Monday, November 13, 2023

ChatGPT may be better than doctors at evidence-based management of clinical depression

severe depression — Credit: Unsplash/CC0 Public Domain

ChatGPT, the AI language model capable of mirroring human conversation, may be better than a doctor at following recognized treatment standards for clinical depression, and without any of the gender or social class biases sometimes seen in the primary care doctor-patient relationship, finds research published in the open access journal Family Medicine and Community Health.

13 nov 2023--However, further research is needed into how well this technology might manage severe cases as well as potential risks and ethical issues arising from its use, say the researchers.

Depression is very common, and many of those affected turn first to their family (primary care) doctors for help. The recommended course of treatment should largely be guided by evidence-based clinical guidelines, which usually suggest a tiered approach to care, in line with the severity of the depression.

ChatGPT has the potential to offer fast, objective, data-derived insights that can supplement traditional diagnostic methods as well as providing confidentiality and anonymity, say the researchers. They therefore wanted to find out how the technology evaluated the recommended therapeutic approach for mild and severe major depression and whether this was influenced by gender or social class biases, when compared with 1,249 French primary care doctors (73% women).

The researchers drew on carefully designed and previously validated vignettes, centering around patients with symptoms of sadness, sleep problems, and loss of appetite during the preceding three weeks and a diagnosis of mild to moderate depression.

Eight versions of these vignettes were developed with different variations of patient characteristics, such as gender, social class, and depression severity. Each vignette was repeated 10 times for ChatGPT versions 3.5 and 4.

For each of the eight vignettes, ChatGPT was asked, "What do you think a primary care physician should suggest in this situation?" The possible responses were watchful waiting; referral for psychotherapy; prescribed drugs (for depression/anxiety/sleep problems); referral for psychotherapy plus prescribed drugs; none of these.

Only just over 4% of family doctors exclusively recommended referral for psychotherapy for mild cases in line with clinical guidance, compared with ChatGPT-3.5 and ChatGPT-4, which selected this option in 95% and 97.5% of cases, respectively.

Most of the medical practitioners proposed either drug treatment exclusively (48%) or psychotherapy plus prescribed drugs (32.5%).

In severe cases, most of the doctors recommended psychotherapy plus prescribed drugs (44.5%). ChatGPT proposed this more frequently than the doctors (72%, ChatGPT 3.5; 100%, ChatGPT 4 in line with clinical guidelines). Four out of 10 of the doctors proposed prescribed drugs exclusively, which neither ChatGPT version recommended.

When medication was recommended, the AI and human participants were asked to specify which types of drugs they would prescribe.

The doctors recommended a combination of antidepressants and anti-anxiety drugs and sleeping pills in 67.5% of cases, exclusive use of antidepressants in 18%, and exclusive use of anti-anxiety and sleeping pills in 14%.

ChatGPT was more likely than the doctors to recommend antidepressants exclusively: 74%, version 3.5; and 68%, version 4. ChatGPT-3.5 (26%) and ChatGPT-4 (32%) also suggested using a combination of antidepressants and anti-anxiety drugs and sleeping pills more frequently than did the doctors.

But unlike the findings of previously published research, ChatGPT didn't exhibit any gender or social class biases in its recommended treatment.

The researchers acknowledge that the study was limited to iterations of ChatGPT-3 and ChatGPT-4 at specific points in time and that the ChatGPT data were compared with data from a representative sample of primary care doctors from France, so might not be more widely applicable.

Lastly, the cases described in the vignettes were for an initial visit due to a complaint of depression, so didn't represent ongoing treatment of the disease or other variables that the doctor would know about the patient.

"ChatGPT-4 demonstrated greater precision in adjusting treatment to comply with clinical guidelines. Furthermore, no discernible biases related to gender and [socioeconomic status] were detected in the ChatGPT systems," highlight the researchers.

But there are ethical issues to consider, particularly around ensuring data privacy and security which are supremely important, considering the sensitive nature of mental health data, they point out, adding that AI shouldn't ever be a substitute for human clinical judgment in the diagnosis or treatment of depression.

Nevertheless, they conclude, "The study suggests that ChatGPT…. has the potential to enhance decision making in primary health care. However, it underlines the need for ongoing research to verify the dependability of its suggestions. Implementing such AI systems could bolster the quality and impartiality of mental health services."

More information: Identifying depression and its determinants upon initiating treatment: ChatGPT versus primary care physicians, Family Medicine and Community Health (2023). DOI: 10.1136/fmch-2023-002391

Fluctuating blood pressure: A warning sign for dementia and heart disease

by University of South Australia

A new study by Australian researchers has shown that fluctuating blood pressure can increase the risk of dementia and vascular problems in older people.

13 nov 2023--Short blood pressure (BP) fluctuations within 24 hours as well as over several days or weeks are linked with impaired cognition, say University of South Australia (UniSA) researchers who led the study.

