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"McNally, Richard J"
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A Complex Network Perspective on Clinical Science
Contemporary classification systems for mental disorders assume that abnormal behaviors are expressions of latent disease entities. An alternative to the latent disease model is the complex network approach. Instead of assuming that symptoms arise from an underlying disease entity, the complex network approach holds that disorders exist as systems of interrelated elements of a network. This approach also provides a framework for the understanding of therapeutic change. Depending on the structure of the network, change can occur abruptly once the network reaches a critical threshold (the tipping point). Homogeneous and highly connected networks often recover more slowly from local perturbations when the network approaches the tipping point, potentially making it possible to predict treatment change, relapse, and recovery. In this article, we discuss the complex network approach as an alternative to the latent disease model and its implications for classification, therapy, relapse, and recovery.
Journal Article
Social Anxiety Disorder as a Densely Interconnected Network of Fear and Avoidance for Social Situations
The hallmark symptoms of social anxiety disorder (SAD) are fear and avoidance of social evaluative situations. Yet, even people without SAD sometimes fear and avoid certain social situations without ever developing the disorder. Apart from differences in number and severity, uncertainty abounds about how fear and avoidance of distinct interpersonal and social evaluative situations organize differently in people with and without SAD. Inspired by novel network approaches to psychopathology, we sought to characterize the network structure of fear and avoidance of distinct social evaluative situations among individuals with (n = 238) and without SAD (n = 232). Although the network structure and node centrality metrics did not differ between the groups, the network for those with SAD was more strongly interconnected than that of people free of the diagnosis. This study is the first to provide evidence that SAD can be conceptualized as a densely interconnected network of fear and avoidance of social situations. Our results are consistent with the network theory of mental disorders that regards networks with strong between-symptom connections as more pathogenic than similar networks with weaker connections. As prior studies indicated that overall network connectivity can predict the course of mental disorders, our findings set the scene for novel indicators of SAD prognosis.
Journal Article
Network analysis of multivariate data in psychological science
In recent years, network analysis has been applied to identify and analyse patterns of statistical association in multivariate psychological data. In these approaches, network nodes represent variables in a data set, and edges represent pairwise conditional associations between variables in the data, while conditioning on the remaining variables. This Primer provides an anatomy of these techniques, describes the current state of the art and discusses open problems. We identify relevant data structures in which network analysis may be applied: cross-sectional data, repeated measures and intensive longitudinal data. We then discuss the estimation of network structures in each of these cases, as well as assessment techniques to evaluate network robustness and replicability. Successful applications of the technique in different research areas are highlighted. Finally, we discuss limitations and challenges for future research.Network analysis allows the investigation of complex patterns and relationships by examining nodes and the edges connecting them. Borsboom et al. discuss the adoption of network analysis in psychological research.
Journal Article
A Bayesian network analysis of posttraumatic stress disorder symptoms in adults reporting childhood sexual abuse
Background: The network approach to mental disorders offers a novel framework for conceptualizing posttraumatic stress disorder (PTSD) as a causal system of interacting symptoms.
Objective: In this study, we extended this work by estimating the structure of relations among PTSD symptoms in adults reporting personal histories of childhood sexual abuse (CSA; N = 179).
Method: We employed two complementary methods. First, using the graphical LASSO, we computed a sparse, regularized partial correlation network revealing associations (edges) between pairs of PTSD symptoms (nodes). Next, using a Bayesian approach, we computed a directed acyclic graph (DAG) to estimate a directed, potentially causal model of the relations among symptoms.
Results: For the first network, we found that physiological reactivity to reminders of trauma, dreams about the trauma, and lost of interest in previously enjoyed activities were highly central nodes. However, stability analyses suggest that these findings were unstable across subsets of our sample. The DAG suggests that becoming physiologically reactive and upset in response to reminders of the trauma may be key drivers of other symptoms in adult survivors of CSA.
Conclusions: Our study illustrates the strengths and limitations of these network analytic approaches to PTSD.
Journal Article
Colonoscopy quality measures: experience from the NHS Bowel Cancer Screening Programme
ObjectivesColonoscopy is central to colorectal cancer (CRC) screening. Success of CRC screening is dependent on colonoscopy quality. The NHS Bowel Cancer Screening Programme (BCSP) offers biennial faecal occult blood (FOB) testing to 60–74 year olds and colonoscopy to those with positive FOB tests. All colonoscopists in the screening programme are required to meet predetermined standards before starting screening and are subject to ongoing quality assurance. In this study, the authors examine the quality of colonoscopy in the NHS BCSP and describe new and established measures to assess and maintain quality.DesignThe NHS BCSP database collects detailed data on all screening colonoscopies. Prospectively collected data from the first 3 years of the programme (August 2006 to August 2009) were analysed. Colonoscopy quality indicators (adenoma detection rate (ADR), polyp detection rate, colonoscopy withdrawal time, caecal intubation rate, rectal retroversion rate, polyp retrieval rate, mean sedation doses, patient comfort scores, bowel preparation quality and adverse event incidence) were calculated along with measures of total adenoma detection.Results2 269 983 individuals returned FOB tests leading to 36 460 colonoscopies. Mean unadjusted caecal intubation rate was 95.2%, and mean withdrawal time for normal procedures was 9.2 min. The mean ADR per colonoscopist was 46.5%. The mean number of adenomas per procedure (MAP) was 0.91; the mean number of adenomas per positive procedure (MAP+) was 1.94. Perforation occurred after 0.09% of procedures. There were no procedure-related deaths.ConclusionsThe NHS BCSP provides high-quality colonoscopy, as demonstrated by high caecal intubation rate, ADR and comfort scores, and low adverse event rates. Quality is achieved by ensuring BCSP colonoscopists meet a high standard before starting screening and through ongoing quality assurance. Measuring total adenoma detection (MAP and MAP+) as adjuncts to ADR may further enhance quality assurance.
