1
|
Creswell C, Taylor L, Giles S, Howitt S, Radley L, Whitaker E, Brooks E, Knight F, Raymont V, Hill C, van Santen J, Williams N, Mort S, Harris V, Yu S, Pollard J, Violato M, Waite P, Yu LM. Digitally augmented, parent-led CBT versus treatment as usual for child anxiety problems in child mental health services in England and Northern Ireland: a pragmatic, non-inferiority, clinical effectiveness and cost-effectiveness randomised controlled trial. Lancet Psychiatry 2024; 11:193-209. [PMID: 38335987 DOI: 10.1016/s2215-0366(23)00429-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/24/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Anxiety problems are common in children, yet few affected children access evidence-based treatment. Digitally augmented psychological therapies bring potential to increase availability of effective help for children with mental health problems. This study aimed to establish whether therapist-supported, digitally augmented, parent-led cognitive behavioural therapy (CBT) could increase the efficiency of treatment without compromising clinical effectiveness and acceptability. METHODS We conducted a pragmatic, unblinded, two-arm, multisite, randomised controlled non-inferiority trial to evaluate the clinical effectiveness and cost-effectiveness of therapist-supported, parent-led CBT using the Online Support and Intervention (OSI) for child anxiety platform compared with treatment as usual for child (aged 5-12 years) anxiety problems in 34 Child and Adolescent Mental Health Services in England and Northern Ireland. We examined acceptability of OSI plus therapist support via qualitative interviews. Participants were randomly assigned (1:1) to OSI plus therapist support or treatment as usual, minimised by child age, gender, service type, and baseline child anxiety interference. Outcomes were assessed at week 14 and week 26 after randomisation. The primary clinical outcome was parent-reported interference caused by child anxiety at week 26 assessment, using the Child Anxiety Impact Scale-parent report (CAIS-P). The primary measure of health economic effect was quality-adjusted life-years (QALYs). Outcome analyses were conducted blind in the intention-to-treat (ITT) population with a standardised non-inferiority margin of 0·33 for clinical analyses. The trial was registered with ISRCTN, 12890382. FINDINGS Between Dec 5, 2020, and Aug 3, 2022, 706 families (706 children and their parents or carers) were referred to the study information. 444 families were enrolled. Parents reported 255 (58%) child participants' gender to be female, 184 (41%) male, three (<1%) other, and one (<1%) preferred not to report their child's gender. 400 (90%) children were White and the mean age was 9·20 years (SD 1·79). 85% of families for whom clinicians provided information in the treatment as usual group received CBT. OSI plus therapist support was non-inferior for parent-reported anxiety interference on the CAIS-P (SMD 0·01, 95% CI -0·15 to 0·17; p<0·0001) and all secondary outcomes. The mean difference in QALYs across trial arms approximated to zero, and OSI plus therapist support was associated with lower costs than treatment as usual. OSI plus therapist support was likely to be cost effective under certain scenarios, but uncertainty was high. OSI plus therapist support acceptability was good. No serious adverse events were reported. INTERPRETATION Digitally augmented intervention brought promising savings without compromising outcomes and as such presents a valuable tool for increasing access to psychological therapies and meeting the demand for treatment of child anxiety problems. FUNDING Department for Health and Social Care and United Kingdom Research and Innovation Research Grant, National Institute for Health and Care (NIHR) Research Policy Research Programme, Oxford and Thames Valley NIHR Applied Research Collaboration, Oxford Health NIHR Biomedical Research Centre.
Collapse
Affiliation(s)
- Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.
| | - Lucy Taylor
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Sophie Giles
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | | | - Lucy Radley
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Emily Whitaker
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Emma Brooks
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Fauzia Knight
- Centre for Psychological Sciences, University of Westminster, London, UK
| | - Vanessa Raymont
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Claire Hill
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - James van Santen
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - Nicola Williams
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - Sam Mort
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - Victoria Harris
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - Shuye Yu
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jack Pollard
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Polly Waite
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| |
Collapse
|
2
|
Karvandi E, Helmy A, Kolias AG, Belli A, Ganau M, Gomes C, Grey M, Griffiths M, Griffiths T, Griffiths P, Holliman D, Jenkins P, Jones B, Lawrence T, McLoughlin T, McMahon C, Messahel S, Newton J, Noad R, Raymont V, Sharma K, Sylvester R, Tadmor D, Whitfield P, Wilson M, Woodberry E, Parker M, Hutchinson PJ. Specialist healthcare services for concussion/mild traumatic brain injury in England: a consensus statement using modified Delphi methodology. BMJ Open 2023; 13:e077022. [PMID: 38070886 PMCID: PMC10729241 DOI: 10.1136/bmjopen-2023-077022] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To establish a consensus on the structure and process of healthcare services for patients with concussion in England to facilitate better healthcare quality and patient outcome. DESIGN This consensus study followed the modified Delphi methodology with five phases: participant identification, item development, two rounds of voting and a meeting to finalise the consensus statements. The predefined threshold for agreement was set at ≥70%. SETTING Specialist outpatient services. PARTICIPANTS Members of the UK Head Injury Network were invited to participate. The network consists of clinical specialists in head injury practising in emergency medicine, neurology, neuropsychology, neurosurgery, paediatric medicine, rehabilitation medicine and sports and exercise medicine in England. PRIMARY OUTCOME MEASURE A consensus statement on the structure and process of specialist outpatient care for patients with concussion in England. RESULTS 55 items were voted on in the first round. 29 items were removed following the first voting round and 3 items were removed following the second voting round. Items were modified where appropriate. A final 18 statements reached consensus covering 3 main topics in specialist healthcare services for concussion; care pathway to structured follow-up, prognosis and measures of recovery, and provision of outpatient clinics. CONCLUSIONS This work presents statements on how the healthcare services for patients with concussion in England could be redesigned to meet their health needs. Future work will seek to implement these into the clinical pathway.
Collapse
Affiliation(s)
- Elika Karvandi
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Adel Helmy
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Angelos G Kolias
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Antonio Belli
- Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Mario Ganau
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Clint Gomes
- Royal Liverpool University Hospital, Liverpool, UK
- UK Sports Institute, Liverpool, UK
| | - Michael Grey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Michael Griffiths
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric Neurology, Alder-Hey Children's NHS Trust, Liverpool, UK
| | - Timothy Griffiths
- Department of Cognitive Neurology, Newcastle University, Newcastle Upon Tyne, UK
- Institute of Neurology, University College London, London, UK
| | - Philippa Griffiths
- Sunderland & South Tyneside Community Acquired Brain Injury Service, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Damian Holliman
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Peter Jenkins
- Wessex Neuroscience Centre, Southampton General Hospital, Southampton, UK
- Imperial College London, London, UK
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University-Headingley Campus, Leeds, UK
- England Performance Unit, Rugby Football League Ltd, Leeds, UK
| | - Tim Lawrence
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Catherine McMahon
- Manchester Centre for Clinical Neurosciences (MCCN), Salford Royal Infirmary, Northern Care Alliance, Liverpool, UK
| | - Shrouk Messahel
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Joanne Newton
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Rupert Noad
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Kanchan Sharma
- Department of Neurology, North Bristol NHS Trust, Westbury on Trym, UK
| | - Richard Sylvester
- National Hospital for Neurology and Neurosurgery, London, London, UK
- Institute of Exercise and Health, University College London, London, UK
| | - Daniel Tadmor
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Medical, Leeds Rhinos Rugby League Club, Leeds, UK
| | | | - Mark Wilson
- Imperial College London, London, UK
- Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK
| | - Emma Woodberry
- Department of Neuropsychology, University of Cambridge, Cambridge, UK
| | | | | |
Collapse
|
3
|
Goel V, Gossai D, Smith KW, Goel N, Raymont V, Krueger F, Grafman J. Right BA 10 lesions impair performance on real-world planning but are not sensitive to problem novelty or tower tasks. Cortex 2023; 169:353-373. [PMID: 37984254 DOI: 10.1016/j.cortex.2023.09.016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/20/2023] [Accepted: 09/13/2023] [Indexed: 11/22/2023]
Abstract
The prefrontal cortex (PFC) is associated with many cognitive functions, including planning. In the neuropsychology literature planning is reduced to "look ahead" ability and most extensively studied with the "tower" tasks. The most influential theoretical explanation is that planning is required in the absence of a routine solution and PFC patients have difficulty coping with novelty. There is an alternate view of planning that emphasizes the distinction between real world tasks and laboratory tower tasks. This account focuses on the structure of problem spaces and why patients with lesions to right PFC have difficulty navigating ill-structured problem spaces. To further explore these issues we administered two real world travel planning tasks to 56 Vietnam War veterans with penetrating brain lesions and 14 matched normal controls. One planning task involved familiar knowledge while the other involved knowledge unfamiliar to our participants. Participants also completed the D-KEFS tower task. A subset of 18 patients-with lesions to right anterior prefrontal cortex (BA 10)-were impaired in the travel planning task compared to normal controls. The task familiarity/novelty dimension affected performance across participant groups (familiar-task scores were higher than unfamiliar-task scores), but it did not differentially affect any group. An examination of cognitive strategies utilized by participants revealed that the impaired patient group had difficulty maintaining a sufficient level of abstraction and engaged the task at a much more concrete level than other participants. Interestingly, patients impaired in the real-world planning tasks were not impaired in the tower tasks. We conclude that patients with lesions to right BA 10 have difficulty in real-world planning tasks that can be attributed to difficulties in engaging problems at the appropriate level of abstraction.
Collapse
Affiliation(s)
- Vinod Goel
- Department of Psychology, York University, Canada; Department of Psychology, Capital Normal University, Beijing, China.
| | - Divya Gossai
- Department of Psychology, York University, Canada
| | | | - Natasha Goel
- Department of Political Science, University of Toronto, Canada
| | | | - Frank Krueger
- School of Systems Biology, George Mason University, Fairfax, VA, USA; Department of Psychology, University of Mannheim, Germany
| | - Jordan Grafman
- Shirley Ryan AbilityLab, Chicago, USA; Northwestern University Medical School, Cognitive Neurology and Psychiatry and Behavioral Sciences and Physical Medicine and Rehabilitation, Chicago, IL, USA
| |
Collapse
|
4
|
Newby D, Orgeta V, Marshall CR, Lourida I, Albertyn CP, Tamburin S, Raymont V, Veldsman M, Koychev I, Bauermeister S, Weisman D, Foote IF, Bucholc M, Leist AK, Tang EYH, Tai XY, Llewellyn DJ, Ranson JM. Artificial intelligence for dementia prevention. Alzheimers Dement 2023; 19:5952-5969. [PMID: 37837420 PMCID: PMC10843720 DOI: 10.1002/alz.13463] [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] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION A wide range of modifiable risk factors for dementia have been identified. Considerable debate remains about these risk factors, possible interactions between them or with genetic risk, and causality, and how they can help in clinical trial recruitment and drug development. Artificial intelligence (AI) and machine learning (ML) may refine understanding. METHODS ML approaches are being developed in dementia prevention. We discuss exemplar uses and evaluate the current applications and limitations in the dementia prevention field. RESULTS Risk-profiling tools may help identify high-risk populations for clinical trials; however, their performance needs improvement. New risk-profiling and trial-recruitment tools underpinned by ML models may be effective in reducing costs and improving future trials. ML can inform drug-repurposing efforts and prioritization of disease-modifying therapeutics. DISCUSSION ML is not yet widely used but has considerable potential to enhance precision in dementia prevention. HIGHLIGHTS Artificial intelligence (AI) is not widely used in the dementia prevention field. Risk-profiling tools are not used in clinical practice. Causal insights are needed to understand risk factors over the lifespan. AI will help personalize risk-management tools for dementia prevention. AI could target specific patient groups that will benefit most for clinical trials.
Collapse
Affiliation(s)
- Danielle Newby
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, W1T 7BN, UK
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, E1 4NS, UK
- Department of Neurology, Royal London Hospital, London, E1 1BB, UK
| | - Ilianna Lourida
- Population Health Sciences Institute, Newcastle University, Newcastle, NE2 4AX, UK
- University of Exeter Medical School, Exeter, EX1 2HZ, UK
| | - Christopher P Albertyn
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, 37129, Italy
| | - Vanessa Raymont
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Michele Veldsman
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, OX3 9DU, UK
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK
| | - Ivan Koychev
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Sarah Bauermeister
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK
| | - David Weisman
- Abington Neurological Associates, Abington, PA 19001, USA
| | - Isabelle F Foote
- Preventive Neurology Unit, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, E1 4NS, UK
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Magda Bucholc
- Cognitive Analytics Research Lab, School of Computing, Engineering & Intelligent Systems, Ulster University, Derry, BT48 7JL, UK
| | - Anja K Leist
- Institute for Research on Socio-Economic Inequality (IRSEI), Department of Social Sciences, University of Luxembourg, L-4365, Luxembourg
| | - Eugene Y H Tang
- Population Health Sciences Institute, Newcastle University, Newcastle, NE2 4AX, UK
| | - Xin You Tai
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, OX3 9DU, UK
- Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, OX3 9DU, UK
| | | | - David J. Llewellyn
- University of Exeter Medical School, Exeter, EX1 2HZ, UK
- The Alan Turing Institute, London, NW1 2DB, UK
| | | |
Collapse
|
5
|
Tari B, Künzi M, Pflanz CP, Raymont V, Bauermeister S. Education is power: preserving cognition in the UK biobank. Front Public Health 2023; 11:1244306. [PMID: 37841724 PMCID: PMC10568007 DOI: 10.3389/fpubh.2023.1244306] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Dementia is a debilitating syndrome characterized by the gradual loss of memory and cognitive function. Although there are currently limited, largely symptomatic treatments for the diseases that can lead to dementia, its onset may be prevented by identifying and modifying relevant life style risk factors. Commonly described modifiable risk factors include diet, physical inactivity, and educational attainment. Importantly, however, to maximize the utility of our understanding of these risk factors, tangible and meaningful changes to policy must also be addressed. Objectives Here, we aim to identify the mechanism(s) by which educational attainment influences cognition. Methods We investigated data from 502,357 individuals (Mage = 56.53, SDage = 8.09, 54.40% female) from the UK Biobank cohort via Structural Equation Modelling to illustrate links between predictor variables (i.e., Townsend Deprivation Index, coastal distance, greenspace, years of education), covariates (i.e., participant age) and cognitive function as outcome variables (i.e., pairs-matching, trail-making task B, fluid intelligence). Results Our model demonstrated that higher education was associated with better cognitive performance (ps < 0.001), and this relationship was mediated by indices of deprivation, and coastal distance. Conclusion Accordingly, our model evinces the mediating effect of socioeconomic and environmental factors on the relationship between years of education and cognitive function. These results further demonstrate the utility and necessity of adapting public policy to encourage equitable access to education and other supports in deprived areas.
