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Álvarez-Cadenas L, García-Vázquez P, Ezquerra B, Stiles BJ, Lahera G, Andrade-González N, Vieta E. Detection of bipolar disorder in the prodromal phase: A systematic review of assessment instruments. J Affect Disord 2023; 325:399-412. [PMID: 36623571 DOI: 10.1016/j.jad.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/22/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023]
Abstract
BACKGROUND Early detection of prodromal symptoms may contribute to improving the prognosis of patients with bipolar disorder (BD). The main objective of this systematic review is to present the different procedures for the identification of initial and relapse prodromes in these patients. METHODS PsycINFO, Web of Science and PubMed databases were searched using a predetermined strategy, until January 4, 2022. Then, by means of a regulated process, studies that used a BD prodrome detection procedure, in English-language and all ages participants were selected. Quantitative and qualitative studies were assessed using a modified version of the Newcastle-Ottawa Scale and by Critical Appraisals Skills Programme checklist, respectively. RESULTS Forty-five studies were selected. Of these, 26 used procedures for identifying initial prodromes (n = 8014) and 19 used procedures for detecting relapse prodromes (n = 1136). The interview was the most used method in the detection of both types of prodromes (k = 30 papers, n = 4068). It was variable in its degree of structure. Mobile applications and digital technologies are gaining importance in the detection of the relapse prodromes. LIMITATIONS A retrospective design in most papers, small samples sizes, existence of persistent subsyndromal symptoms and difficulty to identify the end of the prodrome and the onset of the disorder. CONCLUSIONS There is a wide variety of assessment instruments to detect prodromes in BD, among which the clinical interview is most frequently used. Future research should consider development of a brief tool to be applied in different formats to patients and family members.
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Affiliation(s)
- Laura Álvarez-Cadenas
- Central University Hospital of Asturias, Health Service of Principality of Asturias, Oviedo, Spain.
| | - Paula García-Vázquez
- Central University Hospital of Asturias, Health Service of Principality of Asturias, Oviedo, Spain
| | - Berta Ezquerra
- Rey Juan Carlos University Hospital, Móstoles, Madrid, Spain
| | - Bryan J Stiles
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Guillermo Lahera
- Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain; IRyCIS, CIBERSAM, Madrid, Spain; Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain
| | - Nelson Andrade-González
- Psychiatry and Mental Health Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain; Faculty of Medicine, Alfonso X el Sabio University, Villanueva de la Cañada, Madrid, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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2
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Harvey D, Lobban F, Rayson P, Warner A, Jones S. Natural Language Processing Methods and Bipolar Disorder: Scoping Review. JMIR Ment Health 2022; 9:e35928. [PMID: 35451984 PMCID: PMC9077496 DOI: 10.2196/35928] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/15/2022] [Accepted: 03/20/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Health researchers are increasingly using natural language processing (NLP) to study various mental health conditions using both social media and electronic health records (EHRs). There is currently no published synthesis that relates specifically to the use of NLP methods for bipolar disorder, and this scoping review was conducted to synthesize valuable insights that have been presented in the literature. OBJECTIVE This scoping review explored how NLP methods have been used in research to better understand bipolar disorder and identify opportunities for further use of these methods. METHODS A systematic, computerized search of index and free-text terms related to bipolar disorder and NLP was conducted using 5 databases and 1 anthology: MEDLINE, PsycINFO, Academic Search Ultimate, Scopus, Web of Science Core Collection, and the ACL Anthology. RESULTS Of 507 identified studies, a total of 35 (6.9%) studies met the inclusion criteria. A narrative synthesis was used to describe the data, and the studies were grouped into four objectives: prediction and classification (n=25), characterization of the language of bipolar disorder (n=13), use of EHRs to measure health outcomes (n=3), and use of EHRs for phenotyping (n=2). Ethical considerations were reported in 60% (21/35) of the studies. CONCLUSIONS The current literature demonstrates how language analysis can be used to assist in and improve the provision of care for people living with bipolar disorder. Individuals with bipolar disorder and the medical community could benefit from research that uses NLP to investigate risk-taking, web-based services, social and occupational functioning, and the representation of gender in bipolar disorder populations on the web. Future research that implements NLP methods to study bipolar disorder should be governed by ethical principles, and any decisions regarding the collection and sharing of data sets should ultimately be made on a case-by-case basis, considering the risk to the data participants and whether their privacy can be ensured.
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Affiliation(s)
- Daisy Harvey
- Spectrum Centre for Mental Health Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Paul Rayson
- Department of Computing and Communications, Lancaster University, Lancaster, United Kingdom
| | - Aaron Warner
- Spectrum Centre for Mental Health Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Steven Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster, United Kingdom
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3
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Bipolar Disorder Related Hospitalizations - a Descriptive Nationwide Study Using a Big Data Approach. Psychiatr Q 2022; 93:325-333. [PMID: 34581934 DOI: 10.1007/s11126-021-09951-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
Bipolar Disorder (BD) is a mental disorder which frequently requires long hospitalizations and need for acute psychiatric care. The aim of this study was to describe a nationwide perspective of BD related hospitalizations and to use a BigData based approach in mental health research. We performed a retrospective observational study using a nationwide hospitalization database containing all hospitalizations registered in Portuguese public hospitals from 2008-2015. Hospitalizations with a primary diagnosis of BD were selected based on International Classification of Diseases version 9, Clinical Modification (ICD-9-CM) codes of diagnosis 296.xx (excluding 296.2x; 296.3x and 296.9x). From 20,807 hospitalizations belonging to 13,300 patients, around 33.4% occurred in male patients with a median length of stay of 16.0 days and a mean age of 47.9 years. The most common hospitalization diagnosis in BD has the code 296.4x (manic episode) representing 34.3% of all hospitalizations, followed by the code 296.5x (depressed episode) with 21.4%. The mean estimated hospitalization charge was 3,508.5€ per episode, with a total charge of 73M€ in the 8-year period of this study.This is a nationwide study giving a broad perspective of the BD hospitalization panorama at a national level. We found important differences in hospitalization characteristics by sex, age and primary diagnosis.
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Monteith S, Glenn T, Geddes J, Whybrow PC, Achtyes E, Bauer M. Expectations for Artificial Intelligence (AI) in Psychiatry. Curr Psychiatry Rep 2022; 24:709-721. [PMID: 36214931 PMCID: PMC9549456 DOI: 10.1007/s11920-022-01378-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Artificial intelligence (AI) is often presented as a transformative technology for clinical medicine even though the current technology maturity of AI is low. The purpose of this narrative review is to describe the complex reasons for the low technology maturity and set realistic expectations for the safe, routine use of AI in clinical medicine. RECENT FINDINGS For AI to be productive in clinical medicine, many diverse factors that contribute to the low maturity level need to be addressed. These include technical problems such as data quality, dataset shift, black-box opacity, validation and regulatory challenges, and human factors such as a lack of education in AI, workflow changes, automation bias, and deskilling. There will also be new and unanticipated safety risks with the introduction of AI. The solutions to these issues are complex and will take time to discover, develop, validate, and implement. However, addressing the many problems in a methodical manner will expedite the safe and beneficial use of AI to augment medical decision making in psychiatry.
