eHealth tools for assessing psychomotor activity in schizophrenia: A systematic review

Objective: Psychomotor abnormalities are relevant symptoms in the clinical presentation of schizophrenia, and assessing them could facilitate monitoring. New technologies can measure psychomotor activity objectively and continuously, but evidence on the topic is scarce. Our aim is to systematically review the existing evidence about eHealth tools for assessing psychomotor activity in patients diagnosed with schizophrenia. Method: We performed a systematic search of the PubMed and Embase databases and identified 15 relevant articles on eHealth tools for assessing psychomotor activity in schizophrenia. Results: eHealth devices accurately assessed psychomotor activity and were well accepted. Abnormalities in psychomotor activity helped differentiate between different subtypes of schizophrenia. Abnormal increases in psychomotor activity were correlated with acute presentations, while lower activity was associated with relapses, deterioration, and negative symptoms. Conclusion: Actigraphy is still the preferred eHealth device in research settings, but mobile applications have great potential. Further studies are needed to explore the possibilities of psychomotor monitoring and mobile health applications for preventing relapses in schizophrenia. eHealth could be useful for monitoring psychomotor activity, which might help prevent relapses.This study received grant support from the Instituto de Salud Carlos III (Grant/Award Number: ISCIII CM19/ 00026)

Assessment of Variability in Irregularly Sampled Time Series: Applications to Mental Healthcare

Variability is defined as the propensity at which a given signal is likely to change. There are many choices for measuring variability, and it is not generally known which ones offer better properties. This paper compares different variability metrics applied to irregularly (nonuniformly) sampled time series, which have important clinical applications, particularly in mental healthcare. Using both synthetic and real patient data, we identify the most robust and interpretable variability measures out of a set 21 candidates. Some of these candidates are also proposed in this work based on the absolute slopes of the time series. An additional synthetic data experiment shows that when the complete time series is unknown, as it happens with real data, a non-negligible bias that favors normalized and/or metrics based on the raw observations of the series appears. Therefore, only the results of the synthetic experiments, which have access to the full series, should be used to draw conclusions. Accordingly, the median absolute deviation of the absolute value of the successive slopes of the data is the best way of measuring variability for this kind of time series

Psychosis and Dandy-Walker syndrome: a case report and review of the literature

Dandy-Walker syndrome (DWS) is a group of brain malformations which sometimes present with psychotic symptoms. We present the case of a patient diagnosed with Dandy-Walker variant who presented with schizophrenia-like psychosis. A man in his 30s was admitted to an acute psychiatric unit presenting with persecutory delusions, auditory hallucinations and violent behaviour. The MRI performed showed the typical alterations of Dandy-Walker variant: vermian hypoplasia and cystic dilatation of the fourth ventricle. He also suffered from mild intellectual disability. After being treated with olanzapine 10 mg/d for a month, his psychotic symptoms greatly improved and he was discharged. In conclusion, DWS may cause psychosis through a dysfunction in the circuit connecting prefrontal, thalamic and cerebellar areas. The association between these two conditions may contribute to the understanding of the aetiopathogenesis of schizophrenia

Patients at high risk of suicide before and during a COVID-19 lockdown: ecological momentary assessment study

The coronavirus disease 2019 (COVID-19) outbreak may have affected the mental health of patients at high risk of suicide. In this study we explored the wish to die and other suicide risk factors using smartphone-based ecological momentary assessment (EMA) in patients with a history of suicidal thoughts and behaviour. Contrary to our expectations we found a decrease in the wish to die during lockdown. This is consistent with previous studies showing that suicide rates decrease during periods of social emergency. Smartphone-based EMA can allow us to remotely assess patients and overcome the physical barriers imposed by lockdown.This study received grant support from Instituto de Salud Carlos III (ISCIII PI13/02200; PI16/ 01852; CM19/00026), Delegación del Gobierno para el Plan Nacional de Drogas (20151073), the American Foundation for Suicide Prevention (LSRG-1-005-16), the Ministerio de Ciencia, Innovación y Universidades (RTI2018-099655-B-I00; TEC2017-92552-EXP) and by the Comunidad de Madrid (Y2018/TCS-4705, PRACTICO-CM)

Hearts and Minds:Real-Life Cardiotoxicity with Clozapine in Psychosis

Schizophrenia has a 1% prevalence in the population; 30% of these patients are treatment refractory. Clozapine is the only drug licensed to treat treatment refractory psychosis, but concerns about potential adverse effects result in only a proportion of eligible patients being treated. Although a well-documented neutropenia risk is mitigated by routine blood testing, cardiac toxicity is a commonly cited reason to discontinue clozapine treatment. However, there is little data on the real-life cardiac outcomes in those receiving clozapine treatment. Retrospective review of electrocardiogram, echocardiogram, and clinical outcomes in 39 inpatients with treatment-refractory schizophrenia, treated with clozapine and other antipsychotic medication, referred for cardiology opinion. Commonest reasons for referral were development of left ventricular (LV) impairment or sinus tachycardia with normal LV function. Patients were reviewed by a range of cardiologists, receiving varied interventions.Median LV ejection fraction in the clozapine group was normal (52%). Serial echocardiograms demonstrated that clozapine-treated patients with LV impairment had no change in LV ejection fraction over a 4-month follow-up. Left ventricular ejection fraction did not differ between patients treated with clozapine and other antipsychotics. However, over an 11-year follow-up period, 48% of patients had discontinued clozapine treatment. This naturalistic study demonstrates that clozapine is not associated with significant cardiac mortality or morbidity. There is a real need for multidisciplinary working between specialist cardiologists and psychiatrists caring for these complex patients to facilitate optimal long-term physical and mental health outcomes

