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Salehi MA, Zafari R, Mohammadi S, Shahrabi Farahani M, Dolatshahi M, Harandi H, Poopak A, Dager SR. Brain-based sex differences in schizophrenia: A systematic review of fMRI studies. Hum Brain Mapp 2024; 45:e26664. [PMID: 38520370 PMCID: PMC10960555 DOI: 10.1002/hbm.26664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/29/2024] [Accepted: 03/08/2024] [Indexed: 03/25/2024] Open
Abstract
Schizophrenia is a chronic psychiatric disorder with characteristic symptoms of delusions, hallucinations, lack of motivation, and paucity of thought. Recent evidence suggests that the symptoms of schizophrenia, negative symptoms in particular, vary widely between the sexes and that symptom onset is earlier in males. A better understanding of sex-based differences in functional magnetic resonance imaging (fMRI) studies of schizophrenia may provide a key to understanding sex-based symptom differences. This study aimed to summarize sex-based functional magnetic resonance imaging (fMRI) differences in brain activity of patients with schizophrenia. We searched PubMed and Scopus to find fMRI studies that assessed sex-based differences in the brain activity of patients with schizophrenia. We excluded studies that did not evaluate brain activity using fMRI, did not evaluate sex differences, and were nonhuman or in vitro studies. We found 12 studies that met the inclusion criteria for the current systematic review. Compared to females with schizophrenia, males with schizophrenia showed more blood oxygen level-dependent (BOLD) activation in the cerebellum, the temporal gyrus, and the right precuneus cortex. Male patients also had greater occurrence of low-frequency fluctuations in cerebral blood flow in frontal and parietal lobes and the insular cortex, while female patients had greater occurrence of low-frequency fluctuations in the hippocampus, parahippocampus, and lentiform nucleus. The current study summarizes fMRI studies that evaluated sex-based fMRI brain differences in schizophrenia that may help to shed light on the underlying pathophysiology and further understanding of sex-based differences in the clinical presentation and course of the disorder.
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Affiliation(s)
| | - Rasa Zafari
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Soheil Mohammadi
- School of MedicineTehran University of Medical SciencesTehranIran
| | | | - Mahsa Dolatshahi
- Mallinckrodt Institute of Radiology, Division of NeuroradiologyWashington University in St. LouisSt. LouisMissouriUSA
| | - Hamid Harandi
- School of MedicineTehran University of Medical SciencesTehranIran
| | | | - Stephen R. Dager
- Department of RadiologyUniversity of WashingtonSeattleWashingtonUSA
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2
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Schick A, Rauschenberg C, Ader L, Daemen M, Wieland LM, Paetzold I, Postma MR, Schulte-Strathaus JCC, Reininghaus U. Novel digital methods for gathering intensive time series data in mental health research: scoping review of a rapidly evolving field. Psychol Med 2023; 53:55-65. [PMID: 36377538 PMCID: PMC9874995 DOI: 10.1017/s0033291722003336] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022]
Abstract
Recent technological advances enable the collection of intensive longitudinal data. This scoping review aimed to provide an overview of methods for collecting intensive time series data in mental health research as well as basic principles, current applications, target constructs, and statistical methods for this type of data.In January 2021, the database MEDLINE was searched. Original articles were identified that (1) used active or passive data collection methods to gather intensive longitudinal data in daily life, (2) had a minimum sample size of N ⩾ 100 participants, and (3) included individuals with subclinical or clinical mental health problems.In total, 3799 original articles were identified, of which 174 met inclusion criteria. The most widely used methods were diary techniques (e.g. Experience Sampling Methodology), various types of sensors (e.g. accelerometer), and app usage data. Target constructs included affect, various symptom domains, cognitive processes, sleep, dysfunctional behaviour, physical activity, and social media use. There was strong evidence on feasibility of, and high compliance with, active and passive data collection methods in diverse clinical settings and groups. Study designs, sampling schedules, and measures varied considerably across studies, limiting the generalisability of findings.Gathering intensive longitudinal data has significant potential to advance mental health research. However, more methodological research is required to establish and meet critical quality standards in this rapidly evolving field. Advanced approaches such as digital phenotyping, ecological momentary interventions, and machine-learning methods will be required to efficiently use intensive longitudinal data and deliver personalised digital interventions and services for improving public mental health.
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Affiliation(s)
- Anita Schick
- Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Christian Rauschenberg
- Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Leonie Ader
- Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Maud Daemen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Lena M. Wieland
- Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Isabell Paetzold
- Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Mary Rose Postma
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Julia C. C. Schulte-Strathaus
- Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Ulrich Reininghaus
- Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
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3
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Stefancic A, Rogers RT, Styke S, Xu X, Buchsbaum R, Nossel I, Cabassa LJ, Stroup TS, Kimhy D. Development of the First Episode Digital Monitoring mHealth Intervention for People With Early Psychosis: Qualitative Interview Study With Clinicians. JMIR Ment Health 2022; 9:e41482. [PMID: 36331539 PMCID: PMC9675009 DOI: 10.2196/41482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) technologies have been used extensively in psychosis research. In contrast, their integration into real-world clinical care has been limited despite the broad availability of smartphone-based apps targeting mental health care. Most apps developed for treatment of individuals with psychosis have focused primarily on encouraging self-management skills of patients via practicing cognitive behavioral techniques learned during face-to-face clinical sessions (eg, challenging dysfunctional thoughts and relaxation exercises), reminders to engage in health-promoting activities (eg, exercising, sleeping, and socializing), or symptom monitoring. In contrast, few apps have sought to enhance the clinical encounter itself to improve shared decision-making (SDM) and therapeutic relationships with clinicians, which have been linked to positive clinical outcomes. OBJECTIVE This qualitative study sought clinicians' input to develop First Episode Digital Monitoring (FREEDoM), an app-based mHealth intervention. FREEDoM was designed to improve the quality, quantity, and timeliness of clinical and functional data available to clinicians treating patients experiencing first-episode psychosis (FEP) to enhance their therapeutic relationship and increase SDM. METHODS Following the app's initial development, semistructured qualitative interviews were conducted with 11 FEP treatment providers at 3 coordinated specialty care clinics to elicit input on the app's design, the data report for clinicians, and planned usage procedures. We then generated a summary template and conducted matrix analysis to systematically categorize suggested adaptations to the evidence-based intervention using dimensions of the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) and documented the rationale for adopting or rejecting suggestions. RESULTS The clinicians provided 31 suggestions (18 adopted and 13 rejected). Suggestions to add or refine the content were most common (eg, adding questions in the app). Adaptations to context were most often related to plans for implementing the intervention, how the reported data were displayed to clinicians, and with whom the reports were shared. Reasons for suggestions primarily included factors related to health narratives and priorities of the patients (eg, focus on the functional impact of symptoms vs their severity), providers' clinical judgment (eg, need for clinically relevant information), and organizations' mission and culture. Reasons for rejecting suggestions included requests for data and procedures beyond the intervention's scope, concerns regarding dilution of the intervention's core components, and concerns about increasing patient burden while using the app. CONCLUSIONS FREEDoM focuses on a novel target for the deployment of mHealth technologies in the treatment of FEP patients-the enhancement of SDM and improvement of therapeutic relationships. This study illustrates the use of the FRAME, along with methods and tools for rapid qualitative analysis, to systematically track adaptations to the app as part of its development process. Such adaptations may contribute to enhanced acceptance of the intervention by clinicians and a higher likelihood of integration into clinical care. TRIAL REGISTRATION ClinicalTrials.gov NCT04248517; https://tinyurl.com/tjuyxvv6.