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Affiliation(s)
- Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, 49684, USA.
| | | | - John Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Peter C. Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA USA
| | - Eric Achtyes
- Michigan State University College of Human Medicine, Grand Rapids, MI 49684 USA ,Network180, Grand Rapids, MI USA
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Dresden, Germany
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5
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Ortiz A, Maslej MM, Husain MI, Daskalakis ZJ, Mulsant BH. Apps and gaps in bipolar disorder: A systematic review on electronic monitoring for episode prediction. J Affect Disord 2021; 295:1190-1200. [PMID: 34706433 DOI: 10.1016/j.jad.2021.08.140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/18/2021] [Accepted: 08/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term clinical monitoring in bipolar disorder (BD) is an important therapeutic tool. The availability of smartphones and wearables has sparked the development of automated applications to remotely monitor patients. This systematic review focus on the current state of electronic (e-) monitoring for episode prediction in BD. METHODS We systematically reviewed the literature on e-monitoring for episode prediction in adult BD patients. The systematic review was done according to the guidelines for reporting of systematic reviews and meta-analyses (PRISMA) and was registered in PROSPERO on April 29, 2020 (CRD42020155795). We conducted a search of Web of Science, MEDLINE, EMBASE, and PsycINFO (all 2000-2020) databases. We identified and extracted data from 17 published reports on 15 relevant studies. RESULTS Studies were heterogeneous and most had substantial methodological and technical limitations. Models varied widely in their performance. Published metrics were too heterogeneous to lend themselves to a meta-analysis. Four studies reported sensitivity (range: 0.21 - 0.95); and two reported specificity for prediction of mood episodes (range: 0.36 - 0.99). Two studies reported accuracy (range: 0.64 - 0.88) and four reported area under the curve (AUC; range: 0.52-0.95). Overall, models were better in predicting manic or hypomanic episodes, but their performance depended on feature type. LIMITATIONS Our conclusions are tempered by the lack of appropriate information impeding our ability to synthesize the available evidence. CONCLUSIONS Given the clinical variability in BD, predicting mood episodes remains a challenging task. Emerging e-monitoring technology for episode prediction in BD requires more development before it can be adopted clinically.
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Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Marta M Maslej
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of California San Diego, United States
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
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Chiauzzi E, Wicks P. Beyond the Therapist's Office: Merging Measurement-Based Care and Digital Medicine in the Real World. Digit Biomark 2021; 5:176-182. [PMID: 34723070 PMCID: PMC8460973 DOI: 10.1159/000517748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/04/2021] [Indexed: 12/26/2022] Open
Abstract
This viewpoint focuses on the ways in which digital medicine and measurement-based care can be utilized in tandem to promote better assessment, patient engagement, and an improved quality of psychiatric care. To date, there has been an underutilization of digital measurement in psychiatry, and there is little discussion of the feedback and patient engagement process in digital medicine. Measurement-based care is a recognized evidence-based strategy that engages patients in an understanding of their outcome data. When implemented as designed, providers review the scores and trends in outcome immediately and then provide feedback to their patients. However, the process is typically confined to office visits, which does not provide a complete picture of a patient's progress and functioning. The process is labor intensive, even with digital feedback systems, but the integration of passive metrics obtained through wearables and apps can supplement office-based observations. This enhanced measurement-based care process can provide a picture of real-world patient functioning through passive metrics (activity, sleep, etc.). This can potentially engage patients more in their health data and involve a critically needed therapeutic alliance component in digital medicine.
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Affiliation(s)
| | - Paul Wicks
- Wicks Digital Health, Ltd., Lichfield, United Kingdom
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7
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Monteith S, Glenn T. Comparison of potential psychiatric drug interactions in six drug interaction database programs: A replication study after 2 years of updates. Hum Psychopharmacol 2021; 36:e2802. [PMID: 34228368 DOI: 10.1002/hup.2802] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Drug interaction database programs are a fundamental clinical tool. In 2018, we compared the category of potential drug-drug interaction (DDI) provided by six drug interaction database programs for 100 drug interaction pairs including psychiatric drugs, and found the category often differed. This study replicated the comparison in 2020 after 2 years of updates to all six drug interaction database programs. METHODS The 100 drug pairs included 94 different drugs: 67 pairs with a psychiatric and non-psychiatric drug, and 33 pairs with two psychiatric drugs. The assigned category of potential DDI for the drug pairs was compared using percent agreement and Fleiss kappa statistic of interrater reliability. RESULTS Despite 67 updates involving 46 of the 100 drug pairs, differences remained. The overall percent agreement among the six drug interaction database programs for the category of potential DDI was 67%. The interrater agreement results did not change. The Fleiss kappa overall interrater agreement was fair. The kappa agreement for a drug pair with any severe category rating was substantial, and the kappa agreement for a drug pair with any major category rating was fair. CONCLUSIONS Physicians should be aware of the inconsistency among drug interaction database programs in the category of potential DDI for drug pairs including psychiatric drugs. Additionally, the category of potential DDI for a drug pair may change over time. This study highlights the importance of ongoing international efforts to standardize methods used to define and classify potential DDI.
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Affiliation(s)
- Scott Monteith
- Michigan State University College of Human Medicine, Department of Psychiatry, Traverse City Campus, Traverse City, Michigan, USA
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, California, USA
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8
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Chu L, Ioannidis JPA, Egilman AC, Vasiliou V, Ross JS, Wallach JD. Vibration of effects in epidemiologic studies of alcohol consumption and breast cancer risk. Int J Epidemiol 2021; 49:608-618. [PMID: 31967637 DOI: 10.1093/ije/dyz271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/27/2019] [Accepted: 12/06/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Different analytical approaches can influence the associations estimated in observational studies. We assessed the variability of effect estimates reported within and across observational studies evaluating the impact of alcohol on breast cancer. METHODS We abstracted largest harmful, largest protective and smallest (closest to the null value of 1.0) relative risk estimates in studies included in a recent alcohol-breast cancer meta-analysis, and recorded how they differed based on five model specification characteristics, including exposure definition, exposure contrast levels, study populations, adjustment covariates and/or model approaches. For each study, we approximated vibration of effects by dividing the largest by the smallest effect estimate [i.e. ratio of odds ratio (ROR)]. RESULTS Among 97 eligible studies, 85 (87.6%) reported both harmful and protective relative effect estimates for an alcohol-breast cancer relationship, which ranged from 1.1 to 17.9 and 0.0 to 1.0, respectively. The RORs comparing the largest and smallest estimates in value ranged from 1.0 to 106.2, with a median of 3.0 [interquartile range (IQR) 2.0-5.2]. One-third (35, 36.1%) of the RORs were based on extreme effect estimates with at least three different model specification characteristics; the vast majority (87, 89.7%) had different exposure definitions or contrast levels. Similar vibrations of effect were observed when only extreme estimates with differences based on study populations and/or adjustment covariates were compared. CONCLUSIONS Most observational studies evaluating the impact of alcohol on breast cancer report relative effect estimates for the same associations that diverge by >2-fold. Therefore, observational studies should estimate the vibration of effects to provide insight regarding the stability of findings.
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Affiliation(s)
- Lingzhi Chu
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA
| | - Alex C Egilman
- Collaboration for Research Integrity and Transparency (CRIT), Yale Law School, New Haven, CT, USA
| | - Vasilis Vasiliou
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Joseph S Ross
- Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.,National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA.,Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, CT, USA
| | - Joshua D Wallach
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA.,Collaboration for Research Integrity and Transparency (CRIT), Yale Law School, New Haven, CT, USA
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9
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Sanchez M, Lytle S, Neudecker M, McVoy M. Medication Adherence in Pediatric Patients with Bipolar Disorder: A Systematic Review. J Child Adolesc Psychopharmacol 2021; 31:86-94. [PMID: 33465006 DOI: 10.1089/cap.2020.0098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: Pediatric bipolar disorder is a severe disabling condition affecting 1%-3% of youth worldwide. Both acute and maintenance treatment with medications are mainstays of treatment. It is well established in adult literature that adherence to medications improves outcomes and many adult studies have examined factors impacting adherence. This systematic review set out to identify the current state of research examining adherence to medications and characteristics influencing adherence in pediatric bipolar disorder. Methods: We performed a systematic literature review in the Medline, PsycINFO, CINAHL, EMBASE, Wiley Clinical Trials, and Cochrane databases. New research regarding characteristics and measurement of adherence to psychotropic medication for bipolar disorder (I, II, or not otherwise specified) in patients ≤18 years old were included for review. Exclusion criteria included no bipolar diagnosis, inclusion of patients >18 years old, no pharmacologic treatment, and lack of adherence measurements. Results: Initial search generated 439 articles after duplicate removal. One hundred thirty-three full-text articles were reviewed, 16 underwent additional review and 6 were selected for final inclusion. The majority of articles were excluded for patients >18 years old. Included articles were extremely heterogeneous for multiple measures, including methodology, determination of adherence, adherence rates, and characteristics influencing adherence. Of medications evaluated, 6/6 studies included mood stabilizers, 4/6 antidepressants, 3/6 antipsychotics, and 2/6 psychostimulants. Three out of six articles included patients <12 years old. Some significant factors affecting adherence included polypharmacy, comorbid psychiatric diagnoses, socioeconomic status, sex, family history and functioning, side effects, race, stability of bipolar diagnosis, and number of follow-up visits attended. Conclusions: Pediatric-specific information on medication adherence in bipolar disorder is very limited. Information on patient characteristics that may influence adherence rates is critical to target interventions to improve adherence. No articles reported on interventions to improve adherence. Given the different psychosocial situations of pediatric patients versus adults, it is likely that targets for improving adherence differ in pediatric patients.
