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Sekhon H, Dickinson RA, Kimball JE, Cray HV, Alkhatib F, Preston A, Moore I, Trueba-Yepez AF, Fahed M, Vahia IV. Safety Considerations in the Use of Extended Reality Technologies for Mental Health with Older Adults. Am J Geriatr Psychiatry 2024; 32:648-651. [PMID: 38246832 DOI: 10.1016/j.jagp.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Harmehr Sekhon
- McLean Hospital, Belmont, MA; Centre for addictions and Mental Health (CAMH), University of Toronto Affiliated Hospital, Toronto, Canada
| | | | | | | | | | - A'mie Preston
- Central Arkansas Veterans Healthcare System Eugene J Towbin Healthcare Center (AP, IM), North Little Rock, AR
| | - Ian Moore
- Central Arkansas Veterans Healthcare System Eugene J Towbin Healthcare Center (AP, IM), North Little Rock, AR
| | - Ana F Trueba-Yepez
- McLean Hospital, Belmont, MA; Universidad San Francisco de Quito, Quito, Ecuador
| | - Mario Fahed
- University of Connecticut Health Care (MF), Farmington, CT
| | - Ipsit V Vahia
- McLean Hospital, Belmont, MA; Department of Psychiatry (IVV), Harvard Medical School, Boston, MA.
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Vahia IV. Navigating New Realities in Aging Care as Artificial Intelligence Enters Clinical Practice. Am J Geriatr Psychiatry 2024; 32:267-269. [PMID: 38218703 DOI: 10.1016/j.jagp.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/15/2024]
Affiliation(s)
- Ipsit V Vahia
- McLean Hospital (IVV), Belmont, MA; Department of Psychiatry (IVV), Harvard Medical School, Boston, MA.
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Paret H, Vahia IV. Is Alzheimer's disease a single illness or multiple illnesses? Int Psychogeriatr 2024; 36:161-162. [PMID: 36594252 DOI: 10.1017/s1041610222001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Hayley Paret
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Ipsit V Vahia
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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O'Neill J, Nakisa B, Eyre H, Vahia IV, Schueller SM, Tolou-Shams M, Lundin RM. As a new challenger approaches, how will modern psychiatry cope with 'shifting realities'? Acta Neuropsychiatr 2023; 35:377-379. [PMID: 37593982 DOI: 10.1017/neu.2023.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Affiliation(s)
- John O'Neill
- Waikato District Health Board, Mental Health and Addiction Services, Hamilton, New Zealand
| | - Bahareh Nakisa
- Deakin University, School of Information Technology, Geelong, Australia
| | - Harris Eyre
- Center for Health and Biosciences, The Baker Institute for Public Policy, Rice University, Houston, TX, USA
- Brain Capital Alliance, San Francisco, CA, USA
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia
| | - Ipsit V Vahia
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Stephen M Schueller
- Department of Psychological Science, University of California, Irvine, CA, USA
- Department of Informatics, University of California, Irvine, CA, USA
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Robert M Lundin
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia
- Mental Health, Drug and Alcohol Services, Barwon Health, Geelong, VIC, Australia
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Deliyannides DA, Graff JA, Niño I, Lee S, Husain MM, Forester BP, Crocco E, Vahia IV, Devanand DP. Effects of lithium on serum Brain-Derived Neurotrophic Factor in Alzheimer's patients with agitation. Int J Geriatr Psychiatry 2023; 38:e6002. [PMID: 37732619 DOI: 10.1002/gps.6002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND There is ample evidence in animal models that lithium increases Brain-Derived Neurotrophic Factor (BDNF) with supporting evidence in human studies. Little is known, however, about the effects of lithium on BDNF in Alzheimer's Dementia (AD). In one study of patients with Mild Cognitive Impairment, serum BDNF increased after treatment with lithium. These patients also showed mild improvement in cognitive function. OBJECTIVES To evaluate low-dose lithium treatment of agitation in Alzheimer's disease (AD). METHOD We measured levels of BDNF in patients treated with lithium prior to and after a 12-week randomized placebo-controlled trial. RESULTS BDNF levels did not change significantly and were not associated with improvement in overall neuropsychiatric symptoms or in cognitive function. CONCLUSIONS More research is needed to understand the potential effects of lithium on BDNF in AD including whether its use might be dependent on the stage of cognitive decline and dementia.
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Affiliation(s)
- Deborah A Deliyannides
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Jamie A Graff
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Izael Niño
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Seonjoo Lee
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
- Department of Biostatistics, Columbia University Medical Center, New York, New York, USA
- Mental Health Data Science, New York State Psychiatric Institute, New York, New York, USA
| | - Mustafa M Husain
- Departments of Psychiatry and Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA
| | - Elizabeth Crocco
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ipsit V Vahia
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA
| | - Davangere P Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
- Department of Neurology and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York, USA
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Vahia IV, Sava RN, Cray HV, Kim HJ, Dickinson RA, Ressler KJ, Trueba AF. Digital Collateral Information Through Electronic and Social Media in Psychotherapy: Comparing Clinician-reported Trends Before and During the COVID-19 Pandemic. J Psychiatr Pract 2023; 29:367-372. [PMID: 37678366 PMCID: PMC10798232 DOI: 10.1097/pra.0000000000000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Patient clinical collateral information is critical for providing psychiatric and psychotherapeutic care. With the shift to primarily virtual care triggered by the COVID-19 pandemic, psychotherapists may have received less clinical information than they did when they were providing in-person care. This study assesses whether the shift to virtual care had an impact on therapists' use of patients' electronic and social media to augment clinical information that may inform psychotherapy. METHODS In 2018, we conducted a survey of a cohort of psychotherapists affiliated with McLean Hospital. We then reapproached the same cohort of providers for the current study, gathering survey responses from August 10, 2020, to September 1, 2020, for this analysis. We asked clinicians whether they viewed patients' electronic and social media in the context of their psychotherapeutic relationship, what they viewed, how much they viewed it, and their attitudes about doing so. RESULTS Of the 99 respondents, 64 (64.6%) had viewed at least 1 patient's social media and 8 (8.1%) had viewed a patient's electronic media. Of those who reported viewing patients' media, 70 (97.2%) indicated they believed this information helped them provide more effective treatment. Compared with the 2018 prepandemic data, there were significantly more clinicians with>10 years of experience reporting media use in therapy. There was also a significant increase during the pandemic in the viewing of media of adult patients and a trend toward an increase in viewing of media of older adult patients. CONCLUSIONS Review of patients' electronic and social media in therapy became more common among clinicians at a large psychiatric teaching hospital during the COVID-19 pandemic. These findings support continuing research about how reviewing patients' media can inform and improve clinical care.
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Chen A, Chang T, Chen L, Vahia IV. Understanding Technology-Related Hidden Costs Associated With Virtual Care for Older Adults. Am J Geriatr Psychiatry 2023; 31:653-654. [PMID: 37149434 DOI: 10.1016/j.jagp.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Anderson Chen
- McLean Hospital, Belmont, MA; Harvard Medical School, Cambridge, MA.
| | - Tiffany Chang
- McLean Hospital, Belmont, MA; Harvard Medical School, Cambridge, MA
| | - Lauren Chen
- Franklin and Marshall College, Lancaster, PA
| | - Ipsit V Vahia
- McLean Hospital, Belmont, MA; Harvard Medical School, Cambridge, MA
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Trueba A, Park S, Dickinson R, Cray HV, Kimball J, Vahia IV. Developing Low-Cost and Scalable Virtual Reality Mindfulness Interventions for Older Psychiatry Inpatients. The American Journal of Geriatric Psychiatry 2023. [DOI: 10.1016/j.jagp.2022.12.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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9
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Fahed M, McManus K, Vahia IV, Offodile AC. Digital Phenotyping of Behavioral Symptoms as the Next Frontier for Personalized and Proactive Cancer Care. JCO Clin Cancer Inform 2022; 6:e2200095. [DOI: 10.1200/cci.22.00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Mario Fahed
- Department of Psychiatry, University of Connecticut, Farmington, CT
- Department of Psychiatry, Yale University, New Haven, CT
| | - Kaitlin McManus
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA
| | - Ipsit V. Vahia
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Anaeze C. Offodile
- Department of Plastic Surgery, UT MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, UT MD Anderson Cancer Center, Houston, TX
- Baker Institute for Public Policy, Rice University, Houston, TX
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10
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Stone DIG, Potter MP, Trueba AF, Boger KD, Vahia IV. Virtual Reality for Targeted and Personalized Augmentation of Late-Life Psychotherapy: Proof of Concept. Am J Geriatr Psychiatry 2022; 30:647-648. [PMID: 34838448 DOI: 10.1016/j.jagp.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Daniel I Gittins Stone
- McLean Hospital Belmont (DIGS, MPP, AFT, KDB, IVV), Belmont, MA; Department of Psychiatry, Harvard Medical School (DIGS, MPP, AFT, KDB, IVV), Cambridge, MA; InStride Health (MPP, KDB), Boston, MA; Department of Psychology, Universidad San Francisco de Quito (AFT), Quito, Ecuador
| | - Mona P Potter
- McLean Hospital Belmont (DIGS, MPP, AFT, KDB, IVV), Belmont, MA; Department of Psychiatry, Harvard Medical School (DIGS, MPP, AFT, KDB, IVV), Cambridge, MA; InStride Health (MPP, KDB), Boston, MA; Department of Psychology, Universidad San Francisco de Quito (AFT), Quito, Ecuador
| | - Ana F Trueba
- McLean Hospital Belmont (DIGS, MPP, AFT, KDB, IVV), Belmont, MA; Department of Psychiatry, Harvard Medical School (DIGS, MPP, AFT, KDB, IVV), Cambridge, MA; InStride Health (MPP, KDB), Boston, MA; Department of Psychology, Universidad San Francisco de Quito (AFT), Quito, Ecuador
| | - Kathryn D Boger
- McLean Hospital Belmont (DIGS, MPP, AFT, KDB, IVV), Belmont, MA; Department of Psychiatry, Harvard Medical School (DIGS, MPP, AFT, KDB, IVV), Cambridge, MA; InStride Health (MPP, KDB), Boston, MA; Department of Psychology, Universidad San Francisco de Quito (AFT), Quito, Ecuador
| | - Ipsit V Vahia
- McLean Hospital Belmont (DIGS, MPP, AFT, KDB, IVV), Belmont, MA; Department of Psychiatry, Harvard Medical School (DIGS, MPP, AFT, KDB, IVV), Cambridge, MA; InStride Health (MPP, KDB), Boston, MA; Department of Psychology, Universidad San Francisco de Quito (AFT), Quito, Ecuador.