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Affiliation(s)
- Ana Stefancic
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - R Tyler Rogers
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - Sarah Styke
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - Xiaoyan Xu
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - Richard Buchsbaum
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Ilana Nossel
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States.,Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - Leopoldo J Cabassa
- Brown School of Social Work, Washington University in St Louis, St Louis, MO, United States
| | - T Scott Stroup
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States.,Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine, New York, NY, United States.,New York Mental Illness Research Education and Clinical Center, The James J Peters Veteran's Affairs Medical Center, Bronx, NY, United States
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4
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Deakin E, Ng F, Young E, Thorpe N, Newby C, Coupland C, Craven M, Slade M. Design decisions and data completeness for experience sampling methods used in psychosis: systematic review. BMC Psychiatry 2022; 22:669. [PMID: 36307752 PMCID: PMC9617456 DOI: 10.1186/s12888-022-04319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/18/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The experience sampling method (ESM) is an intensive longitudinal research method. Participants complete questionnaires at multiple times about their current or very recent state. The design of ESM studies is complex. People with psychosis have been shown to be less adherent to ESM study protocols than the general population. It is not known how to design studies that increase adherence to study protocols. A lack of typology makes it is hard for researchers to decide how to collect data in a way that allows for methodological rigour, quality of reporting, and the ability to synthesise findings. The aims of this systematic review were to characterise the design choices made in ESM studies monitoring the daily lives of people with psychosis, and to synthesise evidence relating the data completeness to different design choices. METHODS A systematic review was conducted of published literature on studies using ESM with people with psychosis. Studies were included if they used digital technology for data collection and reported the completeness of the data set. The constant comparative method was used to identify design decisions, using inductive identification of design decisions with simultaneous comparison of design decisions observed. Weighted regression was used to identify design decisions that predicted data completeness. The review was pre-registered (PROSPERO CRD42019125545). RESULTS Thirty-eight studies were included. A typology of design choices used in ESM studies was developed, which comprised three superordinate categories of design choice: Study context, ESM approach and ESM implementation. Design decisions that predict data completeness include type of ESM protocol used, length of time participants are enrolled in the study, and if there is contact with the research team during data collection. CONCLUSIONS This review identified a range of design decisions used in studies using ESM in the context of psychosis. Design decisions that influence data completeness were identified. Findings will help the design and reporting of future ESM studies. Results are presented with the focus on psychosis, but the findings can be applied across different mental health populations.
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Affiliation(s)
- Emilia Deakin
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK. .,Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK. .,Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.
| | - Fiona Ng
- grid.4563.40000 0004 1936 8868School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU UK
| | - Emma Young
- grid.439378.20000 0001 1514 761XNottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Naomi Thorpe
- grid.439378.20000 0001 1514 761XNottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Christopher Newby
- grid.4563.40000 0004 1936 8868School of Medicine, University of Nottingham, Nottingham, UK
| | - Carol Coupland
- grid.4563.40000 0004 1936 8868School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael Craven
- grid.4563.40000 0004 1936 8868Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK ,grid.4563.40000 0004 1936 8868Human Factors Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK ,grid.4563.40000 0004 1936 8868Institute of Mental Health, NIHR MindTech MedTech Co-Operative, University of Nottingham, Nottingham, UK
| | - Mike Slade
- grid.4563.40000 0004 1936 8868School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU UK ,grid.4563.40000 0004 1936 8868Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK ,grid.465487.cNord University, Postboks 474, 7801 Namsos, Norway
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5
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The Interrelation between Interleukin-2 and Schizophrenia. Brain Sci 2022; 12:brainsci12091154. [PMID: 36138890 PMCID: PMC9496814 DOI: 10.3390/brainsci12091154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/23/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
Interleukin-2 (IL-2) is a growth factor that regulates T-cell autocrine secretion and has long been considered to be closely related to immune response. With the advance in neuroinflammation theory and immunology research on schizophrenia, it is interesting and meaningful to discuss the possible role of IL-2 in schizophrenia. Here, we reviewed a series of studies published from the 1990s and found that IL-2 was closely associated with schizophrenia. For example, IL-2 is responsible for mediating toxic reactions, which are the causes of schizophrenia symptoms in patients, and such symptoms resolve after discontinuation of the drug. In addition, we focused on the changes of IL-2 in the onset, progression and treatment of schizophrenia and the possible mechanisms by which IL-2 affects schizophrenia. Our review suggests that IL-2 is associated with schizophrenia and plays a role in its pathogenesis, and progression IL-2 and sIL-2R could serve as potential biomarkers of schizophrenia.
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6
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Kalinich M, Ebrahim S, Hays R, Melcher J, Vaidyam A, Torous J. Applying machine learning to smartphone based cognitive and sleep assessments in schizophrenia. Schizophr Res Cogn 2022; 27:100216. [PMID: 34934638 PMCID: PMC8655108 DOI: 10.1016/j.scog.2021.100216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022] Open
Abstract
Background Methods Results Discussion
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Affiliation(s)
- Mark Kalinich
- Harvard Medical School, Boston, MA, USA
- Watershed Informatics, Inc., Boston, MA, USA
| | - Senan Ebrahim
- Harvard Medical School, Boston, MA, USA
- Delfina Inc., Boston, MA, USA
| | - Ryan Hays
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jennifer Melcher
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aditya Vaidyam
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - John Torous
- Harvard Medical School, Boston, MA, USA
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Corresponding author at: Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA.
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7
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The Impact of Sleep on Neurocognition and Functioning in Schizophrenia—Is It Time to Wake-Up? JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2022; 7. [PMID: 35224206 PMCID: PMC8880843 DOI: 10.20900/jpbs.20220001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
People with schizophrenia (SZ) display substantial neurocognitive deficits that have been implicated as major contributors to poor daily functioning and disability. Previous reports have identified a number of predictors of poor neurocognition in SZ including demographics, symptoms, and treatment adherence, as well as body mass index, aerobic fitness, and exercise activity. However, the putative impact of sleep has received relatively limited consideration, despite sleep disturbances, which are pervasive in this population, resulting in symptoms that are strikingly similar to the neurocognitive deficits commonly observed in SZ. Here we argue for the consideration of the impact of sleep on neurocognition in people with SZ and propose recommendations for future research to elucidate the links between sleep parameters, neurocognition and daily functioning.
