Characterising illness stages and recovery trajectories of eating disorders in young people via remote measurement technology (STORY):A multi-centre prospective cohort study protocol

Background: Eating disorders (EDs) are serious, often chronic, conditions associated with pronounced morbidity, mortality, and dysfunction increasingly affecting young people worldwide. Illness progression, stages and recovery trajectories of EDs are still poorly characterised. The STORY study dynamically and longitudinally assesses young people with different EDs (restricting; bingeing/bulimic presentations) and illness durations (earlier; later stages) compared to healthy controls. Remote measurement technology (RMT) with active and passive sensing is used to advance understanding of the heterogeneity of earlier and more progressed clinical presentations and predictors of recovery or relapse. Methods: STORY follows 720 young people aged 16–25 with EDs and 120 healthy controls for 12 months. Online self-report questionnaires regularly assess ED symptoms, psychiatric comorbidities, quality of life, and socioeconomic environment. Additional ongoing monitoring using multi-parametric RMT via smartphones and wearable smart rings (‘Ōura ring’) unobtrusively measures individuals’ daily behaviour and physiology (e.g., Bluetooth connections, sleep, autonomic arousal). A subgroup of participants completes additional in-person cognitive and neuroimaging assessments at study-baseline and after 12 months. Discussion: By leveraging these large-scale longitudinal data from participants across ED diagnoses and illness durations, the STORY study seeks to elucidate potential biopsychosocial predictors of outcome, their interplay with developmental and socioemotional changes, and barriers and facilitators of recovery. STORY holds the promise of providing actionable findings that can be translated into clinical practice by informing the development of both early intervention and personalised treatment that is tailored to illness stage and individual circumstances, ultimately disrupting the long-term burden of EDs on individuals and their families.</p

Seasonal Patterns of Body Temperature Daily Rhythms in Group-Living Cape Ground Squirrels Xerus inauris

Organisms respond to cyclical environmental conditions by entraining their endogenous biological rhythms. Such physiological responses are expected to be substantial for species inhabiting arid environments which incur large variations in daily and seasonal ambient temperature (Ta). We measured core body temperature (Tb) daily rhythms of Cape ground squirrels Xerus inauris inhabiting an area of Kalahari grassland for six months from the Austral winter through to the summer. Squirrels inhabited two different areas: an exposed flood plain and a nearby wooded, shady area, and occurred in different social group sizes, defined by the number of individuals that shared a sleeping burrow. Of a suite of environmental variables measured, maximal daily Ta provided the greatest explanatory power for mean Tb whereas sunrise had greatest power for Tb acrophase. There were significant changes in mean Tb and Tb acrophase over time with mean Tb increasing and Tb acrophase becoming earlier as the season progressed. Squirrels also emerged from their burrows earlier and returned to them later over the measurement period. Greater increases in Tb, sometimes in excess of 5°C, were noted during the first hour post emergence, after which Tb remained relatively constant. This is consistent with observations that squirrels entered their burrows during the day to ‘offload’ heat. In addition, greater Tb amplitude values were noted in individuals inhabiting the flood plain compared with the woodland suggesting that squirrels dealt with increased environmental variability by attempting to reduce their Ta-Tb gradient. Finally, there were significant effects of age and group size on Tb with a lower and less variable Tb in younger individuals and those from larger group sizes. These data indicate that Cape ground squirrels have a labile Tb which is sensitive to a number of abiotic and biotic factors and which enables them to be active in a harsh and variable environment

Treatment of personality disorder using a whole of service stepped care approach: A cluster randomized controlled trial

Background and objectives People with personality disorders are prevalent in emergency and inpatient mental health services. We examined whether implementing a stepped care model of psychological therapy reduces demand on hospital units by people with personality disorder, in a cluster randomized controlled trial. Method A total of 642 inpatients (average age 36.8, 50.5% female) with a primary ICD-10 personality disorder were recruited during 18 months baseline, then monitored during an 18 month active trial phase. In the active trial phase two equivalent sites were randomised to either treatment as usual (TAU), or a whole of service intervention that diverted people away from hospital and into stepped care psychological therapy clinics. The study design was cost neutral, with no additional staff or resources deployed between sites. A linear mixed models analysis evaluated outcomes. Results As predicted, demand on hospital services reduced significantly in the intervention compared to TAU site. The intervention site evidenced shorter bed days, from an average of 13.46 days at baseline to 4.28 days per admission, and patients were 1.3 times less likely to re-present to the emergency department compared to TAU. Direct cost savings for implementing the approach was estimated at USD$2,720 per patient per year. Limitations included not directly comparing individual symptom changes. Conclusions Using a whole of service stepped care model of treatment for personality disorder significantly reduced demand on hospital services

Mental health presentations to acute psychiatric services: 3-year study of prevalence and readmission risk for personality disorders compared with psychotic, affective, substance or other disorders

Background The relative burden and risk of readmission for people with personality disorders in hospital settings is unknown. Aims To compare hospital use of people with personality disorder with that of people with other mental health diagnoses, such as psychoses and affective disorders. Method Naturalistic study of hospital presentations for mental health in a large community catchment. Mixed-effects Cox regression and survival curves were generated to examine risk of readmission for each group. Results Of 2894 people presenting to hospital, patients with personality disorder represented 20.5% of emergency and 26.6% of in-patients. Patients with personality disorder or psychoses were 2.3 times (95% CI 1.79-2.99) more likely than others to re-present within 28 days. Personality disorder diagnosis increases rate of readmission by a factor of 8.7 (s.e. = 0.31), marginally lower than psychotic disorders (10.02, s.e. = 0.31). Conclusions Personality disorders place significant demands on in-patient and emergency departments, similar to that of psychoses in terms of presentation and risk of readmission

What’s to be done when ‘foul whisp rings are abroad’? : gossip and rumour in health organisations

Objectives: This article explores the relevance of gossip and rumour to health organisations and presents what limited empirical research is available specific to the management of gossip and rumour in health organisations. Conclusion: The concept of a sentinel function for gossip and rumour in health organisations is proposed as a topic worthy of further research

When should I attempt my centrally administered summative assessments in the RANZCP competency-based training program?