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Cray HV, Vahia IV. Two Years of COVID-19: Understanding Impact and Implications for the Mental Health of Older Adults. Am J Geriatr Psychiatry 2022; 30:444-447. [PMID: 35248452 PMCID: PMC8842407 DOI: 10.1016/j.jagp.2022.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 11/24/2022]
Affiliation(s)
| | - Ipsit V. Vahia
- McLean Hospital (HV Cray, IV Vahia), Belmont, MA,Harvard Medical School (IV Vahia), Boston, MA,Send correspondence and reprint requests to Ipsit V. Vahia, M.D., McLean Hospital, 115 Mill Street, Mail stop 234, Belmont, MA 02478
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12
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Sekhon H, Cray HV, Vahia IV. Robots in Geriatric Mental Health: Pipe Dream or Viable Solution? Am J Geriatr Psychiatry 2022; 30:246-248. [PMID: 34593303 DOI: 10.1016/j.jagp.2021.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Harmehr Sekhon
- Department of Psychiatry, McGill University (HS), Montreal, QC; Division of Geriatric Psychiatry, McLean Hospital (HS, HVC, IVV), Belmont, MA
| | - Hailey V Cray
- Division of Geriatric Psychiatry, McLean Hospital (HS, HVC, IVV), Belmont, MA
| | - Ipsit V Vahia
- Division of Geriatric Psychiatry, McLean Hospital (HS, HVC, IVV), Belmont, MA; Department of Psychiatry, Harvard Medical School (IVV), Boston, MA.
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Adrien TV, Kim HJ, Cray HV, Vahia IV. Training Older Adults to Use Telemedicine for Mental Health may have Limited Impact. Am J Geriatr Psychiatry 2022; 30:262-263. [PMID: 34176731 DOI: 10.1016/j.jagp.2021.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | | | | | - Ipsit V Vahia
- McLean Hospital, Belmont, MA; Harvard Medical School, Boston, MA.
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Gedde MH, Husebo BS, Vahia IV, Mannseth J, Vislapuu M, Naik M, Berge LI. Impact of COVID-19 restrictions on behavioural and psychological symptoms in home-dwelling people with dementia: a prospective cohort study (PAN.DEM). BMJ Open 2022; 12:e050628. [PMID: 35074810 PMCID: PMC8787843 DOI: 10.1136/bmjopen-2021-050628] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To investigate the impact of the COVID-19 restrictions on behavioural and psychological symptoms of dementia (BPSD). DESIGN Prospective cohort study (PAN.DEM) nested within the halted parent trial (LIVE@Home.Path). SETTING Households in Norway immediate before and 6-9 weeks into the COVID-19 restrictions. PARTICIPANTS 104 dyads (persons with mild to moderate dementia aged ≥65 and their informal carers) completed both prepandemic and pandemic assessments, among 237 in the parent trial. Mini-Mental Status Examination score 15-26 or Functional Assessment Staging score 3-7 covered dementia severity. MAIN OUTCOME MEASURES Neuropsychiatric Inventory (NPI-12) total (range 0-144), psychosis (range 0-24), hyperactive behaviour (range 0-60) and mood subsyndrome (range 0-48) scores; Cornell Scale for Depression in Dementia (CSDD) total score (range 0-38). RESULTS We found an overall increase in BPSD by NPI-12 total score comparing prepandemic to pandemic levels (median 16 IQR (4.5-29) to 20 (7-32.5), p=0.03) over a mean of 86 days (SD 19). NPI-12 total score worsened in 57 (55%) of people with dementia and was associated with postponed or averted contacts with healthcare professionals (logistic regression, OR 3.96, 95% CI 1.05 to 14.95). Psychosis subsyndrome levels increased (0 (0-3) to 0.5 (0-6), p=0.01) in 37 (36%) persons; this worsening was associated with partial insight (9.57, 1.14 to 80.71) and reduced informal carer contact (4.45, 1.01 to 19.71). Moreover, depressive symptoms increased as assessed by CSDD total score (5 (3-9) to 7 (4-12), p=0.01) and worsened for 56 (54%), which was inversely associated with psychotropic drugs on-demand (0.16, 0.03 to 0.75). CONCLUSIONS BPSD worsened during the first months of the COVID-19 restrictions, most pronounced for psychosis and depression. These BPSD exacerbations have implications for pandemic policies, emphasising that restrictions must balance COVID-19 morbidity and mortality against dementia deterioration. TRIAL REGISTRATION NUMBER NCT04043364; Results.
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Affiliation(s)
- Marie H Gedde
- Haraldsplass Deaconess Hospital, Bergen, Norway
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Bettina S Husebo
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Bergen Municipality, Bergen, Norway
| | - Ipsit V Vahia
- McLean Hospital, Belmont, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Janne Mannseth
- Section for Epidemiology and Medical Statistic, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Maarja Vislapuu
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Mala Naik
- Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Line I Berge
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- NKS Olaviken Gerontopsychiatric Hospital, Askøy, Norway
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Karim HT, Vahia IV, Iaboni A, Lee EE. Editorial: Artificial Intelligence in Geriatric Mental Health Research and Clinical Care. Front Psychiatry 2022; 13:859175. [PMID: 35299825 PMCID: PMC8921095 DOI: 10.3389/fpsyt.2022.859175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ipsit V Vahia
- Division of Geriatrics, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Andrea Iaboni
- Knowledge, Innovation, Talent, Everywhere (KITE), Toronto Rehab Institute, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ellen E Lee
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States.,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA, United States.,Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
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16
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Devanand DP, Crocco E, Forester BP, Husain MM, Lee S, Vahia IV, Andrews H, Simon-Pearson L, Imran N, Luca L, Huey ED, Deliyannides DA, Pelton GH. Low Dose Lithium Treatment of Behavioral Complications in Alzheimer's Disease: Lit-AD Randomized Clinical Trial. Am J Geriatr Psychiatry 2022; 30:32-42. [PMID: 34059401 PMCID: PMC8586042 DOI: 10.1016/j.jagp.2021.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND A case series suggested efficacy for lithium to treat agitation in dementia, but no placebo-controlled trials have been conducted. OBJECTIVES To evaluate low-dose lithium treatment of agitation in Alzheimer's disease (AD). METHOD In a four-site trial, patients with AD and agitation/aggression score ≥4 on the Neuropsychiatric Inventory (NPI) were randomized, double-blind, to lithium carbonate 150-600 mg daily or placebo for 12 weeks. Primary efficacy outcome was change in NPI agitation/aggression; secondary efficacy outcome was treatment response (30% reduction in NPI score for agitation/aggression plus psychosis and a Clinical Global Impression (CGI) score of much or very much improved). Safety profile of lithium was assessed. RESULTS Fifty-eight of 77 patients (75.3%) completed the trial. In linear mixed effects model analyses, lithium was not significantly superior to placebo for agitation/aggression. Proportion of responders was 31.6% on lithium and 17.9% on placebo (χ2=1.26, p = 0.26). Moderate or marked improvement (CGI) was greater on lithium (10/38=36.8%) than placebo (0/39=0%, Fisher's exact test p <0.001). In exploratory analyses, improvement on lithium was greater than placebo on NPI delusions and irritability/lability (p's<0.05). Lithium showed greater reduction than placebo in patients with high Young Mania Rating Scale scores (β=5.06; 95%CI,1.18 to 8.94, p = 0.01). Oral dose and serum levels demonstrated similar associations with efficacy outcomes. Lithium did not differ significantly from placebo on safety outcomes. CONCLUSIONS Low-dose lithium was not efficacious in treating agitation but was associated with global clinical improvement and excellent safety. A larger trial may be warranted of likely lithium-responsive behavioral symptoms that overlap with mania.