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8
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Mestdagh M, Dejonckheere E. Ambulatory assessment in psychopathology research: Current achievements and future ambitions. Curr Opin Psychol 2021; 41:1-8. [DOI: 10.1016/j.copsyc.2021.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
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Halverson TF, Meyer-Kalos PS, Perkins DO, Gaylord SA, Palsson OS, Nye L, Algoe SB, Grewen K, Penn DL. Enhancing stress reactivity and wellbeing in early schizophrenia: A randomized controlled trial of Integrated Coping Awareness Therapy (I-CAT). Schizophr Res 2021; 235:91-101. [PMID: 34332429 DOI: 10.1016/j.schres.2021.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/14/2021] [Accepted: 07/19/2021] [Indexed: 11/18/2022]
Abstract
Individuals with schizophrenia spectrum disorders (SSD) are at heightened risk for exposure to stressful life events which can lead to increased sensitivity to stress and a dysregulated stress response, which are in turn associated with poor long-term functioning. Stress reactivity is thus a promising treatment target in the early stages of SSD. Integrated-Coping Awareness Therapy (I-CAT) is a manualized intervention integrating mindfulness and positive psychology to target a dysregulated stress response in SSD. The current study is a preliminary randomized-controlled trial (RCT) comparing I-CAT (n = 18) with treatment as usual (TAU; n = 18) in individuals in the early stages of SSD. I-CAT was hypothesized to be more effective than TAU on primary outcomes: increasing positive emotions, decreasing negative emotions, reducing stress, and improving functioning and quality of life; and secondary outcomes: reducing symptoms, increasing mindfulness, and improving overall well-being. Excellent therapy attendance rates, low study attrition, and positive participant feedback demonstrated that I-CAT was a feasible and well-tolerated psychosocial intervention. Results suggest I-CAT led to greater reduction in symptoms (i.e., overall, negative, and disorganized symptoms), increased observational mindfulness, increased endorsement of a sense of purpose in life, and preservation of work abilities and school social functioning compared with TAU. Future work should replicate and extend these findings in a larger-scale RCT.
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Affiliation(s)
- Tate F Halverson
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, United States of America.
| | - Piper S Meyer-Kalos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, United States of America
| | - Diana O Perkins
- Department of Psychiatry, The University of North Carolina at Chapel Hill, United States of America
| | - Susan A Gaylord
- Department of Physical Medicine and Rehabilitation, The University of North Carolina at Chapel Hill, United States of America
| | - Olafur S Palsson
- Department of Medicine, The University of North Carolina at Chapel Hill, United States of America
| | - Lana Nye
- College of Social Work, The University of Utah, United States of America
| | - Sara B Algoe
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, United States of America
| | - Karen Grewen
- Department of Psychiatry, The University of North Carolina at Chapel Hill, United States of America
| | - David L Penn
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, United States of America; School of Behavioural and Health Sciences, Australian Catholic University, Australia
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10
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Wright AC, Browne J, Skiest H, Bhiku K, Baker JT, Cather C. The relationship between conventional clinical assessments and momentary assessments of symptoms and functioning in schizophrenia spectrum disorders: A systematic review. Schizophr Res 2021; 232:11-27. [PMID: 34004382 DOI: 10.1016/j.schres.2021.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/09/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Symptoms and functioning are critical dimensions in those with schizophrenia and are typically measured using validated conventional clinical assessments. Researchers and clinicians have begun to use real-time digital methods, such as ecological momentary assessment (EMA), to assess symptoms and functioning in the moment and outside of traditional hospital and laboratory settings, which may yield more naturalistic data. Although digital methods have advantages, it is unclear whether these momentary assessments capture core aspects of symptoms and functioning. OBJECTIVE This systematic literature review aimed to evaluate the association between conventional clinical and momentary-based assessments of functioning and symptoms in individuals with schizophrenia. METHODS Studies were included if they met the following criteria: (1) written or translated into English; (2) peer-reviewed; (3) included primary quantitative data; (4) 60% of the clinical sample included persons with schizophrenia spectrum disorders; (5) included a clinical assessment of functioning and/or symptoms; (6) included active momentary assessment and/or passive data; and (7) assessed the relationship between the momentary and conventional clinical assessments. RESULTS A total of 49 studies (87 analyses) were included. Conventional clinical assessments of functioning and positive, negative, and depressive symptoms were related to momentary assessments of these symptom domains. Passive data was beneficial for assessing negative symptoms, but research is warranted for other domains. CONCLUSIONS The reviewed studies highlight the utility of EMA methodologies to collect detailed data on symptoms and functioning. Such data is being used to develop more sophisticated models of schizophrenia to enhance our understanding of important mechanisms and develop targeted interventions.
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Affiliation(s)
- Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Hannah Skiest
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kamila Bhiku
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Justin T Baker
- Harvard Medical School, Boston, MA, USA; Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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11
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Enhancement of aerobic fitness improves social functioning in individuals with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2021; 271:367-376. [PMID: 33389108 PMCID: PMC7778707 DOI: 10.1007/s00406-020-01220-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/02/2020] [Indexed: 12/16/2022]
Abstract
Individuals with schizophrenia display substantial deficits in social functioning (SF), characterized by chronic, lifelong presentations. Yet, at present there are few effective interventions to enhance SF in this population. Emerging evidence from studies of clinical populations that display similar SF deficits suggests that aerobic exercise (AE) may improve social skills. However, this putative impact has not been investigated in schizophrenia. Employing a single-blind, randomized clinical trial design, 33 individuals with schizophrenia were randomized to receive 12 weeks of Treatment-As-Usual (TAU; n = 17) or TAU + AE (n = 16) utilizing active-play video games (Xbox 360 Kinect) and traditional AE equipment. Participants completed an evaluation of aerobic fitness (VO2max) as well as self-, informant-, and clinician-reported SF measures at baseline and after 12 weeks. Twenty-six participants completed the study (79%; TAU = 13; AE = 13). At follow-up, the AE participants improved their VO2max by 18.0% versus - 0.5% in the controls (group x time interaction, F1,24 = 12.88; p = .002). Hierarchical stepwise regression analyses indicated improvements in VO2max significantly predicted enhancement in SF as indexed by self-, informant-, and clinician-reported measures, predicting 47%, 33%, and 25% of the variance, respectively (controlling for baseline demographics, medications, mood symptoms, and social networks). Compared to the TAU group, AE participants reported significant improvement in SF (23.0% vs. - 4.2%; group × time interaction, F1,24 = 7.48, p = .012). The results indicate that VO2max enhancement leads to improvements in SF in people with schizophrenia. Furthermore, low VO2max represents a modifiable risk factor of SF in people with schizophrenia, for which AE training offers a safe, non-stigmatizing, and nearly side-effect-free intervention.
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12
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Buck B, Hallgren KA, Campbell AT, Choudhury T, Kane JM, Ben-Zeev D. mHealth-Assisted Detection of Precursors to Relapse in Schizophrenia. Front Psychiatry 2021; 12:642200. [PMID: 34135781 PMCID: PMC8202824 DOI: 10.3389/fpsyt.2021.642200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/03/2021] [Indexed: 11/18/2022] Open
Abstract
Theoretical views and a growing body of empirical evidence suggest that psychiatric relapses in schizophrenia-spectrum disorders (SSDs) have measurable warning signs. However, because they are time- and resource-intensive, existing assessment approaches are not well-suited to detect these warning signs in a timely, scalable fashion. Mobile technologies deploying frequent measurements-i.e., ecological momentary assessment-could be leveraged to detect increases in symptoms that may precede relapses. The present study examined EMA measurements with growth curve models in the 100 days preceding and following 27 relapses (among n = 20 individuals with SSDs) to identify (1) what symptoms changed in the periods gradually preceding, following, and right as relapses occur, (2) how large were these changes, and (3) on what time scale did they occur. Results demonstrated that, on average, participants reported elevations in negative mood (d = 0.34), anxiety (d =0.49), persecutory ideation (d =0.35), and hallucinations (d =0.34) on relapse days relative to their average during the study. These increases emerged gradually on average from significant and steady increases (d = 0.05 per week) in persecutory ideation and hallucinations over the 100-day period preceding relapse. This suggests that brief (i.e., 1-2 item) assessments of psychotic symptoms may detect meaningful signals that precede psychiatric relapses long before they occur. These assessments could increase opportunities for relapse prevention as remote measurement-based care management platforms develop.
