Mobile Phone and Wearable Sensor-Based mHealth Approach for Psychiatric Disorders and Symptoms : Systematic Review and Link to the m-RESIST Project

Background: Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST) is an EU Horizon 2020-funded project aimed at designing and validating an innovative therapeutic program for treatment-resistant schizophrenia. The program exploits information from mobile phones and wearable sensors for behavioral tracking to support intervention administration. Objective: To systematically review original studies on sensor-based mHealth apps aimed at uncovering associations between sensor data and symptoms of psychiatric disorders in order to support the m-RESIST approach to assess effectiveness of behavioral monitoring in therapy. Methods: A systematic review of the English-language literature, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed through Scopus, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials databases. Studies published between September 1, 2009, and September 30, 2018, were selected. Boolean search operators with an iterative combination of search terms were applied. Results: Studies reporting quantitative information on data collected from mobile use and/or wearable sensors, and where that information was associated with clinical outcomes, were included. A total of 35 studies were identified; most of them investigated bipolar disorders, depression, depression symptoms, stress, and symptoms of stress, while only a few studies addressed persons with schizophrenia. The data from sensors were associated with symptoms of schizophrenia, bipolar disorders, and depression. Conclusions: Although the data from sensors demonstrated an association with the symptoms of schizophrenia, bipolar disorders, and depression, their usability in clinical settings to support therapeutic intervention is not yet fully assessed and needs to be scrutinized more thoroughly.Peer reviewe

Lifetime antipsychotic medication and cognitive performance in schizophrenia at age 43 years in a general population birth cohort

This naturalistic study analysed the association between cumulative lifetime antipsychotic dose and cognition in schizophrenia after an average of 16.5 years of illness. Sixty participants with schizophrenia and 191 controls from the Northern Finland Birth Cohort 1966 were assessed at age 43 years with a neurocognitive test battery. Cumulative lifetime antipsychotic dose-years were collected from medical records and interviews. The association between antipsychotic dose-years and a cognitive composite score based on principal component analysis was analysed using linear regression. Higher lifetime antipsychotic dose-years were significantly associated with poorer cognitive composite score, when adjusted for gender, onset age and lifetime hospital treatment days. The effects of typical and atypical antipsychotics did not differ. This is the first report of an association between cumulative lifetime antipsychotic dose and global cognition in midlife schizophrenia. Based on these data, higher lifetime antipsychotic dose-years may be associated with poorer cognitive performance at age 43 years. Potential biases related to the naturalistic design may partly explain the results; nonetheless, it is possible that large antipsychotic doses harm cognition in schizophrenia in the long-term.Peer reviewe

Mobile Phone and Wearable Sensor-Based mHealth Approach for Psychiatric Disorders and Symptoms : Systematic Review and Link to the m-RESIST Project

Background: Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST) is an EU Horizon 2020-funded project aimed at designing and validating an innovative therapeutic program for treatment-resistant schizophrenia. The program exploits information from mobile phones and wearable sensors for behavioral tracking to support intervention administration. Objective: To systematically review original studies on sensor-based mHealth apps aimed at uncovering associations between sensor data and symptoms of psychiatric disorders in order to support the m-RESIST approach to assess effectiveness of behavioral monitoring in therapy. Methods: A systematic review of the English-language literature, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed through Scopus, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials databases. Studies published between September 1, 2009, and September 30, 2018, were selected. Boolean search operators with an iterative combination of search terms were applied. Results: Studies reporting quantitative information on data collected from mobile use and/or wearable sensors, and where that information was associated with clinical outcomes, were included. A total of 35 studies were identified; most of them investigated bipolar disorders, depression, depression symptoms, stress, and symptoms of stress, while only a few studies addressed persons with schizophrenia. The data from sensors were associated with symptoms of schizophrenia, bipolar disorders, and depression. Conclusions: Although the data from sensors demonstrated an association with the symptoms of schizophrenia, bipolar disorders, and depression, their usability in clinical settings to support therapeutic intervention is not yet fully assessed and needs to be scrutinized more thoroughly.Peer reviewe

Renal Phenotype in Mitochondrial Diseases : A Multicenter Study

Aims: This study aimed to investigate associations between renal and extrarenal manifestations of mitochondrial diseases and their natural history as well as predictors of renal disease severity and overall disease outcome. The secondary aim was to generate a protocol of presymptomatic assessment and monitoring of renal function in patients with a defined mitochondrial disease. Methods: A multicenter, retrospective cohort study was performed by the Mitochondrial Clinical and Research Network (MCRN). Patients of any age with renal manifestations associated with a genetically verified mitochondrial disease were included from 8 expert European centers specializing in mitochondrial diseases: Gothenburg, Oulu, Copenhagen, Bergen, Helsinki, Stockholm, Rotterdam, and Barcelona. Results: Of the 36 patients included, two-thirds had mitochondrial DNA-associated disease. Renal manifestations were the first sign of mitochondrial disease in 19%, and renal involvement was first identified by laboratory tests in 57% of patients. Acute kidney injury occurred in 19% of patients and was the first sign of renal disease in the majority of these. The most common renal manifestation was chronic kidney disease (75% with stage 2 or greater), followed by tubulopathy (44.4%), the latter seen mostly among patients with single large-scale mitochondrial DNA deletions. Acute kidney injury and tubulopathy correlated with worse survival outcome. The most common findings on renal imaging were increased echogenicity and renal dysplasia/hypoplasia. Renal histology revealed focal segmental glomerulosclerosis, nephrocalcinosis, and nephronophthisis. Conclusion: Acute kidney injury is a distinct renal phenotype in patients with mitochondrial disease. Our results highlight the importance to recognize renal disease as a sign of an underlying mitochondrial disease. Acute kidney injury and tubulopathy are 2 distinct indicators of poor survival in patients with mitochondrial diseases.Peer reviewe

