Diagnosing Schizophrenia from Activity Records using Hidden Markov Model Parameters

The diagnosis of Schizophrenia is mainly based on qualitative characteristics. With the usage of portable devices which measure activity of humans, the diagnosis of Schizophrenia can be enriched through quantitative features. The goal of this work is to classify between schizophrenic and non-schizophrenic subjects based on their measured activity over a certain amount of time. To do so, the periods in which a subject was resting or active were identified by the application of a Hidden Markov model (HMM). The trained model parameters of the HMM, such as the mean or variance of activity during the state of rest or activity, are used as classification features for a logistic regression model. Our results indicate that the features from the HMM are significant in classifying between schizophrenic and non-schizophrenic subjects. Moreover, the features outperform the features derived through other methods in literature in terms of goodness-of-fit and classification performance.acceptedVersio

Motor activity patterns in acute schizophrenia and other psychotic disorders can be differentiated from bipolar mania and unipolar depression

Under embargo until: 02.10.2019The purpose of this study was to compare 24-h motor activity patterns between and within three groups of acutely admitted inpatients with schizophrenia and psychotic disorders (n = 28), bipolar mania (n = 18) and motor-retarded unipolar depression (n = 25) and one group of non-hospitalized healthy individuals (n = 28). Motor activity was measured by wrist actigraphy, and analytical approaches using linear and non-linear variability and irregularity measures were undertaken. In between-group comparisons, the schizophrenia group showed more irregular activity patterns than depression cases and healthy individuals. The schizophrenia and mania cases were clinically similar with respect to high prevalence of psychotic symptoms. Although they could not be separated by a formal statistical test, the schizophrenia cases showed more normal amplitudes in morning to evening mean activity and activity variability. Schizophrenia constituted an independent entity in terms of motor activation that could be distinguished from the other diagnostic groups of psychotic and non-psychotic affective disorders. Despite limitations such as small subgroups, short recordings and confounding effects of medication/hospitalization, these results suggest that detailed temporal analysis of motor activity patterns can identify similarities and differences between prevalent functional psychiatric disorders. For this purpose, irregularity measures seem particularly useful to characterize psychotic symptoms and should be explored in larger samples with longer-term recordings, while searching for underlying mechanisms of motor activity disturbances.acceptedVersio

Reduced heart rate variability during mania in a repeated naturalistic observational study

BackgroundBipolar disorder (BD) is a chronic recurrent mood disorder associated with autonomic nervous system (ANS) dysfunction, indexed by heart rate variability (HRV). Changes in HRV between mood states are sparsely studied longitudinally. We aimed to compare HRV of hospitalized manic individuals with their own euthymic selves in a naturalistic observational study.Methods34 individuals were included, of which 16 were lost to follow-up. Ultimately 15 patients provided reliable heart rate data in both a manic and euthymic state, using photoplethysmography (PPG) sensor wristbands overnight. We calculated HRV measures Root Mean Square of Successive Differences (RMSSD), High-frequency (HF: 0.15–0.40 Hz), Low-frequency (LF: 0.40–0.15 Hz), Very low-frequency (VLF: 0.0033–0.04 Hz), Total power and Sample Entropy in 5-min night-time resting samples. We compared HRV measures by mood state within individuals using paired t-tests and linear regression to control for age and sex.ResultsHRV was lower in the manic state when compared to the euthymic state for all HRV metrics (p ≤ 0.02), with large to medium effect sizes (g = 1.24 to 0.65). HRV changes were not significantly affected by age or sex.ConclusionThis longitudinal study provides evidence of lower HRV in manic states compared to euthymia, indicating an association between ANS dysregulation and changes in bipolar mood state. This corroborates previous cross-sectional studies, although the association may be less clear or reversed in hypomanic states. Further investigation in larger longitudinal samples is warranted

Lower Cardiac Vagal Activity Predicts Self-Reported Difficulties With Emotion Regulation in Adolescents With ADHD

Objective: To investigate the relation between cardiac vagal activity (CVA), a measure of autonomic nervous system (ANS) flexibility, and self-reported emotion regulation (ER) difficulties in adolescents with attention-deficit/hyperactivity disorder (ADHD) and controls. Methods: The sample comprised 11-17-year-old adolescents with ADHD (n=34) and controls (n = 33). Multiple linear regression analyses investigated the relation between CVA, as indexed by high frequency heart rate variability (HF-HRV), and ER difficulties as assessed by the Difficulties in Emotion Regulation Scale (DERS). Supplemental analyses were performed in ADHD and control groups separately. Analyses assessed effects of body mass index (BMI), physical activity levels, and HF peak as a surrogate of respiration on CVA. Results: Lower CVA was associated with ER difficulties, and specifically with limited access to effective ER strategies. When investigating the relation between CVA and ER in the ADHD and control groups separately, there was a tendency of lower CVA predicting limited access to effective ER strategies in the ADHD group, and not in the control group. Conclusion: The results suggest that lower CVA, i.e., reduced ANS flexibility, in adolescents with ADHD and controls is associated with self-reported ER difficulties, and specifically with limited access to effective ER strategies. There was a tendency for lower CVA to predict limited ER strategies only in the adolescents with ADHD and not controls. Keywords: attention-deficit/hyperactivity disorder; autonomic nervous system; cardiac vagal activity; difficulties in emotion regulation scale; emotion regulation; heart rate variability

Vagally mediated heart rate variability, stress, and perceived social support: a focus on sex differences