Journal Article
Choose Wisely! – Considering the Perceived Threat in the Selection of Trauma Film Clips May Improve the Ecological Validity of the Trauma Film Paradigm
BackgroundThe trauma film paradigm (TFP) is the gold standard experimental psychopathology model of psychological trauma. However, different film clips with distinct effects on trauma-analogue symptoms are used across TFP studies, raising questions about the generalizability of study-specific results and the ecological validity of the TFP. Little is known about differences among film clips commonly used in the TFP regarding key features of psychological trauma (i.e., threat and anxiety) and their veridicality.MethodsThirty healthy participants watched eight trauma film clips in randomized order and subsequently rated each in view of perceived threat, anxiety, and realism. In addition to descriptive statistics, variance analyses and pairwise comparisons were performed to test for differences on these outcomes.ResultsThe results indicated significant differences among the trauma film clips in terms of perceived threat and realism. However, nearly all trauma film clips evoked moderate anxiety levels.ConclusionsThis study stressed the importance of perceived threat as a key feature in selecting film clips for the TFP, as highly threatening film clips were also perceived as more realistic. When replicated using delayed outcomes (e.g., intrusive memories), choosing trauma film clips in view of their perceived threat might improve the ecological validity of the TFP.
Journal Article
Network analysis: An overview for mental health research
Network approaches to psychopathology have become increasingly common in mental health research, with many theoretical and methodological developments quickly gaining traction. This article illustrates contemporary practices in applying network analytical tools, bridging the gap between network concepts and their empirical applications. We explain how we can use graphs to construct networks representing complex associations among observable psychological variables. We then discuss key network models, including dynamic networks, time‐varying networks, network models derived from panel data, network intervention analysis, latent networks, and moderated models. In addition, we discuss Bayesian networks and their role in causal inference with a focus on cross‐sectional data. After presenting the different methods, we discuss how network models and psychopathology theories can meaningfully inform each other. We conclude with a discussion that summarizes the insights each technique can provide in mental health research.
Journal Article
Points of contact between network psychometrics and experimental psychopathology
Experimental psychology has long embodied the quest to identify the causes of psychopathology. This venerable tradition has been joined in this quest by network theory, a novel approach to conceptualizing episodes of disorder as emerging from complex systems characterized by dynamic interactions of symptoms. Although issuing from the correlational, psychometric tradition rather than the experimental one, it nevertheless offers methods for identifying symptom targets for clinical experimental intervention. The purpose of this article is to sketch the points of contact between network psychometrics and experimental psychopathology.
Journal Article
Clinical prevalence of Lewy body dementia
Background
The prevalence of dementia with Lewy bodies (DLB) and dementia in Parkinson’s disease (PDD) in routine clinical practice is unclear. Prevalence rates observed in clinical and population-based cohorts and neuropathological studies vary greatly. Small sample sizes and methodological factors in these studies limit generalisability to clinical practice.
Methods
We investigated prevalence in a case series across nine secondary care services over an 18-month period, to determine how commonly DLB and PDD cases are diagnosed and reviewed within two regions of the UK.
Results
Patients with DLB comprised 4.6% (95% CI 4.0–5.2%) of all dementia cases. DLB was represented in a significantly higher proportion of dementia cases in services in the North East (5.6%) than those in East Anglia (3.3%; χ
2
= 13.6,
p
< 0.01). DLB prevalence in individual services ranged from 2.4 to 5.9%. PDD comprised 9.7% (95% CI 8.3–11.1%) of Parkinson’s disease cases. No significant variation in PDD prevalence was observed between regions or between services.
Conclusions
We found that the frequency of clinical diagnosis of DLB varied between geographical regions in the UK, and that the prevalence of both DLB and PDD was much lower than would be expected in this case series, suggesting considerable under-diagnosis of both disorders. The significant variation in DLB diagnostic rates between these two regions may reflect true differences in disease prevalence, but more likely differences in diagnostic practice. The systematic introduction of more standardised diagnostic practice could improve the rates of diagnosis of both conditions.
Journal Article