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Affiliation(s)
- Benjamin Buck
- Department of Psychiatry and Behavioral Sciences, Behavioral Research in Technology and Engineering (BRiTE) Center, University of Washington, Seattle, WA, United States
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, Behavioral Research in Technology and Engineering (BRiTE) Center, University of Washington, Seattle, WA, United States
| | - Andrew T Campbell
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Tanzeem Choudhury
- Department of Information Science, Cornell University, Ithaca, NY, United States
| | - John M Kane
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Dror Ben-Zeev
- Department of Psychiatry and Behavioral Sciences, Behavioral Research in Technology and Engineering (BRiTE) Center, University of Washington, Seattle, WA, United States
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13
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He-Yueya J, Buck B, Campbell A, Choudhury T, Kane JM, Ben-Zeev D, Althoff T. Assessing the relationship between routine and schizophrenia symptoms with passively sensed measures of behavioral stability. NPJ SCHIZOPHRENIA 2020; 6:35. [PMID: 33230099 PMCID: PMC7683525 DOI: 10.1038/s41537-020-00123-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/09/2020] [Indexed: 11/25/2022]
Abstract
Increased stability in one's daily routine is associated with well-being in the general population and often a goal of behavioral interventions for people with serious mental illnesses like schizophrenia. Assessing behavioral stability has been limited in clinical research by the use of retrospective scales, which are susceptible to reporting biases and memory inaccuracies. Mobile passive sensors, which are less susceptible to these sources of error, have emerged as tools to assess behavioral patterns in a range of populations. The present study developed and examined a metric of behavioral stability from data generated by a passive sensing system carried by 61 individuals with schizophrenia for one year. This metric-the Stability Index-appeared orthogonal from existing measures drawn from passive sensors and matched the predictive performance of state-of-the-art features. Specifically, greater stability in social activity (e.g., calls and messages) were associated with lower symptoms, and greater stability in physical activity (e.g., being still) appeared associated with elevated symptoms. This study provides additional support for the predictive value of individualized over population-level data in psychiatric populations. The Stability Index offers also a promising tool for generating insights about the impact of behavioral stability in schizophrenia-spectrum disorders.
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Affiliation(s)
- Joy He-Yueya
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, USA.
| | - Benjamin Buck
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Andrew Campbell
- Department of Computer Science, Dartmouth College, Hanover, USA
| | | | - John M Kane
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, East Garden City, USA
| | - Dror Ben-Zeev
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Tim Althoff
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, USA
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14
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Smulevich AB, Kluschnik TP, Lobanova VM, Voronova EI. [Negative and positive disorders of schizophrenia (issues of co-dependence, psychopathology and pathogenesis)]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:13-22. [PMID: 32729686 DOI: 10.17116/jnevro202012006213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The authors consider current and own conceptions about correlations of the processes underlying the pathogenesis of schizophrenia presented by negative and positive disorders. With growth of academic psychiatry, evaluation of a correlation between positive and negative dimensions has changed dramatically: on the one hand presenting in clinical unity - simultaneous psychopathologic structures, and on the other hand being clinically and pathogenetically heterogenic in dimensional structure. According to our clinical and biological findings and an analysis of fundamental neurobiological studies, positive and negative disorders present in the clinical picture of schizophrenia as two separate psychopathological and pathogenetic structures. A new paradigm of the correlation between positive and negative structures - the interaction between positive and deficit symptoms - reveals psychopathological functions differentiated for each of dimensional structures. Negative disorders act as «transformers» modifying characteristics of primary transnosological positive disorders to the level of psychopathological structures preferable for schizophrenia; positive disorders, in their turn, act as «moderators» augmenting, amplifying manifestations of negative symptoms. This psychopathological construct of the correlation between dimensional structures paves a way for the development of a new concept of psychopharmacological treatment of schizophrenic deficit: both negative symptoms and amplifying positive symptoms are considered as «target symptoms» for pharmacological interventions.
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Affiliation(s)
- A B Smulevich
- Mental health research center, Moscow, Russia.,Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | | | - E I Voronova
- Mental health research center, Moscow, Russia.,Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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15
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Kimhy D, Lister A, Liu Y, Vakhrusheva J, Delespaul P, Malaspina D, Ospina LH, Mittal VA, Gross JJ, Wang Y. The impact of emotion awareness and regulation on psychotic symptoms during daily functioning. NPJ SCHIZOPHRENIA 2020; 6:7. [PMID: 32210232 PMCID: PMC7093537 DOI: 10.1038/s41537-020-0096-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/13/2020] [Indexed: 02/06/2023]
Abstract
Emotion regulation (ER) difficulties are ubiquitous among individuals with schizophrenia and have been hypothesized to contribute to stress sensitivity and exacerbation of psychotic symptoms in this population. However, the evidence supporting this link is equivocal, potentially due to previous studies' reliance on retrospective assessments of ER and psychosis, as well as lack of consideration of putative moderators such as emotion awareness. To address these limitations, we employed experience sampling method using mobile electronic devices to investigate the links between momentary in vivo use of ER strategies (mER), emotion awareness, and psychotic symptoms during daily functioning. Fifty-four individuals with schizophrenia completed assessment of mER and psychotic symptoms, along with traditional retrospective measures of ER and symptoms. Use of mER suppression predicted significant increases in momentary experiences of thought insertion, mind reading, auditory and visual hallucinations. Use of mER reappraisal predicted significant increases in momentary experiences of suspiciousness, thought insertion, and mind reading. Emotion awareness, driven primarily by difficulties identifying feelings, moderated the impact of ER on psychotic symptoms. There were no associations between retrospective measures of ER and symptoms. Our results indicate that, among individuals with schizophrenia, emotion awareness significantly impacts the relationship between use of ER and exacerbations in psychotic symptoms during the course of daily functioning. Our results highlight the need to incorporate emotion awareness and regulation difficulties into the development of treatment models and interventions for psychosis. In addition, our results underscore the need to employ in vivo, high time-resolution assessment methods to study dynamic clinical phenomena such as ER and psychotic symptoms.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- MIRECC, James J. Peters VA Medical Center, Bronx, NY, USA.