A multicenter study on Leigh syndrome: Disease course and predictors of survival

Background: Leigh syndrome is a progressive neurodegenerative disorder, associated with primary or secondary dysfunction of the mitochondrial oxidative phosphorylation. Despite the fact that Leigh syndrome is the most common phenotype of mitochondrial disorders in children, longitudinal natural history data is missing. This study was undertaken to assess the phenotypic and genotypic spectrum of patients with Leigh syndrome, characterise the clinical course and identify predictors of survival in a large cohort of patients. Methods. This is a retrospective study of patients with Leigh syndrome that have been followed at eight centers specialising in mitochondrial diseases in Europe; Gothenburg, Rotterdam, Helsinki, Copenhagen, Stockholm, Brussels, Bergen and Oulu. Results: A total of 130 patients were included (78 males; 52 females), of whom 77 patients had identified pathogenic mutations. The median age of disease onset was 7 months, w

A Method to Compare the Delivery of Psychiatric Care for People with Treatment-Resistant Schizophrenia

Abstract Introduction: Community services are gaining ground when it comes to attention to patients with psychiatric diseases. Regarding patients with treatment-resistant schizophrenia (TRS), the use of information and communication technology (ICT) could help to shift the focus from hospital-centered attention to community services. This study compares the differences in mental health services provided for patients with TRS in Budapest (Hungary), Tel-Aviv (Israel) and Catalonia (Spain) by means of a method for the quick appraisal of gaps among the three places, for a potential implementation of the same ICT tool in these regions. Methods: An adapted version of the Description and Standardised Evaluation of Services and Directories in Europe for Long Term Care (DESDE-LTC) instrument was made by researchers in Semmelweis University (Budapest, Hungary), Gertner Institute (Tel-Aviv, Israel) and Hospital de la Santa Creu I Sant Pau and Parc Sanitari Sant Joan de Déu (Catalonia, Spain). Results: Two types of outpatient care services were available in the three regions. Only one type of day-care facility was common in the whole study area. Two residential care services, one for acute and the other for non-acute patients were available in every region. Finally, two self-care and volunteer-care facilities were available in the three places. Conclusion: Although the availability of services was different in each region, most of the services provided were sufficiently similar to allow the implementation of the same ICT solution in the three places.The m-RESIST Group is composed of: Francisco Alcalde Enrico d’Amico Caritat Almazán Anna Alonso-Solís Jesús Berdún István Bitter Walter Baccinelli Chiara Bonizzi María Bulgheroni Johanna Caro Mendivelso Asaf Caspi Tanguy Coenen Anat Cohen Xavier Constant Iluminada Corripio Marisol Escobar Kinga Farkas Kata Fazekas Yoram Feldman Emmanuel Gimenez Shenja van der Graaf Eva Grasa Levente Herman Margarita Hospedales Elena Huerta-Ramos Matti Isohanni Erika Jääskeläinen Charlotte Jewel Teija Juola Timo Jämsä Rachelle Kaye Panagiotis Kokkinakis Hannu J. Koponen Silvia Marcó Gregoris Mentzas Jouko Miettunen Jani Moilanen Susana Ochoa Ilias Papas Fotis Paraskevopoulos Elisabeth Reixach Alexandra Roldán Katya Rubinstein Elena Rubio-Abadal Garifalia Sebú Annika Seppälä Jussi Seppälä Valentina Simonetti Matthias Stevens Vittorio Tauro Anna Triantafillou Zsolt Szabolcs Unoka Judith Usall Vincenzo Vella David Vermeir Ilaria de Vit

Lääkäri ja huippuvaikuttajien mielenterveys:miten diagnosoida, keskustella ja hoitaa?