Collapse
Affiliation(s)
- Benjamin Tari
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Morgane Künzi
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - C. Patrick Pflanz
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | |
Collapse
|
6
|
O'Donoghue MC, Blane J, Gillis G, Mitchell R, Lindsay K, Semple J, Pretorius PM, Griffanti L, Fossey J, Raymont V, Martos L, Mackay CE. Oxford brain health clinic: protocol and research database. BMJ Open 2023; 13:e067808. [PMID: 37541753 PMCID: PMC10407419 DOI: 10.1136/bmjopen-2022-067808] [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: 08/26/2022] [Accepted: 06/22/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION Despite major advances in the field of neuroscience over the last three decades, the quality of assessments available to patients with memory problems in later life has barely changed. At the same time, a large proportion of dementia biomarker research is conducted in selected research samples that often poorly reflect the demographics of the population of patients who present to memory clinics. The Oxford Brain Health Clinic (BHC) is a newly developed clinical assessment service with embedded research in which all patients are offered high-quality clinical and research assessments, including MRI, as standard. METHODS AND ANALYSIS Here we describe the BHC protocol, including aligning our MRI scans with those collected in the UK Biobank. We evaluate rates of research consent for the first 108 patients (data collection ongoing) and the ability of typical psychiatry-led NHS memory-clinic patients to tolerate both clinical and research assessments. ETHICS AND DISSEMINATION Our ethics and consenting process enables patients to choose the level of research participation that suits them. This generates high rates of consent, enabling us to populate a research database with high-quality data that will be disseminated through a national platform (the Dementias Platform UK data portal).
Collapse
Affiliation(s)
- Melissa Clare O'Donoghue
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Jasmine Blane
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Grace Gillis
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Karen Lindsay
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Juliet Semple
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Ludovica Griffanti
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Jane Fossey
- Oxford Health NHS Foundation Trust, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Lola Martos
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Clare E Mackay
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| |
Collapse
|
7
|
Woods M, Lennon MJ, Raymont V. Understanding and managing the long-term cognitive consequences of traumatic brain injuries. Br J Hosp Med (Lond) 2023; 84:1-3. [PMID: 37490437 DOI: 10.12968/hmed.2023.0161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
This editorial critically evaluates the current data on traumatic brain injuries and their effects on cognitive function. It discusses management strategies and clinical considerations to improve patient outcomes in light of these findings.
Collapse
Affiliation(s)
- Mitchell Woods
- Department of Geriatric Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew J Lennon
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | |
Collapse
|
8
|
Natarajan A, Shetty A, Delanerolle G, Zeng Y, Zhang Y, Raymont V, Rathod S, Halabi S, Elliot K, Shi JQ, Phiri P. A systematic review and meta-analysis of long COVID symptoms. Syst Rev 2023; 12:88. [PMID: 37245047 DOI: 10.1186/s13643-023-02250-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 02/02/2022] [Accepted: 05/03/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Ongoing symptoms or the development of new symptoms following a SARS-CoV-2 diagnosis has caused a complex clinical problem known as "long COVID" (LC). This has introduced further pressure on global healthcare systems as there appears to be a need for ongoing clinical management of these patients. LC personifies heterogeneous symptoms at varying frequencies. The most complex symptoms appear to be driven by the neurology and neuropsychiatry spheres. METHODS A systematic protocol was developed, peer reviewed, and published in PROSPERO. The systematic review included publications from the 1st of December 2019-30th June 2021 published in English. Multiple electronic databases were used. The dataset has been analyzed using a random-effects model and a subgroup analysis based on geographical location. Prevalence and 95% confidence intervals (CIs) were established based on the data identified. RESULTS Of the 302 studies, 49 met the inclusion criteria, although 36 studies were included in the meta-analysis. The 36 studies had a collective sample size of 11,598 LC patients. 18 of the 36 studies were designed as cohorts and the remainder were cross-sectional. Symptoms of mental health, gastrointestinal, cardiopulmonary, neurological, and pain were reported. CONCLUSIONS The quality that differentiates this meta-analysis is that they are cohort and cross-sectional studies with follow-up. It is evident that there is limited knowledge available of LC and current clinical management strategies may be suboptimal as a result. Clinical practice improvements will require more comprehensive clinical research, enabling effective evidence-based approaches to better support patients.
Collapse
Affiliation(s)
- Arun Natarajan
- Hillingdon Hospital NHS Foundation Trust, Pain Services, Uxbridge, UK
| | - Ashish Shetty
- University College London Hospitals NHS Foundation Trust, London, UK
- University College London, London, UK
| | - Gayathri Delanerolle
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Yutian Zeng
- Department of Statistics and Data Science, Southern University of Science and Technology, Shezhen, China
| | - Yingzhe Zhang
- West China Hospital of Sichuan University, Chengdu, China
| | | | - Shanaya Rathod
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, UK
| | - Sam Halabi
- O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA
| | - Kathryn Elliot
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, UK
| | - Jian Qing Shi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shezhen, China
| | - Peter Phiri
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, UK.
- Department of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| |
Collapse
|
9
|
Lennon MJ, Brooker H, Creese B, Thayanandan T, Rigney G, Aarsland D, Hampshire A, Ballard C, Corbett A, Raymont V. Lifetime Traumatic Brain Injury and Cognitive Domain Deficits in Late Life: The PROTECT-TBI Cohort Study. J Neurotrauma 2023. [PMID: 36716779 DOI: 10.1089/neu.2022.0360] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Traumatic brain injury (TBI) causes cognitive impairment but it remains contested regarding which cognitive domains are most affected. Further, moderate-severe TBI is known to be deleterious, but studies of mild TBI (mTBI) show a greater mix of negative and positive findings. This study examines the longer-term cognitive effects of TBI severity and number of mTBIs in later life. We examined a subset (n = 15,764) of the PROTECT study, a cohort assessing risk factors for cognitive decline (ages between 50 and 90 years). Participants completed cognitive assessments annually for 4 years. Cognitive tests were grouped using a principal components analysis (PCA) into working memory, episodic memory, attention, processing speed, and executive function. Lifetime TBI severity and number were retrospectively recalled by participants using the Brain Injury Screening Questionnaire (BISQ). Linear mixed models (LMMs) examined the effect of severity of head injury (non-TBI head strike, mTBI, and moderate-severe TBI) and number of mTBI at baseline and over time. mTBI was considered as a continuous and categorical variable (groups: 0 mTBI, 1 mTBI, 2 mTBIs, 3 mTBIs, and 4+ mTBIs). Of the participants 5725 (36.3%) reported at least one mTBI and 510 (3.2%) at least one moderate-severe TBI, whereas 3711 (23.5%) had suffered at worst a non-TBI head strike and 5818 (32.9%) reported no head injuries. The participants had suffered their last reported head injury an average (standard deviation, SD) of 29.6 (20.0) years prior to the study. Regarding outcomes, there was no worsening in longitudinal cognitive trajectories over the study duration but at baseline there were significant cognitive deficits associated with TBI. At baseline, compared with those without head injury, individuals reporting at least one moderate-severe TBI had significantly poorer attention (B = -0.163, p < 0.001), executive scores (B = -0.151, p = 0.004), and processing speed (B = -0.075, p = 0.033). Those who had suffered at least a single mTBI also demonstrated significantly poorer attention scores at baseline compared with the no head injury group (B = -0.052, p = 0.001). Compared with those with no mTBI, those in the 3 mTBI group manifested poorer baseline executive function (B = -0.149, p = 0.025) and attention scores (B = -0.085, p = 0.015). At baseline, those who had suffered four or more mTBIs demonstrated poorer attention (B = -0.135, p < 0.001), processing speed (B = -0.072, p = 0.009), and working memory (B = -0.052, p = 0.036), compared with those reporting no mTBI. TBI is associated with fixed, dose, and severity-dependent cognitive deficits. The most sensitive cognitive domains are attention and executive function, with approximately double the effect compared with processing speed and working memory. Post-TBI cognitive rehabilitation should be targeted appropriately to domain-specific effects. Significant long-term cognitive deficits were associated with three or more lifetime mTBIs, a critical consideration when counseling individuals post-TBI about continuing high-risk activities.
Collapse
Affiliation(s)
- Matthew J Lennon
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Helen Brooker
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Byron Creese
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Tony Thayanandan
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Grant Rigney
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
| | - Dag Aarsland
- Department of Old Age Psychiatry, IoPPN, Kings College London, London, United Kingdom.,Centre for Age-Related Research, Stavanger University Hospital, Stavanger, Norway
| | - Adam Hampshire
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
10
|
Lanskey JH, Kocagoncu E, Quinn AJ, Cheng YJ, Karadag M, Pitt J, Lowe S, Perkinton M, Raymont V, Singh KD, Woolrich M, Nobre AC, Henson RN, Rowe JB. New Therapeutics in Alzheimer's Disease Longitudinal Cohort study (NTAD): study protocol. BMJ Open 2022; 12:e055135. [PMID: 36521898 PMCID: PMC9756184 DOI: 10.1136/bmjopen-2021-055135] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/01/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION With the pressing need to develop treatments that slow or stop the progression of Alzheimer's disease, new tools are needed to reduce clinical trial duration and validate new targets for human therapeutics. Such tools could be derived from neurophysiological measurements of disease. METHODS AND ANALYSIS The New Therapeutics in Alzheimer's Disease study (NTAD) aims to identify a biomarker set from magneto/electroencephalography that is sensitive to disease and progression over 1 year. The study will recruit 100 people with amyloid-positive mild cognitive impairment or early-stage Alzheimer's disease and 30 healthy controls aged between 50 and 85 years. Measurements of the clinical, cognitive and imaging data (magnetoencephalography, electroencephalography and MRI) of all participants will be taken at baseline. These measurements will be repeated after approximately 1 year on participants with Alzheimer's disease or mild cognitive impairment, and clinical and cognitive assessment of these participants will be repeated again after approximately 2 years. To assess reliability of magneto/electroencephalographic changes, a subset of 30 participants with mild cognitive impairment or early-stage Alzheimer's disease will also undergo repeat magneto/electroencephalography 2 weeks after baseline. Baseline and longitudinal changes in neurophysiology are the primary analyses of interest. Additional outputs will include atrophy and cognitive change and estimated numbers needed to treat each arm of simulated clinical trials of a future disease-modifying therapy. ETHICS AND DATA STATEMENT The study has received a favourable opinion from the East of England Cambridge Central Research Ethics Committee (REC reference 18/EE/0042). Results will be disseminated through internal reports, peer-reviewed scientific journals, conference presentations, website publication, submission to regulatory authorities and other publications. Data will be made available via the Dementias Platform UK Data Portal on completion of initial analyses by the NTAD study group.
Collapse
Affiliation(s)
| | - Ece Kocagoncu
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Andrew J Quinn
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Yun-Ju Cheng
- Lilly Corporate Center, Indianapolis, Indiana, USA
| | - Melek Karadag
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Jemma Pitt
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Stephen Lowe
- Lilly Centre for Clinical Pharmacology, Singapore
| | | | | | - Krish D Singh
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, UK
| | - Mark Woolrich
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Anna C Nobre
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Richard N Henson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - James B Rowe
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| |
Collapse
|
11
|
Taylor L, Giles S, Howitt S, Ryan Z, Brooks E, Radley L, Thomson A, Whitaker E, Knight F, Hill C, Violato M, Waite P, Raymont V, Yu LM, Harris V, Williams N, Creswell C. A randomised controlled trial to compare clinical and cost-effectiveness of an online parent-led treatment for child anxiety problems with usual care in the context of COVID-19 delivered in Child and Adolescent Mental Health Services in the UK (Co-CAT): a study protocol for a randomised controlled trial. Trials 2022; 23:942. [PMID: 36384704 PMCID: PMC9667839 DOI: 10.1186/s13063-022-06833-5] [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] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the context of COVID-19, NHS Child and Adolescent Mental Health Services (CAMHS) and other children's mental health services have faced major challenges in providing psychological treatments that (i) work when delivered remotely and (ii) can be delivered efficiently to manage increases in referrals as social distancing measures have been relaxed. Anxiety problems are a common reason for referral to CAMHS, children with pre-existing anxiety problems are particularly vulnerable in the context of COVID-19, and there were concerns about increases in childhood anxiety as schools reopened. The proposed research will evaluate the clinical and cost-effectiveness of a brief online parent-led cognitive behavioural treatment (CBT) delivered by the OSI (Online Support and Intervention for child anxiety) platform with remote support from a CAMHS therapist compared to 'COVID-19 treatment as usual' (C-TAU) in CAMHS and other children's mental health services throughout the COVID-19 pandemic. METHODS We will conduct a two-arm, multi-site, randomised controlled non-inferiority trial to evaluate the clinical and cost-effectiveness of OSI with therapist support compared to CAMHS and other child mental health services 'COVID-19 treatment as usual' (C-TAU) during the COVID-19 outbreak and to explore parent and therapists' experiences. DISCUSSION If non-inferiority is shown, the research will provide (1) a solution for efficient psychological treatment for child anxiety disorders while social distancing (for the COVID-19 context and future pandemics); (2) an efficient means of treatment delivery as 'normal service' resumes to enable CAMHS to cope with the anticipated increase in referrals; and (3) a demonstration of rapid, high-quality evaluation and application of online interventions within NHS CAMHS to drive forward much-needed further digital innovation and evaluation in CAMHS settings. The primary beneficiaries will be children with anxiety disorders and their families, NHS CAMHS teams, and commissioners who will access a potentially effective, cost-effective, and efficient treatment for child anxiety problems. TRIAL REGISTRATION ISRCTN ISRCTN12890382 . Registered prospectively on 23 October 2020.