| | - Amanda Lister
- New York State Psychiatric Institute, New York, NY, USA
| | - Ying Liu
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Philippe Delespaul
- Departments of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Dolores Malaspina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luz H Ospina
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Chicago, IL, USA
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Yuanjia Wang
- Department of Psychiatry, Columbia University, New York, NY, USA
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16
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Granholm E, Holden JL, Mikhael T, Link PC, Swendsen J, Depp C, Moore RC, Harvey PD. What Do People With Schizophrenia Do All Day? Ecological Momentary Assessment of Real-World Functioning in Schizophrenia. Schizophr Bull 2020; 46:242-251. [PMID: 31504955 PMCID: PMC7442321 DOI: 10.1093/schbul/sbz070] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Schizophrenia is a major cause of disability worldwide. As new treatments for functioning are tested, the need grows to demonstrate real-world functioning gains. Ecological momentary assessment (EMA) may provide a more ecologically valid measure of functioning. In this study, smartphone-based EMA was used to signal participants with schizophrenia (N = 100) and controls (N = 71) 7 times a day for 7 days to respond to brief questionnaires about social interactions and functioning behaviors. Excellent adherence was found, with both groups completing an average of 85% of surveys and only 3% of participants with schizophrenia excluded for poor adherence. Four-week test-retest reliability was high (r = .83 for total productive behaviors). Relative to controls, participants with schizophrenia reported significantly less total productive activity (d = 1.2), fewer social interactions (d = 0.3), more nonproductive behaviors (d = 1.0; watching TV, resting), and more time at home (d = 0.8). Within the schizophrenia group, participants living independently showed better functioning on EMA relative to participants in supported housing (d = 0.8) and participants engaged in vocational activities showed better functioning than individuals not engaged in vocational activities (d = 0.55). Modest correlations were found between EMA and an in-lab self-report measure of functioning activities performed in the community, but not between EMA and measures of functional capacity or potential. This study demonstrated the feasibility, sensitivity reliability, and validity of EMA methods to assess functioning in schizophrenia. EMA provides a much-needed measure of what individuals with schizophrenia are actually doing in real-world contexts. These results also suggest that there may be important disjunctions between indices of abilities and actual real-world functioning.
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Affiliation(s)
- Eric Granholm
- University of California, San Diego
- VA San Diego Healthcare System, San Diego, CA
| | | | | | | | - Joel Swendsen
- University of Bordeaux, CNRS, EPHE PSL Research University
| | - Colin Depp
- University of California, San Diego
- VA San Diego Healthcare System, San Diego, CA
| | | | - Philip D Harvey
- University of Miami Miller School of Medicine
- Bruce W. Carter VA Medical Center, Miami, FL
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17
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Vachon H, Viechtbauer W, Rintala A, Myin-Germeys I. Compliance and Retention With the Experience Sampling Method Over the Continuum of Severe Mental Disorders: Meta-Analysis and Recommendations. J Med Internet Res 2019; 21:e14475. [PMID: 31808748 PMCID: PMC6925392 DOI: 10.2196/14475] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/13/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023] Open
Abstract
Background Despite the growing interest in the experience sampling method (ESM) as a data collection tool for mental health research, the absence of methodological guidelines related to its use has resulted in a large heterogeneity of designs. Concomitantly, the potential effects of the design on the response behavior of the participants remain largely unknown. Objective The objective of this meta-analysis was to investigate the associations between various sample and design characteristics and the compliance and retention rates of studies using ESM in mental health research. Methods ESM studies investigating major depressive disorder, bipolar disorder, and psychotic disorder were considered for inclusion. Besides the compliance and retention rates, a number of sample and design characteristics of the selected studies were collected to assess their potential relationships with the compliance and retention rates. Multilevel random/mixed effects models were used for the analyses. Results Compliance and retention rates were lower for studies with a higher proportion of male participants (P<.001) and individuals with a psychotic disorder (P<.001). Compliance was positively associated with the use of a fixed sampling scheme (P=.02), higher incentives (P=.03), higher time intervals between successive evaluations (P=.02), and fewer evaluations per day (P=.008), while no significant associations were observed with regard to the mean age of the sample, the study duration, or other design characteristics. Conclusions The findings demonstrate that ESM studies can be carried out in mental health research, but the quality of the data collection depends upon a number of factors related to the design of ESM studies and the samples under study that need to be considered when designing such protocols.
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Affiliation(s)
- Hugo Vachon
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Wolfgang Viechtbauer
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium.,School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Aki Rintala
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
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18
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Buck B, Scherer E, Brian R, Wang R, Wang W, Campbell A, Choudhury T, Hauser M, Kane JM, Ben-Zeev D. Relationships between smartphone social behavior and relapse in schizophrenia: A preliminary report. Schizophr Res 2019; 208:167-172. [PMID: 30940400 PMCID: PMC6580857 DOI: 10.1016/j.schres.2019.03.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 02/07/2023]
Abstract
Social dysfunction is a hallmark of schizophrenia. Social isolation may increase individuals' risk for psychotic symptom exacerbation and relapse. Monitoring and timely detection of shifts in social functioning are hampered by the limitations of traditional clinic-based assessment strategies. Ubiquitous mobile technologies such as smartphones introduce new opportunities to capture objective digital indicators of social behavior. The goal of this study was to evaluate whether smartphone-collected digital measures of social behavior can provide early indication of relapse events among individuals with schizophrenia. Sixty-one individuals with schizophrenia with elevated risk for relapse were given smartphones with the CrossCheck behavioral sensing system for a year of remote monitoring. CrossCheck leveraged the device's microphone, call record, and text messaging log to capture digital socialization data. Relapse events including psychiatric hospitalizations, suicidal ideation, and significant psychiatric symptom exacerbations were recorded by trained assessors. Exploratory mixed effects models examined relationships of social behavior to relapse, finding that reductions in number and duration of outgoing calls, as well as number of text messages were associated with relapses. Number and duration of incoming phone calls and in-person conversations were not. Smartphone enabled social activity may provide an important metric in determining relapse risk in schizophrenia and provide access to sensitive, meaningful and ecologically valid data streams never before available in routine care.
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Affiliation(s)
- Benjamin Buck
- Health Services Research & Development, Puget Sound VA Healthcare System, Seattle, WA, United States of America; Department of Health Services, School of Public Health, Univ. of Washington, Seattle, WA, United States of America; Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America.
| | - Emily Scherer
- Geisel School of Medicine, Dartmouth College, Hanover, NH
| | - Rachel Brian
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Rui Wang
- Department of Computer Science, Dartmouth College, Hanover, NH
| | - Weichen Wang
- Department of Computer Science, Dartmouth College, Hanover, NH
| | - Andrew Campbell
- Department of Computer Science, Dartmouth College, Hanover, NH
| | | | - Marta Hauser
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - John M. Kane
- The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Dror Ben-Zeev
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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19
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Andorko ND, Rakhshan-Rouhakhtar P, Hinkle C, Mittal VA, McAllister M, DeVylder J, Schiffman J. Assessing validity of retrospective recall of physical activity in individuals with psychosis-like experiences. Psychiatry Res 2019; 273:211-217. [PMID: 30658204 PMCID: PMC7535082 DOI: 10.1016/j.psychres.2019.01.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/27/2018] [Accepted: 01/09/2019] [Indexed: 01/26/2023]
Abstract
Psychosis-like experiences are present in the general population and may indicate risk for more severe forms of psychosis. They are associated with cognitive impairments, potentially impacting ability to accurately complete certain self-report measures. This study investigated whether the presence of psychosis-like experiences was associated with impairments in retrospective reports of physical activity, a measure salient to this population, by comparing post-study questionnaire data on activity level with reports of activity contemporaneously collected through ecological momentary assessment (EMA). Participants (n = 39) were 18-25 years of age and recruited via stratified sampling to maximize representation of a full psychosis-like experience spectrum. Mobile questionnaires were sent six times a day for one week, and included questions probing amount and intensity of activity. Upon completion of the EMA week, participants completed a retrospective recall of the past week's activity. High levels of psychosis-like experiences were associated with poorer recall for past sedentary behavior as evidenced by the moderating effect of psychosis-like experiences on the relation between retrospective and in vivo measured sedentary activity (interaction effect: b = -0.26, t(1) = -2.04, p = 0.05, f2 = 0.08). Findings call into question the validity of retrospective self-reporting of activity level for those experiencing psychosis-like experiences.
