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      Computational psychiatry as a bridge from neuroscience to clinical applications

      research-article
      1 , 2 , 3 , 4
      Nature neuroscience

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          Abstract

          Translating advances in neuroscience into benefits for patients with mental illness presents enormous challenges because it involves both the most complex organ, the brain, and its interaction with a similarly complex environment. Dealing with such complexities demands powerful techniques. Computational psychiatry combines multiple levels and types of computation with multiple types of data in an effort to improve understanding, prediction and treatment of mental illness. Computational psychiatry, broadly defined, encompasses two complementary approaches: data driven and theory driven. Data-driven approaches apply machine-learning methods to high-dimensional data to improve classification of disease, predict treatment outcomes or improve treatment selection. These approaches are generally agnostic as to the underlying mechanisms. Theory-driven approaches, in contrast, use models that instantiate prior knowledge of, or explicit hypotheses about, such mechanisms, possibly at multiple levels of analysis and abstraction. We review recent advances in both approaches, with an emphasis on clinical applications, and highlight the utility of combining them.

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          Bayesian Interpolation

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            Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report.

            This report describes the participants and compares the acute and longer-term treatment outcomes associated with each of four successive steps in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. A broadly representative adult outpatient sample with nonpsychotic major depressive disorder received one (N=3,671) to four (N=123) successive acute treatment steps. Those not achieving remission with or unable to tolerate a treatment step were encouraged to move to the next step. Those with an acceptable benefit, preferably symptom remission, from any particular step could enter a 12-month naturalistic follow-up phase. A score of or=11 (HRSD(17)>or=14) defined relapse. The QIDS-SR(16) remission rates were 36.8%, 30.6%, 13.7%, and 13.0% for the first, second, third, and fourth acute treatment steps, respectively. The overall cumulative remission rate was 67%. Overall, those who required more treatment steps had higher relapse rates during the naturalistic follow-up phase. In addition, lower relapse rates were found among participants who were in remission at follow-up entry than for those who were not after the first three treatment steps. When more treatment steps are required, lower acute remission rates (especially in the third and fourth treatment steps) and higher relapse rates during the follow-up phase are to be expected. Studies to identify the best multistep treatment sequences for individual patients and the development of more broadly effective treatments are needed.
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              The neural bases of emotion regulation.

              Emotions are powerful determinants of behaviour, thought and experience, and they may be regulated in various ways. Neuroimaging studies have implicated several brain regions in emotion regulation, including the ventral anterior cingulate and ventromedial prefrontal cortices, as well as the lateral prefrontal and parietal cortices. Drawing on computational approaches to value-based decision-making and reinforcement learning, we propose a unifying conceptual framework for understanding the neural bases of diverse forms of emotion regulation.
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                Author and article information

                Journal
                9809671
                21092
                Nat Neurosci
                Nat. Neurosci.
                Nature neuroscience
                1097-6256
                1546-1726
                23 April 2017
                March 2016
                24 May 2017
                : 19
                : 3
                : 404-413
                Affiliations
                [1 ]Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zürich and Swiss Federal Institute of Technology (ETH) Zürich, Zürich, Switzerland
                [2 ]Centre for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zürich, Zürich, Switzerland
                [3 ]School of Medicine and Institute for Molecular Medicine, University of Lisbon, Lisbon, Portugal
                [4 ]Computation in Brain and Mind, Brown Institute for Brain Science, Psychiatry and Human Behavior, Brown University, Providence, USA
                Author notes
                Correspondence should be addressed to Q.J.M.H. ( qhuys@ 123456cantab.net )
                [5]

                These authors contributed equally to this work.

                Article
                PMC5443409 PMC5443409 5443409 nihpa869778
                10.1038/nn.4238
                5443409
                26906507
                c2d9de14-1c2a-4be7-bab4-d9a18ee3c679

                Reprints and permissions information is available online at http://www.nature.com/reprints/index.html

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