Collapse
Affiliation(s)
- Lucy Taylor
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Sophie Giles
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Sophie Howitt
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Zoe Ryan
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Emma Brooks
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Lucy Radley
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Abigail Thomson
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Emily Whitaker
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Fauzia Knight
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Claire Hill
- grid.9435.b0000 0004 0457 9566School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Mara Violato
- grid.4991.50000 0004 1936 8948Health Economics Research Centre, Nuffield Department of Population Health, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Polly Waite
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Vanessa Raymont
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- grid.4991.50000 0004 1936 8948Oxford Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Victoria Harris
- grid.4991.50000 0004 1936 8948Oxford Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Williams
- grid.4991.50000 0004 1936 8948Oxford Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Cathy Creswell
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
12
|
Shetty A, Delanerolle G, Zeng Y, Shi JQ, Ebrahim R, Pang J, Hapangama D, Sillem M, Shetty S, Shetty B, Hirsch M, Raymont V, Majumder K, Chong S, Goodison W, O’Hara R, Hull L, Pluchino N, Shetty N, Elneil S, Fernandez T, Brownstone RM, Phiri P. A systematic review and meta-analysis of digital application use in clinical research in pain medicine. Front Digit Health 2022; 4:850601. [PMID: 36405414 PMCID: PMC9668017 DOI: 10.3389/fdgth.2022.850601] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE Pain is a silent global epidemic impacting approximately a third of the population. Pharmacological and surgical interventions are primary modes of treatment. Cognitive/behavioural management approaches and interventional pain management strategies are approaches that have been used to assist with the management of chronic pain. Accurate data collection and reporting treatment outcomes are vital to addressing the challenges faced. In light of this, we conducted a systematic evaluation of the current digital application landscape within chronic pain medicine. OBJECTIVE The primary objective was to consider the prevalence of digital application usage for chronic pain management. These digital applications included mobile apps, web apps, and chatbots. DATA SOURCES We conducted searches on PubMed and ScienceDirect for studies that were published between 1st January 1990 and 1st January 2021. STUDY SELECTION Our review included studies that involved the use of digital applications for chronic pain conditions. There were no restrictions on the country in which the study was conducted. Only studies that were peer-reviewed and published in English were included. Four reviewers had assessed the eligibility of each study against the inclusion/exclusion criteria. Out of the 84 studies that were initially identified, 38 were included in the systematic review. DATA EXTRACTION AND SYNTHESIS The AMSTAR guidelines were used to assess data quality. This assessment was carried out by 3 reviewers. The data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES Before data collection began, the primary outcome was to report on the standard mean difference of digital application usage for chronic pain conditions. We also recorded the type of digital application studied (e.g., mobile application, web application) and, where the data was available, the standard mean difference of pain intensity, pain inferences, depression, anxiety, and fatigue. RESULTS 38 studies were included in the systematic review and 22 studies were included in the meta-analysis. The digital interventions were categorised to web and mobile applications and chatbots, with pooled standard mean difference of 0.22 (95% CI: -0.16, 0.60), 0.30 (95% CI: 0.00, 0.60) and -0.02 (95% CI: -0.47, 0.42) respectively. Pooled standard mean differences for symptomatologies of pain intensity, depression, and anxiety symptoms were 0.25 (95% CI: 0.03, 0.46), 0.30 (95% CI: 0.17, 0.43) and 0.37 (95% CI: 0.05, 0.69), respectively. A sub-group analysis was conducted on pain intensity due to the heterogeneity of the results (I 2 = 82.86%; p = 0.02). After stratifying by country, we found that digital applications were more likely to be effective in some countries (e.g., United States, China) than others (e.g., Ireland, Norway). CONCLUSIONS AND RELEVANCE The use of digital applications in improving pain-related symptoms shows promise, but further clinical studies would be needed to develop more robust applications. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier: CRD42021228343.
Collapse
Affiliation(s)
- Ashish Shetty
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Gayathri Delanerolle
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Yutian Zeng
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China,Alan Turing Institute, London, United Kingdom
| | - Jian Qing Shi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen, China,Alan Turing Institute, London, United Kingdom
| | - Rawan Ebrahim
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Joanna Pang
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Dharani Hapangama
- Department of Women and Children’s Health, Liverpool Women’s NHS Foundation, Liverpool, United Kingdom
| | - Martin Sillem
- Praxisklinik am Rosengarten Mannheim, Saarland University Medical Centre, Homburg, Germany
| | | | | | - Martin Hirsch
- Queen Square Institute of Neurology, University College London, London, United Kingdom,Oxford University Hospitals NHS Foundation Trust, Gynaecology, Oxford, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Kingshuk Majumder
- University of Manchester NHS Foundation Trust, Gynaecology, Manchester, United Kingdom
| | - Sam Chong
- University College London Hospitals NHS Foundation Trust, London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - William Goodison
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Rebecca O’Hara
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Louise Hull
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | | | - Naresh Shetty
- Department of Orthopedics, M.S. Ramaiah Medical College, Bangalore, India
| | - Sohier Elneil
- University College London Hospitals NHS Foundation Trust, London, United Kingdom,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Tacson Fernandez
- Queen Square Institute of Neurology, University College London, London, United Kingdom,Chronic Pain Medicine, Royal National Orthopaedic Hospital, London, United Kingdom
| | - Robert M. Brownstone
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Peter Phiri
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom,Primary Care, Population Sciences and Medical Education Division, University of Southampton, Southampton, United Kingdom,Correspondence: Peter Phiri
| |
Collapse
|
13
|
Delanerolle G, Zeng YT, Phiri P, Phan T, Tempest N, Busuulwa P, Shetty A, Raymont V, Rathod S, Shi JQ, Hapangama DK. Mental health impact on Black, Asian and Minority Ethnic populations with preterm birth: A systematic review and meta-analysis. World J Psychiatry 2022; 12:1233-1254. [PMID: 36186507 PMCID: PMC9521531 DOI: 10.5498/wjp.v12.i9.1233] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/16/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Preterm birth (PTB) is one of the main causes of neonatal deaths globally, with approximately 15 million infants are born preterm. Women from the Black, Asian, and Minority Ethnic (BAME) populations maybe at higher risk of PTB, therefore, the mental health impact on mothers experiencing a PTB is particularly important, within the BAME populations.
AIM To determine the prevalence of mental health conditions among BAME women with PTB as well as the methods of mental health assessments used to characterise the mental health outcomes.
METHODS A systematic methodology was developed and published as a protocol in PROSPERO (CRD42020210863). Multiple databases were used to extract relevant data. I2 and Egger’s tests were used to detect the heterogeneity and publication bias. A trim and fill method was used to demonstrate the influence of publication bias and the credibility of conclusions.
RESULTS Thirty-nine studies met the eligibility criteria from a possible 3526. The prevalence rates of depression among PTB-BAME mothers were significantly higher than full-term mothers with a standardized mean difference of 1.5 and a 95% confidence interval (CI) 29%-74%. The subgroup analysis indicated depressive symptoms to be time sensitive. Women within the very PTB category demonstrated a significantly higher prevalence of depression than those categorised as non-very PTB. The prevalence rates of anxiety and stress among PTB-BAME mothers were significantly higher than in full-term mothers (odds ratio of 88% and 60% with a CI of 42%-149% and 24%-106%, respectively).
CONCLUSION BAME women with PTB suffer with mental health conditions. Many studies did not report on specific mental health outcomes for BAME populations. Therefore, the impact of PTB is not accurately represented in this population, and thus could negatively influence the quality of maternity services they receive.
Collapse
Affiliation(s)
- Gayathri Delanerolle
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford OX3 7JX, United Kingdom
- Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Yu-Tian Zeng
- Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
| | - Peter Phiri
- Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- Psychology Department, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Thuan Phan
- Department of Women's and Children's Health, University of Liverpool, Liverpool L7 8TX, United Kingdom
| | - Nicola Tempest
- Department of Women's and Children's Health, University of Liverpool, Liverpool L7 8TX, United Kingdom
- Gynaecology Directorate and Hewitt Centre for Reproductive Medicine, Liverpool Women's NHS Foundation, Liverpool L8 7SS, United Kingdom
| | - Paula Busuulwa
- Department of Women's and Children's Health, University of Liverpool, Liverpool L7 8TX, United Kingdom
| | - Ashish Shetty
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London W1T 4AJ, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Shanaya Rathod
- Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Jian-Qing Shi
- National Centre for Applied Mathematics Shenzhen, Shenzhen 518055, Guangdong Province, China
- Department of Statistics, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
| | - Dharani K Hapangama
- Department of Women's and Children's Health, University of Liverpool, Liverpool L7 8TX, United Kingdom
- Gynaecology Directorate and Hewitt Centre for Reproductive Medicine, Liverpool Women's NHS Foundation, Liverpool L8 7SS, United Kingdom
| |
Collapse
|
14
|
Raymont V, Fleminger S. Alwyn Lishman's contribution to the neuropsychiatry of head injury (traumatic brain injury); two key papers. Cogn Neuropsychiatry 2022; 27:289-295. [PMID: 35253617 DOI: 10.1080/13546805.2022.2047631] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Alwyn Lishman appreciated that if we are to understand the psychological consequences of cerebral disorder we must study the interaction between organic disease and psychological processes. METHODS We have reviewed Lishman's two major publications on the neuropsychiatry of head injury, published in 1968 and 1988, and considered their conclusions in the light of current knowledge. RESULTS In his 1968 paper on the psychiatric sequelae of open head injuries sustained in World War II Lishman demonstrated associations between the type of psychiatric sequelae and the location of the injury. He also found that those with "somatic complaints", such as fatigue or sensitivity to light, showed less evidence of organic injury. In his 1988 paper, he attempted to explain why a mild head injury may be followed by long-lasting symptoms. He suggested that in the absence of complications early, organic, symptoms (physiogenesis) should recover quickly. However, this healthy recovery could be jeopardised by psychological factors (psychogenesis), resulting in long-lasting symptoms. This model of physiogenesis and psychogenesis remains relevant today. CONCLUSIONS The ideas Lishman developed in these two papers were the basis for his huge contribution to the field of neuropsychiatry, and remain relevant today.
Collapse
Affiliation(s)
- Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Simon Fleminger
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
15
|
Delanerolle G, Zeng Y, Shi JQ, Yeng X, Goodison W, Shetty A, Shetty S, Haque N, Elliot K, Ranaweera S, Ramakrishnan R, Raymont V, Rathod S, Phiri P. Mental health impact of the Middle East respiratory syndrome, SARS, and COVID-19: A comparative systematic review and meta-analysis. World J Psychiatry 2022; 12:739-765. [PMID: 35663292 PMCID: PMC9150040 DOI: 10.5498/wjp.v12.i5.739] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/24/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Over the last few decades, 3 pathogenic pandemics have impacted the global population; severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV) and SARS-CoV-2. The global disease burden has attributed to millions of deaths and morbidities, with the majority being attributed to SARS-CoV-2. As such, the evaluation of the mental health (MH) impact across healthcare professionals (HCPs), patients and the general public would be an important facet to evaluate to better understand short, medium and long-term exposures.
AIM To identify and report: (1) MH conditions commonly observed across all 3 pandemics; (2) Impact of MH outcomes across HCPs, patients and the general public associated with all 3 pandemics; and (3) The prevalence of the MH impact and clinical epidemiological significance.
METHODS A systematic methodology was developed and published on PROSPERO (CRD42021228697). The databases PubMed, EMBASE, ScienceDirect and the Cochrane Central Register of Controlled Trials were used as part of the data extraction process, and publications from January 1, 1990 to August 1, 2021 were searched. MeSH terms and keywords used included Mood disorders, PTSD, Anxiety, Depression, Psychological stress, Psychosis, Bipolar, Mental Health, Unipolar, Self-harm, BAME, Psychiatry disorders and Psychological distress. The terms were expanded with a ‘snowballing’ method. Cox-regression and the Monte-Carlo simulation method was used in addition to I2 and Egger’s tests to determine heterogeneity and publication bias.
RESULTS In comparison to MERS and SARS-CoV, it is evident SAR-CoV-2 has an ongoing MH impact, with emphasis on depression, anxiety and post-traumatic stress disorder.
CONCLUSION It was evident MH studies during MERS and SARS-CoV was limited in comparison to SARS-CoV-2, with much emphasis on reporting symptoms of depression, anxiety, stress and sleep disturbances. The lack of comprehensive studies conducted during previous pandemics have introduced limitations to the “know-how” for clinicians and researchers to better support patients and deliver care with limited healthcare resources.
Collapse
Affiliation(s)
- Gayathri Delanerolle
- Nuffield Department of Primary Health Care Science, University of Oxford, Oxford OX2 6ED, United Kingdom
| | - Yutian Zeng
- Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
| | - Jian-Qing Shi
- Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
- The Alan Turing Institute, London NW1 2DB, United Kingdom
| | - Xuzhi Yeng
- Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
| | - Will Goodison
- University College London Hospital NHS Foundation Trust, London NW1 2PG, United Kingdom
| | - Ashish Shetty
- University College London Hospital NHS Foundation Trust, London NW1 2PG, United Kingdom
- University College London, London WC1E 6BT, United Kingdom
| | - Suchith Shetty
- Department of Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Nyla Haque
- Department of Psychiatry, University of Oxford, Oxford OX2 6ED, United Kingdom
| | - Kathryn Elliot
- Department of Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Sandali Ranaweera
- Department of BioSystems Technology, University of Sri Jayewardenepura, Nugegoda 10100, Sri Lanka
| | - Rema Ramakrishnan
- National Perinatal Epidemiology Unit, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford OX2 6ED, United Kingdom
| | - Shanaya Rathod
- Department of Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Peter Phiri
- Department of Research and Innovation, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- Faculty of Environmental and Life Sciences, Psychology Department, University of Southampton, Southampton SO17 1PS, United Kingdom
| |
Collapse
|
16
|
Griffanti L, Gillis G, O'Donoghue MC, Blane J, Pretorius PM, Mitchell R, Aikin N, Lindsay K, Campbell J, Semple J, Alfaro-Almagro F, Smith SM, Miller KL, Martos L, Raymont V, Mackay CE. Adapting UK Biobank imaging for use in a routine memory clinic setting: The Oxford Brain Health Clinic. Neuroimage Clin 2022; 36:103273. [PMID: 36451375 PMCID: PMC9723313 DOI: 10.1016/j.nicl.2022.103273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/24/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
The Oxford Brain Health Clinic (BHC) is a joint clinical-research service that provides memory clinic patients and clinicians access to high-quality assessments not routinely available, including brain MRI aligned with the UK Biobank imaging study (UKB). In this work we present how we 1) adapted the UKB MRI acquisition protocol to be suitable for memory clinic patients, 2) modified the imaging analysis pipeline to extract measures that are in line with radiology reports and 3) explored the alignment of measures from BHC patients to the largest brain MRI study in the world (ultimately 100,000 participants). Adaptations of the UKB acquisition protocol for BHC patients include dividing the scan into core and optional sequences (i.e., additional imaging modalities) to improve patients' tolerance for the MRI assessment. We adapted the UKB structural MRI analysis pipeline to take into account the characteristics of a memory clinic population (e.g., high amount of white matter hyperintensities and hippocampal atrophy). We then compared the imaging derived phenotypes (IDPs) extracted from the structural scans to visual ratings from radiology reports, non-imaging factors (age, cognition) and to reference distributions derived from UKB data. Of the first 108 BHC attendees (August 2020-November 2021), 92.5 % completed the clinical scans, 88.0 % consented to use of data for research, and 43.5 % completed the additional research sequences, demonstrating that the protocol is well tolerated. The high rates of consent to research makes this a valuable real-world quality research dataset routinely captured in a clinical service. Modified tissue-type segmentation with lesion masking greatly improved grey matter volume estimation. CSF-masking marginally improved hippocampal segmentation. The IDPs were in line with radiology reports and showed significant associations with age and cognitive performance, in line with the literature. Due to the age difference between memory clinic patients of the BHC (age range 65-101 years, average 78.3 years) and UKB participants (44-82 years, average 64 years), additional scans on elderly healthy controls are needed to improve reference distributions. Current and future work aims to integrate automated quantitative measures in the radiology reports and evaluate their clinical utility.