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Affiliation(s)
- Nicole D. Andorko
- Department of Psychology, University of Maryland Baltimore County, Maryland, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Pamela Rakhshan-Rouhakhtar
- Department of Psychology, University of Maryland Baltimore County, Maryland, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Caroline Hinkle
- Department of Psychology, University of Maryland Baltimore County, Maryland, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Illinois. Swift Hall 102, 2029 Sheridan Rd, Evanston, IL 60208, USA
| | - Maureen McAllister
- Department of Psychology, University of Maryland Baltimore County, Maryland, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Jordan DeVylder
- Graduate School of Social Service, Fordham University, 113W 60th, St., New York, NY 10023, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland Baltimore County, Maryland, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
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20
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Kheirkhahan M, Nair S, Davoudi A, Rashidi P, Wanigatunga AA, Corbett DB, Mendoza T, Manini TM, Ranka S. A smartwatch-based framework for real-time and online assessment and mobility monitoring. J Biomed Inform 2018; 89:29-40. [PMID: 30414474 DOI: 10.1016/j.jbi.2018.11.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 11/04/2018] [Accepted: 11/05/2018] [Indexed: 11/25/2022]
Abstract
Smartphone and smartwatch technology is changing the transmission and monitoring landscape for patients and research participants to communicate their healthcare information in real time. Flexible, bidirectional and real-time control of communication allows development of a rich set of healthcare applications that can provide interactivity with the participant and adapt dynamically to their changing environment. Additionally, smartwatches have a variety of sensors suitable for collecting physical activity and location data. The combination of all these features makes it possible to transmit the collected data to a remote server, and thus, to monitor physical activity and potentially social activity in real time. As smartwatches exhibit high user acceptability and increasing popularity, they are ideal devices for monitoring activities for extended periods of time to investigate the physical activity patterns in free-living condition and their relationship with the seemingly random occurring illnesses, which have remained a challenge in the current literature. Therefore, the purpose of this study was to develop a smartwatch-based framework for real-time and online assessment and mobility monitoring (ROAMM). The proposed ROAMM framework will include a smartwatch application and server. The smartwatch application will be used to collect and preprocess data. The server will be used to store and retrieve data, remote monitor, and for other administrative purposes. With the integration of sensor-based and user-reported data collection, the ROAMM framework allows for data visualization and summary statistics in real-time.
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Affiliation(s)
- Matin Kheirkhahan
- University of Florida, Gainesville, FL 32611, United States; Johns Hopkins University, Baltimore, MD 21205, United States.
| | - Sanjay Nair
- University of Florida, Gainesville, FL 32611, United States; Johns Hopkins University, Baltimore, MD 21205, United States
| | - Anis Davoudi
- University of Florida, Gainesville, FL 32611, United States; Johns Hopkins University, Baltimore, MD 21205, United States
| | - Parisa Rashidi
- University of Florida, Gainesville, FL 32611, United States; Johns Hopkins University, Baltimore, MD 21205, United States
| | - Amal A Wanigatunga
- University of Florida, Gainesville, FL 32611, United States; Johns Hopkins University, Baltimore, MD 21205, United States
| | - Duane B Corbett
- University of Florida, Gainesville, FL 32611, United States; Johns Hopkins University, Baltimore, MD 21205, United States
| | - Tonatiuh Mendoza
- University of Florida, Gainesville, FL 32611, United States; Johns Hopkins University, Baltimore, MD 21205, United States
| | - Todd M Manini
- University of Florida, Gainesville, FL 32611, United States; Johns Hopkins University, Baltimore, MD 21205, United States
| | - Sanjay Ranka
- University of Florida, Gainesville, FL 32611, United States; Johns Hopkins University, Baltimore, MD 21205, United States
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21
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Myin-Germeys I, Kasanova Z, Vaessen T, Vachon H, Kirtley O, Viechtbauer W, Reininghaus U. Experience sampling methodology in mental health research: new insights and technical developments. World Psychiatry 2018; 17:123-132. [PMID: 29856567 PMCID: PMC5980621 DOI: 10.1002/wps.20513] [Citation(s) in RCA: 263] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In the mental health field, there is a growing awareness that the study of psychiatric symptoms in the context of everyday life, using experience sampling methodology (ESM), may provide a powerful and necessary addition to more conventional research approaches. ESM, a structured self-report diary technique, allows the investigation of experiences within, and in interaction with, the real-world context. This paper provides an overview of how zooming in on the micro-level of experience and behaviour using ESM adds new insights and additional perspectives to standard approaches. More specifically, it discusses how ESM: a) contributes to a deeper understanding of psychopathological phenomena, b) allows to capture variability over time, c) aids in identifying internal and situational determinants of variability in symptomatology, and d) enables a thorough investigation of the interaction between the person and his/her environment and of real-life social interactions. Next to improving assessment of psychopathology and its underlying mechanisms, ESM contributes to advancing and changing clinical practice by allowing a more fine-grained evaluation of treatment effects as well as by providing the opportunity for extending treatment beyond the clinical setting into real life with the development of ecological momentary interventions. Furthermore, this paper provides an overview of the technical details of setting up an ESM study in terms of design, questionnaire development and statistical approaches. Overall, although a number of considerations and challenges remain, ESM offers one of the best opportunities for personalized medicine in psychiatry, from both a research and a clinical perspective.