Higher systolic BP variations (the top number that measures the pressure in arteries when a heart beats) are also linked with stiffening of the arteries, associated with heart disease.

The findings have been published in the journal Cerebral Circulation—Cognition and Behaviour.

Lead author Daria Gutteridge, a Ph.D. candidate based in UniSA's Cognitive Aging and Impairment Neuroscience Laboratory (CAIN), says it's well known that high blood pressure is a risk factor for dementia, but little attention is paid to fluctuating blood pressure.

"Clinical treatments focus on hypertension, while ignoring the variability of blood pressure," Gutteridge says.

"Blood pressure can fluctuate across different time frames—short and long—and this appears to heighten the risk of dementia and blood vessel health."

To help explore the mechanisms that link BP fluctuations with dementia, UniSA researchers recruited 70 healthy older adults aged 60–80 years, with no signs of dementia or cognitive impairment.

Their blood pressure was monitored, they completed a cognitive test, and their arterial stiffness in the brain and arteries was measured using transcranial doppler sonography and pulse wave analysis.

"We found that higher blood pressure variability within a day, as well as across days, was linked with reduced cognitive performance. We also found that higher blood pressure variations within the systolic BP were linked with higher blood vessel stiffness in the arteries.

"These results indicate that the different types of BP variability likely reflect different underlying biological mechanisms, and that systolic and diastolic blood pressure variation are both important for cognitive functioning in older adults."

The links were present in older adults without any clinically relevant cognitive impairment, meaning that BP variability could potentially serve as an early clinical marker or treatment target for cognitive impairment, the researchers say.

More information: D.S. Gutteridge et al, Cross-sectional associations between short and mid-term blood pressure variability, cognition, and vascular stiffness in older adults, Cerebral Circulation—Cognition and Behavior (2023). DOI: 10.1016/j.cccb.2023.100181

Tai chi may curb Parkinson's disease symptoms and complications for several years

by British Medical Journal

Tai chi, the Chinese martial art that involves sequences of very slow controlled movements, may curb the symptoms and complications of Parkinson's disease for several years, reveals research published online in the Journal of Neurology Neurosurgery & Psychiatry.

13 nov 2023--Its practice was associated with slower disease progression and lower doses of required drugs over time, the findings show.

Parkinson's disease is a debilitating and progressive neurodegenerative disorder, characterized by slowness of movement, resting tremor, and stiff and inflexible muscles. It is the fastest growing neurological condition in the world, with the numbers of those affected projected to reach nearly 5 million by 2030 in China alone. In the UK, two people are diagnosed with the disease every hour according to the charity Parkinson's UK.

As yet, there is no cure for Parkinson's, and while drugs can improve clinical symptoms, they don't treat all the manifestations of the disease. There's no evidence that they slow progression either, explain the researchers. Previously published research suggests that tai chi eases Parkinson's symptoms in the short term, but whether this improvement can be sustained over the long term isn't known.

In a bid to find out, the researchers monitored two groups of patients with Parkinson's disease for more than five years from January 2016 to June 2021.

One group of 147 patients practiced tai chi twice a week for an hour, aided by the provision of classes to improve their technique. The other group of 187 patients continued with their standard care, but didn't practice tai chi.

Disease severity was formally assessed in all the participants at the start of the monitoring period, and disease progression, including increases in the need for medication, were subsequently monitored in November 2019, October 2020, and June 2021.

The extent of movement and other symptoms, such as autonomic nervous system function (to include bowel movements, urinary and cardiovascular issues); mood, sleep quality, and cognition; and the prevalence of complications, such as dyskinesia (involuntary movement); dystonia (abnormal muscle tone); decline in responsiveness to drug treatment over time; mild cognitive impairment; hallucinations; restless leg syndrome were also tracked, using validated scales.

Disease severity, medication use, sex, age, and education level, were similar in both groups.

Disease progression was slower at all monitoring points in the tai chi group, as assessed by three validated scales to assess overall symptoms, movement, and balance.

The number of patients who needed to increase their medication in the comparison group was also significantly higher than it was in the tai chi group: 83.5% in 2019 and just over 96% in 2020 compared with 71% and 87.5%, respectively.

Cognitive function deteriorated more slowly in the tai chi group as did other non-movement symptoms, while sleep and quality of life continuously improved.

And the prevalence of complications was significantly lower in the tai chi group than in the comparison group: dyskinesia 1.4% vs. 7.5%; dystonia 0% vs. 1.6%; hallucinations 0% vs. just over 2%; mild cognitive impairment 3% vs. 10%; restless leg syndrome 7% vs. 15.5%.

Falls, dizziness, and back pain were the three side effects reported by study participants, but these were all significantly lower in the tai chi group. While 23 people sustained a fracture, these all occurred during routine daily life and were fewer in the tai chi group: 6 vs. 17.