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Affiliation(s)
- D. P. Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Medical Center, New York, USA; Department of Neurology and Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, USA
| | - Elizabeth Crocco
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine Miami, Florida, USA
| | - Brent P. Forester
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Mustafa M. Husain
- Departments of Psychiatry and Neurology, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Seonjoo Lee
- Department of Psychiatry, Columbia University Medical Center, New York, USA; Mental Health Data Science, Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, USA
| | - Ipsit V. Vahia
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Howard Andrews
- Department of Psychiatry, Columbia University Medical Center, New York, USA; Mental Health Data Science, Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, New York, USA
| | - Laura Simon-Pearson
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, USA
| | - Nadia Imran
- Departments of Psychiatry and Neurology, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Luminita Luca
- Center for Cognitive Neuroscience and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine Miami, Florida, USA
| | - Edward D. Huey
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Medical Center, New York, USA; Department of Neurology and Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, USA
| | - Deborah A. Deliyannides
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Medical Center, New York, USA
| | - Gregory H. Pelton
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Medical Center, New York, USA
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17
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Au-Yeung WTM, Miller L, Beattie Z, May R, Cray HV, Kabelac Z, Katabi D, Kaye J, Vahia IV. Monitoring Behaviors of Patients With Late-Stage Dementia Using Passive Environmental Sensing Approaches: A Case Series. Am J Geriatr Psychiatry 2022; 30:1-11. [PMID: 34039534 PMCID: PMC8531172 DOI: 10.1016/j.jagp.2021.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To show the feasibility of using different unobtrusive activity-sensing technologies to provide objective behavioral markers of persons with dementia (PwD). DESIGN Monitored the behaviors of two PwD living in memory care unit using the Oregon Center for Aging & Technology (ORCATECH) platform, and the behaviors of two PwD living in assisted living facility using the Emerald device. SETTING A memory care unit in Portland, Oregon and an assisted living facility in Framingham, Massachusetts. PARTICIPANTS A 63-year-old male with Alzheimer's disease (AD), and an 80-year-old female with frontotemporal dementia, both lived in a memory care unit in Portland, Oregon. An 89-year-old woman with a diagnosis of AD, and an 85-year-old woman with a diagnosis of major neurocognitive disorder, Alzheimer's type with behavioral symptoms, both resided at an assisted living facility in Framingham, Massachusetts. MEASUREMENTS These include: sleep quality measured by the bed pressure mat; number of transitions between spaces and dwell times in different spaces measured by the motion sensors; activity levels measured by the wearable actigraphy device; and couch usage and limb movements measured by the Emerald device. RESULTS Number of transitions between spaces can identify the patient's episodes of agitation; activity levels correlate well with the patient's excessive level of agitation and lack of movement when the patient received potentially inappropriate medication and neared the end of life; couch usage can detect the patient's increased level of apathy; and periodic limb movements can help detect risperidone-induced side effects. This is the first demonstration that the ORCATECH platform and the Emerald device can measure such activities. CONCLUSION The use of technologies for monitoring behaviors of PwD can provide more objective and intensive measurements of PwD behaviors.
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Affiliation(s)
- Wan-Tai M. Au-Yeung
- Department of Neurology, Oregon Health & Science University, Portland, OR,Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR,NIA-Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University, Portland, OR
| | - Lyndsey Miller
- Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR,School of Nursing, Oregon Health & Science University, Portland, OR
| | - Zachary Beattie
- Department of Neurology, Oregon Health & Science University, Portland, OR,Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR,NIA-Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University, Portland, OR
| | | | | | - Zachary Kabelac
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA
| | - Dina Katabi
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health & Science University, Portland, OR,Oregon Center for Aging & Technology, Oregon Health & Science University, Portland, OR,NIA-Layton Aging & Alzheimer’s Disease Center, Oregon Health & Science University, Portland, OR
| | - Ipsit V. Vahia
- McLean Hospital, Belmont, MA,Harvard Medical School, Boston, MA
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18
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Affiliation(s)
- Caroline S Bader
- From Harvard Medical School (Drs. Bader and Vahia) and McLean Hospital (all)
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19
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Vahia IV. The future has been preponed: building a new digitally-enhanced psychiatry in the aftermath of the pandemic. Int Rev Psychiatry 2021; 33:363-365. [PMID: 34284696 DOI: 10.1080/09540261.2021.1891744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ipsit V Vahia
- McLean Hospital, Belmont, MA, USA.,Harvard Medical School, Boston, MA, USA
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20
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Abstract
The goals of this scoping literature review are to (1) aggregate the current research involving socially assistive robots in the setting of geriatric psychiatry and (2) examine the outcome measures used in these studies and determine where the gaps and needs are. In light of the global COVID-19 pandemic, the geriatric psychiatric population in particular is vulnerable to both the physical and mental toll COVID-19 may cause. Recently, socially assistive robots have gained attention for their ability to aid in the care of the geriatric psychiatry population and are being explored as a realistic way to deliver certain elements of psychiatric care that have the potential to be safe even in the setting of COVID-19. The results of this review indicate that robots are in the early stages of clinical applicability, they display usability for a range of psychiatric indications, and their impact on clinical care is notable. We project that in the next few years, robotic applications will be tailored to address clinical outcomes with a greater degree of precision and efficacy.
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Affiliation(s)
- Emily Kulpa
- Mountain Area Health Education Center, Asheville, NC, USA
| | | | - Ipsit V Vahia
- McLean Hospital, Belmont, MA, USA.,Harvard Medical School, Boston, MA, USA
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21
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Benrimoh D, Tanguay-Sela M, Perlman K, Israel S, Mehltretter J, Armstrong C, Fratila R, Parikh SV, Karp JF, Heller K, Vahia IV, Blumberger DM, Karama S, Vigod SN, Myhr G, Martins R, Rollins C, Popescu C, Lundrigan E, Snook E, Wakid M, Williams J, Soufi G, Perez T, Tunteng JF, Rosenfeld K, Miresco M, Turecki G, Gomez Cardona L, Linnaranta O, Margolese HC. Using a simulation centre to evaluate preliminary acceptability and impact of an artificial intelligence-powered clinical decision support system for depression treatment on the physician-patient interaction. BJPsych Open 2021; 7:e22. [PMID: 33403948 PMCID: PMC8058891 DOI: 10.1192/bjo.2020.127] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recently, artificial intelligence-powered devices have been put forward as potentially powerful tools for the improvement of mental healthcare. An important question is how these devices impact the physician-patient interaction. AIMS Aifred is an artificial intelligence-powered clinical decision support system (CDSS) for the treatment of major depression. Here, we explore the use of a simulation centre environment in evaluating the usability of Aifred, particularly its impact on the physician-patient interaction. METHOD Twenty psychiatry and family medicine attending staff and residents were recruited to complete a 2.5-h study at a clinical interaction simulation centre with standardised patients. Each physician had the option of using the CDSS to inform their treatment choice in three 10-min clinical scenarios with standardised patients portraying mild, moderate and severe episodes of major depression. Feasibility and acceptability data were collected through self-report questionnaires, scenario observations, interviews and standardised patient feedback. RESULTS All 20 participants completed the study. Initial results indicate that the tool was acceptable to clinicians and feasible for use during clinical encounters. Clinicians indicated a willingness to use the tool in real clinical practice, a significant degree of trust in the system's predictions to assist with treatment selection, and reported that the tool helped increase patient understanding of and trust in treatment. The simulation environment allowed for the evaluation of the tool's impact on the physician-patient interaction. CONCLUSIONS The simulation centre allowed for direct observations of clinician use and impact of the tool on the clinician-patient interaction before clinical studies. It may therefore offer a useful and important environment in the early testing of new technological tools. The present results will inform further tool development and clinician training materials.
