The Impact of COVID-19 Lockdown on Adults with Major Depressive Disorder from Catalonia : A Decentralized Longitudinal Study

The RADAR-CNS project received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 115902. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation program and EFPIA (www.imi.europa.eu accessed on 8 February 2023). This communication reflects the views of the RADAR-CNS consortium and neither IMI nor the European Union and EFPIA are liable for any use that may be made of the information contained herein. The funding body has been involved in the design of the study, the collection or analysis of data, or the interpretation of data. MTPM (7Z22/009) is partially released of clinical activity through a personal research grant of IDIAP Jordi Gol and Institut Català de la Salut (ICS).The present study analyzes the effects of each containment phase of the first COVID-19 wave on depression levels in a cohort of 121 adults with a history of major depressive disorder (MDD) from Catalonia recruited from 1 November 2019, to 16 October 2020. This analysis is part of the Remote Assessment of Disease and Relapse-MDD (RADAR-MDD) study. Depression was evaluated with the Patient Health Questionnaire-8 (PHQ-8), and anxiety was evaluated with the Generalized Anxiety Disorder-7 (GAD-7). Depression's levels were explored across the phases (pre-lockdown, lockdown, and four post-lockdown phases) according to the restrictions of Spanish/Catalan governments. Then, a mixed model was fitted to estimate how depression varied over the phases. A significant rise in depression severity was found during the lockdown and phase 0 (early post-lockdown), compared with the pre-lockdown. Those with low pre-lockdown depression experienced an increase in depression severity during the "new normality", while those with high pre-lockdown depression decreased compared with the pre-lockdown. These findings suggest that COVID-19 restrictions affected the depression level depending on their pre-lockdown depression severity. Individuals with low levels of depression are more reactive to external stimuli than those with more severe depression, so the lockdown may have worse detrimental effects on them

The polygenic basis of relapse after a first episode of schizophrenia

Little is known about genetic predisposition to relapse. Previous studies have linked cognitive and psychopathological (mainly schizophrenia and bipolar disorder) polygenic risk scores (PRS) with clinical manifestations of the disease. This study aims to explore the potential role of PRS from major mental disorders and cognition on schizophrenia relapse. 114 patients recruited in the 2EPs Project were included (56 patients who had not experienced relapse after 3 years of enrollment and 58 patients who relapsed during the 3-year follow-up). PRS for schizophrenia (PRS-SZ), bipolar disorder (PRS-BD), education attainment (PRS-EA) and cognitive performance (PRS-CP) were used to assess the genetic risk of schizophrenia relapse.Patients with higher PRS-EA, showed both a lower risk (OR=0.29, 95% CI [0.11–0.73]) and a later onset of relapse (30.96± 1.74 vs. 23.12± 1.14 months, p=0.007. Our study provides evidence that the genetic burden of neurocognitive function is a potentially predictors of relapse that could be incorporated into future risk prediction models. Moreover, appropriate treatments for cognitive symptoms appear to be important for improving the long-term clinical outcome of relapse

Factors del neuro-desenvolupament i de la pubertat que es relacionen amb l'edat d'inicide primers episodis de psicosi