Objective: To provide information relevant to decision-making around the timing of attempting the centrally administered summative assessments in the Royal Australian and New Zealand College of Psychiatrists (RANZCP) 2012 Fellowship Program. Methods: We consider the new Competency-Based Fellowship Program of the RANZCP and its underlying philosophy, the trainee trajectory within the program and the role of the supervisor. The relationship between workplace-based and external assessments is discussed. The timing of attempting centrally administered summative assessments is considered within the pedagogical framework of medical competencies development. Results: Although successful completion of all the centrally administered summative assessments requires demonstration of a junior consultant standard of competency, the timing at which this standard will most commonly be achieved is likely to vary from assessment to assessment. There are disadvantages attendant upon prematurely attempting assessments, and trainees are advised to carefully consider the requirements of each assessment and match this against their current level of knowledge and skills. Conclusions: Trainees and supervisors need to be clear about the competencies required for each of the external assessments and match this against the trainee\u27s current competencies to assist in decision-making about the timing of assessments and planning for future learning

Treatment of personality disorder using a whole of service stepped care approach: A cluster randomized controlled trial

Background and objectives: People with personality disorders are prevalent in emergency and inpatient mental health services. We examined whether implementing a stepped care model of psychological therapy reduces demand on hospital units by people with personality disorder, in a cluster randomized controlled trial. Method: A total of 642 inpatients (average age 36.8, 50.5% female) with a primary ICD-10 personality disorder were recruited during 18 months baseline, then monitored during an 18 month active trial phase. In the active trial phase two equivalent sites were randomised to either treatment as usual (TAU), or a whole of service intervention that diverted people away from hospital and into stepped care psychological therapy clinics. The study design was cost neutral, with no additional staff or resources deployed between sites. A linear mixed models analysis evaluated outcomes. Results: As predicted, demand on hospital services reduced significantly in the intervention compared to TAU site. The intervention site evidenced shorter bed days, from an average of 13.46 days at baseline to 4.28 days per admission, and patients were 1.3 times less likely to re-present to the emergency department compared to TAU. Direct cost savings for implementing the approach was estimated at USD$2,720 per patient per year. Limitations included not directly comparing individual symptom changes. Conclusions: Using a whole of service stepped care model of treatment for personality disorder significantly reduced demand on hospital services

Using mHealth devices to track mental state in young people with severe mental illness: the unWIRED project

Background: Services with an orientation to early intervention strive to intervene at the earliest opportunity in the onset of mental illness or relapse. However, clinicians remain at a disadvantage as they catch up with the mental state of their clients often days or weeks after a deterioration in a person’s mental state.  mHealth provides the possibility of real time tracking of key psychophysiological indices of good mental health such as sleep, arousal and activity. This project is using a mHealth device to track and record these indices with the aim of recognizing signs of early deterioration in mental health.Aims: Assess the effectiveness of integrating a mHealth device in the clinical care of young people with a mental illness.Methods: A randomised controlled trial of the use of the E2 (empatica) device measuring sleep, arousal, and level of activity is being conducted in two youth mental health services. Data is being examined using machine learning to predict significant changes in mental state. Results: Using a Random Forest Classifier we were able to predict clinical deterioration with a high degree of specificity (0.94) but a low sensitivity (0.33). This current project looks to improve upon this accuracy. Conclusion: We have been able to demonstrate the acceptability of wearing a mHealth device over an extended period. While reasonable accuracy was achieved it did not reach an acceptable level for clinical use.  The presentation will report on the next iteration of this project in improving the usefulness of the data

Using a mobile health device to monitor physiological stress for serious mental illness : A qualitative analysis of patient and clinician-related acceptability

Objective: There is growing interest in using mobile health (mHealth) devices to monitor physiological stress associated with mental deterioration. Research is currently examining whether physiological information returned to individuals with serious mental illness (SMI) and their clinicians enhances early intervention. The aim of this study was to explore patient and clinician-related acceptability of an mHealth device to monitor stress for SMI. Method: Individuals with SMI and their clinicians at a community youth mental health service were shown how an mHealth device could be used to monitor stress. Focus groups and interviews regarding the acceptability of the mHealth device were then conducted with participants (N = 22). Content was transcribed and analyzed using an inductive thematic analysis focusing on perceptions of potential benefit, barriers and facilitators of uptake. Results: Six themes were identified. Individuals with SMI and clinicians identified two themes related to benefits of the mHealth device: (a) self-monitoring improves symptom insight and (b) clinician monitoring as a benefit to treatment. They identified one barrier theme: (c) privacy and data misuse concerns. They also identified three facilitators of uptake: (d) ease of use, (e) engaging design and (f) procedural guidelines. Conclusions and Implications for Practice: The perceived benefits of passive physiological monitoring afforded by an mHealth device come with concerns regarding its privacy and the potential for ambiguity in the patient–clinician relationship. Results suggest the importance of codesign to ensure that it is secure, easy to use and engaging. (PsycInfo Database Record (c) 2022 APA, all rights reserved