Tiivistelmä Merkittävässä asemassa olevat huippuvaikuttajat (poliitikot, johtajat, asiantuntijat, taiteilijat ja mediavaikuttajat) ovat suorituskykyisiä, mutta heissä on myös epävakaita, paineensiedoltaan rajoittuneita, ikääntyviä ja sairastuvia vallankäyttäjiä. Huippuvaikuttajien mielenterveysongelmien ja niihin liittyvän toimintakyvyn heikkenemisen yhteiskunnallinen vaikutus voi olla suuri. Katsauksessa käydään läpi joidenkin huippuvaikuttajien psykiatrisia sairauksia. Lääkärikunta on avainasemassa vallankäyttäjien terveyden diagnostiikassa, seuraamisessa ja hoidossa. Lääkärien osallistuminen vallankäyttäjien terveyteen liittyvään mediakeskusteluun on toivottavaa mutta edellyttää eettisten periaatteiden noudattamista. Lääkärin ei ole eettisesti sopivaa ottaa julkista kantaa yksittäisen henkilön terveydentilaan. Korkea asema ei välttämättä helpota sairauksien varhaista toteamista ja hoitoa. Huippuvaikuttaja on lääkärille haastava potilas, joka vaatii erityistä osaamista, kokemusta, vuorovaikutustaitoja sekä usein eri erikoisalojen yhteistyötä.Abstract The presence of psychiatric disorders among high-level politicians, civil servants and military leaders has been noted in many studies and in the media. High-level leadership has become increasingly demanding and stressful over the past decades. These positions do not necessarily facilitate early detection or intervention of mental disorders. In the media, psychiatrists should ensure that people with mental illness are treated in a manner which preserves their dignity. Commonly accepted ethical principles stress that psychiatrists should not make announcements to the media about presumed psychopathology and diagnosis of any individuals. For a physician and psychiatrist, these persons present a clinical challenge that requires experience, clinical skills and multidisciplinary team work

Mental health of high-level politicians and soldiers in Finland:diagnostics, public discussion and treatment

Abstract The presence of psychiatric disorders among high-level politicians and military leaders has been noted in historical studies and in the media. This article focuses on political and military leadership in Finland during the wartime period of 1939–1944 and to 1981. The historical literature contains well-described cases, but lacks properly designed studies focusing on epidemiological and medical issues. High-level leadership is demanding and stressful during wartime, but has also been in general over the past several decades. Leadership positions do not necessary facilitate early detection of and intervention in mental disorders. In the media, psychiatrists should ensure that people with mental illness are treated in a manner which preserves their dignity. Commonly accepted ethical principles stress that psychiatrists should not make announcements to the media about presumed psychopathology and diagnosis of any individuals. For a psychiatrist, the care of these eminent persons presents a clinical challenge that requires experience, clinical skills and multidisciplinary team work, usually within the occupational health system. Emperor Nero burned Rome — modern leaders may burn the whole world. While unstable dictators mainly belong in history books, democracy and decentralized power do not always offer protection against such leaders. This article focuses on Finnish heads of state and military leaders, particularly from 1939 to 1981. The state of health of those working in demanding positions, such as soldiers, can be monitored; the President of Finland is also the commander-in-chief of the Finnish Defence Forces. The state of health of soldiers, including their mental health, must fulfil specific requirements. Most likely, no standard models to monitor or treat the mental health of high-level leaders exist. Only limited research data is available in this area. I have previously written an article in Finnish of the mental health of top executives (1). The bibliography of this article lists key sources (in Finnish) of the medical records of Finland’s Presidents and military leaders during Finland’s wars

Mental health of high-level politicians:diagnostics, public discussion and treatment―a narrative review

Abstract Objectives: To narratively review the presence and treatments of mental health problems among high-level political leaders. These questions have been noted in few epidemiologically sound studies and in the media. Methods: The literature search was performed and it resulted well-described cases and case series, but lacks properly designed studies focusing on medical issues. Results: High-level political leadership is a high-risk occupation, especially during crises and wartime, but also stressful in modern, democratic society. Leadership positions do not necessary facilitate the early detection of and intervention in mental disorders. In the media, psychiatrists should ensure that leaders with mental disorders are treated in a manner that preserves their dignity. Commonly accepted ethical principles stress that psychiatrists should not make announcements to the media about presumed psychopathology and diagnosis of any individuals. Conclusions: Current top leaders are mostly in midlife and rarely seriously mentally ill, but many are prone to anxiety, depression, addictions or stress-related disorders. The care of these eminent persons presents a clinical challenge that requires experience, clinical skills and multidisciplinary team work, usually within the occupational health system which is familiar with the working conditions and state of health of each patient

Life span development of schizophrenia:symptoms, clinical course, and outcomes

Abstract Schizophrenia is a common, often life-long disorder, beginning mostly in early adulthood. It has remarkably negative effects on personal, familial, somatic, and social well-being. Outcomes range from recovery to chronic disability. Subtle premorbid deviances in motor, cognitive, emotional, and behavioral domains exist. Continuous symptomatology, brain matter loss, cognitive deterioration, excess somatic comorbidity, and premature mortality are seen throughout the life span. The proportion achieving full recovery is small (13.5%) and appears to be stable over recent decades. Many aged individuals with schizophrenia have a favorable clinical and social course. A gap exists in the areas of health and adult creative potential between people with and without schizophrenia. We have an incomplete understanding of the disease mechanisms, lifelong natural course and of how to optimize care during the life span. Current evidence-based treatments have moderate effects and are used insufficiently