This is an observational study, and as such, can't establish cause and effect. The researchers also acknowledge that the number of study participants was relatively small and they weren't randomly assigned to their group.

But they conclude, "Our study has shown that tai chi retains the long-term beneficial effect on [Parkinson's disease], indicating the potential disease-modifying effects on both motor and non-motor symptoms, especially gait, balance, autonomic symptoms and cognition."

They add, "[Parkinson's disease] can worsen motor function and non-motor symptoms progressively with time, resulting in disability and influencing the quality of life. The long-term beneficial effect on [the disease] could prolong the time without disability, leading to a higher quality of life, a lower burden for caregivers, and less drug usage."

More information: Effect of long-term Tai Chi training on Parkinson's disease: a 3.5-year follow-up cohort study, Journal of Neurology Neurosurgery & Psychiatry (2023). DOI: 10.1136/jnnp-2022-330967

Mediterranean diet plus exercise burns fat, adds muscle

by Denise Mann

Rich in colorful fruits and vegetables, healthy fats and lean proteins, a Mediterranean style of eating consistently earns accolades for its long list of health benefits, including the prevention of heart disease and diabetes.

13 nov 2023--Now, new research from Spain shows this way of eating, when combined with regular exercise and fewer calories, can slash dangerous belly fat in older folks while helping to preserve their muscle mass.

Fat that accumulates around the midsection is known to cause inflammation and has been linked to heart disease, stroke, diabetes and some forms of cancer. Muscle mass is known to decline with advancing age, and this can lead to weakness, less mobility and a greater chance of falls.

The study, led by researcher Dora Romaguera, from the Health Research Institute of the Balearic Islands, included just over 1,500 middle-aged and older people who were overweight or obese and had metabolic syndrome, a cluster of disorders that signal a person's increased risk of diabetes, heart disease and stroke.

One group of people followed a Mediterranean diet while cutting their calories by 30% and increasing their physical activity. They were also told to limit their consumption of processed foods, meats, butter, added sugar and to eat more whole grains. But the advice did not stop with food: They were also encouraged to increase their physical activity progressively, with a goal of walking 45 minutes per day or more on six days per week, along with exercises to improve strength.

A second group of people followed a Mediterranean diet without calorie restrictions or changes in physical activity.

Folks who reduced their calories and got regular exercise while adhering to a Mediterranean diet showed decreases in the belly and total fat, and they kept much of it off for three years.

In contrast, people in the other group did not see any changes in belly fat.

Both groups did gain some lean muscle mass, but the folks in the exercise plus calorie restriction arm lost more fat than muscle.

The study, published Oct. 23 in the journal JAMA Network Open, presents the three-year results of an ongoing eight-year study designed to see if this style of eating can slash the risk for heart attack and stroke.

Two experts were not surprised the combination did the trick.

"This is an ambitious and elegant study," said Cewin Chao, director of clinical nutrition services at Montefiore Health System in New York City. "If you eat a high-quality diet, exercise and reduce calories, you will lose more body fat, especially the more dangerous deeper fat around the belly area surrounding your organs, and preserve more muscle. These investments do look like they will pay off at the three-year mark."

"If you reduce your calorie intake and increase your physical activity, you will lose weight. This works every time," said Marion Nestle, a retired professor of nutrition, food studies and public health at New York University in New York City.

"People following a Mediterranean diet… are able to maintain a reduced calorie intake and better calorie balance for the three years of the study," said Nestle. "This kind of diet is associated with all kinds of good health and is highly recommended."

More information: Jadwiga Konieczna et al, An Energy-Reduced Mediterranean Diet, Physical Activity, and Body Composition, JAMA Network Open (2023). DOI: 10.1001/jamanetworkopen.2023.37994

Intermittent fasting is safe, effective for those with type 2 diabetes, suggests new study

by Emily Stone, University of Illinois at Chicago

Time-restricted eating, also known as intermittent fasting, can help people with type 2 diabetes lose weight and control their blood sugar levels, according to a new study published in JAMA Network Open from researchers at the University of Illinois Chicago.

13 nov 2023--Participants who ate only during an eight-hour window between noon and 8 p.m. each day actually lost more weight over six months than participants who were instructed to reduce their calorie intake by 25%. Both groups had similar reductions in long-term blood sugar levels, as measured by a test of hemoglobin A1C, which shows blood sugar levels over the past three months.

The study was conducted at UIC and enrolled 75 participants into three groups: those who followed the time-restricted eating rules, those who reduced calories and a control group. Participants' weight, waist circumference, blood sugar levels and other health indicators were measured over the course of six months.

Senior author Krista Varady said that participants in the time-restricted eating group had an easier time following the regime than those in the calorie-reducing group. The researchers believe this is partly because patients with diabetes are generally told to cut back on calories by their doctors as a first line of defense, so many of these participants likely had already tried—and struggled with—that form of dieting. And while the participants in the time-restricted eating group were not instructed to reduce their calorie intake, they ended up doing so by eating within a fixed window.