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Affiliation(s)
- David Benrimoh
- Department of Psychiatry, McGill University, Canada; Aifred Heath Inc., Montreal, Canada; and Faculty of Medicine, McGill University, Canada
| | - Myriam Tanguay-Sela
- Montreal Neurological Institute, McGill University, Canada; and Aifred Health Inc., Montreal, Canada
| | - Kelly Perlman
- Douglas Mental Health University Institute, Montreal, Canada; and Aifred Health Inc., Montreal, Canada
| | | | - Joseph Mehltretter
- Department of Computer Science, University of Southern California, Los Angeles, USA; and Aifred Health Inc., Montreal, Canada
| | - Caitrin Armstrong
- School of Computer Science, McGill University, Canada; and Aifred Health Inc., Montreal, Canada
| | | | | | - Jordan F Karp
- Department of Psychiatry, University of Pittsburgh, USA
| | | | - Ipsit V Vahia
- Department of Psychiatry, McLean Hospital/Harvard University, USA
| | | | | | | | - Gail Myhr
- Department of Psychiatry, McGill University, Canada
| | - Ruben Martins
- Douglas Mental Health University Institute, Montreal, Canada; and Department of Psychiatry, McGill University, Canada
| | - Colleen Rollins
- Department of Psychiatry, University of Cambridge, UK; and Aifred Health Inc., Montreal, Canada
| | - Christina Popescu
- Douglas Mental Health University Institute, Montreal, Canada; and Aifred Health Inc., Montreal, Canada
| | - Eryn Lundrigan
- Department of Anatomy and Cell Biology, McGill University, Canada
| | - Emily Snook
- Faculty of Medicine, University of Toronto, Canada
| | - Marina Wakid
- Douglas Mental Health University Institute, Montreal, Canada
| | | | | | - Tamara Perez
- Department of Experimental Medicine, McGill University, Canada
| | | | | | - Marc Miresco
- Department of Psychiatry, McGill University, Canada
| | - Gustavo Turecki
- Douglas Mental Health University Institute, Montreal, Canada; and Department of Psychiatry, McGill University, Canada
| | - Liliana Gomez Cardona
- Douglas Mental Health University Institute, Montreal, Canada; and Department of Psychiatry, McGill University, Canada
| | - Outi Linnaranta
- Douglas Mental Health University Institute, Montreal, Canada; and Department of Psychiatry, McGill University, Canada
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22
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Zhang G, Vahia IV, Liu Y, Yang Y, May R, Cray HV, McGrory W, Katabi D. Contactless In-Home Monitoring of the Long-Term Respiratory and Behavioral Phenotypes in Older Adults With COVID-19: A Case Series. Front Psychiatry 2021; 12:754169. [PMID: 34777058 PMCID: PMC8580478 DOI: 10.3389/fpsyt.2021.754169] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Currently, there is a limited understanding of long-term outcomes of COVID-19, and a need for in-home measurements of patients through the whole course of their disease. We study a novel approach for monitoring the long-term trajectories of respiratory and behavioral symptoms of COVID-19 patients at home. We use a sensor that analyzes the radio signals in the room to infer patients' respiration, sleep and activities in a passive and contactless manner. We report the results of continuous monitoring of three residents of an assisted living facility for 3 months, through the course of their disease and subsequent recovery. In total, we collected 4,358 measurements of gait speed, 294 nights of sleep, and 3,056 h of respiration. The data shows differences in the respiration signals between asymptomatic and symptomatic patients. Longitudinally, we note sleep and motor abnormalities that persisted for months after becoming COVID negative. Our study represents a novel phenotyping of the respiratory and behavioral trajectories of COVID recovery, and suggests that the two may be integral components of the COVID-19 syndrome. It further provides a proof-of-concept that contactless passive sensors may uniquely facilitate studying detailed longitudinal outcomes of COVID-19, particularly among older adults.
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Affiliation(s)
- Guo Zhang
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Ipsit V Vahia
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Yingcheng Liu
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Yuzhe Yang
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Rose May
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Hailey V Cray
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - William McGrory
- Mary Ann Morse at Heritage Affordable Senior Living, Framingham, MA, United States
| | - Dina Katabi
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, United States
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23
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Affiliation(s)
- Ipsit V Vahia
- McLean Hospital, Belmont, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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24
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Vahia IV, May R, Kabelac Z, Owoyemi P, Hoti K, Munir U, Katabi D. Mapping behavior symptoms in dementia using passive radio sensing. Alzheimers Dement 2020. [DOI: 10.1002/alz.044139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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25
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Parker CB, Forbes MP, Vahia IV, Forester BP, Jeste DV, Reynolds CF. Facing the Change Together: Reflections of Coping and Resilience From American Geriatric Psychiatrists During COVID-19. Am J Geriatr Psychiatry 2020; 28:1015-1019. [PMID: 32713753 PMCID: PMC7376343 DOI: 10.1016/j.jagp.2020.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Carmen Black Parker
- Yale University School of Medicine, Connecticut Mental Health Center, New Haven, CT.
| | - Malcolm P Forbes
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Ipsit V Vahia
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA
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26
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Vahia IV, Blazer DG, Smith GS, Karp JF, Steffens DC, Forester BP, Tampi R, Agronin M, Jeste DV, Reynolds CF. COVID-19, Mental Health and Aging: A Need for New Knowledge to Bridge Science and Service. Am J Geriatr Psychiatry 2020; 28:695-697. [PMID: 32278745 PMCID: PMC7142692 DOI: 10.1016/j.jagp.2020.03.007] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 03/21/2020] [Indexed: 01/29/2023]
Affiliation(s)
- Ipsit V. Vahia
- McLean Hospital (IVV, BPF), Belmont, MA,Harvard Medical School (IVV, BPF), Boston, MA,Send correspondence and reprint requests to Ipsit V. Vahia, MD, McLean Hospital, 115 Mill Street, Mail stop 234, Belmont, MA 02478.
| | | | | | - Jordan F. Karp
- University of Pittsburgh Medical Center (JFK), Pittsburgh, PA
| | | | - Brent P. Forester
- McLean Hospital (IVV, BPF), Belmont, MA,Harvard Medical School (IVV, BPF), Boston, MA
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27
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Affiliation(s)
- Ipsit V Vahia
- McLean Hospital, Belmont, MA; Harvard Medical School, Boston, MA.
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28
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Hawkes E, Heintz H, Vahia IV. Digitally Enhanced Art Therapy and Mindfulness in Older Adults. Am J Geriatr Psychiatry 2020; 28:495-496. [PMID: 31676237 DOI: 10.1016/j.jagp.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Elaine Hawkes
- Division of Geriatric Psychiatry, McLean Hospital (HH, EH, IVV), Belmont, MA
| | - Hannah Heintz
- Division of Geriatric Psychiatry, McLean Hospital (HH, EH, IVV), Belmont, MA
| | - Ipsit V Vahia
- Division of Geriatric Psychiatry, McLean Hospital (HH, EH, IVV), Belmont, MA; Harvard Medical School (IVV), Boston, MA.
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29
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Husebo BS, Heintz HL, Berge LI, Owoyemi P, Rahman AT, Vahia IV. Corrigendum: Sensing Technology to Monitor Behavioral and Psychological Symptoms and to Assess Treatment Response in People With Dementia. A Systematic Review. Front Pharmacol 2020; 11:254. [PMID: 32210826 PMCID: PMC7068906 DOI: 10.3389/fphar.2020.00254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/24/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,Department of Nursing Home Medicine, Municipality of Bergen, Bergen, Norway
| | - Hannah L Heintz
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Line I Berge
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,NKS Olaviken Gerontopsychiatric Hospital, Bergen, Norway
| | - Praise Owoyemi
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Aniqa T Rahman
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Ipsit V Vahia
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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30
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Rutter LA, Vahia IV, Forester BP, Ressler KJ, Germine L. Heterogeneous Indicators of Cognitive Performance and Performance Variability Across the Lifespan. Front Aging Neurosci 2020; 12:62. [PMID: 32210793 PMCID: PMC7068851 DOI: 10.3389/fnagi.2020.00062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 02/20/2020] [Indexed: 12/04/2022] Open
Abstract
Reaction time (RT) and RT variability are core components of cognitive performance that can be captured through brief and easy-to-administer tasks of simple RT and choice RT. The current study aims to describe age-related differences in cognitive performance, toward better characterizing normative performance across the lifespan. We examined mean and variability of response times on a simple RT and choice RT tasks in a large and diverse web-based sample (10,060 visitors to TestMyBrain.org). We also examined lifespan-related differences in response time variability using multiple different approaches (raw variability, mean scaled variability, and mean residualized variability). These analyses revealed significant heterogeneity in the patterns of age-related differences in performance, across metrics and within different estimates of the same metric. Based on segmented regression analysis, age of peak performance differed significantly across metrics, with young adults having the best performance based on measures of median RT, middle age adults at peak on certain measures of RT variability (standard deviation and coefficient of variability), and older adults showing the best performance based on accuracy and mean-corrected RT variability. Our results indicate that no single measure of cognitive performance and performance variability produces the same findings with respect to age related change, with further work needed to establish the validity of particular metrics for different applications.
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Affiliation(s)
- Lauren A Rutter
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States
| | - Ipsit V Vahia
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Brent P Forester
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Kerry J Ressler
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, United States
| | - Laura Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States.,Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA, United States
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31
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Husebo BS, Heintz HL, Berge LI, Owoyemi P, Rahman AT, Vahia IV. Sensing Technology to Monitor Behavioral and Psychological Symptoms and to Assess Treatment Response in People With Dementia. A Systematic Review. Front Pharmacol 2020; 10:1699. [PMID: 32116687 PMCID: PMC7011129 DOI: 10.3389/fphar.2019.01699] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/31/2019] [Indexed: 01/28/2023] Open
Abstract
Background The prevalence of dementia is expected to rapidly increase in the next decades, warranting innovative solutions improving diagnostics, monitoring and resource utilization to facilitate smart housing and living in the nursing home. This systematic review presents a synthesis of research on sensing technology to assess behavioral and psychological symptoms and to monitor treatment response in people with dementia. Methods The literature search included medical peer-reviewed English language publications indexed in Embase, Medline, Cochrane library and Web of Sciences, published up to the 5th of April 2019. Keywords included MESH terms and phrases synonymous with "dementia", "sensor", "patient", "monitoring", "behavior", and "therapy". Studies applying both cross sectional and prospective designs, either as randomized controlled trials, cohort studies, and case-control studies were included. The study was registered in PROSPERO 3rd of May 2019. Results A total of 1,337 potential publications were identified in the search, of which 34 were included in this review after the systematic exclusion process. Studies were classified according to the type of technology used, as (1) wearable sensors, (2) non-wearable motion sensor technologies, and (3) assistive technologies/smart home technologies. Half of the studies investigated how temporarily dense data on motion can be utilized as a proxy for behavior, indicating high validity of using motion data to monitor behavior such as sleep disturbances, agitation and wandering. Further, up to half of the studies represented proof of concept, acceptability and/or feasibility testing. Overall, the technology was regarded as non-intrusive and well accepted. Conclusions Targeted clinical application of specific technologies is poised to revolutionize precision care in dementia as these technologies may be used both by patients and caregivers, and at a systems level to provide safe and effective care. To highlight awareness of legal regulations, data risk assessment, and patient and public involvement, we propose a necessary framework for sustainable ethical innovation in healthcare technology. The success of this field will depend on interdisciplinary cooperation and the advance in sustainable ethic innovation. Systematic Review Registration PROSPERO, identifier CRD42019134313.
