Background:Herein, we report on the initial development, progress, and future plans for an autonomous artificial intelligence (AI) system designed to manage major depressive disorder (MDD). The system is a web-based, patient-facing conversational AI that collects medical history, provides presumed diagnosis, recommends treatment, and coordinates care for patients with MDD.Methods:The system includes seven components, five of which are complete and two are in development. The first component is the AI’s knowledgebase, which was constructed using Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression to analyze extensive patient medical histories and identify factors influencing response to antidepressants. The second component is a series of adjustments to the knowledgebase designed to correct algorithm bias in patient subgroups. The third component is a conversational Large Language Model (LLM) that efficiently gathers patients’ medical histories. The fourth component is a dialogue management system that minimizes digressions in the LLM conversations, using a topic network statistically derived from the AI’s own knowledgebase. The fifth component is planned to enable real-time, human-in-the-loop monitoring. The sixth component is an existing analytical, non-generative module that provides and explains treatment advice. The seventh component is planned to coordinate care with clinicians via closed-loop referrals.Results:In component 1, the AI’s knowledgebase correctly predicted 69.2% to 78.5% of the variation in response to 15 oral antidepressants. Patients treated by AI-concordant clinicians were 17.5% more likely to benefit from their treatment than patients of AI-discordant clinicians. In component 2, the use of the system required adjustments to improve accuracy for predicting the responses of African Americans to four antidepressants and no adjustments were required for the remaining 10 antidepressants. In component 3, the conversational intake efficiently covered 1499 relevant medical history events (including 700 diagnoses, 550 medications, 151 procedures, and 98 prior antidepressant responses). In the fourth component, the dialogue management system was effective in maintaining a long dialogue with many turns in the conversation. In the sixth component, the advice system was able to rely exclusively on pre-set text. An online ad campaign attracted 1536 residents of Virginia to use the advice system. Initially, a focus group of clinicians was skeptical of the value of the advice system and requested more prospective studies before they would implement the system in their clinics. When the system was redesigned to advise patients at home, clinicians were willing to receive referrals from the system and discuss the advice of the system with their patients.Conclusions:Further research is needed to refine and evaluate the system. We outline our plans for a prospective randomized trial to assess the system’s impact on prescription patterns and patient outcomes.

This study assessed the effect of intermittent fasting on anxiety, depression, and connectivity of the amygdala by functional magnetic resonance imaging in healthy adults. The findings could provide insights into IF as a potential non-pharmacological intervention for anxiety, offering clinical significance as a cost-effective and accessible alternative or adjunct therapy. Twenty-six healthy adults followed a time-restricted eating regimen for 50 days, fasting for 18 hours daily. Assessments were conducted at baseline, during fasting (days 10, 30, and 50), and after fasting (days 20 and ~60). Measurements included body mass index (BMI), metabolic parameters, Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and resting-state functional magnetic resonance imaging (fMRI) connectivity of the amygdala. The BMI, glucose and insulin concentrations, insulin resistance, and anxiety scores significantly decreased during and after fasting compared to the baseline measurements (all p < 0.05), lasting for two months. Furthermore, we used the bilateral laterobasal amygdala as seed regions, which are responsible for emotional regulation and anxiety-like behaviours; we found changes in resting-state connectivity with the postcentral gyrus on fasting days 30 and 50. IF reduces anxiety by modulating amygdala functional connectivity and enhancing brain plasticity, suggesting its potential as a therapeutic approach for anxiety and related emotional disorders. The findings underscore IF's promise as an alternative or adjuvant intervention in psychiatric care. The study was registered at Clinicaltrials.gov (https://www.chictr.org.cn/showproj.html?proj=136213), registration number: ChiCTR2100052473.