"Our study shows that time-restricted eating might be an effective alternative to traditional dieting for people who can't do the traditional diet or are burned out on it," said Varady, a professor of kinesiology and nutrition. "For many people trying to lose weight, counting time is easier than counting calories."

There were no serious adverse events reported during the six-month study. Occurrences of hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) did not differ between the diet groups and control groups.

Today, one in 10 U.S. residents has diabetes, and that number is expected to rise to one in three by 2050 if current trends continue, the researchers explain. Finding more options for controlling weight and blood sugar levels for these patients, therefore, is crucial.

Just over half the participants in the study were Black and another 40% were Hispanic. This is notable as diabetes is particularly prevalent among those groups, so having studies that document the success of time-restricted eating for them is particularly useful, the researchers said.

The study was small and should be followed up by larger ones, said Varady, who is also a member of the University of Illinois Cancer Center. While it acts as a proof of concept to show that time-restricted eating is safe for those with type 2 diabetes, Varady said people with diabetes should consult their doctors before starting this sort of diet.

More information: Krista Varady et al, Effect of Time-Restricted Eating onWeight Loss in Adults With Type 2 Diabetes A Randomized Clinical Trial, JAMA Network Open (2023). DOI: 10.1001/jamanetworkopen.2023.39337

Newly published updates on hypertensive heart disease burden in older adults

by Cactus Communications

High blood pressure, also called hypertension, has become quite a common health problem among adults worldwide, with over one billion cases reported in 2019. When blood pressure is not properly controlled, the heart undergoes adaptive changes at the macroscopic and microscopic levels, affecting its valves, chambers, and muscles. This condition, known as hypertensive hearth disease (HHD), can cause permanent remodeling of the heart over time, affecting its normal function and ultimately leading to heart failure.

13 nov 2023--Today, over 15 million people worldwide suffer from HDD, which has become the second leading cause of heart failure. Thus, HDD represents a massive challenge in health care that needs to be urgently addressed. Although HDD manifests mainly in older adults, there is limited data on its trends in this population.

To tackle this problem, a research team from the Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China conducted a comprehensive statistical analysis on the impact of HHD among older adults (60–89 years old) at the global, regional, and national levels.

Their study, which was led by Professor Jun Cai, was published in the Chinese Medical Journal.

"HHD remains a major concern in the management of hypertension and an important public health challenge," says Prof. Cai.

The data for this study came from the Global Burden of Disease Study 2019 project. Using its publicly available dataset, the researchers estimated the incidence, prevalence, mortality, and disability-adjusted life years (DALY) associated with HHD of 204 countries by age, sex, location, and year between 1990 and 2019.

The authors noted that there was an overall increase in the global prevalence of HHD between 1990 and 2019, but a decrease in mortality and DALY rates. This pattern was mostly maintained for both sexes across all age groups, as well as for sociodemographic index (SDI), which summarizes health-related social and economic development indicators.

Unfortunately, these results paint a particularly difficult situation for health care systems, as higher prevalence but lower mortality imply that more people will require treatment for HHD. "We observed the largest increasing trend in the prevalence of HHD since 2017 with a slowing of decreasing trends in HHD-related mortality and DALY rate since 2014," says Prof. Cai, "This finding suggests that we are presently facing even more rapid growth of the burden of HHD, which needs urgent attention."

Interestingly, the results for males and females were considerably different in a few regards. While males exhibited a higher prevalence of HHD, females had higher mortality and DALY rates. This suggests that the management of cardiovascular diseases in females is less effective, leading to worse prognosis. Moreover, the increasing trend of HHD prevalence was also higher in females, with a steep increase in 2017. Thus, the gap in prevalence between males and females seems to be narrowing.

"Our findings highlight disparities in the disease burden between the sexes, and the burden of HHD in older females should not be ignored," says Prof. Cai.

Worth noting, there were significant differences in the indicators for HHD between different countries and for different SDI groups. Overall, there were 85 countries with a significant increasing trend in HHD prevalence and 81 with a significant decreasing trend between 1990 and 2019. Notably, high-income Asia-Pacific countries (such as Japan, Singapore, and South Korea) exhibited the largest increase in HHD prevalence, but also the largest decrease in HHD mortality and DALY rate.

Despite the increasingly aging population in these countries contributing to the prevalence of HHD, it appears that they have managed to keep risk factors in check by providing adequate health care and keeping their populations informed.

Taken together, the study sheds light on the burden of HHD at the global, regional, and national level and provides a solid groundwork for the development of strategies to combat this challenging disorder.

"There are gaps in the prevention, management, and treatment of HHD world-wide," concludes Prof. Cai. "Our findings regarding the current situation of HHD and its temporal trends highlight inequities in the burden of HHD among older adults globally as well as a need for public health interventions at the individual and population levels."