Collapse
Affiliation(s)
- Ludovica Griffanti
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom.
| | - Grace Gillis
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| | - M Clare O'Donoghue
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| | - Jasmine Blane
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Pieter M Pretorius
- Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | | | - Nicola Aikin
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| | - Karen Lindsay
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Jon Campbell
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| | - Juliet Semple
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| | - Fidel Alfaro-Almagro
- Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| | - Stephen M Smith
- Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| | - Karla L Miller
- Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| | - Lola Martos
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Clare E Mackay
- Department of Psychiatry, University of Oxford, United Kingdom; Wellcome Centre for Integrative Neuroimaging, University of Oxford, United Kingdom
| |
Collapse
|
17
|
Manca R, De Marco M, Colston A, Raymont V, Amin J, Davies R, Kumar P, Russell G, Blackburn DJ, Venneri A. The Impact of Social Isolation Due to COVID-19 on Symptom Progression in People With Dementia: Findings of the SOLITUDE Study. Front Psychiatry 2022; 13:877595. [PMID: 35619615 PMCID: PMC9127264 DOI: 10.3389/fpsyt.2022.877595] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND People with dementia (PWD) are vulnerable to abrupt changes to daily routines. The lockdown enforced on the 23rd of March 2020 in the UK to contain the expansion of the COVID-19 pandemic limited opportunities for PWD to access healthcare services and socialise. The SOLITUDE study explored the potential long-term effects of lockdown on PWD's symptoms and carers' burden. METHODS Forty-five carers and 36 PWD completed a telephone-based assessment at recruitment (T0) and after 3 (T1) and 6 months (T2). PWD completed measures validated for telephonic evaluations of cognition and depression. Carers completed questionnaires on their burden and on PWD's health and answered a customised interview on symptom changes observed in the initial months of lockdown. Longitudinal changes were investigated for all outcome variables with repeated-measures models. Additional post hoc multiple regression analyses were carried out to investigate whether several objective factors (i.e., demographics and time under social restrictions) and carer-reported symptom changes observed following lockdown before T0 were associated with all outcomes at T0. RESULTS No significant changes were observed in any outcomes over the 6 months of observations. However, post hoc analyses showed that the length of social isolation before T0 was negatively correlated with episodic and semantic memory performance at T0. Carers reporting worsening of neuropsychiatric symptoms and faster disease progression in PWD also reported higher burden. Moreover, carer-reported worsening of cognitive symptoms was associated with poorer semantic memory at T0. CONCLUSION PWD's symptoms and carers' burden remained stable over 6 months of observation. However, the amount of time spent under social restrictions before T0 appears to have had a significant detrimental impact on cognitive performance of patients. In fact, carer-reported cognitive decline during social isolation was consistent with the finding of poorer semantic memory, a domain sensitive to progression in Alzheimer's disease. Therefore, the initial stricter period of social isolation had greater detrimental impact on patients and their carers, followed then by a plateau. Future interventions may be designed to maintain an optimal level of social and cognitive engagement for PWD in challenging times, to prevent abrupt worsening of symptoms and associated detrimental consequences on patients' carers.
Collapse
Affiliation(s)
- Riccardo Manca
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Matteo De Marco
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Amanda Colston
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Vanessa Raymont
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Jay Amin
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Memory Assessment and Research Centre, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Rhys Davies
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Pramod Kumar
- Berkshire Healthcare NHS Foundation Trust, Bracknell, United Kingdom
| | - Gregor Russell
- Bradford District Care NHS Foundation Trust, Bradford, United Kingdom
| | - Daniel J Blackburn
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Annalena Venneri
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom.,Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
18
|
Blane J, ClareO'Donoghue M, Craig E, Clarke L, Raymont V, Mackay C, Martos L. Patient attitudes towards remote memory clinic assessment. Alzheimers Dement 2022; 17 Suppl 11:e053742. [PMID: 34971057 DOI: 10.1002/alz.053742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Due to demand on UK memory clinic services, most patients have limited consultant interaction before diagnosis/discharge. Technology offers an opportunity for remote assessment, from telephone/video-based consultations to fully digitised cognitive assessments with potential to track disease progression. Whilst many acute services utilise remote assessment, there are perceived barriers in memory clinic populations. However, COVID-19 and related national restrictions may have altered patients' attitudes towards and experience with remote assessment tools. We aimed to investigate attitudes including confidence and perceived challenges towards remote assessment as well as access and experience with technology amongst Oxfordshire memory clinic patients. METHOD Between June and September 2020, all patients awaiting initial memory clinic assessment were asked to participate in a standardised semi-quantitative survey as part of an Oxford Health NHS Foundation Trust service evaluation. Designed with service-user input, questions aimed to capture availability, experience and confidence using technology and patients' comfort with assessment, diagnosis and future care discussions being conducted remotely, as well as any concerns or comments. RESULT Amongst 73 respondents (average age=79.1 years), access to technology was high; 82% reported telephone access and 58% to a laptop, tablet, smartphone or combination of the three. 17% reported previous use of web-based video conferencing tools, and although confidence using these tools was 7%, this increased with written instruction or relative assistance. Similarly, whilst under half of the respondents felt comfortable with assessments, diagnosis or future care discussions occurring remotely, this increased to approximately two thirds with relative presence (67%, 69% and 66%, respectively). Qualitative analysis of patient's comments regarding remote assessment also revealed concerns over wait times/urgent need for assessment. However, 62% preferred to wait for an in-person visit, rather than an immediate remote appointment. CONCLUSION This survey demonstrates availability of technology in this population but a disparity in willingness to engage in remote assessment. Consequently, there is a need to diverge from one-size-fits-all models to a tiered approach that helps facilitate individual choice based on the availability/confidence with technology and level of relative support. The Oxford Brain Health Centre, an integrated clinical-research service, provides an opportunity to research this tiered approach in clinical practice.
Collapse
Affiliation(s)
- Jasmine Blane
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- University of Oxford, Oxford, United Kingdom
| | - M ClareO'Donoghue
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- University of Oxford, Oxford, United Kingdom
| | - Emma Craig
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- University of Oxford, Oxford, United Kingdom
| | - Laura Clarke
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Vanessa Raymont
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- University of Oxford, Oxford, United Kingdom
| | | | - Lola Martos
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- University of Oxford, Oxford, United Kingdom
| |
Collapse
|
19
|
Lennon MJ, Thayanandan T, Corbett A, Aarsland D, Ballard C, Raymont V. Repeated concussions associated with worsened working memory, attention and processing speed, but preserved delayed memory: A PROTECT study. Alzheimers Dement 2021. [DOI: 10.1002/alz.054430] [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: 11/08/2022]
Affiliation(s)
- Matthew J Lennon
- UNSW Kensington NSW Australia
- University of Oxford Oxford United Kingdom
| | | | - Anne Corbett
- University of Exeter Medical School Exeter United Kingdom
| | - Dag Aarsland
- King's College London London United Kingdom
- Institute of Psychiatry, Psychology & Neuroscience, King's College London London United Kingdom
- Akershus University Hospital Lørenskog Norway
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society Stockholm Sweden
| | - Clive Ballard
- University of Exeter Medical School Exeter United Kingdom
- King's College London London United Kingdom
- The University of Exeter College of Medicine and Health Exeter United Kingdom
| | - Vanessa Raymont
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| |
Collapse
|
20
|
O'Donoghue MC, Blane J, Mitchell R, Aikin N, Lindsay K, Campbell J, Semple J, Raymont V, Martos L, Mackay C. Embedding dementia research in clinical practice: Progress of the Oxford Brain Health Centre. Alzheimers Dement 2021. [DOI: 10.1002/alz.049778] [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]
Affiliation(s)
- M Clare O'Donoghue
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Jasmine Blane
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Robert Mitchell
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Nicola Aikin
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Karen Lindsay
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Jon Campbell
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Juliet Semple
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Vanessa Raymont
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Lola Martos
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | | |
Collapse
|
21
|
Pitt J, Quinn AJ, Kocagoncu E, Karadag‐Assem M, Lanskey J, Klimovich‐Gray A, Cheng Y, Raymont V, Rowe JB, Nobre AC, Woolrich MW. Alpha power is associated with hippocampal volume in Alzheimer’s disease: A combined MEG and MRI study. Alzheimers Dement 2021. [DOI: 10.1002/alz.052308] [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: 11/09/2022]
Affiliation(s)
- Jemma Pitt
- University of Oxford Oxford United Kingdom
| | | | | | | | | | | | | | - Vanessa Raymont
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - James B. Rowe
- University of Cambridge Cambridge United Kingdom
- Cambridge University Cambridge United Kingdom
| | | | | |
Collapse
|
22
|
Griffanti L, Clare O'Donoghue M, Blane J, Mitchell R, Aikin N, Lindsay K, Campbell J, Semple J, Nobis L, Raymont V, Martos L, Mackay C. Translating magnetic resonance imaging research in clinical practice for dementia: The Oxford Brain Health Centre. Alzheimers Dement 2021. [DOI: 10.1002/alz.051016] [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: 11/09/2022]
Affiliation(s)
| | - M. Clare O'Donoghue
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Jasmine Blane
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Robert Mitchell
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Nicola Aikin
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Karen Lindsay
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Jon Campbell
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Juliet Semple
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Lisa Nobis
- University of Oxford Oxford United Kingdom
| | - Vanessa Raymont
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Lola Martos
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | | |
Collapse
|
23
|
Manca R, De Marco M, Blackburn DJ, Russell G, Evans K, Kirkland S, Amin J, Davies L, Firth C, Raymont V, Colston A, Collett Z, Kumar P, Balckman S, McCoy S, Davies R, Robertson S, van Diepen E, Venneri A. Study protocol: SOcial LImitations Turn Up DEmentia (SOLITUDE)—Impact of COVID‐19 social isolation on patients’ cognition and mental health and on carers’ wellbeing. Alzheimers Dement 2021. [PMCID: PMC9011510 DOI: 10.1002/alz.053813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background Method Result Conclusion
Collapse
Affiliation(s)
| | | | | | - Gregor Russell
- Bradford District Care NHS Foundation Trust Bradford United Kingdom
| | - Kimberly Evans
- Bradford District Care NHS Foundation Trust Bradford United Kingdom
| | - Sarah Kirkland
- Bradford District Care NHS Foundation Trust Bradford United Kingdom
| | - Jay Amin
- Southern Health NHS Foundation Trust Southampton United Kingdom
- University of Southampton Southampton United Kingdom
| | - Lynn Davies
- Southern Health NHS Foundation Trust Southampton United Kingdom
| | - Claire Firth
- Southern Health NHS Foundation Trust Southampton United Kingdom
| | - Vanessa Raymont
- University of Oxford Oxford United Kingdom
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Amanda Colston
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Zoe Collett
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | - Pramod Kumar
- Berkshire Healthcare NHS Foundation Trust Reading United Kingdom
| | - Sarra Balckman
- Berkshire Healthcare NHS Foundation Trust Reading United Kingdom
| | - Shani McCoy
- Berkshire Healthcare NHS Foundation Trust Reading United Kingdom
| | - Rhys Davies
- The Walton Centre NHS Foundation Trust Liverpool United Kingdom
| | | | - Erik van Diepen
- Betsi Cadwaladr University Health Board Bangor United Kingdom
| | - Annalena Venneri
- University of Sheffield Sheffield United Kingdom
- Brunel University London United Kingdom
| |
Collapse
|
24
|
Abstract
Effective, disease modifying therapies for Alzheimer's disease (AD) remain a quandary, following a panoply of expensive failures in human clinical trials. Given the stagnation in therapeutics, alternative approaches are needed. Recent successes of genetic therapies in other neurodegenerative diseases may highlight the way forward. This scoping review explores suggested targets of genetic therapy in AD, with a focus on vector-based approaches in pre-clinical and clinical trials. Putative targets of genetic therapies tested in pre-clinical trials include amyloid pathway intermediates and enzymes modulation, tau protein downregulation, APOE4 downregulation and APOE2 upregulation, neurotrophin expression (nerve growth factor (NGF) and brain-derived neurotrophic factor), and inflammatory cytokine alteration, among several other approaches. There have been three completed human clinical trials for genetic therapy in AD patients, all of which upregulated NGF in AD patients, showing some mixed evidence of benefit. Several impediments remain to be surpassed before genetic therapies can be successfully applied to AD, including the challenge of delivering monogenic genetic therapies for complex polygenic disorders, risks in the dominant delivery method (intracranial injection), stability of genetic therapies in vivo, poor translatability of pre-clinical AD models, and the expense of genetic therapy production. Genetic therapies represent an exciting opportunity within the world of AD therapeutics, but clinical applications likely remain a long term, rather than short term, possibility.
