Diagnostic evaluations and early interventions of patients with bipolar disorder (BD) rely on clinical evaluations. Smartphones have been proposed to facilitate continuous and fine-grained ...self-monitoring of symptoms. The present study aimed to (1) validate daily smartphone-based self-monitored mood, activity, and sleep, against validated questionnaires and clinical ratings in young patients with newly diagnosed BD, unaffected relatives (UR), and healthy controls persons (HC); (2) investigate differences in daily smartphone-based self-monitored mood, activity, and sleep in young patients with newly diagnosed BD, UR, and HC; (3) investigate associations between self-monitored mood and self-monitored activity and sleep, respectively, in young patients with newly diagnosed BD. 105 young patients with newly diagnosed BD, 24 UR and 77 HC self-monitored 2 to 1077 days (median IQR = 65 17.5–112.5). There was a statistically significantly negative association between the mood item on Hamilton Depression Rating Scale (HAMD) and smartphone-based self-monitored mood (
B
= − 0.76, 95% CI − 0.91; − 0.63,
p
< 0.001) and between psychomotor item on HAMD and self-monitored activity (
B
= − 0.44, 95% CI − 0.63; − 0.25,
p
< 0.001). Smartphone-based self-monitored mood differed between young patients with newly diagnosed BD and HC (
p
< 0.001), and between UR and HC (
p
= 0.008) and was positively associated with smartphone-based self-reported activity (
p
< 0.001) and sleep duration (
p
< 0.001). The findings support the potential of smartphone-based self-monitoring of mood and activity as part of a biomarker for young patients with BD and UR. Smartphone-based self-monitored mood is better to discriminate between young patients with newly diagnosed BD and HC, and between UR and HC, compared with smartphone-based activity and sleep.
Trial registration
clinicaltrials.gov NCT0288826
Non-adherence to medication is associated with increased risk of relapse in patients with bipolar disorder (BD).
To (1) validate patient-evaluated adherence to medication measured via smartphones ...against validated adherence questionnaire; and (2) investigate characteristics for adherence to medication measured via smartphones.
Patients with BD (n=117) evaluated adherence to medication daily for 6-9 months via smartphones. The Medication Adherence Rating Scale (MARS) and the Rogers' Empowerment questionnaires were filled out. The 17-item Hamilton Depression Rating Scale, the Young Mania Rating Scale and the Functional Assessment Short Test were clinically rated. Data were collected multiple times per patient. The present study represents exploratory pooled reanalyses of data collected as part of two randomised controlled trials.
During the study 90.50% of the days were evaluated as 'medication taken', 6.91% as 'medication taken with changes' and 2.59% as 'medication not taken'. Adherence to medication measured via smartphones was valid compared with the MARS (B: -0.049, 95% CI -0.095 to -0.003, p=0.033). Younger age and longer illness duration were significant predictors for non-adherence to medication (model concerning age: B: 0.0039, 95% CI 0.00019 to 0.0076, p=0.040). Decreased affective symptoms measured with smartphone-based patient-reported mood and clinical ratings as well as decreased empowerment were associated with non-adherence.
Smartphone-based monitoring of adherence to medication was valid compared with validated adherence questionnaire. Younger age and longer illness duration were predictors for non-adherence. Increased empowerment was associated with adherence.
Using smartphones for empowerment of adherence using patient-reported measures may be helpful in everyday clinical settings.
NCT01446406 and NCT02221336.
Background: Cognitive dysfunction in unipolar disorder (UD) and bipolar disorder (BD) may persist into remission and affect psychosocial function. Executive and memory deficits during remission may ...be more pronounced in BD than UD. However, patients' subjective experience of cognitive difficulties is poorly understood, and it is unclear whether BD and UD patients experience different cognitive difficulties. Aims: To investigate whether there are differences in the quality and magnitude of subjective cognitive difficulties between UD and BD, and which factors influence the subjective cognitive difficulties in these patients. Methods: Patients with BD (n = 54) or UD (n = 45) were referred to the outpatient mood disorder clinic at Department of Psychiatry, Copenhagen University Hospital, following hospital discharge. Affective symptoms and patients' experience of cognitive symptoms were assessed at their initial consultation at the clinic. Results: Patients experienced mild to moderate cognitive impairment despite being in partial or full remission, but there were no differences in subjective difficulties between BD and UD. Subjective cognitive dysfunction was predicted by depression severity, anxiety and mania symptoms rather than by diagnosis, age, gender or alcohol misuse. Conclusion: The absence of difference in subjective cognitive difficulties between UD and BD contrasts with evidence of greater objective dysfunction in BD. This highlights a potential discord between subjective and objective measures of cognitive function. Subjective cognitive function was predicted by affective symptoms, perhaps suggesting that this reflects mood symptoms rather than objective deficits. This points to a clinical need for objective assessment of cognitive function in these patient groups.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract
Background.
The efficacy of antidepressant treatment is fair, but the efficacy is considerably lower in patients failing two or more trials underscoring the need for new treatment options. ...Our study evaluated the augmenting antidepressant effect of 8-weeks transcranial pulsed electromagnetic field (T-PEMF) therapy in patients with treatment-resistant depression.
Methods.
A multicenter 8-week single-arm cohort study conducted by the Danish University Antidepressant Group.