More information: Ruixue Yang et al, Global, regional, and national burden of hypertensive heart disease among older adults in 204 countries and territories between 1990 and 2019: a trend analysis, Chinese Medical Journal (2023). DOI: 10.1097/CM9.0000000000002863

Saturday, October 14, 2023

The development of 5G significantly increased the health of older adults, study finds

by Huameng Tang, Chao Guo , Medical Xpress

The Chinese government attaches great importance to the construction of Fifth Generation Mobile Communication Technology infrastructure (5G), which has been shown in a new study to play a positive role in the self-rated health of older adults in mainland China, indicating the health-promoting effects of technological advances.

14 oct 2023--China has built one of the largest and most technologically advanced 5G networks, and 5G industry applications have been integrated into more than 60 national economic categories including the medical and health care industries, aiming at meeting the growing medical and health needs of the people. However, as a new and emerging technology, the impact of 5G on public health at the national level has not been well elucidated with reliable empirical evidence.

In our study published in Global Transitions, we explored the effects of 5G development on self-rated health (SRH) among older adults with different sociodemographic features in mainland China. Using the nationally representative data from the China Family Panel Studies (CFPS) in 2018 and its follow-up in 2020, we used the development of 5G as a natural experiment to capture the impact of 5G development on the health of older adults.

Older adults from provinces with 5G policies in varying levels between 2018 and 2020 were considered as the exposure group while others were considered as the reference group, and the differences in SRH of the older adults were compared in provinces with different numbers of policies.

The health effects of 5G development

Our findings revealed that the development of 5G significantly increased the SRH of older adults. After the enactment of the 5G policies, the probability of self-rated good health increased by 31% for each unit increase in the development level of 5G policies. And there were notable disparities in age group, gender and living areas.

The improvement effect of the 5G policies on SRH was intensified in the younger cohort, those aged 65 to 74 years, females, and those living in urban areas. The probability of self-rating good health of older adults aged 75 years and above, males, and those living in rural areas also increased after being exposed to the 5G policies but was not statistically significant.

Public health facilitated by technological development

To the best of our knowledge, our study provides novel insights into the impact of 5G development on the SRH of older adults for the first time. The findings are that 5G development has a positive effect on the SRH of older adults and SRH is found to be particularly improved in the 65- to 74-year-old groups, female groups, and urban participants.

The introduction of 5G policy provides a micro-opportunities and a macro-environment for older adults to promote their health status. At the micro level, 5G enables more older adults to use smart devices and access the internet, facilitating access to health information and promoting social participation. At the macro level, 5G-related application in the medical and health care industry contributes to meeting the medical and health needs of the older adults.

However, considering the heterogeneity, some older adults are in the economic, health and digital divide at the same time, and the gap between them and the older adults who occupy the advantage of digital resources is gradually increasing with the trend of technology development. Target measures should be adopted to avoid worsening inequality and improve the health of all older adults.

We hope that the fast penetration of digital technologies such as 5G will facilitate and scale up the innovations that can create and spread health, allowing public health to fulfill it vision of everyone, regardless of gender and age, being able to enjoy a healthy life at last.

More information: Huameng Tang et al, The effect of 5G policy development on self-rated health among Chinese older adults: A quasi-experimental study, Global Transitions (2023). DOI: 10.1016/j.glt.2023.08.002

Can ChatGPT help us form personal narratives?

by Erica Moser, University of Pennsylvania

Research has shown that personal narratives—the stories we tell ourselves about our lives—can play a critical role in identity and help us make sense of the past and present. Research has also shown that by helping people reinterpret narratives, therapists can guide patients toward healthier thoughts and behaviors.

14 oct 2023--Now, researchers from the Positive Psychology Center at the University of Pennsylvania have tested the ability of ChatGPT-4 to generate individualized personal narratives based on stream-of-consciousness thoughts and demographic details from participants, and showed that people found the language model's responses accurate.

In a new study in the Journal of Positive Psychology, Abigail Blyler and Martin Seligman found that 25 of the 26 participants rated the AI-generated responses as completely or mostly accurate, 19 rated the narratives as very or somewhat surprising, and 19 indicated they learned something new about themselves.

Seligman, the Zellerbach Family Professor of Psychology, is the director of the Positive Psychology Center, and Blyler is his research manager.

"This is a rare moment in the history of scientific psychology: Artificial intelligence now promises much more effective psychotherapy and coaching," Seligman says.

For each participant, the researchers fed ChatGPT-4 recorded stream-of-consciousness thoughts, which Blyler likened to diary entries with thoughts as simple as "I'm hungry" or "I'm tired."

In a second study published concurrently in The Journal of Positive Psychology, they fed five narratives rated "completely accurate" into ChatGPT-4, asked for specific interventions, and found that the chatbot generated highly plausible coaching strategies and interventions.

