress and negative affective states, is an important diagnostic feature and relates to poorer functional and clinical outcomes. Studies of persons with elevated risk for psychosis demonstrate similar AD to those with schizophrenia, and literature suggest a potential influence of AD in the transition from psychosis-like symptoms (PLEs) to disorder. Cross-sectional investigations to date have supported the link between AD and psychosis, and longitudinal studies have mostly yielded mixed findings without demonstration of potential causal relationships between AD and psychosis. This study examined the concurrent and predictive relationships between AD and PLE in a community sample of youth (n = 630) with attention to distinct facets of AD as a latent construct, including low resiliency, low reactive control, and negative emotionality, using structural equation to estimate a longitudinal cross-lagged and autoregressive model across 3 study waves from 15 to 24 years of age. As hypothesized, AD in the mid-teen years predicted subsequent PLE 3 years later. In addition, we found that increasing PLE in the end of the teen years related to a subsequent increase in AD in the early 20s. A cross-sectional relationship between AD and PLE in the mid-teen years was also supported. Findings overall describe important relationships between AD and PLE that appear to vary with developmental stage, implicating various factors to inform approaches for identifying youth who may be at risk for subsequent PLE or other mental health conditions.

Medial frontal cortex gamma-aminobutyric acid concentrations in psychosis and mood disorders: a meta-analysis of proton magnetic resonance spectroscopy studies

Abstract: Background: Abnormalities of gamma-aminobutyric acid-ergic (GABAegic) systems may play an important role in psychosis spectrum and mood disorders. Proton magnetic resonance spectroscopy allows for non-invasive in vivo quantification of GABA; however, studies of GABA in psychosis have yielded inconsistent findings. This may stem from grouping together disparate voxels from functionally heterogeneous regions. Methods: We searched the PubMed database for magnetic resonance spectroscopy studies of medial frontal cortex (MFC) GABA in patients with psychosis, bipolar disorder, depression, and individuals meeting ultra-high risk for psychosis criteria. Voxel placements were classified as rostral-, rostral-mid-, mid-, or posterior MFC, and random effects meta-analyses conducted for each group, for each MFC sub-region. Results: Of 341 screened articles, 23 studies of psychosis (752 patients,856 controls), 6 studies of bipolar disorder (129 patients, 94 controls), 20 studies of depression (463 cases, 449 controls) and 7 studies of ultra-high risk (229 patients, 232 controls) met inclusion criteria. Meta-analysis revealed lower mid- (SMD = -0.28, 95% confidence interval [CI] = -0.48 to -0.07, p < .01) and posterior (SMD = -0.29, 95% CI = -0.49 to -0.09, p <.01) MFC GABA in psychosis, and increased rostral GABA in bipolar disorder (SMD = 0.76, 95% CI = 0.25 to 1.25, p < .01). In depression, reduced rostral MFC GABA (SMD = -0.36, 95% CI = -0.64 to -0.08, p = .01) did not survive correction for multiple comparisons. Conclusions: These results substantiate the relevance in the ethology of psychosis spectrum and mood disorders and underline the importance of voxel placement.

On predictability of individual functional connectivity networks from clinical characteristics

Abstract: In recent years, understanding functional brain connectivity has become increasingly important as a scientific tool with potential clinical implications. Statistical methods, such as graphical models and network analysis, have been adopted to construct functional connectivity networks for single subjects. Here we focus on studying the association between functional connectivity networks and clinical characteristics such as psychiatric symptoms and diagnoses. Utilizing machine learning algorithms, we propose a method to examine predictability of functional connectivity networks from clinical characteristics. Our methods can identify salient clinical characteristics predictive of the whole brain network or specific subnetworks. We illustrate our methods on the analysis of fMRI data in the Philadelphia Neurodevelopmental Cohort study, demonstrating clinically meaningful results.