Results.
In total, 58 participants (20 men and 38 women) with a moderate to severe depression as part of a depressive disorder according to ICD-10 who fulfilled criteria for treatment resistance were included, with 19 participants being nonresponders to electroconvulsive therapy during the current depressive episode. Fifty-two participants completed the study period. Scores on the Hamilton Depression Scale 17-items version (HAM-D
17
) decreased significantly from baseline (mean = 20.6, SD 4.0) to endpoint (mean = 12.6, SD 7.1;
N
= 58). At endpoint, utilizing a Last Observation Carried Forward analysis, 49 and 28% of those participants with, respectively, a nonchronic current episode (≤2 years;
N
= 33) and a chronic current episode (>2 years;
N
= 25) were responders, that is, achieved a reduction of 50% or more on the HAM-D
17
scale. At endpoint, respectively, 30 and 16% obtained remission, defined as HAM-D
17
≤ 7. On the Hamilton Scale 6-item version (HAM-D
6)
, respectively, 51 and 16% obtained remission, defined as HAM-D
6
≤ 4.
Conclusions.
The findings indicate a potential beneficial role of T-PEMF therapy as an augmentation treatment to ongoing pharmacotherapy in treatment-resistant depression.
To evaluate flare risk when tapering or withdrawing biological or targeted synthetic disease-modifying antirheumatic drugs (b-/tsDMARDs) compared to continuation in patients with inflammatory ...arthritis (IA) in sustained remission or low disease activity.
Articles were identified in Cochrane Library, PubMed, EMBASE and Web of Science. Eligible trials were randomised, controlled trials comparing tapering and/or withdrawal of b- and/or tsDMARDs with standard dose in IA. Random-effects meta-analysis was performed with risk ratio (RR), or Peto's Odds Ratio (POR) for sparse events, and 95% confidence intervals (95%CI).
The meta-analysis comprised 22 trials: 11 assessed tapering and 7 addressed withdrawal (4 assessed both). Only trials with a rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) population were identified. An increased flare risk was demonstrated when b-/tsDMARD tapering was compared to continuation, RR = 1.45 (95%CI: 1.19 to 1.77, I2 = 42.5%), and potentially increased for persistent flare, POR = 1.56 (95%CI: 0.97 to 2.52, I2 = 0%). Comparing tumour necrosis factor inhibitor (TNFi) withdrawal to continuation, a highly increased flare risk (RR = 2.28, 95%CI: 1.78 to 2.93, I2 = 78%) and increased odds of persistent flare (POR = 3.41, 95%CI: 1.91 to 6.09, I2 = 49%) was observed. No clear difference in flare risk between RA or axSpA was observed.
A high risk for flare and persistent flare was demonstrated for TNFi withdrawal whereas an increased risk for flare but not for persistent flare was observed for b-/tsDMARD tapering. Thus, tapering seems to be the more favourable approach.
PROSPERO (CRD42019136905).
In bipolar disorder, the factors provoking a new episode are unknown. As a seasonal variation has been noticed, it has been suggested that weather conditions may play a role. The aim of the study was ...to elucidate whether meteorological parameters influence the development of new bipolar phases. A group of patients with at least three previous hospitalizations for bipolar disorder was examined every 3 months for up to 3 years. At each examination an evaluation of the affective phase was made according to the Hamilton Depression Scale (HAM-D17), and the Bech-Rafaelsen Mania Rating Scale (MAS). In the same period, daily recordings from the Danish Meteorological Institute were received. We found no correlations between onset of bipolar episodes defined as MAS score of 11 or more (mania) and as HAM-D17 score of 12 or more (depression) and any meteorological parameters. We found a statistical significant correlation between mean HAM-D17 scores and change in mean and maximum temperature, and non-statistical significant correlations between mean MAS scores and rainfall plus atmospheric pressure, and non-statistical significant correlations between mean HAM-D17 scores and hours of sunshine and cloudiness. Though meteorological factors may have an impact on triggering new episodes in bipolar patients, they do not constitute a dominant cause.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract
Background: Rating scales used to assess the severity of depression e.g. the Hamilton Depression Rating Scale 17-item (HDRS-17) partly rely on the patient's subjective experience and ...reporting. Such subjective measures tend to have low reliability and adding objective measures to complement the assessment of depression severity would be a major step forward. Aims: To investigate correlations between electronic monitoring of psychomotor activity and severity of depression according to HDRS-17. Methods: A total of 36 patients with unipolar disorder (n = 18) or bipolar disorder (n = 18) and 31 healthy control persons aged 18-60 years were included. Psychomotor activity was measured using a combined heart rate and movement sensor device (Actiheart) for 3 consecutive days, 24 h a day. Results: We found that sleeping heart rate (beats/min) correlated with HDRS-17 in both patients with unipolar disorder and bipolar disorder (unadjusted model: B = 0.46, 95% CI 0.037-0.89, P = 0.034). In contrast, correlations between activity energy expenditure (kJ/kg/day), cardio-respiratory fitness (mlO2/min/kg) and HDRS-17 were non-significant. Conclusions: These results suggest that measuring sleeping heart rate in non-experimental daily life could be an objective supplementary method to measure the severity of depression and perhaps indicate presence of insomnia.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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