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Affiliation(s)
- Matthew Sanchez
- Department of Child and Adolescent Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Sarah Lytle
- Department of Child and Adolescent Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mandy Neudecker
- Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Molly McVoy
- Department of Child and Adolescent Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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10
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Lagan S, Ramakrishnan A, Lamont E, Ramakrishnan A, Frye M, Torous J. Digital health developments and drawbacks: a review and analysis of top-returned apps for bipolar disorder. Int J Bipolar Disord 2020; 8:39. [PMID: 33259047 PMCID: PMC7704602 DOI: 10.1186/s40345-020-00202-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although a growing body of literature highlights the potential benefit of smartphone-based mobile apps to aid in self-management and treatment of bipolar disorder, it is unclear whether such evidence-based apps are readily available and accessible to a user of the app store. RESULTS Using our systematic framework for the evaluation of mental health apps, we analyzed the accessibility, privacy, clinical foundation, features, and interoperability of the top-returned 100 apps for bipolar disorder. Only 56% of the apps mentioned bipolar disorder specifically in their title, description, or content. Only one app's efficacy was supported in a peer-reviewed study, and 32 apps lacked privacy policies. The most common features provided were mood tracking, journaling, and psychoeducation. CONCLUSIONS Our analysis reveals substantial limitations in the current digital environment for individuals seeking an evidence-based, clinically usable app for bipolar disorder. Although there have been academic advances in development of digital interventions for bipolar disorder, this work has yet to be translated to the publicly available app marketplace. This unmet need of digital mood management underscores the need for a comprehensive evaluation system of mental health apps, which we have endeavored to provide through our framework and accompanying database (apps.digitalpsych.org).
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Affiliation(s)
- Sarah Lagan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 75 Fenwood Road, Boston, MA, 02446, USA
| | - Abinaya Ramakrishnan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 75 Fenwood Road, Boston, MA, 02446, USA
- Vanderbilt University, Nashville, TN, USA
| | - Evan Lamont
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 75 Fenwood Road, Boston, MA, 02446, USA
- Boston Graduate School of Psychoanalysis, Boston, MA, USA
| | - Aparna Ramakrishnan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 75 Fenwood Road, Boston, MA, 02446, USA
| | | | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 75 Fenwood Road, Boston, MA, 02446, USA.
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11
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Bauer R, Glenn T, Monteith S, Whybrow PC, Bauer M. Survey of psychiatrist use of digital technology in clinical practice. Int J Bipolar Disord 2020; 8:29. [PMID: 33009954 PMCID: PMC7532734 DOI: 10.1186/s40345-020-00194-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/16/2020] [Indexed: 12/14/2022] Open
Abstract
Background Psychiatrists were surveyed to obtain an overview of how they currently use technology in clinical practice, with a focus on psychiatrists who treat patients with bipolar disorder. Methods Data were obtained using an online-only survey containing 46 questions, completed by a convenience sample of 209 psychiatrists in 19 countries. Descriptive statistics, and analyses of linear associations and to remove country heterogeneity were calculated. Results Virtually all psychiatrists seek information online with many benefits, but some experience information overload. 75.2% of psychiatrists use an EMR/EHR at work, and 64.6% communicate with patients using a new technology, primarily email (48.8%). 66.0% do not ask patients if they use the Internet in relation to bipolar disorder. 67.3% of psychiatrists feel it is too early to tell if patient online information seeking about bipolar disorder is improving the quality of care. 66.3% of psychiatrists think technology-based treatments will improve the quality of care for some or many patients. However, 60.0% of psychiatrists do not recommend technology-based treatments to patients, and those who recommend select a variety of treatments. Psychiatrists use technology more frequently when the patients live in urban rather than rural or suburban areas. Only 23.9% of psychiatrists have any formal training in technology. Conclusions Digital technology is routinely used by psychiatrists in clinical practice. There is near unanimous agreement about the benefits of psychiatrist online information-seeking, but research on information overload is needed. There is less agreement about the appropriate use of other clinical technologies, especially those involving patients. It is too early to tell if technology-based treatments or patient Internet activities will improve the quality of care. The digital divide remains between use of technology for psychiatrists with patients living in urban and rural or suburban areas. Psychiatrists need more formal training in technology to understand risks, benefits and limitations of clinical products.
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Affiliation(s)
- Rita Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Medical Faculty, Technische Universität Dresden, Dresden, Germany.
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12
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Wang L, Alexander CA. Big data analytics in medical engineering and healthcare: methods, advances and challenges. J Med Eng Technol 2020; 44:267-283. [PMID: 32498594 DOI: 10.1080/03091902.2020.1769758] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Big data analytics are gaining popularity in medical engineering and healthcare use cases. Stakeholders are finding big data analytics reduce medical costs and personalise medical services for each individual patient. Big data analytics can be used in large-scale genetics studies, public health, personalised and precision medicine, new drug development, etc. The introduction of the types, sources, and features of big data in healthcare as well as the applications and benefits of big data and big data analytics in healthcare is key to understanding healthcare big data and will be discussed in this article. Major methods, platforms and tools of big data analytics in medical engineering and healthcare are also presented. Advances and technology progress of big data analytics in healthcare are introduced, which includes artificial intelligence (AI) with big data, infrastructure and cloud computing, advanced computation and data processing, privacy and cybersecurity, health economic outcomes and technology management, and smart healthcare with sensing, wearable devices and Internet of things (IoT). Current challenges of dealing with big data and big data analytics in medical engineering and healthcare as well as future work are also presented.
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Affiliation(s)
- Lidong Wang
- Institute for Systems Engineering Research, Mississippi State University, Vicksburg, MS, USA
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Antosik-Wójcińska AZ, Dominiak M, Chojnacka M, Kaczmarek-Majer K, Opara KR, Radziszewska W, Olwert A, Święcicki Ł. Smartphone as a monitoring tool for bipolar disorder: a systematic review including data analysis, machine learning algorithms and predictive modelling. Int J Med Inform 2020; 138:104131. [DOI: 10.1016/j.ijmedinf.2020.104131] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/15/2020] [Accepted: 03/22/2020] [Indexed: 01/06/2023]
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14
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Andrade-González N, Álvarez-Cadenas L, Saiz-Ruiz J, Lahera G. Initial and relapse prodromes in adult patients with episodes of bipolar disorder: A systematic review. Eur Psychiatry 2020; 63:e12. [PMID: 32093795 PMCID: PMC7315869 DOI: 10.1192/j.eurpsy.2019.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Distinguishing prodromes of bipolar disorder (BD) specific to children/adolescents, adults, and elderly patients is essential. The primary objective of this systematic review was to determine initial and relapse prodromes identifying adult patients with BD. METHODS PubMed, PsycINFO, and Web of Science databases were searched using a predetermined strategy. A controlled process of study selection and data extraction was performed. RESULTS The 22 articles selected included 1,809 adult patients with BD. Initial prodromes cited most frequently in these studies showed low specificity. Among relapse prodromes cited most frequently, more talkative than usual, increased energy/more goal-directed behavior, thoughts start to race, increased self-esteem, strong interest in sex, increase in activity, and spending too much were identified exclusively before a manic/hypomanic episode, while loss of interest and hypersomnia were detected only before a depressive episode. Initial prodromal phases lasted longer than prodromal relapse phases. In the selected studies, the most used prodrome identification procedure was the clinical interview. CONCLUSIONS For adult patients with BD, initial and relapse prodromes of manic, hypomanic, and depressive episodes were identified. It is proposed that the most frequent prodromes found in this review be incorporated into a smartphone app that monitors the functioning of people at risk of BD and patients who have already been diagnosed. Data from this app would constitute a relevant source of big data.