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Studies investigating social cognition impairments in substance use disorders (SUD) emerged from attempts to understand the influence of social interactions on substance use. This study aimed to measure Theory of Mind (ToM) performance and possible interactions between ToM performance, personality traits, and substance use severity. Participants (n = 153) were assessed using the Reading the Mind in the Eyes, Dokuz Eylul Theory of Mind Index, Addiction Profile Index (API), Borderline Personality Questionnaire (BPQ), Basic Empathy Scale (BES), and Levenson Self-Report Psychopathy scale (LSRP). Cluster analysis identified two groups: a 'high ToM' (n = 59, 41.2%) and a 'low ToM' (n = 84, 58.8%) group. Comparative analysis showed that the API effect of substance use on life subscale scores (p = 0.033), BES total (p = 0.003), and affective empathy subscale scores (p = 0.001) were higher in the high ToM group compared with the low ToM group. Conversely, BPQ impulsivity subscale scores (p = 0.011), LSRP total (p = 0.026), and primary psychopathy subscale scores (p = 0.007) were lower in the high ToM group compared with the low ToM groups. Binary logistic regression analysis showed that lower affective empathy scores (odds ratio (OR) = 0.896, 95% confidence interval (CI) (0.818-0.982), p = 0.019) and higher primary psychopathy scores (OR = 1.099, 95% CI (1.011-1.195), p = 0.027) predicted ToM abilities in women with SUD. This study provides novel evidence that in women with SUD, affective psychopathic traits and lack of affective empathy predict lower ToM abilities. These findings suggest that intervention targeting affect-related psychopathy dimensions may be effective in alleviating ToM disabilities.

Impaired insight presents a significant obstacle in the management of bipolar disorder. Research on the insight of patients with acute bipolar mania is lacking. The aim of this study was to provide understanding of patient insight in acute bipolar mania. A total of 52 inpatients who were diagnosed with bipolar disorder during a manic episode were included in the study. The Insight Scale for Affective Disorders (ISAD) was utilized, with high scores indicating poor insight. The Self-Appraisal of Illness Questionnaire (SAIQ) was used to assess patient attitudes and treatment experiences, with higher scores reflecting greater insight. Associated factors were identified through Pearson correlation and multiple linear regression analyses. A low ISAD score was correlated with older age (p = 0.003), an extended duration of illness (p = 0.007), presence of a medical comorbidity (p = 0.012), and low scores on the Clinical Global Impressions-Severity (CGI-S) scale (p < 0.001), Clinical Global Impressions-Improvement (CGI-I) scale (p < 0.001), Young Mania Rating Scale (YMRS) (p < 0.001), and Frontal Assessment Battery (FAB) scale (p = 0.007). Multiple linear regression analysis revealed that the presence of a medical comorbidity (p = 0.031), low YMRS scores (p < 0.001), and low CGI-S scale scores (p = 0.044) were associated with low ISAD scores. Inpatients diagnosed with acute bipolar mania, a medical comorbidity, milder disease, and less severe manic symptoms had better insight. Patients with severe symptoms affecting motor activity, energy levels, sexual interest, sleep, and speech rates had less insight.

The Coronavirus disease 2019 (COVID-19) pandemic caused a range of mental health problems, particularly self-harm. Lockdowns are the usual methods of responding to these public health emergencies. However, the effect of the COVID-19 lockdown on self-harm remains poorly characterized. This study aimed to investigate the influence of the COVID-19 pandemic on the incidence of self-harm. The findings may inform future policy development and strategies for managing pandemic-related mental health challenges. A meta-analysis was conducted using several database searches: APA PsycINFO, Embase, PubMed, Web of Science, CNKI, and Wan Fang. Published studies with data on the incidence of self-harm during visits to medical institutions, before and during the COVID-19 pandemic, were included. The pooled risk ratio (RR) value of self-harm incidence variation before and during the COVID-19 lockdown period, expressed as the comparison of clinical institution visits before and during the pandemic, was calculated. Fifteen retrospective cohort studies with observational designs involving 253,600 participants were included. The pooled RR value of self-harm incidence variation was 1.386 (95% confidence interval (CI), 1.205-1.595, I2 = 58.9%, p = 0.002). The subgroup analysis showed that "emergency department type" (p = 0.004) and "mean age of the sample" were the sources of the RR values' heterogeneity (p = 0.026). Our findings suggest that the lockdown during the COVID-19 pandemic was a risk factor for self-harm. Therefore, special attention should be paid to individuals visiting the emergency department and the middle-aged and elderly populations. This study was registered in PROSPERO (CRD42023373026), https://www.crd.york.ac.uk/PROSPERO/view/CRD42023373026.