Collapse
Affiliation(s)
- Matthew J Lennon
- Department of Physiology, Anatomy and Genetics, Sherrington Building, University of Oxford, Oxford, UK.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Grant Rigney
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Perminder Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, NSW, Australia
| |
Collapse
|
25
|
Delanerolle G, Phiri P, Zeng Y, Marston K, Tempest N, Busuulwa P, Shetty A, Goodison W, Muniraman H, Duffy G, Elliot K, Maclean A, Majumder K, Hirsch M, Rathod S, Raymont V, Shi JQ, Hapangama DK. A systematic review and meta-analysis of gestational diabetes mellitus and mental health among BAME populations. EClinicalMedicine 2021; 38:101016. [PMID: 34308317 PMCID: PMC8283332 DOI: 10.1016/j.eclinm.2021.101016] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 04/12/2021] [Revised: 06/02/2021] [Accepted: 06/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a common complication of pregnancy and is associated with an increased risk of mental health (MH) disorders including antenatal and postnatal depression (PND), anxiety and post-traumatic-stress-disorder (PTSD). We hypothesized GDM and MH disorders will disproportionately affect individuals from Black, Asian and Minority Ethnic backgrounds. METHODS A systematic methodology was developed, and a protocol was published in PROSPERO (CRD42020210863) and a systematic review of publications between 1st January 1990 and 30th January 2021 was conducted. Multiple electronic databases were explored using keywords and MeSH terms. The finalised dataset was analysed using statistical methods such as random-effect models, subgroup analysis and sensitivity analysis. These were used to determine odds ratio (OR) and 95% confidence intervals (CI) to establish prevalence using variables of PND, anxiety, PTSD and stress to name a few. FINDINGS Sixty studies were finalised from the 20,040 data pool. Forty-six studies were included systematically with 14 used to meta-analyze GDM and MH outcomes. A second meta-analysis was conducted using 7 studies to determine GDM risk among Black, Asian and Minority Ethnic women with pre-existing MH disorders. The results indicate an increased risk with pooled adjusted OR for both reflected at 1.23, 95% CI of 1.00-1.50 and 1.29, 95% CI of 1.11-1.50 respectively. INTERPRETATION The available studies suggest a MH sequalae with GDM as well as a sequalae of GDM with MH among Black, Asian and Minority Ethnic populations. Our findings warrant further future exploration to better manage these patients. FUNDING Not applicable.
Collapse
Affiliation(s)
| | - Peter Phiri
- Southern Health NHS Foundation Trust, United Kingdom
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, United Kingdom
| | - Yutian Zeng
- Southern University of Science and Technology, United Kingdom
| | | | - Nicola Tempest
- University of Liverpool, United Kingdom
- Liverpool Women's Hospital NHS Foundation Trust, United Kingdom
| | - Paula Busuulwa
- University of Liverpool, United Kingdom
- Liverpool Women's Hospital NHS Foundation Trust, United Kingdom
| | - Ashish Shetty
- University College London Hospitals NHS Foundation Trust, United Kingdom
- University College London, United Kingdom
| | - William Goodison
- University College London Hospitals NHS Foundation Trust, United Kingdom
| | - Hemananda Muniraman
- Department of Pediatrics, Creighton University Medical School, United Kingdom
| | | | | | - Alison Maclean
- University of Liverpool, United Kingdom
- Liverpool Women's Hospital NHS Foundation Trust, United Kingdom
| | | | - Martin Hirsch
- University College London Hospitals NHS Foundation Trust, United Kingdom
| | | | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, United Kingdom
| | - Jian Qing Shi
- Southern University of Science and Technology, United Kingdom
- Alan Turing Institute, United Kingdom
| | - Dharani K. Hapangama
- University of Liverpool, United Kingdom
- Liverpool Women's Hospital NHS Foundation Trust, United Kingdom
| |
Collapse
|
26
|
Delanerolle G, Ramakrishnan R, Hapangama D, Zeng Y, Shetty A, Elneil S, Chong S, Hirsch M, Oyewole M, Phiri P, Elliot K, Kothari T, Rogers B, Sandle N, Haque N, Pluchino N, Silem M, O'Hara R, Hull ML, Majumder K, Shi JQ, Raymont V. A systematic review and meta-analysis of the Endometriosis and Mental-Health Sequelae; The ELEMI Project. ACTA ACUST UNITED AC 2021; 17:17455065211019717. [PMID: 34053382 PMCID: PMC8182632 DOI: 10.1177/17455065211019717] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: It is important to evaluate sequalae for complex chronic health conditions such as endometriosis and mental health disorders. Endometriosis impacts 1 in 10 women. Mental health outcomes can be a primary determinant in many physical health conditions although this is an area not well researched particularly in women’s health. This has been problematic for endometriosis patients in particular, who report mental health issues as well as other key comorbidities such as chronic pelvic pain and infertility. This could be partly due to the complexities associated with comprehensively exploring overlaps between physical and mental health disorders in the presence of multiple comorbidities and their potential mechanistic relationship. Methods: In this evidence synthesis, a systematic methodology and mixed-methods approaches were used to synthesize both qualitative and quantitative data to examine the prevalence of the overlapping sequalae between endometriosis and psychiatric symptoms and disorders. As part of this, an evidence synthesis protocol was developed which included a systematic review protocol that was published on PROSPERO (CRD42020181495). The aim was to identify and evaluate mental health reported outcomes and prevalence of symptoms and psychiatric disorders associated with endometriosis. Findings: A total of 34 papers were included in the systematic review and 15 were included in the meta-analysis. Anxiety and depression symptoms were the most commonly reported mental health outcomes while a pooled analysis also revealed high prevalence of chronic pelvic pain and dyspareunia. Interpretation: It is evident that small-scale cross-sectional studies have been conducted in a variety of settings to determine mental health outcomes among endometriosis patients. Further research is required to comprehensively evaluate the mental health sequalae with endometriosis.
Collapse
Affiliation(s)
| | - Rema Ramakrishnan
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Dharani Hapangama
- University of Liverpool, Liverpool, UK.,Liverpool Women's NHS Foundation, Liverpool, UK
| | - Yutian Zeng
- Southern University of Science and Technology, Shenzhen, China
| | - Ashish Shetty
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Sohier Elneil
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Sam Chong
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Martin Hirsch
- University College London Hospitals NHS Foundation Trust, London, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Molola Oyewole
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Peter Phiri
- Southern Health NHS Foundation Trust, Southampton, UK.,School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | | | - Bryony Rogers
- University of Liverpool, Liverpool, UK.,Liverpool Women's NHS Foundation, Liverpool, UK
| | - Natasha Sandle
- Oxford Brain Health Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Nyla Haque
- Oxford Brain Health Clinical Trials Unit, University of Oxford, Oxford, UK
| | - Nicola Pluchino
- Divisions of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Martin Silem
- University Medical Center Freiburg, Freiburg, Germany
| | - Rebecca O'Hara
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - M Louise Hull
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | | | - Jian Qing Shi
- Southern University of Science and Technology, Shenzhen, China.,The Alan Turing Institute, London, UK
| | - Vanessa Raymont
- Oxford Brain Health Clinical Trials Unit, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
27
|
Delanerolle G, Yang X, Shetty S, Raymont V, Shetty A, Phiri P, Hapangama DK, Tempest N, Majumder K, Shi JQ. Artificial intelligence: A rapid case for advancement in the personalization of Gynaecology/Obstetric and Mental Health care. ACTA ACUST UNITED AC 2021; 17:17455065211018111. [PMID: 33990172 PMCID: PMC8127586 DOI: 10.1177/17455065211018111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To evaluate and holistically treat the mental health sequelae and potential psychiatric comorbidities associated with obstetric and gynaecological conditions, it is important to optimize patient care, ensure efficient use of limited resources and improve health-economic models. Artificial intelligence applications could assist in achieving the above. The World Health Organization and global healthcare systems have already recognized the use of artificial intelligence technologies to address 'system gaps' and automate some of the more cumbersome tasks to optimize clinical services and reduce health inequalities. Currently, both mental health and obstetric and gynaecological services independently use artificial intelligence applications. Thus, suitable solutions are shared between mental health and obstetric and gynaecological clinical practices, independent of one another. Although, to address complexities with some patients who may have often interchanging sequelae with mental health and obstetric and gynaecological illnesses, 'holistically' developed artificial intelligence applications could be useful. Therefore, we present a rapid review to understand the currently available artificial intelligence applications and research into multi-morbid conditions, including clinical trial-based validations. Most artificial intelligence applications are intrinsically data-driven tools, and their validation in healthcare can be challenging as they require large-scale clinical trials. Furthermore, most artificial intelligence applications use rate-limiting mock data sets, which restrict their applicability to a clinical population. Some researchers may fail to recognize the randomness in the data generating processes in clinical care from a statistical perspective with a potentially minimal representation of a population, limiting their applicability within a real-world setting. However, novel, innovative trial designs could pave the way to generate better data sets that are generalizable to the entire global population. A collaboration between artificial intelligence and statistical models could be developed and deployed with algorithmic and domain interpretability to achieve this. In addition, acquiring big data sets is vital to ensure these artificial intelligence applications provide the highest accuracy within a real-world setting, especially when used as part of a clinical diagnosis or treatment.
Collapse
Affiliation(s)
| | - Xuzhi Yang
- Southern University of Science and Technology, Shenzhen, China
| | | | | | - Ashish Shetty
- University College London, London, UK.,University College London NHS Foundation Trust, London, UK
| | - Peter Phiri
- Southern Health NHS Foundation Trust, Southampton, UK.,Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | | | - Kingshuk Majumder
- University of Manchester Hospitals NHS Foundation Trust, Manchester, UK
| | - Jian Qing Shi
- Southern University of Science and Technology, Shenzhen, China.,The Alan Turing Institute, London, UK
| |
Collapse
|
28
|
Abstract
Dementia is a global public health priority which cost global societies $818 billion in 2015 and is disproportionately impacting low and middle-income countries (LMICs). With limited availability of disease modifying drugs to treat Alzheimer's disease (AD), researchers have increasingly focused on preventative strategies which may promote healthy cognitive aging and mitigate the risk of cognitive impairment in aging. Lifelong bilingualism has been presented as both a highly debated and promising cognitive reserve factor which has been associated with better cognitive outcomes in aging. A recent metanalysis has suggested that bilingual individuals present on average 4.05 years later with the clinical features of AD than monolinguals. Bilinguals are also diagnosed with AD ~2.0 years later than monolingual counterparts. In this perspective piece we critically evaluate the findings of this metanalysis and consider the specific implications of these findings to LMICs. Furthermore, we appraise the major epidemiological studies conducted globally on bilingualism and the onset of dementia. We consider how both impactful and robust studies of bilingualism and cognition in older age may be conducted in LMICs. Given the limited expenditure and resources available in LMICs and minimal successes of clinical trials of disease modifying drugs we propose that bilingualism should be positioned as an important and specific public health strategy for maintaining healthy cognitive aging in LMICs. Finally, we reflect upon the scope of implementing bilingualism within the education systems of LMICs and the promotion of bilingualism as a healthy cognitive aging initiative within government policy.
Collapse
Affiliation(s)
| | - Vanessa Raymont
- Oxford Brain Health Clinical Trials Unit, Oxford, United Kingdom
| | - Naji Tabet
- Center for Dementia Studies, Brighton and Sussex Medical School, Brighton, United Kingdom
| |
Collapse
|
29
|
Chau SWH, Wong OWH, Ramakrishnan R, Chan SSM, Wong EKY, Li PYT, Raymont V, Elliot K, Rathod S, Delanerolle G, Phiri P. History for some or lesson for all? A systematic review and meta-analysis on the immediate and long-term mental health impact of the 2002-2003 Severe Acute Respiratory Syndrome (SARS) outbreak. BMC Public Health 2021; 21:670. [PMID: 33827499 PMCID: PMC8025448 DOI: 10.1186/s12889-021-10701-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 03/24/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The aims of this systematic review and meta-analysis are to examine the prevalence of adverse mental health outcomes, both short-term and long-term, among SARS patients, healthcare workers and the general public of SARS-affected regions, and to examine the protective and risk factors associated with these mental health outcomes. METHODS We conducted a systematic search of the literature using databases such as Medline, Pubmed, Embase, PsycInfo, Web of Science Core Collection, CNKI, the National Central Library Online Catalog and dissertation databases to identify studies in the English or Chinese language published between January 2003 to May 2020 which reported psychological distress and mental health morbidities among SARS patients, healthcare workers, and the general public in regions with major SARS outbreaks. RESULTS The literature search yielded 6984 titles. Screening resulted in 80 papers for the review, 35 of which were included in the meta-analysis. The prevalence of post-recovery probable or clinician-diagnosed anxiety disorder, depressive disorder, and post-traumatic stress disorder (PTSD) among SARS survivors were 19, 20 and 28%, respectively. The prevalence of these outcomes among studies conducted within and beyond 6 months post-discharge was not significantly different. Certain aspects of mental health-related quality of life measures among SARS survivors remained impaired beyond 6 months post-discharge. The prevalence of probable depressive disorder and PTSD among healthcare workers post-SARS were 12 and 11%, respectively. The general public had increased anxiety levels during SARS, but whether there was a clinically significant population-wide mental health impact remained inconclusive. Narrative synthesis revealed occupational exposure to SARS patients and perceived stigmatisation to be risk factors for adverse mental health outcomes among healthcare workers, although causality could not be determined due to the limitations of the studies. CONCLUSIONS The chronicity of psychiatric morbidities among SARS survivors should alert us to the potential long-term mental health complications of covid-19 patients. Healthcare workers working in high-risk venues should be given adequate mental health support. Stigmatisation against patients and healthcare workers should be explored and addressed. The significant risk of bias and high degree of heterogeneity among included studies limited the certainty of the body of evidence of the review.