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Affiliation(s)
- Nelson Andrade-González
- Relational Processes and Psychotherapy Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | | | - Jerónimo Saiz-Ruiz
- Ramón y Cajal University Hospital, Madrid, Spain.,Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.,IRyCIS, CIBERSAM, Madrid, Spain
| | - Guillermo Lahera
- Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.,IRyCIS, CIBERSAM, Madrid, Spain
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15
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Harrison PJ, Geddes JR, Tunbridge EM. The Emerging Neurobiology of Bipolar Disorder. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 17:284-293. [PMID: 32015720 DOI: 10.1176/appi.focus.17309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
(Reprinted with permission from Trends in Neurosciences, January 2018, Vol. 41, No. 1 ).
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16
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Bauer M, Glenn T, Geddes J, Gitlin M, Grof P, Kessing LV, Monteith S, Faurholt-Jepsen M, Severus E, Whybrow PC. Smartphones in mental health: a critical review of background issues, current status and future concerns. Int J Bipolar Disord 2020; 8:2. [PMID: 31919635 PMCID: PMC6952480 DOI: 10.1186/s40345-019-0164-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/24/2019] [Indexed: 02/06/2023] Open
Abstract
There has been increasing interest in the use of smartphone applications (apps) and other consumer technology in mental health care for a number of years. However, the vision of data from apps seamlessly returned to, and integrated in, the electronic medical record (EMR) to assist both psychiatrists and patients has not been widely achieved, due in part to complex issues involved in the use of smartphone and other consumer technology in psychiatry. These issues include consumer technology usage, clinical utility, commercialization, and evolving consumer technology. Technological, legal and commercial issues, as well as medical issues, will determine the role of consumer technology in psychiatry. Recommendations for a more productive direction for the use of consumer technology in psychiatry are provided.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
| | - John Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Michael Gitlin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Paul Grof
- Mood Disorders Center of Ottawa, Ottawa, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
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17
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Brietzke E, Hawken ER, Idzikowski M, Pong J, Kennedy SH, Soares CN. Integrating digital phenotyping in clinical characterization of individuals with mood disorders. Neurosci Biobehav Rev 2019; 104:223-230. [DOI: 10.1016/j.neubiorev.2019.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 07/08/2019] [Accepted: 07/15/2019] [Indexed: 12/26/2022]
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18
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Tai AMY, Albuquerque A, Carmona NE, Subramanieapillai M, Cha DS, Sheko M, Lee Y, Mansur R, McIntyre RS. Machine learning and big data: Implications for disease modeling and therapeutic discovery in psychiatry. Artif Intell Med 2019; 99:101704. [PMID: 31606109 DOI: 10.1016/j.artmed.2019.101704] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 03/04/2019] [Accepted: 08/08/2019] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Machine learning capability holds promise to inform disease models, the discovery and development of novel disease modifying therapeutics and prevention strategies in psychiatry. Herein, we provide an introduction on how machine learning/Artificial Intelligence (AI) may instantiate such capabilities, as well as provide rationale for its application to psychiatry in both research and clinical ecosystems. METHODS Databases PubMed and PsycINFO were searched from 1966 to June 2016 for keywords:Big Data, Machine Learning, Precision Medicine, Artificial Intelligence, Mental Health, Mental Disease, Psychiatry, Data Mining, RDoC, and Research Domain Criteria. Articles selected for review were those that were determined to be aligned with the objective of this particular paper. RESULTS Results indicate that AI is a viable option to build useful predictors of outcome while offering objective and comparable accuracy metrics, a unique opportunity, particularly in mental health research. The approach has also consistently brought notable insight into disease models through processing the vast amount of already available multi-domain, semi-structured medical data. The opportunity for AI in psychiatry, in addition to disease-model refinement, is in characterizing those at risk, and it is likely also relevant to personalizing and discovering therapeutics. CONCLUSIONS Machine learning currently provides an opportunity to parse disease models in complex, multi-factorial disease states (e.g. mental disorders) and could possibly inform treatment selection with existing therapies and provide bases for domain-based therapeutic discovery.
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Affiliation(s)
- Andy M Y Tai
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Alcides Albuquerque
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Nicole E Carmona
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | | | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Margarita Sheko
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Rodrigo Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
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19
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Bauer M, Monteith S, Geddes J, Gitlin MJ, Grof P, Whybrow PC, Glenn T. Automation to optimise physician treatment of individual patients: examples in psychiatry. Lancet Psychiatry 2019; 6:338-349. [PMID: 30904127 DOI: 10.1016/s2215-0366(19)30041-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 12/12/2018] [Accepted: 01/16/2019] [Indexed: 12/12/2022]
Abstract
There is widespread agreement by health-care providers, medical associations, industry, and governments that automation using digital technology could improve the delivery and quality of care in psychiatry, and reduce costs. Many benefits from technology have already been realised, along with the identification of many challenges. In this Review, we discuss some of the challenges to developing effective automation for psychiatry to optimise physician treatment of individual patients. Using the perspective of automation experts in other industries, three examples of automation in the delivery of routine care are reviewed: (1) effects of electronic medical records on the patient interview; (2) effects of complex systems integration on e-prescribing; and (3) use of clinical decision support to assist with clinical decision making. An increased understanding of the experience of automation from other sectors might allow for more effective deployment of technology in psychiatry.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Medical Faculty, Technische Universität Dresden, Dresden, Germany.
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - John Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Michael J Gitlin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Paul Grof
- Mood Disorders Center of Ottawa, ON, Canada; Department of Psychiatry, University of Toronto, ON, Canada
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
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20
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Areas of uncertainties and unmet needs in bipolar disorders: clinical and research perspectives. Lancet Psychiatry 2018; 5:930-939. [PMID: 30146246 DOI: 10.1016/s2215-0366(18)30253-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 12/11/2022]
Abstract
This Review discusses crucial areas related to the identification, clinical presentation, course, and therapeutic management of bipolar disorder, a major psychiatric illness. Bipolar disorder is often misdiagnosed, leading to inappropriate, inadequate, or delayed treatment. Even when bipolar disorder is successfully diagnosed, its clinical management presents several major challenges, including how best to optimise treatment for an individual patient, and how to balance the benefits and risks of polypharmacy. We discuss the major unmet needs in the diagnosis and management of bipolar disorder in this Review, including improvement of adequate recognition and intervention in at-risk and early-disease stages, identification of reliable warning signs and prevention of relapses in unstable and rapid cycling patients, treatment of refractory depression, and prevention of suicide. Taken together, there are several promising opportunities for improving treatment of bipolar disorder to deliver medical care that is more personalised.