Higher vagally mediated heart rate variability (vmHRV), reflecting vagal activity as indexed by heart function and lower stress vulnerability, is associated with higher perceived social support. Seeking social support is an adaptive stress response, and evolutionary theories suggest that females use this strategy more than males. The current study investigated the hypothesis that higher vmHRV is related to higher perceived social support under conditions of higher, relative to lower, stress, and that this association is most prominent in females. A healthy student sample (n = 143; 82 males, 61 females; mean age 19.9) completed the short version of the Medical outcomes study social support survey (MOS) and the Perceived stress scale (PSS). Activity in the high frequency band of heart rate variability (HF-HRV), deducted from five-minute resting electrocardiogram (ECG) recordings, indexed vmHRV. A moderation analysis was conducted, with PSS and sex as moderators of the association between vmHRV and MOS. Statistical effects were adjusted for age, education, physical activity, body mass index (BMI), alcohol and drug use, ECG-derived respiration (EDR), and mean heart rate. Higher PSS scores moderated the association between vmHRV and MOS in females but not males. Lower PSS scores did not moderate the relation between vmHRV and MOS. This suggests that higher vmHRV is associated with higher perceived social support under conditions of higher stress in females but not males, consistent with evolution of different stress management strategies in the sexes. The results may have implications for individualized intervention strategies for increasing vmHRV and perceived social support.publishedVersio

Innovative approaches in investigating inter-beat intervals: Graph theoretical method suggests altered autonomic functioning in adolescents with ADHD

Cardiac inter-beat intervals (IBIs) are considered to reflect autonomic functioning and self-regulatory abilities and are often investigated by traditional time- and frequency domain analyses. These analyses investigate IBI fluctuations across relatively long time series. The similarity graph algorithm is a nonlinear method that analyzes segments of IBI time series (i.e., time windows)—possibly being more sensitive to transient and spontaneous IBI fluctuations. We hypothesized that the similarity graph algorithm would detect differences between Attention-Deficit/Hyperactivity Disorder (ADHD) and control groups. Resting electrocardiogram (ECG) recordings were collected in 10–18-year-olds with ADHD (n = 37) and controls (n = 36). IBIs were converted to graphs that were subsequently investigated for similarity. We varied the criterion for defining IBIs as similar, assessing which setting best distinguished ADHD and control groups. Using this setting, we applied the similarity graph algorithm to time windows of 2–5, 6–13 and 12–25 s, respectively. We also performed traditional IBI analyses. Independent samples t tests assessed group differences. Results showed that a 1.5% criterion of similarity and a time window of 2–5 s best distinguished adolescents with ADHD and controls. The similarity graph algorithm showed a higher number of edges, maximum edges and cliques, and lower edges10+10/edges2+2 in the ADHD group compared to controls. The results suggested more similar IBIs in the ADHD group compared to the controls, possibly due to altered vagal activity and less effective regulation of heart rate. Traditional analyses did not detect any group differences. Consequently, the similarity graph algorithm might complement traditional IBI analyses as a marker of psychopathology.publishedVersio

Cyclothymic temperament: Associations with ADHD, other psychopathology, and medical morbidity in the general population

Under embargo until: 2020-08-19Background: Cyclothymic temperament (CT) is an affective disposition often preceding bipolar disorder (BD), and is the most common affective temperament in patients with BD. In depressed patients, CT is a predictor for developing a bipolar course. In a clinical sample of adults with BD and attention deficit hyperactivity disorder (ADHD), CT was associated with higher loads of psychiatric symptoms, somatic comorbidity, impairment, and higher morbidity among first-degree relatives. We aimed to investigate the morbidity and occupational functioning of persons with CT in the general population. Methods: Randomly recruited Norwegian adults (n = 721) were assessed with a 21-item cyclothymic subscale from the TEMPS Autoquestionnaire. Self-reported data were collected on psychiatric symptoms, comorbidity, educational and occupational level, and known family morbidity. Results: Thirteen percent had CT associated with an increased prevalence of ADHD, BD, high scores on the Mood Disorder Questionnaire (MDQ), and childhood and adulthood ADHD symptoms. CT was found in 75% (p < .001) of the bipolar participants, and in 68% (p < .001) of those with a positive MDQ score. CT was associated with more anxiety/depression, substance and alcohol problems, lower educational and occupational levels, and having a first-degree relative with anxiety/depression, alcohol problems, ADHD, and BD. Limitations: The CT subscale alone might include overlapping features with cyclothymic, anxious, irritable, and depressed temperaments, thus increasing the prevalence estimate of CT. Conclusions: CT is a strong predictor of occupational failure and associated with more psychiatric impairment in the participants and their families. CT should be assessed in both mood disorder and ADHD patients.acceptedVersio

Electro-acupuncture at Jianshi (PC5) and Neiguan (PC6) alters heart rate variability (HRV) in frightened volunteers

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Diurnal variation of motor activity in adult ADHD patients analyzed with methods from graph theory

Attention-deficit /hyperactivity disorder (ADHD) is a common neurodevelopmental syndrome characterized by age-inappropriate levels of motor activity, impulsivity and attention. The aim of the present study was to study diurnal variation of motor activity in adult ADHD patients, compared to healthy controls and clinical controls with mood and anxiety disorders. Wrist-worn actigraphs were used to record motor activity in a sample of 81 patients and 30 healthy controls. Time series from registrations in the morning and evening were analyzed using measures of variability, complexity and a newly developed method, the similarity algorithm, based on transforming time series into graphs. In healthy controls the evening registrations showed higher variability and lower complexity compared to morning registrations, however this was evident only in the female controls. In the two patient groups the same measures were not significantly different, with one exception, the graph measure bridges. This was the measure that most clearly separated morning and evening registrations and was significantly different both in healthy controls and in patients with a diagnosis of ADHD. These findings suggest that actigraph registrations, combined with mathematical methods based on graph theory, may be used to elucidate the mechanisms responsible for the diurnal regulation of motor activity.publishedVersio