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Affiliation(s)
- Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,Department of Nursing Home Medicine, Municipality of Bergen, Bergen, Norway
| | - Hannah L Heintz
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Line I Berge
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.,NKS Olaviken Gerontopsychiatric Hospital, Bergen, Norway
| | - Praise Owoyemi
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Aniqa T Rahman
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States
| | - Ipsit V Vahia
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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32
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Ilagan GS, Iliakis EA, Wilks CR, Vahia IV, Choi-Kain LW. Smartphone applications targeting borderline personality disorder symptoms: a systematic review and meta-analysis. Borderline Personal Disord Emot Dysregul 2020; 7:12. [PMID: 32549987 PMCID: PMC7296633 DOI: 10.1186/s40479-020-00127-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Smartphone applications could improve symptoms of borderline personality disorder (BPD) in a scalable and resource-efficient manner in the context limited access to specialized care. OBJECTIVE This systematic review and meta-analysis aims to evaluate the effectiveness of applications designed as treatment interventions for adults with symptoms such as anger, suicidality, or self-harm that commonly occur in BPD. DATA SOURCES Search terms for BPD symptoms, smartphone applications, and treatment interventions were combined on PubMed, MEDLINE, and PsycINFO from database inception to December 2019. STUDY SELECTION Controlled and uncontrolled studies of smartphone interventions for adult participants with symptoms such as anger, suicidality, or self-harm that commonly occur in BPD were included. STUDY APPRAISAL AND SYNTHESIS METHODS Comprehensive Meta-Analysis v3 was used to compute between-groups effect sizes in controlled designs. The primary outcome was BPD-related symptoms such as anger, suicidality, and impulsivity; and the secondary outcome was general psychopathology. An average dropout rate across interventions was computed. Study quality, target audiences, therapeutic approach and targets, effectiveness, intended use, usability metrics, availability on market, and downloads were assessed qualitatively from the papers and through internet search. RESULTS Twelve studies of 10 applications were included, reporting data from 408 participants. Between-groups meta-analyses of RCTs revealed no significant effect of smartphone applications above and beyond in-person treatments or a waitlist on BPD symptoms (Hedges' g = - 0.066, 95% CI [-.257, .125]), nor on general psychopathology (Hedges' g = 0.305, 95% CI [- 0.14, 0.75]). Across the 12 trials, dropout rates ranged from 0 to 56.7% (M = 22.5, 95% CI [0.15, 0.46]). A majority of interventions studied targeted emotion dysregulation and behavioral dyscontrol symptoms. Half of the applications are commercially available. CONCLUSIONS The effects of smartphone interventions on symptoms of BPD are unclear and there is currently a lack of evidence for their effectiveness. More research is needed to build on these preliminary findings in BPD to investigate both positive and adverse effects of smartphone applications and identify the role these technologies may provide in expanding mental healthcare resources.
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Affiliation(s)
| | | | | | - Ipsit V Vahia
- McLean Hospital, 115 Mill St, Belmont, MA 02478 USA.,Harvard Medical School, Boston, USA
| | - Lois W Choi-Kain
- McLean Hospital, 115 Mill St, Belmont, MA 02478 USA.,Harvard Medical School, Boston, USA
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Fortuna KL, Torous J, Depp CA, Jimenez DE, Areán PA, Walker R, Ajilore O, Goldstein CM, Cosco TD, Brooks JM, Vahia IV, Bartels SJ. A Future Research Agenda for Digital Geriatric Mental Healthcare. Am J Geriatr Psychiatry 2019; 27:1277-1285. [PMID: 31196619 PMCID: PMC7059198 DOI: 10.1016/j.jagp.2019.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 12/23/2022]
Abstract
The proliferation of mobile, online, and remote monitoring technologies in digital geriatric mental health has the potential to lead to the next major breakthrough in mental health treatments. Unlike traditional mental health services, digital geriatric mental health has the benefit of serving a large number of older adults, and in many instances, does not rely on mental health clinics to offer real-time interventions. As technology increasingly becomes essential in the everyday lives of older adults with mental health conditions, these technologies will provide a fundamental service delivery strategy to support older adults' mental health recovery. Although ample research on digital geriatric mental health is available, fundamental gaps in the scientific literature still exist. To begin to address these gaps, we propose the following recommendations for a future research agenda: 1) additional proof-of-concept studies are needed; 2) integrating engineering principles in methodologically rigorous research may help science keep pace with technology; 3) studies are needed that identify implementation issues; 4) inclusivity of people with a lived experience of a mental health condition can offer valuable perspectives and new insights; and 5) formation of a workgroup specific for digital geriatric mental health to set standards and principles for research and practice. We propose prioritizing the advancement of digital geriatric mental health research in several areas that are of great public health significance, including 1) simultaneous and integrated treatment of physical health and mental health conditions; 2) effectiveness studies that explore diagnostics and treatment of social determinants of health such as "social isolation" and "loneliness;" and 3) tailoring the development and testing of innovative strategies to minority older adult populations.
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Affiliation(s)
- Karen L Fortuna
- Geisel School of Medicine, Department of Psychiatry, Dartmouth College, Lebanon, NH; CDC Health Promotion Research Center at Dartmouth, Lebanon, NH.
| | - John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Colin A Depp
- Stein Institute for Research on Aging, Department of Psychiatry, University of California, San Diego, CA
| | - Daniel E Jimenez
- University of Miami Miller School of Medicine, Center for Cognitive Neuroscience and Aging, Miami, FL
| | - Patricia A Areán
- University of Washington, Department of Psychiatry & Behavioral Sciences, Seattle, WA
| | - Robert Walker
- Office of Recovery and Empowerment, Massachusetts Department of Mental Health, Boston, MA
| | - Olu Ajilore
- Mood and Anxiety Disorders Program, Department of Mental Health, University of Illinois, Chicago, IL
| | - Carly M Goldstein
- The Miriam Hospital, The Weight Control and Diabetes Research Center, Providence, RI; Alpert Medical School of Brown University, Department of Mental Health & Human Behavior, Providence, RI
| | - Theodore D Cosco
- Gerontology Research Center, Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada; Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
| | - Jessica M Brooks
- James J. Peters VA Medical Center, Geriatric Research, Education and Clinical Center, The Bronx, NY
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Hobbs KW, Monette PJ, Owoyemi P, Beard C, Rauch SL, Ressler KJ, Vahia IV. Incorporating Information From Electronic and Social Media Into Psychiatric and Psychotherapeutic Patient Care: Survey Among Clinicians. J Med Internet Res 2019; 21:e13218. [PMID: 31301127 PMCID: PMC6659389 DOI: 10.2196/13218] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/26/2019] [Accepted: 05/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obtaining collateral information from a patient is an essential component of providing effective psychiatric and psychotherapeutic care. Research indicates that patients' social and electronic media contains information relevant to their psychotherapy and clinical care. However, it remains unclear to what degree this content is being actively utilized by clinicians as a part of diagnosis or therapy. Moreover, clinicians' attitudes around this practice have not been well characterized. OBJECTIVE This survey aimed to establish the current attitudes and behaviors of outpatient clinicians regarding the incorporation of patients' social and electronic media into psychotherapy. METHODS A Web-based survey was sent to outpatient psychotherapists associated with McLean Hospital in Belmont, Massachusetts. The survey asked clinicians to indicate to what extent and with which patients they reviewed patients' social and electronic media content as part of their clinical practice, as well as their reasons for or against doing so. RESULTS Of the total 115 respondents, 71 (61.7%) indicated that they had viewed at least one patient's social or electronic media as part of psychotherapy, and 65 of those 71 (92%) endorsed being able to provide more effective treatment as a result of this information. The use of either short message service text messages or email was significantly greater than the use of other electronic media platforms (χ21=24.1, n=115, P<.001). Moreover, the analysis of survey responses found patterns of use associated with clinicians' years of experience and patient demographics, including age and primary diagnosis. CONCLUSIONS The incorporation of patients' social and electronic media into therapy is currently common practice among clinicians at a large psychiatric teaching hospital. The results of this survey have informed further questions about whether reviewing patient's media impacts the quality and efficacy of clinical care.