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21
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Ienca M, Ferretti A, Hurst S, Puhan M, Lovis C, Vayena E. Considerations for ethics review of big data health research: A scoping review. PLoS One 2018; 13:e0204937. [PMID: 30308031 PMCID: PMC6181558 DOI: 10.1371/journal.pone.0204937] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/17/2018] [Indexed: 12/15/2022] Open
Abstract
Big data trends in biomedical and health research enable large-scale and multi-dimensional aggregation and analysis of heterogeneous data sources, which could ultimately result in preventive, diagnostic and therapeutic benefit. The methodological novelty and computational complexity of big data health research raises novel challenges for ethics review. In this study, we conducted a scoping review of the literature using five databases to identify and map the major challenges of health-related big data for Ethics Review Committees (ERCs) or analogous institutional review boards. A total of 1093 publications were initially identified, 263 of which were included in the final synthesis after abstract and full-text screening performed independently by two researchers. Both a descriptive numerical summary and a thematic analysis were performed on the full-texts of all articles included in the synthesis. Our findings suggest that while big data trends in biomedicine hold the potential for advancing clinical research, improving prevention and optimizing healthcare delivery, yet several epistemic, scientific and normative challenges need careful consideration. These challenges have relevance for both the composition of ERCs and the evaluation criteria that should be employed by ERC members when assessing the methodological and ethical viability of health-related big data studies. Based on this analysis, we provide some preliminary recommendations on how ERCs could adaptively respond to those challenges. This exploration is designed to synthesize useful information for researchers, ERCs and relevant institutional bodies involved in the conduction and/or assessment of health-related big data research.
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Affiliation(s)
- Marcello Ienca
- Health Ethics and Policy Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Agata Ferretti
- Health Ethics and Policy Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Samia Hurst
- Institute for Ethics, History and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Christian Lovis
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, University Hospital of Geneva, Geneva, Switzerland
| | - Effy Vayena
- Health Ethics and Policy Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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22
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Boonstra TW, Nicholas J, Wong QJ, Shaw F, Townsend S, Christensen H. Using Mobile Phone Sensor Technology for Mental Health Research: Integrated Analysis to Identify Hidden Challenges and Potential Solutions. J Med Internet Res 2018; 20:e10131. [PMID: 30061092 PMCID: PMC6090171 DOI: 10.2196/10131] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/22/2018] [Accepted: 06/12/2018] [Indexed: 01/13/2023] Open
Abstract
Background Mobile phone sensor technology has great potential in providing behavioral markers of mental health. However, this promise has not yet been brought to fruition. Objective The objective of our study was to examine challenges involved in developing an app to extract behavioral markers of mental health from passive sensor data. Methods Both technical challenges and acceptability of passive data collection for mental health research were assessed based on literature review and results obtained from a feasibility study. Socialise, a mobile phone app developed at the Black Dog Institute, was used to collect sensor data (Bluetooth, location, and battery status) and investigate views and experiences of a group of people with lived experience of mental health challenges (N=32). Results On average, sensor data were obtained for 55% (Android) and 45% (iOS) of scheduled scans. Battery life was reduced from 21.3 hours to 18.8 hours when scanning every 5 minutes with a reduction of 2.5 hours or 12%. Despite this relatively small reduction, most participants reported that the app had a noticeable effect on their battery life. In addition to battery life, the purpose of data collection, trust in the organization that collects data, and perceived impact on privacy were identified as main factors for acceptability. Conclusions Based on the findings of the feasibility study and literature review, we recommend a commitment to open science and transparent reporting and stronger partnerships and communication with users. Sensing technology has the potential to greatly enhance the delivery and impact of mental health care. Realizing this requires all aspects of mobile phone sensor technology to be rigorously assessed.
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Affiliation(s)
- Tjeerd W Boonstra
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Jennifer Nicholas
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Quincy Jj Wong
- Black Dog Institute, University of New South Wales, Sydney, Australia.,Western Sydney University, Sydney, Australia
| | - Frances Shaw
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Samuel Townsend
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, Australia
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23
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Hidalgo-Mazzei D, Young AH, Vieta E, Colom F. Behavioural biomarkers and mobile mental health: a new paradigm. Int J Bipolar Disord 2018; 6:9. [PMID: 29730832 PMCID: PMC6161977 DOI: 10.1186/s40345-018-0119-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 01/23/2018] [Indexed: 01/15/2023] Open
Abstract
Over recent decades, the field of psychiatry has allocated a vast amount of resources and efforts to make available more accurate and objective methods to diagnose, assess and monitor treatment outcomes in psychiatric disorders. Despite the optimism and some significant progress in biological markers, it has become increasingly evident that they are failing to meet initial expectations due to their lack of specificity, inconsistent reliability and limited availability. On the other hand, there is an increasingly emerging evidence of mobile technologies' feasibility to measure mental illness activity. Moreover, taking into account its widespread use, availability and potential to capture behavioural markers, mobile-connected technologies could be strong candidates to fill and complement-at least at some degree-the gaps that biological markers couldn't. This represents an especially interesting opportunity to reform our current diagnostic system using a bottom-up research methodology based on digital and biological markers data instead of the classical traditional top-down approach. Therefore, the field might benefit of further exploring this promising -and increasingly evidence-based- pathway as well as other auspicious alternatives in order to attain a more holistic and integrative approach in research, which could ultimately impact real-world clinical practice.
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Affiliation(s)
- Diego Hidalgo-Mazzei
- Bipolar Disorder Program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Villaroel 170, 08036, Barcelona, Catalonia, Spain.,Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Allan H Young
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Eduard Vieta
- Bipolar Disorder Program, Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Villaroel 170, 08036, Barcelona, Catalonia, Spain.
| | - Francesc Colom
- Mental Health Group, IMIM-Hospital del Mar, Dr. Aiguader 88, 08003, Barcelona, Catalonia, Spain
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24
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Faurholt-Jepsen M, Bauer M, Kessing LV. Smartphone-based objective monitoring in bipolar disorder: status and considerations. Int J Bipolar Disord 2018; 6:6. [PMID: 29359252 PMCID: PMC6161968 DOI: 10.1186/s40345-017-0110-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 12/19/2017] [Indexed: 12/19/2022] Open
Abstract
In 2001, the WHO stated that: "The use of mobile and wireless technologies to support the achievement of health objectives (mHealth) has the potential to transform the face of health service delivery across the globe". Within mental health, interventions and monitoring systems for depression, anxiety, substance abuse, eating disorder, schizophrenia and bipolar disorder have been developed and used. The present paper presents the status and findings from studies using automatically generated objective smartphone data in the monitoring of bipolar disorder, and addresses considerations on the current literature and methodological as well as clinical aspects to consider in the future studies.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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25
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Harrison PJ, Geddes JR, Tunbridge EM. The Emerging Neurobiology of Bipolar Disorder. Trends Neurosci 2018; 41:18-30. [PMID: 29169634 PMCID: PMC5755726 DOI: 10.1016/j.tins.2017.10.006] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/20/2017] [Accepted: 10/31/2017] [Indexed: 12/12/2022]
Abstract
Bipolar disorder (BD) is a leading cause of global disability. Its biological basis is unknown, and its treatment unsatisfactory. Here, we review two recent areas of progress. First, the discovery of risk genes and their implications, with a focus on voltage-gated calcium channels as part of the disease process and as a drug target. Second, facilitated by new technologies, it is increasingly apparent that the bipolar phenotype is more complex and nuanced than simply one of recurring manic and depressive episodes. One such feature is persistent mood instability, and efforts are underway to understand its mechanisms and its therapeutic potential. BD illustrates how psychiatry is being transformed by contemporary neuroscience, genomics, and digital approaches.