Collapse
Affiliation(s)
- Steven W. H. Chau
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Oscar W. H. Wong
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Rema Ramakrishnan
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Sandra S. M. Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Evelyn K. Y. Wong
- Department of Psychiatry, North District Hospital, Sheung Shui, Hong Kong
| | - Pinky Y. T. Li
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vanessa Raymont
- Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Kathryn Elliot
- Research & Development Department, Tom Rudd Unit, Clinical Trials Facility, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, SO30 3JB UK
| | - Shanaya Rathod
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Gayathri Delanerolle
- Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Peter Phiri
- Research & Development Department, Tom Rudd Unit, Clinical Trials Facility, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, SO30 3JB UK
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
30
|
Phiri P, Ramakrishnan R, Rathod S, Elliot K, Thayanandan T, Sandle N, Haque N, Chau SWH, Wong OWH, Chan SSM, Wong EKY, Raymont V, Au-Yeung SK, Kingdon D, Delanerolle G. An evaluation of the mental health impact of SARS-CoV-2 on patients, general public and healthcare professionals: A systematic review and meta-analysis. EClinicalMedicine 2021; 34:100806. [PMID: 33842872 PMCID: PMC8022621 DOI: 10.1016/j.eclinm.2021.100806] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [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: 12/18/2020] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The global impact of COVID-19 pandemic continues to affect the lives of billions of people with recurrent waves. Healthcare systems are struggling to manage pre-existing patient care and recurring covid-19 demands. As a result, we evaluated the mental health impact using systematic review and meta-analysis. METHODS A comprehensive search was undertaken from April 2020 to 22nd January 2021 using multiple electronic databases. A systematic review protocol was developed and published on PROSPERO registration; CRD42020181481. A random-effects model was used to compute pooled estimates of anxiety, depression, PTSD, insomnia and suicidal thoughts. FINDINGS Our search yielded 11,295 studies and of those 287 met the inclusion criteria. The meta-analysis of 206 studies revealed minimal differences in prevalence of anxiety, depression, and PTSD among HCPs compared with the public during the pandemic but higher prevalence of suicidal thoughts/ideation or self-harm (11% vs 5.8%) and lower prevalence of wellbeing (28.2% vs 52.6%) among the public compared to HCPs. INTERPRETATION The pandemic has led to a high mental health burden especially amongst HCPs and higher suicidal ideation and lower wellbeing in general public which warrants further investigation and management globally. These findings highlight an emerging critical public health issue that requires urgent solutions.
Collapse
Affiliation(s)
- Peter Phiri
- Southern Health NHS Foundation Trust, Research and Development Dept., Clinical Trials Facility, Moorgreen Hospital, Southampton SO30 3JB, UK
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK
| | - Rema Ramakrishnan
- Nuffield Department of Women's and Reproductive Health, University of Oxford, UK
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Research and Development Dept., Clinical Trials Facility, Moorgreen Hospital, Southampton SO30 3JB, UK
| | - Kathryn Elliot
- Southern Health NHS Foundation Trust, Research and Development Dept., Clinical Trials Facility, Moorgreen Hospital, Southampton SO30 3JB, UK
| | - Tony Thayanandan
- Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, Warneford Hospital,University of Oxford, Oxford OX3 7JX, UK
| | - Natasha Sandle
- Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, Warneford Hospital,University of Oxford, Oxford OX3 7JX, UK
| | - Nyla Haque
- Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, Warneford Hospital,University of Oxford, Oxford OX3 7JX, UK
| | - Steven WH Chau
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
| | - Oscar WH Wong
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
| | - Sandra SM Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong
| | - Evelyn KY Wong
- Department of Psychiatry, North District Hospital, Hong Kong
| | - Vanessa Raymont
- Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, Warneford Hospital,University of Oxford, Oxford OX3 7JX, UK
| | - Sheena K Au-Yeung
- Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, Warneford Hospital,University of Oxford, Oxford OX3 7JX, UK
| | - David Kingdon
- University Department of Psychiatry, Academic Centre, College Keep, University of Southampton, UK
| | - Gayathri Delanerolle
- Oxford Brain Health Clinical Trials Unit, Department of Psychiatry, Warneford Hospital,University of Oxford, Oxford OX3 7JX, UK
| |
Collapse
|
31
|
Delanerolle G, Rathod S, Elliot K, Ramakrishnan R, Thayanandan T, Sandle N, Haque N, Raymont V, Phiri P. Rapid commentary: Ethical implications for clinical trialists and patients associated with COVID-19 research. World J Psychiatry 2021; 11:58-62. [PMID: 33747803 PMCID: PMC7953365 DOI: 10.5498/wjp.v11.i3.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/28/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023] Open
Abstract
Pandemics disrupt clinical trials worldwide, with lasting effects on research. It can severely impact clinical trialists ability to conduct safe and ethically uncompromised trials. Hence, the mounting pressure results in ethically and morally distressing decisions faced by clinical trial professionals during pandemic situations. Whilst clinical trialists attempt to think about preparedness and responses during a pandemic, the need to have an ethical framework that has real-world applicability is imperative. Pandemics are a challenging time for all, however, the safety and access to support for clinical trialists and patients within clinical trials should be at the forefront for their organisations and the government.
Collapse
Affiliation(s)
| | - Shanaya Rathod
- Research and Development Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Kathryn Elliot
- Research and Development Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
| | - Rema Ramakrishnan
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Tony Thayanandan
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Natasha Sandle
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Nyla Haque
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Peter Phiri
- Research and Development Department, Southern Health NHS Foundation Trust, Southampton SO30 3JB, United Kingdom
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton SO16 5ST, United Kingdom
| |
Collapse
|
32
|
Baksh RA, Ritchie CW, Terrera GM, Norton J, Raymont V, Ritchie K. The association between anxiety disorders and hippocampal volume in older adults. Psychol Aging 2021; 36:288-297. [PMID: 33661669 DOI: 10.1037/pag0000597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The hippocampus, through its mediation of fear responses is thought to play a central role in the onset and maintenance of anxiety disorders. Prevalence of anxiety disorders remains high in older populations; however, little is known about their association with hippocampal changes in this age group. Due to differing levels of cortisol as adults age, age-related decreases in hippocampal volume, and the suggestion that age-related loss of neurogenesis results in anxiety disorders, this area requires investigation. We examined the association between hippocampal volume and anxiety disorders (social anxiety disorder, generalized anxiety disorder, agoraphobia, panic disorder, obsessive compulsive disorder and posttraumatic stress disorder) in 534 older adults participating in the Enquête de Santé Psychologique-Risques, Incidence et Traitement (ESPRIT) study of late-life neuropsychiatric disorders. Anxiety disorders were diagnosed using the Mini International Neuropsychiatric Interview MINI, French version 5.00. Cross-sectional analyses adjusted for age, educational level, gender, Mini-Mental State Examination scores, National Adult Reading Test scores, whole brain volume and depression found that a diagnosis of generalized anxiety disorder was positively associated with larger hippocampal volume. No other anxiety disorder was significantly associated with hippocampal volume. The present study is the first to examine the association between several anxiety disorders and hippocampal volume in an older population and the results highlight the need for further research relating to the relationship between hippocampal volume and anxiety disorders in older adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
- R Asaad Baksh
- Centre for Dementia Prevention, University of Edinburgh
| | | | | | - Joanna Norton
- Inserm, U1061 Neuropsychiatry, University of Montpellier
| | | | - Karen Ritchie
- Centre for Dementia Prevention, University of Edinburgh
| |
Collapse
|
33
|
Calvin CM, de Boer C, Raymont V, Gallacher J, Koychev IG. Continuous and risk‐score‐based predictors of ATN Alzheimer's disease status among cognitively healthy individuals: Findings from the EPAD‐LCS study. Alzheimers Dement 2020. [DOI: 10.1002/alz.041097] [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: 11/09/2022]
Affiliation(s)
| | - Casper de Boer
- Alzheimer Center Amsterdam Amsterdam Neuroscience Vrije Universiteit Amsterdam, Amsterdam UMC Amsterdam Netherlands
| | | | | | | | | |
Collapse
|
34
|
O'Donoghue MC, Raymont V, Fossey J, Semple J, Griffanti L, Zokaei N, Nobre AC, Martos L, Mackay C. The Oxford Brain Health Centre: Embedding dementia research in clinical practice. Alzheimers Dement 2020. [DOI: 10.1002/alz.044907] [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: 11/10/2022]
Affiliation(s)
| | | | - Jane Fossey
- Oxford Health NHS Trust Oxford United Kingdom
| | | | | | | | | | - Lola Martos
- Oxford Health NHS Foundation Trust Oxford United Kingdom
| | | |
Collapse
|
35
|
Raymont V, O'Donoghue MC, Mak E, Dounavi M, Su L, MacKay C, O'Brien JT, Ritchie CW. Impact of mild head injury on diffusion MRI brain characteristics in midlife: Data from the PREVENT Dementia Study. Alzheimers Dement 2020. [DOI: 10.1002/alz.044517] [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: 11/08/2022]
Affiliation(s)
| | | | - Elijah Mak
- University of Cambridge Cambridge United Kingdom
| | | | - Li Su
- University of Cambridge Cambridge United Kingdom
| | | | - John T O'Brien
- Department of Psychiatry University of Cambridge Cambridge United Kingdom
| | - Craig W Ritchie
- Centre for Clinical Brain Sciences University of Edinburgh Edinburgh United Kingdom
| |
Collapse
|
36
|
Abstract
Traumatic brain injury (TBI) is a risk factor for the later development of dementia, but although the evidence dates back to the early 20th century, the nature of any association and its mechanistic pathways remain unclear. There has been greater focus on this subject over recent years, in part because of increasing reports around sports related TBIs, especially in the USA. Differences in research methods and clinical sampling remain the primary reason for the variable findings, although there is clearly increased prevalence of neurodegenerative disorders in general. Duration of follow up, definition of both TBI and dementia, and differences in the extent to which other dementia risk factors are controlled, as well as concerns about medical record accuracy are all issues yet to be resolved in TBI research, as is an absence pathological evidence. In addition, TBI has been reported to initiate a cascade of pathological processes related to several neurodegenerative disorders, and as such, it is likely that the risks vary between individuals. Given the evidence that dementia risk may increase with injury severity and frequency, a detailed account of age and type of injury, as well as lifetime TBI exposure is essential to document in future studies, and further longitudinal research with biomarker assessments are needed.
Collapse
Affiliation(s)
- Vanessa Raymont
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK -
| | - Tony Thayanandan
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| |
Collapse
|
37
|
Calvin CM, de Boer C, Raymont V, Gallacher J, Koychev I. Prediction of Alzheimer's disease biomarker status defined by the 'ATN framework' among cognitively healthy individuals: results from the EPAD longitudinal cohort study. Alzheimers Res Ther 2020; 12:143. [PMID: 33168064 PMCID: PMC7650169 DOI: 10.1186/s13195-020-00711-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/20/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The Amyloid/Tau/Neurodegeneration (ATN) framework has been proposed as a means of evidencing the biological state of Alzheimer's disease (AD). Predicting ATN status in pre-dementia individuals therefore provides an important opportunity for targeted recruitment into AD interventional studies. We investigated the extent to which ATN-defined biomarker status can be predicted by known AD risk factors as well as vascular-related composite risk scores. METHODS One thousand ten cognitively healthy older adults were allocated to one of five ATN-defined biomarker categories. Multinomial logistic regression tested risk factors including age, sex, education, APOE4, family history of dementia, cognitive function, vascular risk indices (high systolic blood pressure, body mass index (BMI), high cholesterol, physical inactivity, ever smoked, blood pressure medication, diabetes, prior cardiovascular disease, atrial fibrillation and white matter lesion (WML) volume), and three vascular-related composite scores, to predict five ATN subgroups; ROC curve models estimated their added value in predicting pathology. RESULTS Age, APOE4, family history, BMI, MMSE and white matter lesions (WML) volume differed between ATN biomarker groups. Prediction of Alzheimer's disease pathology (versus normal AD biomarkers) improved by 7% after adding family history, BMI, MMSE and WML to a ROC curve that included age, sex and APOE4. Risk composite scores did not add value. CONCLUSIONS ATN-defined Alzheimer's disease biomarker status prediction among cognitively healthy individuals is possible through a combination of constitutional and cardiovascular risk factors but established dementia composite risk scores do not appear to add value in this context.
Collapse
Affiliation(s)
- Catherine M. Calvin
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Casper de Boer
- Alzheimer Center Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Vanessa Raymont
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - John Gallacher
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Ivan Koychev
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | | |
Collapse
|
38
|
Frangou S, Kington J, Raymont V, Shergill SS. Examining ventral and dorsal prefrontal function in bipolar disorder: A functional magnetic resonance imaging study. Eur Psychiatry 2020; 23:300-8. [PMID: 17656073 DOI: 10.1016/j.eurpsy.2007.05.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 05/12/2007] [Accepted: 05/25/2007] [Indexed: 11/20/2022] Open
Abstract
AbstractSeveral lines of research suggest both dorsal and ventral prefrontal cortical dysfunction in bipolar disorder (BD). We used functional magnetic resonance imaging to compare patterns of brain activation in remitted BD patients and controls whilst performing tasks selected for their relative specificity in engaging either the dorsal (n-back sequential-letter working memory task) or ventral (gambling task) PFC. Seven BD patients were selected from participants of the Maudsley Bipolar Disorder Project on the basis of clinical remission, absence of cognitive deficits, and monotherapy with mood stabilisers. Subjects were individually matched by gender, age, and IQ to an equal number of healthy controls. In the n-back task, group differences were only present in response to increasing memory load. Patients did not show the predicted dynamic response in the dorsal PFC, but had increased activation in the parietal cortices. During the gambling task, controls showed significant activation in the ventral and dorsal PFC; this was attenuated in BD patients where increased activation was seen in lateral temporal and polar regions. Our findings suggest that there are trait abnormalities in dorsal and ventral PFC function in BD that may be more pronounced during tasks that rely on ventral–dorsal PFC interaction.