Social support is recognized as a critical factor in both the prevention and management of Major depression Disorder (MDD), and can influence interoceptive processes. The mechanism of sex differences in the association between social support and MDD has not been clarified. This study was to elucidate the mechanism of sex differences in the association between social support and MDD by a mediation analysis with interoception mediator. Participants included 390 depressed patients (male/female: 150/240). Social Support Rating Scale (SSRS) was used to assess the degree of social support; Multidimensional Assessment of Interoceptive Awareness (MAIA-2C) was used to evaluate the interoception; Patient Health Questionnaire-9 (PHQ-9) was used to assess depression status. The pairwise correlated variables were put into the mediation model for the mediation analysis. The depression status in female depressed patients was more severity than that in male depressed patients, while the social support in female depressed patients was less than that in male depressed patients. In male depressed patients, the Noticing of MAIA-2C plays a partial mediating role in social support and depression status, however, in female depressed patients, the Self-Regulation and Trusting of MAIA-2C plays a partial mediating role in social support and depression status. The female depressed patients receive significantly less social support than male counterparts, contributing to more severe symptoms, with the quality and adequacy of social support being crucial due to its mediation by interoception, highlighting a biological mechanism behind MDD. Differences in how interoception mediating role between genders suggest a physiological reason for the heightened severity of depressive symptoms in females.

The factors contributing to adolescents' views of self can be complex and idiosyncratic. Self-esteem can hinge upon a narrow or broad set of factors, depending on how the adolescent conceptualizes the self. The present study examines how narrow and broad views of self may be differentially related to measures of depression severity and suicide risk among adolescents. In total, 90 adolescent psychiatric inpatients were evaluated while hospitalized during a major depressive episode. All patients completed the Children's Depression Inventory, the Hopelessness Scale for Children, the Rosenberg Self-Esteem Scale, and the Self-Esteem Worksheet-an idiographic measure that allows each person to rate the importance and success related to enter their personal values and priorities. Compared to depressed adolescent inpatients, depressed and suicidal teens reported significantly higher levels of depression and hopelessness, along with significantly lower levels of self-esteem on both measures of self-esteem. Further, lower scores on the Self-Esteem Worksheet were associated with more severe depression, elevated hopelessness, and elevated suicidal ideation. The Self-Esteem Worksheet provides insights into the mind of vulnerable teens that may help to guide treatment and prevention efforts.

Compared to the general population, individuals with substance use disorders (SUD) report more frequently to suffer from sleep disturbances and symptoms of depression, and to perceive lower social support. Here, we investigated whether this pattern of mental health issues could be confirmed and replicated among individuals with amphetamine use disorder (AUD). We also assessed the degree of perceived social support from their families, friends and significant others, always compared to healthy controls (HC) of the general population. Individuals with AUD attending the Outpatient Department for Substance Abuse of the Kermanshah University of Medical Sciences (Kermanshah, Iran) (n = 468; 30.8% females; mean age: 29.16 years) and healthy controls (HC; n = 376; 34.6% females; mean age: 24.11 years) participated in the study. Participants completed a series of self-rating questionnaires covering sociodemographic information, symptoms of insomnia and depression, and perceived social support from their families, friends and significant others. Compared to HC, individuals with AUD reported higher scores for insomnia and depression, and lower scores for perceived social support (families; friends; significant others). Older age and higher severity scores for depression and insomnia were the predictors in the binary logistic regression model to identify individuals with AUD and HC with a precision of 97.4%. Individuals with AUD additionally suffer from insomnia and depression, along with lower perceived social support. Given that standardized intervention programs for insomnia, depression and social competencies exist, such interventions might mitigate mental health issues among individuals with AUD and improve their psychosocial behavior.

To investigate the association between repetitive negative thinking and depression as well as feeding status at 3 and 6 months postpartum. One hundred and twenty-eight pregnant women recruited by the hospital from January 2020 to June 2022 were selected for the study. General demographic data of pregnant women, the multiple Persistent Thinking Questionnaire (PTQ), the Edinburgh Postnatal Depression Scale (EPDS) at 3 and 6 months postpartum, and breastfeeding status were collected. According to PTQ scores, the pregnant women were divided into high subgroup (scores ≥30) and low subgroup (scores <30). Intergroup comparisons of continuous variables following a normal distribution were performed using the t-test, while categorical data were analyzed using the χ2 test. Spearman correlation analysis was conducted to examine the relationship between PTQ, EPDS, and breastfeeding status. EPDS scores were higher in the high group than in the low group at 3 and 6 months postpartum (p < 0.001). The breastfeeding rates in the high group were lower than that in the low group at 3 and 6 months postpartum (p < 0.001). Higher PTQ scores were associated with postpartum depression at 3 and 6 months (r = 0.379, p < 0.001; r = 0.358, p < 0.001) and lower breastfeeding rates (r = -0.346, p < 0.001; r = -0.353, p < 0.001). Higher PTQ scores are associated with increased postpartum depression and reduced breastfeeding rates at 3 and 6 months postpartum, suggesting that repetitive negative thinking may be related to postpartum mental health and feeding outcomes.