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Affiliation(s)
| | | | | | - Courtney Beard
- McLean Hospital, Belmont, MA, United States.,Harvard Medical School, Cambridge, MA, United States
| | - Scott L Rauch
- McLean Hospital, Belmont, MA, United States.,Harvard Medical School, Cambridge, MA, United States
| | - Kerry J Ressler
- McLean Hospital, Belmont, MA, United States.,Harvard Medical School, Cambridge, MA, United States
| | - Ipsit V Vahia
- McLean Hospital, Belmont, MA, United States.,Harvard Medical School, Cambridge, MA, United States
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Vahia IV, May R, Kabelac Z, Hoti K, Munir U, Owoyemi P, Monette P, Katabi D. TD‐P‐24: AI‐BASED DIGITAL PHENOTYPING OF BEHAVIORAL AND PSYCHIATRIC SYMPTOMS IN DEMENTIA: CLINICAL IMPLICATIONS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ipsit V. Vahia
- Harvard Medical School Belmont MA USA
- McLean Hospital Belmont MA USA
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Rutter LA, Scheuer L, Vahia IV, Forester BP, Smoller JW, Germine L. Emotion sensitivity and self-reported symptoms of generalized anxiety disorder across the lifespan: A population-based sample approach. Brain Behav 2019; 9:e01282. [PMID: 30993908 PMCID: PMC6576169 DOI: 10.1002/brb3.1282] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/08/2019] [Accepted: 03/14/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Individuals with generalized anxiety disorder (GAD) symptoms show deficits in emotion processing, but results of prior studies have been conflicting, and little is known about developmental trajectories of emotion processing over time. We examined the association between GAD symptoms and sensitivity to recognizing emotional facial expressions (emotion sensitivity: ES) for three emotions (happiness, anger, fear) in a large, diverse, population-based sample. We hypothesized that higher anxiety scores would be associated with poorer performance, and expected that ES performance and anxiety scores would decline across the lifespan. METHOD Participants were 7,176 responders to a web-based ES study (age range = 10-96 years old). RESULTS Higher GAD-7 scores were associated with poorer ES performance for all emotion categories (happiness, anger, fear). The relationship between GAD-7 and ES scores remained significant after controlling for the effects of age and sex, and there was no significant interaction, indicating that the relationship does not change across age. Age significantly predicted ES and GAD-7 scores across emotions, with older ages showing lower ES scores and lower anxiety. CONCLUSIONS In the largest study of its kind, GAD symptoms were associated with impaired ES performance across three emotion types. Future research should explore the connection between anxiety symptoms, cognitive processing, and social processing to better characterize the mechanisms of how GAD is linked with both social and non-social information processing. Future work may also look at if ES is related over time to changes in anxiety, making it a promising target for intervention.
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Affiliation(s)
- Lauren A Rutter
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts.,Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
| | - Luke Scheuer
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts.,Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
| | - Ipsit V Vahia
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts.,Division of Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts
| | - Brent P Forester
- Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts.,Division of Geriatric Psychiatry, McLean Hospital, Belmont, Massachusetts
| | - Jordan W Smoller
- Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts.,Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Stanley Center for Psychiatric Research, Broad Institute, Cambridge, Massachusetts
| | - Laura Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts.,Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts
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Rutter LA, Dodell-Feder D, Vahia IV, Forester BP, Ressler KJ, Wilmer JB, Germine L. Emotion sensitivity across the lifespan: Mapping clinical risk periods to sensitivity to facial emotion intensity. J Exp Psychol Gen 2019; 148:1993-2005. [PMID: 30777778 DOI: 10.1037/xge0000559] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Face emotion perception is important for social functioning and mental health. In addition to recognizing categories of face emotion, accurate emotion perception relies on the ability to detect subtle differences in emotion intensity. The primary aim of this study was to examine participants' ability to discriminate the intensity of facial emotions (emotion sensitivity: ES) in three psychometrically matched ES tasks (fear, anger, or happiness), to identify developmental changes in sensitivity to face emotion intensity across the lifespan. We predicted that increased age would be associated with lower anger and fear ES, with minimal differences in happiness ES. Participants were 9,546 responders to a Web-based ES study (age range = 10 to 85 years old). Results of segmented linear regression confirmed our hypotheses and revealed differential patterns of ES based on age, sex, and emotion category. Females showed enhanced sensitivity to anger and fear relative to males, but similar sensitivity to happiness. While sensitivity to all emotions increased during adolescence and early adulthood, sensitivity to anger showed the largest increase, potentially related to the importance of anger perception during adolescent development. We also observed age-related decreases in both anger and fear sensitivity in older adults, with little to no change in happiness sensitivity. Unlike previous studies, the effect observed here could not be explained by task-related confounds (e.g., ceiling effects for happiness recognition), lending strong support to observed differences in ES for happiness, anger, and fear across age. Implications for everyday functioning and the development of psychopathology across the lifespan are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Lauren A Rutter
- Institute for Technology in Psychiatry, Department of Psychiatry, Division of Depression and Anxiety Disorders
| | - David Dodell-Feder
- Department of Clinical and Social Sciences in Psychology, University of Rochester
| | - Ipsit V Vahia
- Institute for Technology in Psychiatry, Department of Psychiatry, Division of Geriatric Psychiatry, McLean Hospital / Harvard Medical School
| | | | - Kerry J Ressler
- Department of Psychiatry and Division of Depression & Anxiety Disorders
| | | | - Laura Germine
- Institute for Technology in Psychiatry, Department of Psychiatry, Division of Depression and Anxiety Disorders, McLean Hospital / Harvard Medical School
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Affiliation(s)
- Ipsit V. Vahia
- 0000 0000 8795 072Xgrid.240206.2McLean Hospital, Belmont, MA USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, MA USA
| | - Brent P. Forester
- 0000 0000 8795 072Xgrid.240206.2McLean Hospital, Belmont, MA USA ,000000041936754Xgrid.38142.3cHarvard Medical School, Boston, MA USA
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Vahia IV, Kamat R, Vang C, Posada C, Ross L, Oreck S, Bhatt A, Depp C, Jeste DV, Sewell DD. Use of Tablet Devices in the Management of Agitation Among Inpatients with Dementia: An Open-Label Study. Am J Geriatr Psychiatry 2017; 25:860-864. [PMID: 27746070 DOI: 10.1016/j.jagp.2016.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/12/2016] [Accepted: 07/18/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the feasibility, safety, and utility of tablet devices as novel nonpharmacologic tools in managing older psychiatric inpatients with agitation and dementia. METHODS Thirty-six patients at a geriatric psychiatry inpatient unit were provided with tablets when agitated and used various apps on the tablet related to communication, games, music, web browser, and photography during their stay. Study staff documented the frequency, duration, and app usage history and rated the extent to which agitation improved after tablet use. RESULTS All participants, regardless of dementia severity, were able to use apps and were rated by staff to have clinical benefit. Dementia severity was negatively associated with app complexity. Age was negatively associated with frequency and duration of tablet use. CONCLUSION Tablet use as a nonpharmacologic intervention for agitation in older adults, including those with severe dementia, appears to be feasible, safe, and of potential utility.
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Affiliation(s)
- Ipsit V Vahia
- Division of Geriatric Psychiatry, McLean Hospital, Boston, MA; Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA.
| | - Rujvi Kamat
- Department of Psychiatry, University of California, San Diego, San Diego, CA
| | - Cheng Vang
- Department of Psychiatry, University of California, San Diego, San Diego, CA
| | - Carolina Posada
- Department of Psychology, Institute for Living, Hartford Hospital, Hartford, CT
| | - Lisa Ross
- Department of Psychiatry, University of California, San Diego, San Diego, CA
| | - Sarah Oreck
- Department of Psychiatry, Columbia University, New York, NY
| | - Alok Bhatt
- Department of Medicine, Louisville University, Louisville, KY
| | - Colin Depp
- Department of Psychiatry, University of California, San Diego, San Diego, CA; Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, San Diego, CA; Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA
| | - Daniel D Sewell
- Department of Psychiatry, University of California, San Diego, San Diego, CA; Stein Institute for Research on Aging, University of California, San Diego, San Diego, CA
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Affiliation(s)
- Ipsit V Vahia
- McLean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
| | - Kerry J Ressler
- McLean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
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Affiliation(s)
- Ipsit V Vahia
- From the Department of Psychiatry and the Center for Healthy Aging, University of California, San Diego, and the Division of Geriatric Psychiatry, McLean Hospital, Belmont, Mass
| | - Daniel D Sewell
- From the Department of Psychiatry and the Center for Healthy Aging, University of California, San Diego, and the Division of Geriatric Psychiatry, McLean Hospital, Belmont, Mass
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Abstract
OBJECTIVES Our objective was to examine the association of mobile phone use and ownership with psychopathology, cognitive functioning, and functional outcome in 196 outpatients aged 40 years and older who were diagnosed with schizophrenia. METHOD Participants reported their past and current mobile phone use on a standardized self-report scale and they were administered tests of global cognition, functional capacity, and informant-rated functional outcome. RESULTS The great majority of subjects had used a mobile phone (78%) but few currently owned one (27%). After adjusting for age (mean age 51), any past mobile phone use was associated with less severe negative symptoms, and higher global cognitive performance, functional capacity, and functional outcome. A total of 60% of participants reported being comfortable with mobile phones, but comfort was not associated with any cognitive or functional outcomes. CONCLUSION Most of the older patients with schizophrenia have used mobile phones and lifetime mobile phone use is a positive indicator of cognitive and functional status.