Collapse
Affiliation(s)
- Sophia Frangou
- Section of Neurobiology of Psychosis, Institute of Psychiatry, Kings College London, De Crespigny Park, London, UK.
| | | | | | | |
Collapse
|
39
|
Jolly AE, Raymont V, Cole JH, Whittington A, Scott G, De Simoni S, Searle G, Gunn RN, Sharp DJ. Dopamine D2/D3 receptor abnormalities after traumatic brain injury and their relationship to post-traumatic depression. Neuroimage Clin 2019; 24:101950. [PMID: 31352218 PMCID: PMC6664227 DOI: 10.1016/j.nicl.2019.101950] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 06/20/2019] [Accepted: 07/19/2019] [Indexed: 11/18/2022]
Abstract
Objective To investigate dopamine D2/D3 receptor availability following traumatic brain injury (TBI) and their relationship to the presence of DSM-IV Major Depressive Disorder (MDD) and patterns of axonal injury. Methods Twelve moderate-severe TBI patients and 26 controls were imaged using [11C]PHNO positron emission tomography (PET) and structural magnetic resonance imaging (MRI). TBI patients and a second group of 32 controls also underwent diffusion tensor imaging (DTI) and neuropsychological assessment. Patients included six with post-injury MDD (TBI-MDD) and six without (TBI-NON). Non-displaceable binding potential (BPND) [11C]PHNO values were used to index D2/D3 receptor availability, and were calculated using a reference region procedure. Differences in BPND were examined using voxelwise and region-of-interest analyses. White matter microstructure integrity, quantified by fractional anisotropy (FA), was assessed and correlated with BPND. Results Lower [11C]PHNO BPND was found in the caudate across all TBI patients when compared to controls. Lower [11C]PHNO BPND was observed in the caudate of TBI-MDD patients and increased [11C]PHNO BPND in the Amygdala of TBI-NON patients compared to controls. There were no significant differences in [11C]PHNO BPND between TBI-MDD and TBI-NON patients. Furthermore, DTI provided evidence of axonal injury following TBI. The uncinate fasciculus and cingulum had abnormally low FA, with the uncinate particularly affected in TBI-MDD patients. Caudate [11C]PHNO BPND correlated with FA within the nigro-caudate tract. Conclusions [11C]PHNO BPND is abnormal following TBI, which indicates post-traumatic changes in D2/D3 receptors. Patterns of [11C]PHNO BPND seen in patients with and without MDD suggest that further research would be beneficial to determine whether the use of dopaminergic treatment might be effective in the treatment of post-traumatic depression. [11C]PHNO PET is used for the first time in traumatic brain injury (TBI) patients. Post-traumatic changes in dopamine D2/D3 receptors were observed. Patients with major depression showed more prominent reductions in [11C]PHNO BPND. Non-depressed TBI patients had greater [11C]PHNO BPND in the Amygdala. These findings suggest a potential role of D2/D3 changes in post-TBI depression.
Collapse
Affiliation(s)
- Amy E Jolly
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK.
| | - Vanessa Raymont
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK; Centre of Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, UK; Department of Psychiatry, University of Oxford, UK.
| | - James H Cole
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK.
| | - Alex Whittington
- Invicro, Centre for Imaging Sciences, Imperial College London, UK.
| | - Gregory Scott
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK.
| | - Sara De Simoni
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK.
| | - Graham Searle
- Invicro, Centre for Imaging Sciences, Imperial College London, UK.
| | - Roger N Gunn
- Invicro, Centre for Imaging Sciences, Imperial College London, UK.
| | - David J Sharp
- Division of Brain Sciences, Department of Medicine, Imperial College London, UK.
| |
Collapse
|
40
|
Goel V, Marling M, Raymont V, Krueger F, Grafman J. Patients with Lesions to Left Prefrontal Cortex (BA 9 and BA 10) Have Less Entrenched Beliefs and Are More Skeptical Reasoners. J Cogn Neurosci 2019; 31:1674-1688. [PMID: 31298633 DOI: 10.1162/jocn_a_01441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The effect of prior beliefs on reasoning and decision-making is a robust, poorly understood phenomenon, exhibiting considerable individual variation. Neuroimaging studies widely show the involvement of the left pFC in reasoning involving beliefs. However, little patient data exist to speak to the necessity and role of the left pFC in belief-based inference. To address this shortcoming, we tested 102 patients with unilateral focal penetrating traumatic brain injuries and 49 matched controls. Participants provided plausibility ratings (plausible/implausible) to simple inductive arguments and (separately) strength of believability ratings of the conclusion to those same arguments. A voxel-based lesion symptom mapping analysis identified 10 patients, all with lesions to the left pFC (BA 9 and BA 10) as rating significantly fewer arguments with highly believable conclusions as "plausible," compared with all other patients. Subsequent analyses, incorporating the right hemisphere homologue of these patients (n = 12) and normal controls (n = 24), revealed patients with lesions to left pFC found fewer arguments plausible in the high believable than either of these groups, and there was no difference in the behavioral scores of the right pFC patients and normal controls. Further analysis, utilizing the belief ratings as the dependent measure, revealed a Group × Belief Rating interaction, with left pFC patients having less intense beliefs about the conclusions of moderately believable and highly believable arguments. We interpreted these results to indicate that lesions to left pFC (BA 9, BA 10) increase incredulity and make these patients more skeptical reasoners. The former can partially, but not fully, explain the latter. The other relevant factor may be that unilateral left pFC lesions disrupt hemispheric equilibrium and allow for an increased inhibitory role of the right pFC. We speculate that individual differences in belief bias in reasoning in the normal population may be a function of individual differences in the left and right pFC interactional dynamics.
Collapse
Affiliation(s)
- Vinod Goel
- York University, Toronto, Canada.,Capital Normal University, Beijing, China
| | | | | | | | - Jordan Grafman
- Shirley Ryan AbilityLab, Chicago, IL.,Northwestern University Medical School
| |
Collapse
|
41
|
Koychev I, Lawson J, Chessell T, Mackay C, Gunn R, Sahakian B, Rowe JB, Thomas AJ, Rochester L, Chan D, Tom B, Malhotra P, Ballard C, Chessell I, Ritchie CW, Raymont V, Leroi I, Lengyel I, Murray M, Thomas DL, Gallacher J, Lovestone S. Deep and Frequent Phenotyping study protocol: an observational study in prodromal Alzheimer's disease. BMJ Open 2019; 9:e024498. [PMID: 30904851 PMCID: PMC6475176 DOI: 10.1136/bmjopen-2018-024498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/24/2022] Open
Abstract
INTRODUCTION Recent failures of potential novel therapeutics for Alzheimer's disease (AD) have prompted a drive towards clinical studies in prodromal or preclinical states. However, carrying out clinical trials in early disease stages is extremely challenging-a key reason being the unfeasibility of using classical outcome measures of dementia trials (eg, conversion to dementia) and the lack of validated surrogate measures so early in the disease process. The Deep and Frequent Phenotyping (DFP) study aims to resolve this issue by identifying a set of markers acting as indicators of disease progression in the prodromal phase of disease that could be used as indicative outcome measures in proof-of-concept trials. METHODS AND ANALYSIS The DFP study is a repeated measures observational study where participants will be recruited through existing parent cohorts, research interested lists/databases, advertisements and memory clinics. Repeated measures of both established (cognition, positron emission tomography (PET) imaging or cerebrospinal fluid (CSF) markers of pathology, structural MRI markers of neurodegeneration) and experimental modalities (functional MRI, magnetoencephalography and/or electroencephalography, gait measurement, ophthalmological and continuous smartphone-based cognitive and other assessments together with experimental CSF, blood, tear and saliva biomarkers) will be performed. We will be recruiting male and female participants aged >60 years with prodromal AD, defined as absence of dementia but with evidence of cognitive impairment together with AD pathology as assessed using PET imaging or CSF biomarkers. Control participants without evidence of AD pathology will be included at a 1:4 ratio. ETHICS AND DISSEMINATION The study gained favourable ethical opinion from the South Central-Oxford B NHS Research Ethics Committee (REC reference 17/SC/0315; approved on 18 August 2017; amendment 13 February 2018). Data will be shared with the scientific community no more than 1 year following completion of study and data assembly.
Collapse
Affiliation(s)
- Ivan Koychev
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Tharani Chessell
- IMED Neuroscience, AstraZeneca UK Ltd, Cambridge, Cambridgeshire, UK
| | - Clare Mackay
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Roger Gunn
- Invicro, London, UK
- Department of Medicine, Imperial College London, London, UK
| | - Barbara Sahakian
- Department of Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Alan J Thomas
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Dennis Chan
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- MRC Cognition and Brain Sciences Unit, Cambridge, Cambridgeshire, UK
| | - Brian Tom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Paresh Malhotra
- Department of Neurology, Imperial College London Faculty of Medicine, London, UK
| | | | - Iain Chessell
- IMED Neuroscience, AstraZeneca UK Ltd, Cambridge, Cambridgeshire, UK
| | - Craig W Ritchie
- Department of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Vanessa Raymont
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Iracema Leroi
- Manchester Academic Health Sciences Centre, Institute of Brain, Behaviour, and Mental Health, Manchester, UK
| | | | | | - David L Thomas
- Leonard Wolfson Experimental Neurology Centre, University College London Institute of Neurology, London, London, UK
| | - John Gallacher
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | |
Collapse
|
42
|
Robert Brašić J, Mari Z, Lerner A, Raymont V, Zaidi E, Wong DF. Remission of Gilles de la Tourette Syndrome after Heat-Induced Dehydration. ACTA ACUST UNITED AC 2018; 6. [PMID: 30090843 PMCID: PMC6078428 DOI: 10.4172/2329-9096.1000472] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Heat has been reported to exert variable effects on people with Gilles de
la Tourette syndrome (TS). At age 24 years, a 32-year-old right-handed man with
TS experienced a marked reduction in tics for two years after undergoing
dehydration by entering a hot tub at 103°F (39.4°C) to
104°F (40.0°C) for 3 to 4 hours. On the Yale Global Tic Severity
Scale (YGTSS) he scored 55 seven months before dehydration and 13 one month
after dehydration. An intense heat exposure and dehydration led to an apparent
remission in tics. The remission continued without the use of prescribed or
nonprescribed medications or substances for two years until tics returned in the
worst ever exacerbation after a tetanus immunization. The heat exposure may have
altered at least temporarily his thermostat for normal heat-loss mechanisms
through dopaminergic pathways from the anterior hypothalamus to the basal
ganglia and the substantia nigra. Whether or not that mechanism or some other
mechanism relevant to the heat exposure and/or dehydration is at play, the
sudden and marked improvement in his tics needs further attention. Prospective
testing of the heat and dehydration effect on tics should be pursued.
Collapse
Affiliation(s)
- James Robert Brašić
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Section of High Resolution Brain Positron Emission Tomography Imaging, Johns Hopkins Outpatient Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zoltan Mari
- Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, Maryland, USA
| | - Alicja Lerner
- Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, Maryland, USA
| | - Vanessa Raymont
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Section of High Resolution Brain Positron Emission Tomography Imaging, Johns Hopkins Outpatient Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eram Zaidi
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Section of High Resolution Brain Positron Emission Tomography Imaging, Johns Hopkins Outpatient Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dean F Wong
- Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Section of High Resolution Brain Positron Emission Tomography Imaging, Johns Hopkins Outpatient Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
43
|
Eimontaite I, Goel V, Raymont V, Krueger F, Schindler I, Grafman J. Differential roles of polar orbital prefrontal cortex and parietal lobes in logical reasoning with neutral and negative emotional content. Neuropsychologia 2018; 119:320-329. [PMID: 29772219 PMCID: PMC6200855 DOI: 10.1016/j.neuropsychologia.2018.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 07/11/2017] [Revised: 05/10/2018] [Accepted: 05/12/2018] [Indexed: 11/15/2022]
Abstract
To answer the question of how brain pathology affects reasoning about negative emotional content, we administered a disjunctive logical reasoning task involving arguments with neutral content (e.g. Either there are tigers or women in NYC, but not both; There are no tigers in NYC; There are women in NYC) and emotionally laden content (e.g. Either there are pedophiles or politicians in Texas, but not both; There are politicians in Texas; There are no pedophiles in Texas) to 92 neurological patients with focal lesions to various parts of the brain. A Voxel Lesion Symptom Mapping (VLSM) analysis identified 16 patients, all with lesions to the orbital polar prefrontal cortex (BA 10 & 11), as being selectively impaired in the emotional reasoning condition. Another 17 patients, all with lesions to the parietal cortex, were identified as being impaired in the neutral content condition. The reasoning scores of these two patient groups, along with 23 matched normal controls, underwent additional analysis to explore the effect of belief bias. This analysis revealed that the differences identified above were largely driven by trials where there was an incongruency between the believability of the conclusion and the validity of the argument (i.e. valid argument/false conclusion or invalid argument/true conclusion). Patients with lesions to polar orbital prefrontal cortex underperformed in incongruent emotional content trials and over performed in incongruent neutral content trials (compared to both normal controls and patients with parietal lobe lesions). Patients with lesions to parietal lobes underperformed normal controls (at a trend level) in neutral trials where there was a congruency between the believability of the conclusion and the validity of the argument (i.e. valid argument/true conclusion or invalid argument/false conclusion). We conclude that lesions to the polar orbital prefrontal cortex (i) prevent these patients from enjoying any emotionally induced cognitive boost, and (ii) block the belief bias processing route in the neutral condition. Lesions to parietal lobes result in a generalized impairment in logical reasoning with neutral content. Polar/orbital PFC lesions result in impaired reasoning in emotional content reasoning. Polar/orbital PFC lesion patients overperform in neutral content reasoning trials. These differences were driven by incongruent reasoning trials. Parietal lesions result in impaired reasoning with neutral but not emotional content.
Collapse
Affiliation(s)
| | - Vinod Goel
- Department of Psychology, York University, 4700 Keele St., Toronto, Ont., Canada M3J 1P3.
| | - Vanessa Raymont
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Imperial College, London, UK
| | - Frank Krueger
- School of Systems Biology, George Mason University, Fairfax, VA, USA; Department of Psychology, George Mason University, Fairfax, VA, USA
| | | | - Jordan Grafman
- Northwestern University Medical School, Cognitive Neurology and Psychiatry and Behavioral Sciences and Physical Medicine and Rehabilitation, Chicago, IL, USA
| |
Collapse
|
44
|
Mueller C, Wesenberg S, Nestmann F, Stubbs B, Bebbington P, Raymont V. Interventions to enhance coping after traumatic brain injury: A systematic review. International Journal of Therapy and Rehabilitation 2018. [DOI: 10.12968/ijtr.2018.25.3.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: The aim of this study was to identify effective psychosocial interventions to enhance coping in people who have experienced a traumatic brain injury, in order to inform clinical practice and articulate future research directions. Methods: Five electronic databases (CINAHL, Medline, EMBASE, PsycINFO, and Cochrane Library) were searched. Titles and abstracts were independently screened by two of the authors and selected for inclusion. The full text of all potentially relevant studies were retrieved and assessed for eligibility, reporting and methodological quality, and risk of bias. Findings: Eight included studies were very heterogeneous in terms of study design, type of intervention, the population studied and instruments used to evaluate coping. All studies were judged to have a moderately high risk of bias. Six studies used cognitive behavioural therapy-based interventions. Two interventions (a peer-mentoring programme and cognitive behavioural therapy combined with motivational interviewing) showed significant treatment effects on maladaptive coping. Two cognitive behavioural therapy-based group programmes improved adaptive coping, but increases were either not sustained over time or no longer significant when compared to an active control. Conclusions: There is insufficient evidence to support practice recommendations strongly. Targeting specific subgroups of people who have experienced traumatic brain injury might allow the development of more effective coping interventions. Further, a more unified concept of coping in traumatic brain injury needs to be articulated allowing larger scale evaluations.