"Since coaching and therapy typically involve a great deal of initial time spent fleshing out such an identity, deriving this automatically from 50 thoughts represents a major savings," the authors write.

What are personal narratives, how do they shape identity, and what is their role in therapeutic approaches?

Stories of the self, the way people talk about the journey of their lives and who they are, is really what pulled me into psychology. I've come to understand that these narratives impact our behaviors, how we view the world and others, and, importantly, our well-being.

One thing Marty [Seligman] and I have discussed a lot is, How do we get to knowing what our narratives are? Narratives help to construct a coherent story, make sense of everything in our lives.

We found that ChatGPT was able to, with just 50 of those thoughts and very basic demographic information, come up with a highly accurate and detailed personal narrative. This could be a tool for helping people gain self-insight. We see this as something that can be used in the therapeutic context, not as something that would replace a therapist.

Can the coach use this to help understand the client better, and can the client in turn understand themselves better? We're hoping there's this reciprocal relationship, where this speeds up the process of getting to mutual understanding, so the deep work can take place.

How did you come up with the idea of using ChatGPT-4 to create personal narratives?

I really credit Marty [Seligman]. He has been such a leader in the field of positive psychology for so long. To me, he is the paragon of curiosity, particularly when it comes to the cutting-edge, and so he's been really steeped in the things that people are doing with AI and psychology.

The idea came from a series of discussions we were having around my interest in personal narratives, asking, What are the things we're consistently telling ourselves? Might that give us a window into the narratives that play on a loop in people's minds? Can AI be of use here?

The personal narratives were generated from 50 stream-of-consciousness thoughts the participants recorded. What instructions were they given?

We didn't give any description of what the content of the thoughts should be, just that they should be fairly automatic. We asked that people try not to edit them in their minds. We gave them the option to record it via a voice memo or write it down in a Word document or Notes app. However they chose to do it, we gave them 48 hours to just collect 50 of them.

How did you determine the coaching strategies and interventions ChatGPT-4 generated were highly plausible?

We based it on the literature. There are very many evidence-based therapeutic interventions, and what the machine does here is select the ones that seem most appropriate to the narrative identity. This research is exploratory; there is absolutely a need to continue the research and deploy this with coaches.

That's where we are now, getting this into the hands of coaches. We have just begun collaborations to find out if therapy and coaching are more effective when assisted by our new methods.

More information: Abigail P. Blyler et al, Personal narrative and stream of consciousness: an AI approach, The Journal of Positive Psychology (2023). DOI: 10.1080/17439760.2023.2257666

Abigail P. Blyler et al, AI assistance for coaches and therapists, The Journal of Positive Psychology (2023). DOI: 10.1080/17439760.2023.2257642

Scientists discover 'long colds' may exist, as well as long COVID

by Queen Mary, University of London

A new study from Queen Mary University of London, published in eClinicalMedicine, has found that people may experience long-term symptoms—or "long colds"—after acute respiratory infections that test negative for COVID-19.

14 oct 2023--Some of the most common symptoms of the "long cold" included coughing, stomach pain, and diarrhea more than four weeks after the initial infection. While the severity of an illness appears to be a key driver of risk of long-term symptoms, more research is being carried out to establish why some people suffer extended symptoms while others do not.

The findings suggest that there may be long-lasting health impacts following non-COVID acute respiratory infections, such as colds, influenza, or pneumonia, that are currently going unrecognized. However, the researchers do not yet have evidence suggesting that the symptoms have the same severity or duration as long COVID.

The research compared the prevalence and severity of long-term symptoms after an episode of COVID-19 vs. an episode of another acute respiratory infection that tested negative for COVID-19. Those recovering from COVID-19 were more likely to experience light-headedness or dizziness and problems with taste and smell compared to those who had a non-COVID-19 respiratory infection.

While long COVID is now a recognized condition, there have been few studies comparing long-term symptoms following SARS-CoV-2 coronavirus infection vs. other respiratory infections.

The study is the latest output from COVIDENCE UK, Queen Mary University of London's national study of COVID-19, launched back in 2020 and still in follow-up, with over 19,000 participants enrolled. This study analyzed data from 10,171 UK adults, with responses collected via questionnaires and statistical analysis carried out to identify symptom clusters.

Giulia Vivaldi, researcher on COVIDENCE UK from Queen Mary University of London and the lead author of the study, said, "Our findings shine a light not only on the impact of long COVID on people's lives, but also other respiratory infections. A lack of awareness—or even the lack of a common term—prevents both reporting and diagnosis of these conditions.

"As research into long COVID continues, we need to take the opportunity to investigate and consider the lasting effects of other acute respiratory infections.

"These 'long' infections are so difficult to diagnose and treat primarily because of a lack of diagnostic tests and there being so many possible symptoms. There have been more than 200 investigated for long COVID alone."