[cat] Introducció: Estudis previs han demostrat que una edat d'inici de psicosi (EIP) precoç s'associa a major gravetat clínica i funcional i pitjor pronòstic. El coneixement en profunditat de l'EIP pot contribuir a una milloria del coneixement de l'etiopatogènia i a poder dirigir de forma específica el tractament precoç de la psicosi. Hi ha diversos factors genètics i ambientals que s'ha demostrat poden fer variar l'EIP, com l’edat de la pubertat, complicacions obstètriques, antecedents familiars o ús de substàncies. Objectius: Amb el present projecte es vol estudiar com es relacionen aquests factors i l'EIP en una mostra de pacients amb un primer episodi de psicosi. Al primer treball l’objectiu és relacionar, en la submostra de dones, l’edat de menarquia, com a mesura de pubertat, amb l’EIP, i estudiar la relació entre l’edat de menarquia i la gravetat i el pronòstic clínics. Al segon treball, determinar la relació entre EIP i antecedents de complicacions de tipus obstètric i dades al néixer com el baix pes o la prematuritat fetal, i avaluar com es relacionen amb l'EIP els antecedents familiars de psicosi i l’edat del pare i de la mare. Mètodes: Es van reclutar per aquest estudi pacients d'entre 10 i 65 anys amb un primer episodi psicòtic, atesos tant a serveis de salut mental comunitaris com d’hospitalització i pertanyents a les xarxes d'adults o d'infanto-juvenil. La mostra final va ser de 90 pacients. Per a realitzar aquest estudi es va crear un qüestionari sòcio-demogràfic, completat a través d'entrevista clínica, i es varen administrar les següents escales: PANSS (Positive and Negative Syndrome Scale), ICG-ESQ (Clinical Global Impression – Schizophrenia Scale), GAF (Global Assessment of Functioning), DAS-sv (Disability Assessment Schedule versió curta), escala d'Intel·ligència de Wechsler, i escala EuroQol 5D de qualitat de vida. Es va obtenir l'edat decimal del/la pacient en l'inici dels primers símptomes psicòtics, en el primer contacte amb psiquiatria i en el primer ingrés a hospital psiquiàtric, si n’era el cas. L'edat de menarquia es va obtenir de forma retrospectiva. Mitjançant entrevista clínica i el qüestionari dissenyat per a l'estudi es va obtenir a més a més l'edat del pare i de la mare en el moment del naixement del fill/a i l'ús de substàncies previ al debut de psicosi (criteris d'abús i dependència del DSM-IV). Els antecedents de psicosi en la mare o pare es varen recollir seguint el model d'Andreasen i els antecedents obstètrics utilitzant l'escala de complicacions obstètriques de Lewis i Murray. També es recollí el pes i edat gestacional del o la pacient al néixer, i si la mare havia patit avortaments previs o havia consumit substàncies durant l'embaràs. Resultats: No es va trobar una correlació estadísticament significativa entre l’edat de menarquia i EIP. Tampoc es varen trobar dades significatives en quant a la relació entre l'edat de menarquia i l'escala PANNS, ICG-ESQ, GAF, DAS total o EuroQol. La pre-eclàmpsia, la necessitat d'ús d'incubadora en néixer, l'ús de fòrceps, l'antecedent patern de psicosi i un pes baix en néixer, es van relacionar amb una edat de EIP més primerenca. L’ús de fòrceps i el pes en néixer eren les variables que millor predeien l’EIP. Conclusions: Els resultats obtinguts suggereixen una major complexitat de la hipòtesi estrogènica, involucrant altres factors com biològics i psicosocials, i posen en relleu el rol del període prenatal en el desenvolupament de la psicosi i la importància de monitoritzar de forma adequada l'embaràs i el part, especialment en casos de mares i pares amb antecedents de psicosi. Factors de risc com la càrrega familiar i genètica, complicacions al part i embaràs i l’ús de tòxics durant l’adolescència podrien ser utilitzats de forma efectiva com predictors de trastorns psicòtics.[eng] Introduction: Previous studies have shown that age at onset of psychosis (AOP) is associated with higher clinical and functional severity and worse prognosis. An in-depth study of AOP can contribute to the improvement of knowledge of psychosis pathogenesis and help improve its early and specific treatment. There are several genetic and environmental factors that have been related to AOP variations such as age of puberty, obstetric complications, family history or substance use. Objectives: The purpose of this project is to study how these factors relate to AOP in a sample of patients with a first episode of psychosis. The objective of the first study is to relate, in the women subsample, the age of menarche, as a measure of puberty, with AOP, and to study the relationship between age of menarche and clinical severity and prognosis. In the second study, the objective is to determine the relationship between AOP and history of obstetric complications, low birth weight and preterm birth and to evaluate how family history of psychosis and age of parents relate to AOP. Methods: Patients included in the the study were aged between 10 and 65 years old, with a first psychotic episode, both recruited in community and hospital facilities, and belonging to adults or children and adolescent mental health services. The final sample was of 90 patients. For this study a socio-demographic questionnaire was designed, completed through clinical interview, and the following scales were administered: PANSS (Positive and Negative Syndrome Scale) ICG-ESQ (Clinical Global Impression - Schizophrenia Scale), GAF (Global Assessment of Functioning) sv-DAS (Disability Assessment Schedule short version), Wechsler Intelligence scale and EuroQol 5D quality of life scale. We obtained the decimal ages of onset of psychotic symptoms, of first contact with psychiatry and of first admission to a psychiatric hospital, if that was the case. Age of menarche was obtained retrospectively. Through clinical interview and the questionnaire designed for the study, ages of the father and the mother at time of child birth and substance use prior to the psychosis onset (DSM-IV abuse and dependence criteria) were also obtained. The history of psychosis in the mother or father was collected following the Andreasen model and obstetric antecedents using the scale of Lewis and Murray obstetric complications. Also weight and gestational age of the patient at time of birth were collected, and whether the mother had experienced previous miscarriages or had used any substances during pregnancy. Results: A significant correlation between age of menarche and AOP, PANSS scale, ICG-ESQ, GAF, total DAS or EuroQol was not found. Pre-eclampsia, need of incubator at birth, use of forceps, paternal history of psychosis and low birth weight, were associated with an earlier AOP. Use of forceps and birth weight were the variables that best predicted AOP. Conclusions: The results suggest a greater complexity of estrogen hypothesis, involving other factors such as biological and psychosocial ones, and highlight the role of the prenatal period in the development of psychosis and the importance of adequately monitor pregnancy and delivery, especially in cases of parents with a history of psychosis. Risk factors such as genetic and family burden, pregnancy and childbirth complications and the use of substances during adolescence could be used effectively to predict psychotic disorders