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Affiliation(s)
- Paul J Harrison
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Elizabeth M Tunbridge
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
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26
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Kalid N, Zaidan AA, Zaidan BB, Salman OH, Hashim M, Muzammil H. Based Real Time Remote Health Monitoring Systems: A Review on Patients Prioritization and Related "Big Data" Using Body Sensors information and Communication Technology. J Med Syst 2017; 42:30. [PMID: 29288419 DOI: 10.1007/s10916-017-0883-4] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/13/2017] [Indexed: 12/31/2022]
Abstract
The growing worldwide population has increased the need for technologies, computerised software algorithms and smart devices that can monitor and assist patients anytime and anywhere and thus enable them to lead independent lives. The real-time remote monitoring of patients is an important issue in telemedicine. In the provision of healthcare services, patient prioritisation poses a significant challenge because of the complex decision-making process it involves when patients are considered 'big data'. To our knowledge, no study has highlighted the link between 'big data' characteristics and real-time remote healthcare monitoring in the patient prioritisation process, as well as the inherent challenges involved. Thus, we present comprehensive insights into the elements of big data characteristics according to the six 'Vs': volume, velocity, variety, veracity, value and variability. Each of these elements is presented and connected to a related part in the study of the connection between patient prioritisation and real-time remote healthcare monitoring systems. Then, we determine the weak points and recommend solutions as potential future work. This study makes the following contributions. (1) The link between big data characteristics and real-time remote healthcare monitoring in the patient prioritisation process is described. (2) The open issues and challenges for big data used in the patient prioritisation process are emphasised. (3) As a recommended solution, decision making using multiple criteria, such as vital signs and chief complaints, is utilised to prioritise the big data of patients with chronic diseases on the basis of the most urgent cases.
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Affiliation(s)
- Naser Kalid
- Computing Department, Universiti Pendidikan Sultan Idris, Tg Malim, 35900, Perak, Malaysia.,Department of Computer Engineering Techniques, Al-Nisour University, Al Adhmia - Haiba Khaton, Baghdad, Iraq
| | - A A Zaidan
- Computing Department, Universiti Pendidikan Sultan Idris, Tg Malim, 35900, Perak, Malaysia.
| | - B B Zaidan
- Computing Department, Universiti Pendidikan Sultan Idris, Tg Malim, 35900, Perak, Malaysia
| | - Omar H Salman
- Networking Department, Engineering College, Al Iraqia university, Baghdad, Iraq
| | - M Hashim
- Computing Department, Universiti Pendidikan Sultan Idris, Tg Malim, 35900, Perak, Malaysia
| | - H Muzammil
- Department of Computer Science, University of Management and Technology, Lahore, Pakistan
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27
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Alda M, Manchia M. Personalized management of bipolar disorder. Neurosci Lett 2017; 669:3-9. [PMID: 29208408 DOI: 10.1016/j.neulet.2017.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 12/15/2022]
Abstract
Bipolar disorder (BD) is one of the most serious psychiatric disorders. The rates of disability, the risk of suicide attempts and their high lethality, as well as frequent and severe psychiatric and medical comorbidities, put it among the major causes of mortality and disability worldwide. At the same time, many patients can do well when treated properly. In this review, we focus on those aspects of the clinical care that offer the potential of individualized approach, in the context of the recent technology driven advances in the comprehension of the neurobiological underpinnings of BD. We first review those clinical and biological factors that can help identifying individuals at high risk of developing BD. Among these are a family history of BD and/or completed suicide, prodromal symptoms (in childhood and/or adolescence) such as anxiety and mood lability, early onset, and poor response to antidepressants. Panels of genetic markers are also being studied to identify subjects at risk for BD. Further, neuroimaging studies have found an increased gray matter density in the right Inferior Frontal Gyrus (rIFG) as a possible risk marker of BD. We then examine clinical factors that influence the initiation, selection and possibly discontinuation of long-term treatment. Lastly, we discuss the risk of side effects in BD, and their relevance for treatment adherence and for treatment monitoring. In summary, we discuss how a personalized approach in BD can be implemented through the identification of specific clinical and molecular predictors. We show that the realization of a personalized management of BD is not only of a theoretical value, but has substantial clinical repercussions, resulting in a significant reduction of the long-term morbidity and mortality associated to BD.
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Affiliation(s)
- Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
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Dogan E, Sander C, Wagner X, Hegerl U, Kohls E. Smartphone-Based Monitoring of Objective and Subjective Data in Affective Disorders: Where Are We and Where Are We Going? Systematic Review. J Med Internet Res 2017; 19:e262. [PMID: 28739561 PMCID: PMC5547249 DOI: 10.2196/jmir.7006] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/31/2017] [Accepted: 05/15/2017] [Indexed: 02/06/2023] Open
Abstract
Background Electronic mental health interventions for mood disorders have increased rapidly over the past decade, most recently in the form of various systems and apps that are delivered via smartphones. Objective We aim to provide an overview of studies on smartphone-based systems that combine subjective ratings with objectively measured data for longitudinal monitoring of patients with affective disorders. Specifically, we aim to examine current knowledge on: (1) the feasibility of, and adherence to, such systems; (2) the association of monitored data with mood status; and (3) the effects of monitoring on clinical outcomes. Methods We systematically searched PubMed, Web of Science, PsycINFO, and the Cochrane Central Register of Controlled Trials for relevant articles published in the last ten years (2007-2017) by applying Boolean search operators with an iterative combination of search terms, which was conducted in February 2017. Additional articles were identified via pearling, author correspondence, selected reference lists, and trial protocols. Results A total of 3463 unique records were identified. Twenty-nine studies met the inclusion criteria and were included in the review. The majority of articles represented feasibility studies (n=27); two articles reported results from one randomized controlled trial (RCT). In total, six different self-monitoring systems for affective disorders that used subjective mood ratings and objective measurements were included. These objective parameters included physiological data (heart rate variability), behavioral data (phone usage, physical activity, voice features), and context/environmental information (light exposure and location). The included articles contained results regarding feasibility of such systems in affective disorders, showed reasonable accuracy in predicting mood status and mood fluctuations based on the objectively monitored data, and reported observations about the impact of monitoring on clinical state and adherence of patients to the system usage. Conclusions The included observational studies and RCT substantiate the value of smartphone-based approaches for gathering long-term objective data (aside from self-ratings to monitor clinical symptoms) to predict changes in clinical states, and to investigate causal inferences about state changes in patients with affective disorders. Although promising, a much larger evidence-base is necessary to fully assess the potential and the risks of these approaches. Methodological limitations of the available studies (eg, small sample sizes, variations in the number of observations or monitoring duration, lack of RCT, and heterogeneity of methods) restrict the interpretability of the results. However, a number of study protocols stated ambitions to expand and intensify research in this emerging and promising field.
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Affiliation(s)
- Ezgi Dogan
- Medical Faculty, Department of Psychiatry and Psychotherapy, University Leipzig, Leipzig, Germany
| | - Christian Sander
- Medical Faculty, Department of Psychiatry and Psychotherapy, University Leipzig, Leipzig, Germany.,Depression Research Centre, German Depression Foundation, Leipzig, Germany
| | - Xenija Wagner
- Medical Faculty, Department of Psychiatry and Psychotherapy, University Leipzig, Leipzig, Germany
| | - Ulrich Hegerl
- Medical Faculty, Department of Psychiatry and Psychotherapy, University Leipzig, Leipzig, Germany.,Depression Research Centre, German Depression Foundation, Leipzig, Germany
| | - Elisabeth Kohls
- Medical Faculty, Department of Psychiatry and Psychotherapy, University Leipzig, Leipzig, Germany
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Aledavood T, Triana Hoyos AM, Alakörkkö T, Kaski K, Saramäki J, Isometsä E, Darst RK. Data Collection for Mental Health Studies Through Digital Platforms: Requirements and Design of a Prototype. JMIR Res Protoc 2017; 6:e110. [PMID: 28600276 PMCID: PMC5483244 DOI: 10.2196/resprot.6919] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 02/13/2017] [Accepted: 04/02/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Mental and behavioral disorders are the main cause of disability worldwide. However, their diagnosis is challenging due to a lack of reliable biomarkers; current detection is based on structured clinical interviews which can be biased by the patient's recall ability, affective state, changing in temporal frames, etc. While digital platforms have been introduced as a possible solution to this complex problem, there is little evidence on the extent of usability and usefulness of these platforms. Therefore, more studies where digital data is collected in larger scales are needed to collect scientific evidence on the capacities of these platforms. Most of the existing platforms for digital psychiatry studies are designed as monolithic systems for a certain type of study; publications from these studies focus on their results, rather than the design features of the data collection platform. Inevitably, more tools and platforms will emerge in the near future to fulfill the need for digital data collection for psychiatry. Currently little knowledge is available from existing digital platforms for future data collection platforms to build upon. OBJECTIVE The objective of this work was to identify the most important features for designing a digital platform for data collection for mental health studies, and to demonstrate a prototype platform that we built based on these design features. METHODS We worked closely in a multidisciplinary collaboration with psychiatrists, software developers, and data scientists and identified the key features which could guarantee short-term and long-term stability and usefulness of the platform from the designing stage to data collection and analysis of collected data. RESULTS The key design features that we identified were flexibility of access control, flexibility of data sources, and first-order privacy protection. We also designed the prototype platform Non-Intrusive Individual Monitoring Architecture (Niima), where we implemented these key design features. We described why each of these features are important for digital data collection for psychiatry, gave examples of projects where Niima was used or is going to be used in the future, and demonstrated how incorporating these design principles opens new possibilities for studies. CONCLUSIONS The new methods of digital psychiatry are still immature and need further research. The design features we suggested are a first step to design platforms which can adapt to the upcoming requirements of digital psychiatry.