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Affiliation(s)
- Colin A Depp
- Department of Psychiatry, UC San Diego, La Jolla, California, VA San Diego Healthcare System, San Diego, California
| | | | - Ipsit V Vahia
- Department of Psychiatry, UC San Diego, La Jolla, California
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Vahia IV, Ng B, Camacho A, Cardenas V, Cherner M, Depp CA, Palmer BW, Jeste. DV, Agha Z. Telepsychiatry for Neurocognitive Testing in Older Rural Latino Adults. Am J Geriatr Psychiatry 2015; 23:666-70. [PMID: 25708655 PMCID: PMC4363076 DOI: 10.1016/j.jagp.2014.08.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 08/14/2014] [Accepted: 08/18/2014] [Indexed: 01/17/2023]
Abstract
As the population of older Latinos in the U.S. increases, availability of culturally adapted geriatric psychiatry services is becoming a growing concern. This issue is exacerbated for rural Latino populations. In this study, we assessed whether neurocognitive assessment via telepsychiatry (TP) using a Spanish-language battery would be comparable to in-person (IP) testing using the same battery in a sample of Spanish-speaking older adults in a rural setting. Patients (N = 22) received IP and TP testing 2 weeks apart. The order of IP and TP test administrations in individual subjects was determined randomly. Comparison of scores indicated that there were no significant differences between IP and TP test performance though both groups scored non-significantly higher at the second visit. This study demonstrates feasibility and utility of neurocognitive testing in Spanish using TP among older rural Latinos.
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Affiliation(s)
- Ipsit V. Vahia
- Department of Psychiatry, University of California, San Diego, Sam and Rose Stein Institute for Research in Aging, University of California, San Diego
| | - Bernardo Ng
- Department of Psychiatry, University of California, San Diego, Sun Valley Behavioral & Research Center, Imperial, CA, Department of Psychology. San Diego State University
| | - Alvaro Camacho
- Department of Psychiatry, University of California, San Diego, Sun Valley Behavioral & Research Center, Imperial, CA, Department of Psychology. San Diego State University
| | - Veronica Cardenas
- Department of Psychiatry, University of California, San Diego, Sam and Rose Stein Institute for Research in Aging, University of California, San Diego
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, HIV Neurobehavioral Research Program, University of California, San Diego
| | - Colin A. Depp
- Department of Psychiatry, University of California, San Diego, Sam and Rose Stein Institute for Research in Aging, University of California, San Diego
| | - Barton W. Palmer
- Department of Psychiatry, University of California, San Diego, Sam and Rose Stein Institute for Research in Aging, University of California, San Diego
| | - Dilip V. Jeste.
- Department of Psychiatry, University of California, San Diego, Sam and Rose Stein Institute for Research in Aging, University of California, San Diego
| | - Zia Agha
- Department of Veterans Affairs and Department of Medicine, University of California, San Diego
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Moore RC, Moore DJ, Thompson W, Vahia IV, Grant I, Jeste DV. A case-controlled study of successful aging in older HIV-infected adults. J Clin Psychiatry 2013; 74:e417-23. [PMID: 23759460 PMCID: PMC3683870 DOI: 10.4088/jcp.12m08100] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 12/11/2012] [Indexed: 10/26/2022]
Abstract
OBJECTIVE There is a growing public health interest in the aging human immunodeficiency virus (HIV)-infected (HIV+) population, although there is a dearth of research on successful aging with HIV. This study aimed to understand the risk and protective factors associated with self-rated successful aging (SRSA) with HIV. DESIGN Cross-sectional, case-controlled. SETTING HIV Neurobehavioral Research Program and the Stein Institute for Research on Aging at University of California, San Diego. PARTICIPANTS Eighty-three community-dwelling HIV+ and 83 demographically matched HIV-uninfected (HIV-) individuals, enrolled between December 1, 2011, and May 10, 2012, mean age of 59 years, primarily white men, 69% with acquired immune deficiency syndrome (AIDS), who had been living with an HIV diagnosis for 16 years. Diagnostic criteria for HIV/AIDS were obtained through a blood analysis. MEASUREMENTS Participants provided ratings of SRSA, the primary outcome measure, as part of a comprehensive survey that included measures of physical and emotional functioning and positive psychological traits. Relationships between how the different variables related to SRSA were explored. RESULTS While SRSA was lower in the HIV+ individuals than their HIV- counterparts, 66% of adults with HIV reported scores of 5 or higher on a 10-point scale of SRSA. Despite worse physical and mental functioning and greater psychosocial stress among the HIV+ participants, the 2 groups had comparable levels of optimism, personal mastery, and social support. Higher SRSA in HIV+ individuals was associated with better physical and emotional functioning and positive psychological factors, but not HIV disease status or negative life events. CONCLUSIONS Successful psychosocial aging is possible in older HIV+ individuals. Positive psychological traits such as resilience, optimism, and sense of personal mastery have stronger relationship with SRSA than duration or severity of HIV disease. Research on interventions to enhance these positive traits in HIV+ adults is warranted.
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Affiliation(s)
- Raeanne C. Moore
- Department of Psychiatry, University of California, San Diego, CA
| | - David J. Moore
- Department of Psychiatry, University of California, San Diego, CA,HIV Neurobehavioral Research Program, University of California, San Diego, CA
| | - Wesley Thompson
- Department of Psychiatry, University of California, San Diego, CA,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA
| | - Ipsit V. Vahia
- Department of Psychiatry, University of California, San Diego, CA,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego, CA,HIV Neurobehavioral Research Program, University of California, San Diego, CA
| | - Dilip V. Jeste
- Department of Psychiatry, University of California, San Diego, CA,Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA,Corresponding Author: Dilip V. Jeste, M.D. 9500 Gilman Drive #00664, La Jolla, California, 92093. Phone: (858) 534-4020. Fax: (858) 534-5475.
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Vahia IV, Lanouette NM, Golshan S, Fellows I, Mohamed S, Kasckow JW, Zisook S. Adding antidepressants to antipsychotics for treatment of subsyndromal depressive symptoms in schizophrenia: Impact on positive and negative symptoms. Indian J Psychiatry 2013; 55:144-8. [PMID: 23825848 PMCID: PMC3696237 DOI: 10.4103/0019-5545.111452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES It remains unclear how augmenting anti-psychotic medications with anti-depressants impacts primary positive and negative symptoms of schizophrenia. In this study, we used data collected from a randomized trial comparing citalopram to placebo for management of subsyndromal depression (SSD) in schizophrenia and schizoaffective disorder, to assess the effects of antidepressant augmentation on positive and negative symptoms. MATERIALS AND METHODS Participants in this study conducted at the University of California, San Diego and the University of Cincinnati, were persons with schizophrenia or schizoaffective disorder aged 40 or older and who met study criteria for SSD. Patients were randomly assigned to flexible-dose treatment with citalopram or placebo augmentation of their current anti-psychotic medication. Analysis of covariance was used to compare changes in positive and negative syndrome scale (PANSS) scores between treatment groups. We also assessed mediating effects of improvement in depression and moderating effects of multiple factors on positive and negative symptoms. RESULTS There was significant improvement in PANSS negative symptoms scores in the citalopram group, which was partially mediated by improvement in depressive symptoms. There was no effect on PANSS positive scores. CONCLUSIONS In patients with schizophrenia/schizoaffective disorder, treating depressive symptoms with citalopram appears to carry the added benefit of improving negative symptoms.
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Affiliation(s)
- Ipsit V Vahia
- Department of Psychiatry, University of California San Diego, California, USA ; Stein Institute for Research on Aging, University of California San Diego, California, USA
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Jeste DV, Savla GN, Thompson WK, Vahia IV, Glorioso DK, Martin AS, Palmer BW, Rock D, Golshan S, Kraemer HC, Depp CA. Association between older age and more successful aging: critical role of resilience and depression. Am J Psychiatry 2013; 170:188-96. [PMID: 23223917 PMCID: PMC3593664 DOI: 10.1176/appi.ajp.2012.12030386] [Citation(s) in RCA: 282] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is growing public health interest in understanding and promoting successful aging. While there has been some exciting empirical work on objective measures of physical health, relatively little published research combines physical, cognitive, and psychological assessments in large, randomly selected, community-based samples to assess self-rated successful aging. METHOD In the Successful AGing Evaluation (SAGE) study, the authors used a structured multicohort design to assess successful aging in 1,006 community-dwelling adults in San Diego County, ages 50-99 years, with oversampling of people over 80. A modified version of random-digit dialing was used to recruit subjects. Evaluations included a 25-minute telephone interview followed by a comprehensive mail-in survey of physical, cognitive, and psychological domains, including positive psychological traits and self-rated successful aging, scaled from 1 (lowest) to 10 (highest). RESULTS The mean age of the respondents was 77.3 years. Their mean self-rating of successful aging was 8.2, and older age was associated with a higher rating, despite worsening physical and cognitive functioning. The best multiple regression model achieved, using all the potential correlates, accounted for 30% of the variance in the score for self-rated successful aging and included resilience, depression, physical functioning, and age (entering the regression model in that order). CONCLUSIONS Resilience and depression had significant associations with self-rated successful aging, with effects comparable in size to that for physical health. While no causality can be inferred from cross-sectional data, increasing resilience and reducing depression might have effects on successful aging as strong as that of reducing physical disability, suggesting an important role for psychiatry in promoting successful aging.