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Affiliation(s)
- Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Zuzana Kasanova
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Thomas Vaessen
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Hugo Vachon
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Olivia Kirtley
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Wolfgang Viechtbauer
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Ulrich Reininghaus
- School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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22
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Leendertse P, Myin-Germeys I, Lataster T, Simons CJP, Oorschot M, Lardinois M, Schneider M, van Os J, Reininghaus U. Subjective quality of life in psychosis: Evidence for an association with real world functioning? Psychiatry Res 2018; 261:116-123. [PMID: 29291477 DOI: 10.1016/j.psychres.2017.11.074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/26/2017] [Accepted: 11/26/2017] [Indexed: 11/28/2022]
Abstract
Subjective quality of life (SQOL) is an established patient-reported outcome in psychosis. However, current self-report measures of SQOL may be affected by recall bias and may not fully capture dynamic changes in SQOL over time. This study aimed to examine the ecological validity of self-reported and momentary assessment measures of SQOL, and their association with emotional experience, social interaction and activity in real life, in both patients with psychotic disorder (n = 56) and controls (n = 71). Self-reported QOL was assessed with the WHO-QOL, momentary QOL and real life experiences were assessed with the Experience Sampling Method (ESM). Results show that both measures were significantly associated in patients and controls, and associations with emotional experience were most relevant, momentary QOL being a stronger predictor than self-reported QOL. The association between momentary QOL and negative affect was stronger in patients than in controls. Overall, momentary QOL was more consistently associated with affect, social interaction and activity, while self-reported QOL displayed a more narrow association with mostly affect. Concluding, concurrent assessment of self-reported QOL and momentary QOL showed that momentary QOL may enhance the ecological validity of SQOL measurement. Experience sampling research may broaden our perspective on SQOL and its associations with real life functioning.
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Affiliation(s)
- Pien Leendertse
- Emergis, Institute for Mental Health Care Zeeland, Goes, The Netherlands.
| | - Inez Myin-Germeys
- KU Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| | - Tineke Lataster
- Maastricht University Medical Center, Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Claudia J P Simons
- Maastricht University Medical Center, Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht, The Netherlands; GGzE, Institute for Mental Health Care Eindhoven and De Kempen, Eindhoven, The Netherlands
| | - Margreet Oorschot
- Maastricht University Medical Center, Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Mariëlle Lardinois
- Maastricht University Medical Center, Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Maude Schneider
- KU Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| | - Jim van Os
- Maastricht University Medical Center, Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht, The Netherlands; Center for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Ulrich Reininghaus
- Maastricht University Medical Center, Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht, The Netherlands; Center for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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23
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Vachon H, Rintala A, Viechtbauer W, Myin-Germeys I. Data quality and feasibility of the Experience Sampling Method across the spectrum of severe psychiatric disorders: a protocol for a systematic review and meta-analysis. Syst Rev 2018; 7:7. [PMID: 29347967 PMCID: PMC5774093 DOI: 10.1186/s13643-018-0673-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/04/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Due to a number of methodological advantages and theoretical considerations, more and more studies in clinical psychology research employ the Experience Sampling Method (ESM) as a data collection technique. Despite this growing interest, the absence of methodological guidelines related to the use of ESM has resulted in a large heterogeneity of designs while the potential effects of the design itself on the response behavior of the participants remain unknown. The objectives of this systematic review are to investigate the associations between the design characteristics and the data quality and feasibility of studies relying on ESM in severe psychiatric disorders. METHODS We will search for all published studies using ambulatory assessment with patients suffering from major depressive disorder, bipolar disorder, and psychotic disorder or individuals at high risk for these disorders. Electronic database searches will be performed in PubMed and Web of Science with no restriction on the publication date. Two reviewers will independently screen original studies in a title/abstract phase and a full-text phase based on the inclusion criteria. The information related to the design and sample characteristics, data quality, and feasibility will be extracted. We will provide results in terms of a descriptive synthesis, and when applicable, a meta-analysis of the findings will be conducted. DISCUSSION Our results will attempt to highlight how the feasibility and data quality of ambulatory assessment might be related to the methodological characteristics of the study designs in severe psychiatric disorders. We will discuss these associations in different subsamples if sufficient data are available and will examine limitations in the reporting of the methods of ambulatory studies in the current literature. SYSTEMATIC REVIEW REGISTRATION The protocol for this systematic review was registered on PROSPERO (PROSPERO 2017: CRD42017060322 ) and is available in full on the University of York website ( http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017060322 ).
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Affiliation(s)
- Hugo Vachon
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33 blok I, 3000, Leuven, Belgium.
| | - Aki Rintala
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33 blok I, 3000, Leuven, Belgium
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, P.O. Box 616 (VIJV1), 6200 MD, Maastricht, The Netherlands
| | - Inez Myin-Germeys
- Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Kapucijnenvoer 33 blok I, 3000, Leuven, Belgium
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Schneider M, Reininghaus U, van Nierop M, Janssens M, Myin-Germeys I. Does the Social Functioning Scale reflect real-life social functioning? An experience sampling study in patients with a non-affective psychotic disorder and healthy control individuals. Psychol Med 2017; 47:2777-2786. [PMID: 28534464 DOI: 10.1017/s0033291717001295] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The ecological validity of retrospective measures of social functioning is currently unknown in patients with schizophrenia. In the present study, patients with a diagnosis of non-affective psychosis were compared with controls on two measures of social functioning: the Social Functioning Scale (SFS) and daily-life measures collected with the Experience Sampling Methodology (ESM). The associations between both measures were examined in each group of participants to test for the ecological validity of the SFS. METHODS A total of 126 participants with a non-affective psychotic disorder and 109 controls completed the SFS and a 6-day momentary ESM protocol assessing various aspects of social functioning. Multiple linear and multilevel regression analyses were performed to test for group differences in social functioning level and examine associations between the two assessment techniques. RESULTS Lower social functioning was observed in patients compared with controls on retrospective and momentary measures. The SFS interpersonal domain (social engagement/withdrawal and interpersonal behaviour dimensions) was associated with the percentage of time spent alone and negative appraisal of social interactions. The SFS activity domain (pro-social and recreational activities dimensions) was negatively associated with time spent in leisure activities. CONCLUSIONS The SFS showed some degree of ecological validity at assessing broad aspects of social functioning. Low scores on the SFS social engagement/withdrawal and interpersonal behaviour dimensions captured social isolation and social avoidance in daily life, but not lack of interest in socializing. Ecological validity of the SFS activity domain was low. ESM offers a rich alternative to classical assessment techniques of social functioning.