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Affiliation(s)
| | | | - Tuomas Alakörkkö
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Kimmo Kaski
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Jari Saramäki
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Richard K Darst
- Department of Computer Science, Aalto University, Espoo, Finland
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30
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Bauer M, Glenn T, Monteith S, Bauer R, Whybrow PC, Geddes J. Ethical perspectives on recommending digital technology for patients with mental illness. Int J Bipolar Disord 2017; 5:6. [PMID: 28155206 PMCID: PMC5293713 DOI: 10.1186/s40345-017-0073-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/04/2017] [Indexed: 12/12/2022] Open
Abstract
The digital revolution in medicine not only offers exciting new directions for the treatment of mental illness, but also presents challenges to patient privacy and security. Changes in medicine are part of the complex digital economy based on creating value from analysis of behavioral data acquired by the tracking of daily digital activities. Without an understanding of the digital economy, recommending the use of technology to patients with mental illness can inadvertently lead to harm. Behavioral data are sold in the secondary data market, combined with other data from many sources, and used in algorithms that automatically classify people. These classifications are used in commerce and government, may be discriminatory, and result in non-medical harm to patients with mental illness. There is also potential for medical harm related to poor quality online information, self-diagnosis and self-treatment, passive monitoring, and the use of unvalidated smartphone apps. The goal of this paper is to increase awareness and foster discussion of the new ethical issues. To maximize the potential of technology to help patients with mental illness, physicians need education about the digital economy, and patients need help understanding the appropriate use and limitations of online websites and smartphone apps.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Tasha Glenn
- ChronoRecord Association, Inc., Fullerton, CA, 92834, USA
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, 1400 Medical Campus Drive, Traverse City, MI, 49684, USA
| | - Rita Bauer
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior University of California Los Angeles (UCLA), 300 UCLA Medical Plaza, Los Angeles, CA, 90095, USA
| | - John Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
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Abstract
Automated decision-making by computer algorithms based on data from our behaviors is fundamental to the digital economy. Automated decisions impact everyone, occurring routinely in education, employment, health care, credit, and government services. Technologies that generate tracking data, including smartphones, credit cards, websites, social media, and sensors, offer unprecedented benefits. However, people are vulnerable to errors and biases in the underlying data and algorithms, especially those with mental illness. Algorithms based on big data from seemingly unrelated sources may create obstacles to community integration. Voluntary online self-disclosure and constant tracking blur traditional concepts of public versus private data, medical versus non-medical data, and human versus automated decision-making. In contrast to sharing sensitive information with a physician in a confidential relationship, there may be numerous readers of information revealed online; data may be sold repeatedly; used in proprietary algorithms; and are effectively permanent. Technological changes challenge traditional norms affecting privacy and decision-making, and continued discussions on new approaches to provide privacy protections are needed.
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Affiliation(s)
- Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, 1400 Medical Campus Drive, Traverse City, MI, 49684, USA.
| | - Tasha Glenn
- ChronoRecord Association, Inc., Fullerton, CA, 92834, USA
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32
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Torous J, Summergrad P, Nassir Ghaemi S. Bipolar disorder in the digital age: new tools for the same illness. Int J Bipolar Disord 2016; 4:25. [PMID: 27858348 PMCID: PMC5114216 DOI: 10.1186/s40345-016-0065-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/27/2016] [Indexed: 01/09/2023] Open
Abstract
“Nothing is more difficult than to ascertain the length of time that a maniacal patient can exist without sleep.”—Dr. Sutherland (Br J Psychiatry 7(37):1–19, 1861). Dr. Sutherland’s patient was suffering from an acute manic episode, which today is called bipolar illness. 150 years later, we continue to struggle with the same challenges in ascertaining accurate symptoms from patients. In era of new digital tools, the quantified self-movement, and precision medicine, we can ask the question: Can we advance understanding and treatment for bipolar illness beyond asking the same questions as in 1861?
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Affiliation(s)
- John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02446, USA. .,Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Paul Summergrad
- Department of Psychiatry, Tufts Medical Center, Tufts University, Boston, MA, USA
| | - S Nassir Ghaemi
- Department of Psychiatry, Tufts Medical Center, Tufts University, Boston, MA, USA
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33
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Auffray C, Balling R, Barroso I, Bencze L, Benson M, Bergeron J, Bernal-Delgado E, Blomberg N, Bock C, Conesa A, Del Signore S, Delogne C, Devilee P, Di Meglio A, Eijkemans M, Flicek P, Graf N, Grimm V, Guchelaar HJ, Guo YK, Gut IG, Hanbury A, Hanif S, Hilgers RD, Honrado Á, Hose DR, Houwing-Duistermaat J, Hubbard T, Janacek SH, Karanikas H, Kievits T, Kohler M, Kremer A, Lanfear J, Lengauer T, Maes E, Meert T, Müller W, Nickel D, Oledzki P, Pedersen B, Petkovic M, Pliakos K, Rattray M, I Màs JR, Schneider R, Sengstag T, Serra-Picamal X, Spek W, Vaas LAI, van Batenburg O, Vandelaer M, Varnai P, Villoslada P, Vizcaíno JA, Wubbe JPM, Zanetti G. Making sense of big data in health research: Towards an EU action plan. Genome Med 2016; 8:71. [PMID: 27338147 PMCID: PMC4919856 DOI: 10.1186/s13073-016-0323-y] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Medicine and healthcare are undergoing profound changes. Whole-genome sequencing and high-resolution imaging technologies are key drivers of this rapid and crucial transformation. Technological innovation combined with automation and miniaturization has triggered an explosion in data production that will soon reach exabyte proportions. How are we going to deal with this exponential increase in data production? The potential of "big data" for improving health is enormous but, at the same time, we face a wide range of challenges to overcome urgently. Europe is very proud of its cultural diversity; however, exploitation of the data made available through advances in genomic medicine, imaging, and a wide range of mobile health applications or connected devices is hampered by numerous historical, technical, legal, and political barriers. European health systems and databases are diverse and fragmented. There is a lack of harmonization of data formats, processing, analysis, and data transfer, which leads to incompatibilities and lost opportunities. Legal frameworks for data sharing are evolving. Clinicians, researchers, and citizens need improved methods, tools, and training to generate, analyze, and query data effectively. Addressing these barriers will contribute to creating the European Single Market for health, which will improve health and healthcare for all Europeans.
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Affiliation(s)
- Charles Auffray
- European Institute for Systems Biology and Medicine, 1 avenue Claude Vellefaux, 75010, Paris, France.