Professor Adrian Martineau, Chief Investigator of COVIDENCE UK and Clinical Professor of Respiratory Infection and Immunity at Queen Mary University of London, added, "Our findings may chime with the experience of people who have struggled with prolonged symptoms after having a respiratory infection despite testing negative for COVID-19 on a nose or throat swab.

"Ongoing research into the long-term effects of COVID-19 and other acute respiratory infections is important because it can help us to get to the root of why some people experience more prolonged symptoms than others. Ultimately this could help us to identify the most appropriate form of treatment and care for affected people."

Victoria King, Director of Funding and Impact at Barts Charity, said, "Barts Charity swiftly supported COVIDENCE UK in response to the outbreak of COVID-19 to help inform of its risk factors and impacts. These findings highlight not only the long-term symptoms experienced by people after COVID infection, but by people after other acute respiratory infections as well. As we learn more about long COVID symptoms and their possible treatments, studies like this help to build greater awareness around other prolonged respiratory infections that may be going unrecognized."

More information: Vivaldi et al, Long-term symptom profiles after COVID-19 vs other acute respiratory infections: a population-based observational study, eClinicalMedicine (2023). doi.org/10.1016/j.eclinm.2023.102251

Antidepressants versus running for depression: Is there a winner?

by European College of Neuropsychopharmacology

The first study to compare effects of antidepressants with running exercises for anxiety, depression and overall health shows that they have about the same benefits for mental health—but a 16-week course of running over the same period scores higher in terms of physical health improvement, whereas antidepressants lead to a slightly worse physical condition, as has been suggested by previous studies. However, the drop-out rate was much higher in the group which initially chose exercise.

14 oct 2023--Professor Brenda Penninx (Vrije University, Amsterdam) is set to present the work at the 36th ECNP Congress, Barcelona, 7–10 October 2023, after recent publication in the Journal of Affective Disorders, saying, "We wanted to compare how exercise or antidepressants affect your general health, not just your mental health."

The researchers studied 141 patients with depression and/or anxiety. They were offered a choice of treatment; SSRI antidepressants for 16 weeks, or group-based running therapy for 16 weeks. 45 chose antidepressants, with 96 participating in running. The members of the group which chose antidepressants were slightly more depressed than the members of the group which chose to take running.

Professor Penninx said, "This study gave anxious and depressed people a real-life choice, medication or exercise. Interestingly, the majority opted for exercise, which led to the numbers in the running group being larger than in the medication group."

Treatment with antidepressants required patients to adhere to their prescribed medication intake but this generally does not directly impact on daily behaviors. In contrast, exercise directly addresses the sedentary lifestyle often found in patients with depressive and anxiety disorders by encouraging persons to go outside, set personal goals, improve their fitness and participate in a group activity.

The antidepressant group took the SSRI Escitalopram for 16 weeks. The running group aimed for two to three closely supervised 45-minute group sessions per week (over 16 weeks). The adherence to the protocol was lower in the running group (52%) than in the antidepressant group (82%), despite the initial preference for running over antidepressants.

At the end of the trial, around 44% % in both groups showed an improvement in depression and anxiety, however the running group also showed improvements in weight, waist circumference, blood pressure, and heart function, whereas the antidepressant group showed a tendency towards a slight deterioration in these metabolic markers.

Brenda Penninx said, "Both interventions helped with the depression to around the same extent. Antidepressants generally had worse impact on body weight, heart rate variability and blood pressure, whereas running therapy led to improved effect on general fitness and heart rate for instance. We are currently looking in more detail for effects on biological aging and processes of inflammation."

"It is important to say that there is room for both therapies in care for depression. The study shows that lots of people like the idea of exercising, but it can be difficult to carry this through, even though the benefits are significant.

"We found that most people are compliant in taking antidepressants, whereas around half of the running group adhered to the two-times-a-week exercise therapy. Telling patients to go run is not enough. Changing physical activity behavior will require adequate supervision and encouragement as we did by implementing exercise therapy in a mental health care institution."

She added, "Antidepressants are generally safe and effective. They work for most people. We know that not treating depression at all leads to worse outcomes; so antidepressants are generally a good choice. Nevertheless, we need to extend our treatment arsenal as not all patients respond to antidepressants or are willing to take them. Our results suggest that implementing exercise therapy is something we should take much more seriously, as it could be a good—and maybe even better—choice for some of our patients."

"In addition, let's also face potential side effects our treatments can have. Doctors should be aware of the dysregulation in nervous system activity that certain antidepressants can cause, especially in patients who already have heart problems. This also provides an argument to seriously consider tapering and discontinuing antidepressants when depressed or anxious episodes have remitted. In the end, patients are only truly helped when we are improving their mental health without unnecessarily worsening their physical health."

This is adapted from a commentary recently published in the journal European Neuropsychopharmacology.