Measuring Users’ Receptivity Toward an Integral Intervention Model Based on mHealth Solutions for Patients With Treatment-Resistant Schizophrenia (m-RESIST): A Qualitative Study

BACKGROUND: Despite the theoretical potential of mHealth solutions in the treatment of patients with schizophrenia, there remains a lack of technological tools in clinical practice. OBJECTIVE: The aim of this study was to measure the receptivity of patients, informal carers, and clinicians to a European integral intervention model focused on patients with persistent positive symptoms: Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST). METHODS: Before defining the system requirements, a qualitative study of the needs of outpatients with treatment-resistant schizophrenia was carried out in Spain, Israel, and Hungary. We analyzed the opinions of patients, informal carers, and clinicians concerning the services originally intended to be part of the solution. A total of 9 focus groups (72 people) and 35 individual interviews were carried out in the 3 countries, using discourse analysis as the framework. RESULTS: A webpage and an online forum were perceived as suitable to get both reliable information on the disease and support. Data transmission by a smart watch (monitoring), Web-based visits, and instant messages (clinical treatment) were valued as ways to improve contact with clinicians. Alerts were appreciated as reminders of daily tasks and appointments. Avoiding stressful situations for outpatients, promoting an active role in the management of the disease, and maintaining human contact with clinicians were the main suggestions provided for improving the effectiveness of the solution. CONCLUSIONS: Positive receptivity toward m-RESIST services is related to its usefulness in meeting user needs, its capacity to empower them, and the possibility of maintaining human contact

Understanding the Subjective Experience of Long-term Remote Measurement Technology Use for Symptom Tracking in People With Depression: Multisite Longitudinal Qualitative Analysis

Background: Remote measurement technologies (RMTs) have the potential to revolutionize major depressive disorder (MDD) disease management by offering the ability to assess, monitor, and predict symptom changes. However, the promise of RMT data depends heavily on sustained user engagement over extended periods. In this paper, we report a longitudinal qualitative study of the subjective experience of people with MDD engaging with RMTs to provide insight into system usability and user experience and to provide the basis for future promotion of RMT use in research and clinical practice. Objective: We aimed to understand the subjective experience of long-term engagement with RMTs using qualitative data collected in a longitudinal study of RMTs for monitoring MDD. The objectives were to explore the key themes associated with long-term RMT use and to identify recommendations for future system engagement. Methods: In this multisite, longitudinal qualitative research study, 124 semistructured interviews were conducted with 99 participants across the United Kingdom, Spain, and the Netherlands at 3-month, 12-month, and 24-month time points during a study exploring RMT use (the Remote Assessment of Disease and Relapse-Major Depressive Disorder study). Data were analyzed using thematic analysis, and interviews were audio recorded, transcribed, and coded in the native language, with the resulting quotes translated into English. Results: There were 5 main themes regarding the subjective experience of long-term RMT use: research-related factors, the utility of RMTs for self-management, technology-related factors, clinical factors, and system amendments and additions. Conclusions: The subjective experience of long-term RMT use can be considered from 2 main perspectives: experiential factors (how participants construct their experience of engaging with RMTs) and system-related factors (direct engagement with the technologies). A set of recommendations based on these strands are proposed for both future research and the real-world implementation of RMTs into clinical practice. Future exploration of experiential engagement with RMTs will be key to the successful use of RMTs in clinical care

Dataset used to perform Focus Groups in Spain, Israel and Hungary (related to m-RESIST project)

<p>Dataset used to perform the following manuscripts: </p> <p>- Huerta-Ramos, E., Escobar-Villegas, M. S., Rubinstein, K., Unoka, Z. S., Grasa, E., Hospedales, M., … Usall, J. (2016). Measuring Users’ Receptivity Toward an Integral Intervention Model Based on mHealth Solutions for Patients With Treatment-Resistant Schizophrenia (m-RESIST): A Qualitative Study. <em>JMIR mHealth and uHealth</em>, <em>4</em>(3), e112. http://doi.org/10.2196/mhealth.5716</p> <p>rom March to June (2015), it was included opinions of patients, informal carers, and clinicians from the three countries concerning the services originally intended to be part of the solution. The activities related to the publication were the following: 9 focus groups (72 people) and 35 individual interviews were carried out in the 3 countries. All recorded data was analysed using discourse analysis as the framework. </p