- CIRI-UMR5308, CNRS-ENS-INSERM-UCBL, Université de Lyon, 50 avenue Tony Garnier, 69007, Lyon, France.
| | - Rudi Balling
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 7 Avenue des Hauts Fourneaux, 4362, Esch-sur-Alzette, Luxembourg.
| | - Inês Barroso
- Wellcome Trust Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - László Bencze
- Health Services Management Training Centre, Faculty of Health and Public Services, Semmelweis University, Kútvölgyi út 2, 1125, Budapest, Hungary
| | - Mikael Benson
- Centre for Personalised Medicine, Linköping University, 581 85, Linköping, Sweden
| | - Jay Bergeron
- Translational & Bioinformatics, Pfizer Inc., 300 Technology Square, Cambridge, MA, 02139, USA
| | - Enrique Bernal-Delgado
- Institute for Health Sciences, IACS - IIS Aragon, San Juan Bosco 13, 50009, Zaragoza, Spain
| | - Niklas Blomberg
- ELIXIR, Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SD, UK
| | - Christoph Bock
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Lazarettgasse 14, AKH BT25.2, 1090, Vienna, Austria
- Department of Laboratory Medicine, Medical University of Vienna, Lazarettgasse 14, AKH BT25.2, 1090, Vienna, Austria
- Max Planck Institute for Informatics, Campus E1 4, 66123, Saarbrücken, Germany
| | - Ana Conesa
- Príncipe Felipe Research Center, C/ Eduardo Primo Yúfera 3, 46012, Valencia, Spain
- University of Florida, Institute of Food and Agricultural Sciences (IFAS), 2033 Mowry Road, Gainesville, FL, 32610, USA
| | | | - Christophe Delogne
- Technology, Data & Analytics, KPMG Luxembourg, Société Coopérative, 39 Avenue John F. Kennedy, 1855, Luxembourg, Luxembourg
| | - Peter Devilee
- Department of Human Genetics, Department of Pathology, Leiden University Medical Centre, Einthovenweg 20, 2333 ZC, Leiden, The Netherlands
| | - Alberto Di Meglio
- Information Technology Department, European Organization for Nuclear Research (CERN), 385 Route de Meyrin, 1211, Geneva 23, Switzerland
| | - Marinus Eijkemans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Paul Flicek
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SD, UK
| | - Norbert Graf
- Department of Pediatric Oncology/Hematology, Saarland University, Campus Homburg, Building 9, 66421, Homburg, Germany
| | - Vera Grimm
- Project Management Jülich, Forschungszentrum Jülich GmbH, Wilhelm-Johnen-Straße, 52428, Jülich, Germany
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Yi-Ke Guo
- Data Science Institute, Imperial College London, South Kensington, London, SW7 2AZ, UK
| | - Ivo Glynne Gut
- CNAG-CRG, Center for Genomic Regulation, Barcelona Institute for Science and Technology (BIST), C/Baldiri Reixac 4, 08029, Barcelona, Spain
| | - Allan Hanbury
- Institute of Software Technology and Interactive Systems, TU Wien, Favoritenstrasse 9-11/188, 1040, Vienna, Austria
| | - Shahid Hanif
- The Association of the British Pharmaceutical Industry, 7th Floor, Southside, 105 Victoria Street, London, SW1E 6QT, UK
| | - Ralf-Dieter Hilgers
- Department of Medical Statistics, RWTH-Aachen University, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Ángel Honrado
- SYNAPSE Research Management Partners, Diputació 237, Àtic 3ª, 08007, Barcelona, Spain
| | - D Rod Hose
- Department of Infection, Immunity and Cardiovascular Disease and Insigneo Institute for In-Silico Medicine, Medical School, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK
| | | | - Tim Hubbard
- Department of Medical & Molecular Genetics, King's College London, London, SE1 9RT, UK
- Genomics England, London, EC1M 6BQ, UK
| | - Sophie Helen Janacek
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SD, UK
| | - Haralampos Karanikas
- National and Kapodistrian University of Athens, Medical School, Xristou Lada 6, 10561, Athens, Greece
| | - Tim Kievits
- Vitromics Healthcare Holding B.V., Onderwijsboulevard 225, 5223 DE, 's-Hertogenbosch, The Netherlands
| | - Manfred Kohler
- Fraunhofer Institute for Molecular Biology and Applied Ecology ScreeningPort, Schnackenburgallee 114, 22525, Hamburg, Germany
| | - Andreas Kremer
- ITTM S.A., 9 avenue des Hauts Fourneaux, 4362, Esch-sur-Alzette, Luxembourg
| | - Jerry Lanfear
- Research Business Technology, Pfizer Ltd, GP4 Building, Granta Park, Cambridge, CB21 6GP, UK
| | - Thomas Lengauer
- Max Planck Institute for Informatics, Campus E1 4, 66123, Saarbrücken, Germany
| | - Edith Maes
- Health Economics & Outcomes Research, Deloitte Belgium, Berkenlaan 8A, 1831, Diegem, Belgium
| | - Theo Meert
- Janssen Pharmaceutica N.V., R&D G3O, Turnhoutseweg 30, 2340, Beerse, Belgium
| | - Werner Müller
- Faculty of Life Sciences, University of Manchester, AV Hill Building, Oxford Road, Manchester, M13 9PT, UK
| | - Dörthe Nickel
- UMR3664 IC/CNRS, Institut Curie, Section Recherche, Pavillon Pasteur, 26 rue d'Ulm, 75248, Paris cedex 05, France
| | - Peter Oledzki
- Linguamatics Ltd, 324 Cambridge Science Park Milton Rd, Cambridge, CB4 0WG, UK
| | - Bertrand Pedersen
- PwC Luxembourg, 2 rue Gerhard Mercator, 2182, Luxembourg, Luxembourg
| | - Milan Petkovic
- Philips, HighTechCampus 36, 5656AE, Eindhoven, The Netherlands
| | - Konstantinos Pliakos
- Department of Public Health and Primary Care, KU Leuven Kulak, Etienne Sabbelaan 53, 8500, Kortrijk, Belgium
| | - Magnus Rattray
- Faculty of Life Sciences, University of Manchester, AV Hill Building, Oxford Road, Manchester, M13 9PT, UK
| | - Josep Redón I Màs
- INCLIVA Health Research Institute, University of Valencia, CIBERobn ISCIII, Avenida Menéndez Pelayo 4 accesorio, 46010, Valencia, Spain
| | - Reinhard Schneider
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, 7 Avenue des Hauts Fourneaux, 4362, Esch-sur-Alzette, Luxembourg
| | - Thierry Sengstag
- Swiss Institute of Bioinformatics (SIB) and University of Basel, Klingelbergstrasse 50/70, 4056, Basel, Switzerland
| | - Xavier Serra-Picamal
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Carrer de Roc Boronat 81-95, 08005, Barcelona, Spain
| | - Wouter Spek
- EuroBioForum Foundation, Chrysantstraat 10, 3135 HG, Vlaardingen, The Netherlands
| | - Lea A I Vaas
- Fraunhofer Institute for Molecular Biology and Applied Ecology ScreeningPort, Schnackenburgallee 114, 22525, Hamburg, Germany
| | - Okker van Batenburg
- EuroBioForum Foundation, Chrysantstraat 10, 3135 HG, Vlaardingen, The Netherlands
| | - Marc Vandelaer
- Integrated BioBank of Luxembourg, 6 rue Nicolas-Ernest Barblé, 1210, Luxembourg, Luxembourg
| | - Peter Varnai
- Technopolis Group, 3 Pavilion Buildings, Brighton, BN1 1EE, UK
| | - Pablo Villoslada
- Hospital Clinic of Barcelona, Institute d'Investigacions Biomediques August Pi Sunyer (IDIBAPS), Rosello 149, 08036, Barcelona, Spain
| | - Juan Antonio Vizcaíno
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, Cambridge, CB10 1SD, UK
| | - John Peter Mary Wubbe
- European Platform for Patients' Organisations, Science and Industry (Epposi), De Meeûs Square 38-40, 1000, Brussels, Belgium
| | - Gianluigi Zanetti
- CRS4, Ed.1 POLARIS, 09129, Pula, Italy
- BBMRI-ERIC, Neue Stiftingtalstrasse 2/B/6, 8010, Graz, Austria
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