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Affiliation(s)
- Dilip V. Jeste
- Stein Institute for Research on Aging, University of California, San Diego (UCSD),Department of Psychiatry, UCSD,Department of Neurosciences, UCSD
| | - Gauri N. Savla
- Stein Institute for Research on Aging, University of California, San Diego (UCSD),Department of Psychiatry, UCSD
| | - Wesley K. Thompson
- Stein Institute for Research on Aging, University of California, San Diego (UCSD),Department of Psychiatry, UCSD
| | - Ipsit V. Vahia
- Stein Institute for Research on Aging, University of California, San Diego (UCSD),Department of Psychiatry, UCSD,San Diego Veterans Affairs Healthcare System
| | - Danielle K. Glorioso
- Stein Institute for Research on Aging, University of California, San Diego (UCSD),Department of Psychiatry, UCSD
| | - A’verria Sirkin Martin
- Stein Institute for Research on Aging, University of California, San Diego (UCSD),Department of Psychiatry, UCSD
| | - Barton W. Palmer
- Stein Institute for Research on Aging, University of California, San Diego (UCSD),Department of Psychiatry, UCSD,San Diego Veterans Affairs Healthcare System
| | - David Rock
- Stein Institute for Research on Aging, University of California, San Diego (UCSD),Department of Psychiatry, UCSD
| | - Shahrokh Golshan
- Stein Institute for Research on Aging, University of California, San Diego (UCSD),Department of Psychiatry, UCSD
| | - Helena C. Kraemer
- Stanford University (Emerita), Department of Psychiatry, University of Pittsburgh
| | - Colin A. Depp
- Stein Institute for Research on Aging, University of California, San Diego (UCSD),Department of Psychiatry, UCSD,San Diego Veterans Affairs Healthcare System
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Thompson WK, Savla GN, Vahia IV, Depp CA, O’Hara R, Jeste DV, Palmer BW. Characterizing trajectories of cognitive functioning in older adults with schizophrenia: does method matter? Schizophr Res 2013; 143:90-6. [PMID: 23218560 PMCID: PMC3540183 DOI: 10.1016/j.schres.2012.10.033] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 10/03/2012] [Accepted: 10/05/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Heterogeneity in clinical outcomes may be caused by factors working at multiple levels, e.g., between groups, between subjects, or within subjects over time. A more nuanced assessment of differences in variation among schizophrenia patients and between patients and healthy comparison subjects can clarify etiology and even facilitate the identification of patient subtypes with common neuropathology and clinical course. METHODS We compared trajectories (mean duration of 3.5years) of cognitive impairments in a sample of 201 community-dwelling schizophrenia (SCZ) patients (aged 40-100years) with 67 healthy comparison (HC) subjects. We employed growth mixture models to discover subclasses with more homogenous between-subject variation in cognitive trajectories. Post hoc analyses determined factors associated with class membership and class-specific correlates of cognitive trajectories. RESULTS Three latent classes were indicated: Class 1 (85% HC and 50% SCZ) exhibited relatively high and stable trajectories of cognition, Class 2 (15% HC and 40% SCZ) exhibited lower, modestly declining trajectories, and Class 3 (10% SCZ) exhibited lower, more rapidly declining trajectories. Within the patient group, membership in Classes 2-3 was associated with worse negative symptoms and living in a board and care facility. DISCUSSION These results bridge the gap between schizophrenia studies demonstrating cognitive decline and those demonstrating stability. Moreover, a finer-grained characterization of heterogeneity in cognitive trajectories has practical implications for interventions and for case management of patients who show accelerated cognitive decline. Such a characterization requires study designs and analyses sensitive to between- and within-patient heterogeneity in outcomes.
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Affiliation(s)
- Wesley K. Thompson
- Stein Center for Research on Aging, 9500 Gilman Drive, University of California San Diego, La Jolla, CA 92093-0664, USA,Department of Psychiatry, 9500 Gilman Drive, University of California San Diego, La Jolla, CA 92093-0664, USA
| | - Gauri N. Savla
- Department of Psychiatry, 9500 Gilman Drive, University of California San Diego, La Jolla, CA 92093-0664, USA
| | - Ipsit V. Vahia
- Stein Center for Research on Aging, 9500 Gilman Drive, University of California San Diego, La Jolla, CA 92093-0664, USA,Department of Psychiatry, 9500 Gilman Drive, University of California San Diego, La Jolla, CA 92093-0664, USA
| | - Colin A. Depp
- Stein Center for Research on Aging, 9500 Gilman Drive, University of California San Diego, La Jolla, CA 92093-0664, USA,Department of Psychiatry, 9500 Gilman Drive, University of California San Diego, La Jolla, CA 92093-0664, USA
| | - Ruth O’Hara
- Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford University School of Medicine, Stanford, CA 94304, USA,VA Sierra-Pacific Mental Illness Education and Clinical Center, Veterans Affairs Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA
| | - Dilip V. Jeste
- Stein Center for Research on Aging, 9500 Gilman Drive, University of California San Diego, La Jolla, CA 92093-0664, USA,Department of Psychiatry, 9500 Gilman Drive, University of California San Diego, La Jolla, CA 92093-0664, USA
| | - Barton W. Palmer
- Stein Center for Research on Aging, 9500 Gilman Drive, University of California San Diego, La Jolla, CA 92093-0664, USA,Department of Psychiatry, 9500 Gilman Drive, University of California San Diego, La Jolla, CA 92093-0664, USA
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Ng B, Verdugo B, Vahia IV. A role for adult day health care centers in earthquake relief efforts. Psychiatr Serv 2012. [PMID: 23203369 DOI: 10.1176/appi.ps.201200232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thompson WK, Charo L, Vahia IV, Depp C, Allison M, Jeste DV. Association between higher levels of sexual function, activity, and satisfaction and self-rated successful aging in older postmenopausal women. J Am Geriatr Soc 2011; 59:1503-8. [PMID: 21797827 DOI: 10.1111/j.1532-5415.2011.03495.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether measures of successful aging are associated with sexual activity, satisfaction, and function in older postmenopausal women. DESIGN Cross-sectional study using self-report surveys; analyses included chi-square and t-tests and multiple linear regression analyses. SETTING Community-dwelling older postmenopausal women in the greater San Diego region. PARTICIPANTS One thousand two hundred thirty-five community-dwelling women aged 60 to 89 participating at the San Diego site of the Women's Health Initiative. MEASUREMENTS Demographic information and self-reported measures of sexual activity, function, and satisfaction and successful aging. RESULTS Sexual activity and functioning (desire, arousal, vaginal tightness, use of lubricants, and ability to climax) were negatively associated with age, as were physical and mental health. In contrast, sexual satisfaction and self-rated successful aging and quality of life remained unchanged across age groups. Successful aging measures were positively associated with sexual measures, especially self-rated quality of life and sexual satisfaction. CONCLUSION Self-rated successful aging, quality of life, and sexual satisfaction appear to be stable in the face of declines in physical health, some cognitive abilities, and sexual activity and function and positively associated with each other from age 60 to 89.
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Affiliation(s)
- Wesley K Thompson
- Department of Psychiatry, University of California at San Diego, San Diego, California, USA
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Abstract
INTRODUCTION: Attitudes toward own aging (ATOA) refers to expectations about the personal experience of aging. As of now, there is limited literature that addresses the impact of ATOA on indicators of psychological, physical, and social health. In this study, we examine associations between ATOA and several measures associated with successful aging. METHODS: A detailed cross-sectional survey questionnaire on successful aging was completed by 1,973 older women enrolled in the San Diego site of the Women's Health Initiative study. ATOA was measured using the Philadelphia Geriatric Morale Scale (PGMS) RESULTS: The final sample consisted of 1151 women. The mean ATOA score was 3.8 indicating generally positive ATOA. Positive ATOA score was significantly associated with younger age, lower income, being married, higher SF-36 Physical Composite scores, higher SF-36 Mental composite scores, lower depression scores, and higher resilience scores. Approximately 40% of variance in ATOA scores was explained by successful aging-related domain scores. CONCLUSIONS: Better physical and emotional functioning, greater resilience and lower depression are associated with more positive ATOA. Associations with sociodemographic traits are complex. Modifying ATOA may have potential to impact a broad range of health and successful aging related outcomes.
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Affiliation(s)
- Harish Kavirajan
- Greater Los Angeles VA Medical Center, Los Angeles, CA and University of California Los Angeles, Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA
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