Collapse
Affiliation(s)
- Christoph Mueller
- Academic clinical lecturer, Department of Old Age Psychiatry, King's College London, London, UK
| | - Sandra Wesenberg
- Research associate, Faculty of Education, Technische Universität Dresden, Germany
| | - Frank Nestmann
- Emeritus professor of counselling and rehabilitation, Faculty of Education, Technische Universität Dresden, Germany
| | - Brendon Stubbs
- Post-doctoral research physiotherapist, King's College London and Head of Physiotherapy at South London and Maudsley NHS Foundation Trust, London, UK
| | - Paul Bebbington
- Emeritus professor of social and community psychiatry, Division of Psychiatry, University College London, London, UK
| | - Vanessa Raymont
- Senior clinical researcher, Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
45
|
Abstract
Suicide has consistently been the most common cause of premature death in schizophrenia. A large 5-year World Health Organization study consisting of the follow-up of 1056 patients exhibiting psychotic symptoms found the most common cause of death in those with schizophrenia was suicide (Sartorius et al, 1986). In their review of the subject Caldwell and Gottesman (1990) found that 9–13% of patients with schizophrenia eventually commit suicide. At least 20–40% make suicide attempts (Meltzer & Fatemi, 1995) and 1–2% go on to complete in their attempt within the next 12 months (Meltzer & Okayli 1995). Therefore, suicide in schizophrenia has long been a major area of concern and research efforts.
Collapse
|
46
|
|
47
|
|
48
|
Mueller C, Wang Y, Brooks A, Morant N, Sullivan P, Raymont V. ‘Attending to the wound and the person' – patients’ experiences and expectations of a newly established traumatic brain injury clinic. Brain Inj 2017; 31:1863-1870. [PMID: 28945462 DOI: 10.1080/02699052.2017.1346290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Christoph Mueller
- West London Mental Health NHS Trust, London, UK
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Programme for North West London, London, UK
| | | | | | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Paul Sullivan
- Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Programme for North West London, London, UK
- Imperial College London, London, UK
| | - Vanessa Raymont
- West London Mental Health NHS Trust, London, UK
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
- University of Oxford, Department of Psychiatry, Oxford, UK
| |
Collapse
|
49
|
Goel V, Lam E, Smith KW, Goel A, Raymont V, Krueger F, Grafman J. Lesions to polar/orbital prefrontal cortex selectively impair reasoning about emotional material. Neuropsychologia 2017; 99:236-245. [PMID: 28263798 PMCID: PMC5496820 DOI: 10.1016/j.neuropsychologia.2017.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 10/20/2022]
Abstract
While it is widely accepted that lesions to orbital prefrontal cortex lead to emotion related disruptions and poor decision-making, there is very little patient data on this issue involving actual logical reasoning tasks. We tested patients with circumscribed, focal lesions largely confined to polar/orbital prefrontal cortex (BA 10 & 11) (N=17) on logical reasoning tasks involving neutral and emotional content, and compared their performance to that of an age and education-matched normal control group (N=22) and a posterior lesion control group (N=24). Our results revealed a significant group by content interaction driven by a selective impairment in the polar/orbital prefrontal cortex group compared to healthy normal controls and to the parietal patient group, in the emotional content reasoning trials. Subsequent analyses of congruent and incongruent reasoning trials indicated that this impairment was driven by the poor performance of patients with polar/orbital lesions in the incongruent trials. We conclude that the polar/orbital prefrontal cortex plays a critical role in filtering emotionally charged content from the material before it is passed on to the reasoning system in lateral/dorsal regions of prefrontal cortex. Where unfiltered content is passed to the reasoning engine, either as a result of pathology (as in the case of our patients) or as a result of individual differences, reasoning performance suffers.
Collapse
Affiliation(s)
- Vinod Goel
- Department of Psychology, York University, Canada; IRCCS Fondazione Ospedale San Camillo, Lido, Venice, Italy
| | - Elaine Lam
- Department of Psychology, York University, Canada
| | | | - Amit Goel
- School of Medicine, University of Western Ontario, Canada
| | - Vanessa Raymont
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA; Department of Medicine, Imperial College, London, UK
| | - Frank Krueger
- Department of Molecular Neuroscience, George Mason University, Fairfax, VA, USA; Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Jordan Grafman
- Northwestern University Medical School, Cognitive Neurology and Psychiatry and Behavioral Sciences and Physical Medicine and Rehabilitation, Chicago, IL, USA
| |
Collapse
|
50
|
Huey ED, Lee S, Lieberman JA, Devanand DP, Brickman AM, Raymont V, Krueger F, Grafman J. Brain Regions Associated With Internalizing and Externalizing Psychiatric Symptoms in Patients With Penetrating Traumatic Brain Injury. J Neuropsychiatry Clin Neurosci 2017; 28:104-11. [PMID: 26715034 DOI: 10.1176/appi.neuropsych.15060150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Indexed: 11/30/2022]
Abstract
A factor structure underlying DSM-IV diagnoses has been previously reported in neurologically intact patients. The authors determined the brain regions associated with factors underlying DSM-IV diagnoses and compared the ability of DSM-IV diagnoses, factor scores, and self-report measures to account for the neuroanatomical findings in patients with penetrating brain injuries. This prospective cohort study included 254 Vietnam War veterans: 199 with penetrating brain injuries and 55 matched control participants. Measures include DSM-IV diagnoses (from a Structured Clinical Interview for DSM), self-report measures of depression and anxiety, and CT scans. Factors underlying DSM-IV diagnoses were determined using an exploratory factor analysis and correlated with percent of brain regions affected. The ability of the factor scores, DSM-IV diagnoses, and the self-report psychiatric measures to account for the anatomical variance was compared with multiple regressions. Internalizing and externalizing factors were identified in these brain-injured patients. Damage to the left amygdala and bilateral basal ganglia was associated with lower internalizing factor scores, and damage to the left medial orbitofrontal cortex (OFC) with higher, and bilateral hippocampi with lower, externalizing factor scores. Factor scores best predicted left amygdala and bilateral hippocampal involvement, whereas DSM-IV diagnoses best predicted bilateral basal ganglia and left OFC involvement. Damage to the limbic areas involved in the processing of emotional and reward information, including structures involved in the National Institute of Mental Health's Research Domain Criteria Negative Valence Domain, influences the development of internalizing and externalizing psychiatric symptoms. Self-report measures underperformed DSM-IV and factor scores in predicting neuroanatomical findings.
Collapse
Affiliation(s)
- Edward D Huey
- From the Taub Institute and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY (EDH, AMB), Division of Geriatric Psychiatry, Dept. of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY (EDH, DPD), Dept. of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (EDH, AMB), Dept. of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, Columbia University, New York, NY (EDH, SL, JAL, DPD), Dept. of Biostatistics, Columbia University, Mailman School of Public Health, New York, NY (SL), Cognitive Neuroscience Division, Dept. of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (AMB), Imperial College London, Dept. of Medicine, London, UK (VR), Dept. of Radiology, Johns Hopkins University, Baltimore, MD (VR), Molecular Neuroscience Dept., George Mason University, Fairfax, VA (FK), Dept. of Psychology, George Mason University, Fairfax, VA (FK), Brain Injury Research Program, Rehabilitation Institute of Chicago, Chicago, IL (JG), and Dept. of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL (JG)
| | - Seonjoo Lee
- From the Taub Institute and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY (EDH, AMB), Division of Geriatric Psychiatry, Dept. of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY (EDH, DPD), Dept. of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (EDH, AMB), Dept. of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, Columbia University, New York, NY (EDH, SL, JAL, DPD), Dept. of Biostatistics, Columbia University, Mailman School of Public Health, New York, NY (SL), Cognitive Neuroscience Division, Dept. of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (AMB), Imperial College London, Dept. of Medicine, London, UK (VR), Dept. of Radiology, Johns Hopkins University, Baltimore, MD (VR), Molecular Neuroscience Dept., George Mason University, Fairfax, VA (FK), Dept. of Psychology, George Mason University, Fairfax, VA (FK), Brain Injury Research Program, Rehabilitation Institute of Chicago, Chicago, IL (JG), and Dept. of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL (JG)
| | - Jeffrey A Lieberman
- From the Taub Institute and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY (EDH, AMB), Division of Geriatric Psychiatry, Dept. of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY (EDH, DPD), Dept. of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (EDH, AMB), Dept. of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, Columbia University, New York, NY (EDH, SL, JAL, DPD), Dept. of Biostatistics, Columbia University, Mailman School of Public Health, New York, NY (SL), Cognitive Neuroscience Division, Dept. of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (AMB), Imperial College London, Dept. of Medicine, London, UK (VR), Dept. of Radiology, Johns Hopkins University, Baltimore, MD (VR), Molecular Neuroscience Dept., George Mason University, Fairfax, VA (FK), Dept. of Psychology, George Mason University, Fairfax, VA (FK), Brain Injury Research Program, Rehabilitation Institute of Chicago, Chicago, IL (JG), and Dept. of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL (JG)
| | - D P Devanand
- From the Taub Institute and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY (EDH, AMB), Division of Geriatric Psychiatry, Dept. of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY (EDH, DPD), Dept. of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (EDH, AMB), Dept. of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, Columbia University, New York, NY (EDH, SL, JAL, DPD), Dept. of Biostatistics, Columbia University, Mailman School of Public Health, New York, NY (SL), Cognitive Neuroscience Division, Dept. of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (AMB), Imperial College London, Dept. of Medicine, London, UK (VR), Dept. of Radiology, Johns Hopkins University, Baltimore, MD (VR), Molecular Neuroscience Dept., George Mason University, Fairfax, VA (FK), Dept. of Psychology, George Mason University, Fairfax, VA (FK), Brain Injury Research Program, Rehabilitation Institute of Chicago, Chicago, IL (JG), and Dept. of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL (JG)
| | - Adam M Brickman
- From the Taub Institute and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY (EDH, AMB), Division of Geriatric Psychiatry, Dept. of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY (EDH, DPD), Dept. of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (EDH, AMB), Dept. of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, Columbia University, New York, NY (EDH, SL, JAL, DPD), Dept. of Biostatistics, Columbia University, Mailman School of Public Health, New York, NY (SL), Cognitive Neuroscience Division, Dept. of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (AMB), Imperial College London, Dept. of Medicine, London, UK (VR), Dept. of Radiology, Johns Hopkins University, Baltimore, MD (VR), Molecular Neuroscience Dept., George Mason University, Fairfax, VA (FK), Dept. of Psychology, George Mason University, Fairfax, VA (FK), Brain Injury Research Program, Rehabilitation Institute of Chicago, Chicago, IL (JG), and Dept. of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL (JG)
| | - Vanessa Raymont
- From the Taub Institute and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY (EDH, AMB), Division of Geriatric Psychiatry, Dept. of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY (EDH, DPD), Dept. of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (EDH, AMB), Dept. of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, Columbia University, New York, NY (EDH, SL, JAL, DPD), Dept. of Biostatistics, Columbia University, Mailman School of Public Health, New York, NY (SL), Cognitive Neuroscience Division, Dept. of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (AMB), Imperial College London, Dept. of Medicine, London, UK (VR), Dept. of Radiology, Johns Hopkins University, Baltimore, MD (VR), Molecular Neuroscience Dept., George Mason University, Fairfax, VA (FK), Dept. of Psychology, George Mason University, Fairfax, VA (FK), Brain Injury Research Program, Rehabilitation Institute of Chicago, Chicago, IL (JG), and Dept. of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL (JG)
| | - Frank Krueger
- From the Taub Institute and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY (EDH, AMB), Division of Geriatric Psychiatry, Dept. of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY (EDH, DPD), Dept. of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (EDH, AMB), Dept. of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, Columbia University, New York, NY (EDH, SL, JAL, DPD), Dept. of Biostatistics, Columbia University, Mailman School of Public Health, New York, NY (SL), Cognitive Neuroscience Division, Dept. of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (AMB), Imperial College London, Dept. of Medicine, London, UK (VR), Dept. of Radiology, Johns Hopkins University, Baltimore, MD (VR), Molecular Neuroscience Dept., George Mason University, Fairfax, VA (FK), Dept. of Psychology, George Mason University, Fairfax, VA (FK), Brain Injury Research Program, Rehabilitation Institute of Chicago, Chicago, IL (JG), and Dept. of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL (JG)
| | - Jordan Grafman
- From the Taub Institute and Gertrude H. Sergievsky Center, Columbia University Medical Center, New York, NY (EDH, AMB), Division of Geriatric Psychiatry, Dept. of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY (EDH, DPD), Dept. of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (EDH, AMB), Dept. of Psychiatry, Columbia University, College of Physicians and Surgeons and New York State Psychiatric Institute, Columbia University, New York, NY (EDH, SL, JAL, DPD), Dept. of Biostatistics, Columbia University, Mailman School of Public Health, New York, NY (SL), Cognitive Neuroscience Division, Dept. of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (AMB), Imperial College London, Dept. of Medicine, London, UK (VR), Dept. of Radiology, Johns Hopkins University, Baltimore, MD (VR), Molecular Neuroscience Dept., George Mason University, Fairfax, VA (FK), Dept. of Psychology, George Mason University, Fairfax, VA (FK), Brain Injury Research Program, Rehabilitation Institute of Chicago, Chicago, IL (JG), and Dept. of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL (JG)
| |
Collapse
|