Commenting, Dr. Eric Ruhe (Amsterdam University Medical Centers) said, "These are very interesting results that again show that physical health can influence mental health and that treatment of depression and anxiety can be achieved by exercising, obviously without the adverse effects of antidepressant drugs. "

"However, several remarks are important. First the patients followed their preference, which is common practice, but ideally we should advise patients what will work best. Following this choice is understandable from a pragmatic point of view when patients have strong preferences, which you have to take into account when doing a study like this.

"The downside is that the comparisons between groups might be biased compared to doing this in a truly randomized study. For example, patients in the antidepressant group were more depressed which might be associated with less chance of persisting engagement in the exercises. So, we have to be careful not to overinterpret the comparisons between groups, which the authors acknowledge properly.

"Finally, a very important finding is the difference in adherence between the interventions: 52% in the exercise group and 82% in the antidepressant group. This shows that it is more difficult to change a lifestyle habit than taking a pill. This is not exclusively found in psychiatry, indicating that we also have to focus on how to improve compliance to healthy behavior. This could have tremendous impact on health care more generally, but also on psychiatric diseases."

More information: Josine E. Verhoeven et al, Antidepressants or running therapy: Comparing effects on mental and physical health in patients with depression and anxiety disorders, Journal of Affective Disorders (2023). DOI: 10.1016/j.jad.2023.02.064

Conference abstract: "Medication and lifestyle interventions in regulating immune function and mental health."

Smartphones could be used to monitor liver disease patients at home

by University College London

A smartphone camera was able to detect changes in skin tone and eye color that require patients to seek medical help, in new research from UCL and the Royal Free Hospital.

14 oct 2023--The study, published in PLOS Digital Health, is the first to assess and compare how smartphone images of the forehead, white of the eye and lower eyelid could be used to accurately predict the bilirubin level of patients with advanced cirrhosis. It found that images of the white of the eye was the best way to predict bilirubin level from an image.

The approach has the potential to monitor liver cirrhosis patients at home more closely, easily and cost effectively than they are currently. The authors expect that this would detect worsening of symptoms before the situation becomes critical, as well as simplify workflows for health care professionals.

Liver disease is the third most common cause of working-age premature death in the UK. While mortality rates have greatly improved for many chronic diseases, the mortality rate for liver disease in the UK increased by 400% between 1970 and 2010. This has increased the need to find non-invasive, cost-effective ways to monitor cirrhosis progression.

Bilirubin is a yellowish pigment that indicates poor liver function when visible in the skin or eye, a condition known as jaundice. Advanced cirrhosis patients' skin and eyes become more yellow as the bilirubin concentration in the blood becomes higher.

Bilirubin levels are currently checked by a blood test performed by a medical professional, which then has to be analyzed. This is usually done in a health care setting. If the level has increased, this indicates that the patient's liver function has deteriorated further and that they need medical help.

In this study, researchers developed a smartphone app that was able to detect the severity of jaundice with a high degree of accuracy. They used a smartphone to take photos of the forehead, white of the eye and lower eyelid of 66 cirrhosis patients. After calibrating the images for lighting conditions, they were analyzed and used to train an algorithm that could predict bilirubin level based on the degree of yellowness in the image.

When these predictions were checked against blood test data, the white of the eye images provided the strongest correlation.

Professor Raj Mookerjee (UCL Medicine), co-author of the study, said, "One of the reasons that liver disease is so challenging is that patients can deteriorate very quickly. It's an unfortunate fact that if a patient arrives at the clinic much more jaundiced than they were previously, the chances are that they have already progressed their disease considerably. The approach that we've assessed in this study could allow us to monitor patients from their own homes much more frequently, than is currently possible and, hopefully, detect worsening of clinical signs and symptoms before things become critical."

One of the challenges the study sought to overcome is the degree of yellowness in patients with cirrhosis, which can be fifty times higher than normal.

"You can look at a patient and tell if they have jaundice right away. But it's a not a question of if the skin looks yellow or not, it's about how much more yellow it looks, which gives you an indication of how badly the liver function has deteriorated," said Professor Mookerjee. "The smartphone app gives us this degree of accuracy. It's a remarkable feat of engineering and shows the power of clinicians and engineers collaborating to solve urgent health care problems."

The next step would be a larger trial to validate the safety and accuracy of the approach. In practice, the approach would likely work by patients frequently taking pictures of their eye via an app, which would inform the clinical care providers of a meaningful change in bilirubin, that might require a change in patient management.

Dr. Terence Leung (UCL Medical Physics & Biomedical Engineering), co-author of the paper, said, "Smartphone camera technology is improving every year, which is allowing us to develop innovative solutions to unmet health care needs using devices that most people have at home. It's great to be able to engineer solutions that are not only cheap and easy to implement, but which will make a real difference to people's lives."

More information: Miranda Nixon-Hill et al, Assessment of bilirubin levels in patients with cirrhosis via forehead, sclera and lower eyelid smartphone images, PLOS Digital Health (2023). DOI: 10.1371/journal.pdig.0000357

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