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Affiliation(s)
- M Schneider
- KU Leuven,Department of Neurosciences,Research Group Psychiatry,Center for Contextual Psychiatry,Leuven,Belgium
| | - U Reininghaus
- Maastricht University Medical Center,Department of Psychiatry & Psychology,School for Mental Health & Neuroscience,Maastricht,The Netherlands
| | - M van Nierop
- KU Leuven,Department of Neurosciences,Research Group Psychiatry,Center for Contextual Psychiatry,Leuven,Belgium
| | - M Janssens
- Faculty of Psychology and Educational Sciences,Open University of the Netherlands,Heerlen,The Netherlands
| | - I Myin-Germeys
- KU Leuven,Department of Neurosciences,Research Group Psychiatry,Center for Contextual Psychiatry,Leuven,Belgium
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Kimhy D, Wall MM, Hansen MC, Vakhrusheva J, Choi CJ, Delespaul P, Tarrier N, Sloan RP, Malaspina D. Autonomic Regulation and Auditory Hallucinations in Individuals With Schizophrenia: An Experience Sampling Study. Schizophr Bull 2017; 43:754-763. [PMID: 28177507 PMCID: PMC5472124 DOI: 10.1093/schbul/sbw219] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Auditory Hallucinations (AH) cause substantial suffering and dysfunction, yet remain poorly understood and modeled. Previous reports have linked AH to increases in negative emotions, suggesting a role for the autonomic nervous system (ANS) in underlying this link. Employing an Experience Sampling Method (ESM) approach, 40 individuals with schizophrenia completed a 36-hour ambulatory assessment of AH and cardiac autonomic regulation. Participants carried mobile electronic devices that prompted them to report 10 times/d the severity of their momentary AH, along with a Holter monitor that continuously recorded their cardiac autonomic regulation. The clocks of the devices and monitors were synchronized, allowing for high time-resolution temporal linking of the AH and concurrent autonomic data. Power spectral analysis was used to determine the relative vagal (parasympathetic) contribution to autonomic regulation during 5 minutes prior to each experience sample. The participants also completed interview-based measures of AH (SAPS; PSYRATS). The ESM-measured severity of AH was significantly correlated with the overall SAPS-indexed AH severity, along with the PSYRATS-indexed AH frequency, duration, loudness, degree of negative content, and associated distress. A mixed-effect regression model indicated that momentary increases in autonomic arousal, characterized by decreases in vagal input, significantly predicted increases in ESM-measured AH severity. Vagal input averaged over the 36-hour assessment displayed a small but significant inverse correlation with the SAPS-indexed AH. The results provide preliminary support for a link between ANS regulation and AH. The findings also underscore the highly dynamic nature of AH and the need to utilize high time-resolution methodologies to investigate AH.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Columbia University, New York, NY;,New York State Psychiatric Institute, New York, NY
| | - Melanie M. Wall
- Department of Psychiatry, Columbia University, New York, NY;,New York State Psychiatric Institute, New York, NY
| | | | | | - C. Jean Choi
- New York State Psychiatric Institute, New York, NY
| | - Philippe Delespaul
- Departments of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Nicholas Tarrier
- Department of Psychology, University of Manchester, Manchester, UK
| | - Richard P. Sloan
- Department of Psychiatry, Columbia University, New York, NY;,New York State Psychiatric Institute, New York, NY
| | - Dolores Malaspina
- Department of Psychiatry & Child Psychiatry, New York University Medical Center, New York, NY
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Bonet L, Izquierdo C, Escartí MJ, Sancho JV, Arce D, Blanquer I, Sanjuan J. Use of mobile technologies in patients with psychosis: A systematic review. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2017; 10:168-178. [PMID: 28258835 DOI: 10.1016/j.rpsm.2017.01.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/15/2016] [Accepted: 01/09/2017] [Indexed: 11/25/2022]
Abstract
There is a growing interest in mobile Health interventions (m-Health) in patients with psychosis. The aim of this study is to conduct a systematic review in order to analysethe current state of research in this area. The search of articles was carried out following the PRISMA criteria, focusing on those studies that used mobile technologies in patients with psychosis during the period from 1990 to 2016. A total of 20 articles were selected from the 431 studies found. Three types of studies are distinguished: 1) Analysis of quality and usability, 2) Improving treatment adherence and reducing hospital admissions, and 3) Analysisof patient symptoms. CONCLUSIONS m-Health interventions are feasible, and are easy to use for patients with psychosis. They evaluate the evolution of psychotic symptoms more efficiently, and improve adherence to treatment, as well as symptoms and hospital admissions. However, a particular strategy does not stand out over the rest, because differences in methodology make them difficult to compare.
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Affiliation(s)
| | | | - Maria Jose Escartí
- Hospital Clínico de Valencia, INCLIVA, Valencia, España; CIBERSAM, España
| | | | - David Arce
- Universidad Politécnica de Valencia, Valencia, España
| | | | - Julio Sanjuan
- Universidad de Valencia, Valencia, España; Hospital Clínico de Valencia, INCLIVA, Valencia, España; CIBERSAM, España.
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Bak M, Drukker M, Hasmi L, van Os J. An n=1 Clinical Network Analysis of Symptoms and Treatment in Psychosis. PLoS One 2016; 11:e0162811. [PMID: 27643994 PMCID: PMC5028060 DOI: 10.1371/journal.pone.0162811] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/29/2016] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Dynamic relationships between the symptoms of psychosis can be shown in individual networks of psychopathology. In a single patient, data collected with the Experience Sampling Method (ESM-a method to construct intensive time series of experience and context) can be used to study lagged associations between symptoms in relation to illness severity and pharmacological treatment. METHOD The patient completed, over the course of 1 year, for 4 days per week, 10 daily assessments scheduled randomly between 10 minutes and 3 hours apart. Five a priori selected symptoms were analysed: 'hearing voices', 'down', 'relaxed', 'paranoia' and 'loss of control'. Regression analysis was performed including current level of one symptom as the dependent variable and all symptoms at the previous assessment (lag) as the independent variables. Resulting regression coefficients were printed in graphs representing a network of symptoms. Network graphs were generated for different levels of severity: stable, impending relapse and full relapse. RESULTS ESM data showed that symptoms varied intensely from moment to moment. Network representations showed meaningful relations between symptoms, e.g. 'down' and 'paranoia' fuelling each other, and 'paranoia' negatively impacting 'relaxed'. During relapse, symptom levels as well as the level of clustering between symptoms markedly increased, indicating qualitative changes in the network. While 'hearing voices' was the most prominent symptom subjectively, the data suggested that a strategic focus on 'paranoia', as the most central symptom, had the potential to bring about changes affecting the whole network. CONCLUSION Construction of intensive ESM time series in a single patient is feasible and informative, particularly if represented as a network, showing both quantitative and qualitative changes as a function of relapse.
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Affiliation(s)
- Maarten Bak
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- * E-mail:
| | - Marjan Drukker
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Laila Hasmi
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
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A structural equation modelling approach to explore the determinants of quality of life in schizophrenia. Schizophr Res 2016; 171:27-34. [PMID: 26781001 DOI: 10.1016/j.schres.2016.01.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/03/2015] [Accepted: 01/04/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to analyse the relationships among psychotic symptoms, depression, neurocognition and functioning as determinants of quality of life (QoL) in patients with schizophrenia. METHODS In this cross-sectional study, we evaluated QoL with the Schizophrenia Quality of Life 18-item scale (S-QoL 18), neurocognition with multiple tests exploring memory, attention and executive functions, the severity of psychotic symptoms with the Positive and Negative Syndrome Scale (PANSS), depression with the Calgary Depression Scale for Schizophrenia (CDSS) and functioning using the Functional Remission Of General Schizophrenia (FROGS) scale. We used Structural Equation Modelling (SEM) to describe the relationships among the severity of psychotic symptoms, depression, neurocognition, functioning and QoL. RESULTS Two hundred and seventy-one outpatients with schizophrenia participated in our study. SEM showed good fit with χ(2)/df=1.97, root mean square error of approximation=0.06, comparative fit index=0.93 and standardized root mean square residuals=0.05. This model revealed that depression was the most important feature associated with QoL, mainly for the self-esteem, autonomy and resilience dimensions (direct path coefficient=-0.46). The direct path between functioning and QoL was also significant (path coefficient=0.26). The severity of psychotic symptoms and neurocognitive impairment were weakly and indirectly associated with QoL via functioning (path coefficients=-0.18 and 0.04, respectively). CONCLUSIONS This study contributes to a better understanding of the determinants of QoL in schizophrenia. Our findings should be considered in developing effective strategies for improving QoL among this population.
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