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Prevalence and correlates of major depressive disorder in Andalusia

La depresión mayor presenta una prevalencia mayor de la esperada en la provincia de Granada. La crisis económica y las características intrínsecas a la población de estudio podrían estar relacionadas con estas diferencias, si bien las diferencias metodológicas impiden una comparación directa de los resultados. El score de riesgo genético desarrollado es un paso más hacia la caracterización genética de los trastornos mentales. Aunque queda un largo camino para que esta tecnología pueda ser aplicada tanto en contextos de salud pública como en la práctica clínica, en el futuro podría tener importantes aplicaciones en la determinación del riesgo genético de sufrir trastornos mentales. En el conjunto de la población andaluza, la prevalencia fue mayor de la esperada y ligeramente superior a la de la provincia de Granada. La crisis económica, principalmente a través del desempleo, puede estar detrás de esta elevada prevalencia, especialmente si tenemos en cuenta que el desempleo fue uno de los factores psicosociales asociados a la depresión mayor en Andalucía. La elevada comorbilidad entre la depresión mayor y las enfermedades físicas crónicas hace necesario un abordaje más completo del paciente en la práctica clínica, así como una adecuada coordinación entre los distintos servicios. El bajo porcentaje de sujetos con depresión mayor que recibe tratamiento antidepresivo puede estar indicando un infradiagnóstico. Con respecto a las variables antropométricas, las diferencias de género en la asociación de la depresión con la obesidad apuntan a la importancia de los factores psicosociales en esta relación. Las distintas exigencias y estándares de belleza impuestas al sexo femenino pueden derivar en pérdida de autoestima y alteraciones en la imagen corporal. El ejercicio físico podría ser una herramienta útil en la prevención y tratamiento de la depresión mayor, evitando los efectos secundarios derivados de los tratamientos tradicionales.Major depresion is a highly prevalent condition in the Granada population, affecting just over 1 in every 20 people at the time data were collected. Prevalence in this area is higher than expected considering previous reports in the Spanish population Reasons for this increased prevalence may be related to the effects of the economic crisis that struck the region with particular strength around the time our data were collected. The negative effects of the economic crisis on the mental health of the Spanish population have been explored in a number of studies, and one of them found that suicide rates had increased abruptly in Andalusia after the crisis. Unemployment is thought to mediate this association. Asociación between female sex and depression may be partially explained by the confounding effect of neuroticism. In the whole Andalusian population, prevalence of major depresion was slightly higher than that of Granada. Both figures are higher than those found in most of the previous community-based mental health surveys carried out in Spain. The economic recession and the cultural idiosyncrasies of the region may help explain this result, although methodological differences preclude a direct comparison of our results with those of previous studies. Major depresion is associated with poorer health status, obesity and chronic physical conditions. The low rate of antidepressant treatment may be indicating an underdiagnosis in the clinical practice. An adequate coordination between different medical departments is needed to grant the best possible mental and physical healthcare.Tesis Univ. Granada.This study was partially financed with a subsidy from the Department of Economy, Innovation and Science of the Regional Government of Andalusia (10-CTS-6682).This study has received financial support by: Carlos III (ISCIII PI16/01852), Delegaci on del Gobierno para el Plan Nacional de Drogas (20151073), American Foundation for Suicide Prevention (LSRG-1-005-16), Comunidad de Madrid (Actividades I + D en Biomedicina B2017/BMD-3740, AGES-CM 2CM) and Structural Funds of the European Union

Implicit Cognition Tests for the Assessment of Suicide Risk: a Systematic Review.

Suicide risk assessment is a challenge in clinical practice. Implicit measures may present with advantages with respect to explicit methods, and therefore may be useful for the assessment of suicide risk. We conducted a systematic review of 2 databases (PubMed and EMBASE) about implicit tests that measure suicide risk to explore their validity and reliability. Initial research revealed 321 articles. After the selection process, 31 articles were included in the review. The most death-related implicit cognition test used was the Death/Suicide Implicit association test (D/S IAT), followed by the Suicide Stroop Task. The Suicide Affect Misattribution Procedure (S-AMP) and the Death version of the Implicit Relational Assessment Procedure (D-IRAP) were also used. We found that the measures reviewed were generally valid for the assessment of past and future suicidal thoughts and behaviors, with statistically significant results regarding retrospective and prospective associations

Prevalence and correlates of major depressive disorder: a systematic review

Objectives: Major depressive disorder (MDD) is one of the most disabling mental illnesses and it has a significant impact on society. This review aims to provide updated scientific evidence about the epidemiology of MDD. Methods: A systematic literature review of the PubMed and MEDLINE databases was performed to identify articles on the prevalence of MDD and its correlates. The search was restricted to manuscripts published between January 2001 and December 2018. Results: Sixty-three articles were included in the review. The lifetime prevalence of MDD ranged from 2 to 21%, with the highest rates found in some European countries and the lowest in some Asian countries. The main sociodemographic correlates were separated/divorced marital status and female gender. Child abuse, intimate partner violence, and comorbidity with other physical and mental disorders also were consistently associated with MDD across the reviewed studies. Conclusions: MDD is a highly prevalent condition worldwide. There are remarkable interregional differences in the disorder’s prevalence, as well as in certain sociodemographic correlates. MDD is also highly comorbid with physical and mental health problems.Instituto de Salud Carlos III ISCIII CM19/0002