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Miklowitz DJ, Weintraub MJ, Ichinose MC, Denenny DM, Walshaw PD, Wilkerson CA, Frey SJ, Morgan-Fleming GM, Brown RD, Merranko JA, Arevian AC. A Randomized Clinical Trial of Technology-Enhanced Family-Focused Therapy for Youth in the Early Stages of Mood Disorders. JAACAP OPEN 2023; 1:93-104. [PMID: 38094620 PMCID: PMC10718175 DOI: 10.1016/j.jaacop.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Objective Family-focused therapy (FFT) is associated with enhanced outcomes in youth with bipolar and depressive disorders, but has not been evaluated in conjunction with mobile health tools. In symptomatic adolescents whose parents had histories of mood disorders, we examined whether the effects of telehealth-based FFT were augmented by mobile health apps that emphasized mood tracking and family coping skills. Method Participants (aged 13-19 years) had active mood symptoms and a parent with major depressive or bipolar disorder. Participants received 12 sessions in 18 weeks of telehealth FFT, with random assignment to (1) a mobile app (MyCoachConnect, MCC) that enabled mood tracking, reviews of session content, and text reminders to practice mood management and family communication skills (FFT-MCC); or (2) a mobile app that enabled mood tracking only (FFT-Track). Independent evaluators assessed youth every 9 weeks over 6 months on depressive symptoms (primary outcome), anxiety, and psychosocial functioning. Results Participants (N = 65; mean age 15.8 ± 1.6 years) significantly improved in depressive symptoms over 6 months (F1,170 = 45.02, p < .0001; ή2 = 0.21, 95% CI = 0.11-0.31), but there were no effects of treatment condition or treatment by time interactions on depression scores. When secondary outcome measures were considered, the subgroup of youth with bipolar spectrum disorders showed greater improvements in anxiety and global functioning in FFT-MCC compared with FFT-Track. Conclusion Youth in the early stages of mood disorder may benefit from FFT enhanced by mobile health apps. Collaborations between researchers and information technologists on mobile app design and user experience may lead to increases in engagement among adolescents. Clinical trial registration information Technology Enhanced Family Treatment; https://clinicaltrials.gov/; NCT03913013.
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Affiliation(s)
- David J Miklowitz
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Marc J Weintraub
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Megan C Ichinose
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Danielle M Denenny
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Patricia D Walshaw
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Catherine A Wilkerson
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Samantha J Frey
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Georga M Morgan-Fleming
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Robin D Brown
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at University of California, Los Angeles, California
| | - John A Merranko
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Chakrabarti S. Bipolar disorder in the International Classification of Diseases-Eleventh version: A review of the changes, their basis, and usefulness. World J Psychiatry 2022; 12:1335-1355. [PMID: 36579354 PMCID: PMC9791613 DOI: 10.5498/wjp.v12.i12.1335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/07/2022] [Accepted: 11/22/2022] [Indexed: 12/16/2022] Open
Abstract
The World Health Organization’s 11th revision of the International Classification of Diseases (ICD-11) including the chapter on mental disorders has come into effect this year. This review focuses on the “Bipolar or Related Disorders” section of the ICD-11 draft. It describes the benchmarks for the new version, particularly the foremost principle of clinical utility. The alterations made to the diagnosis of bipolar disorder (BD) are evaluated on their scientific basis and clinical utility. The change in the diagnostic requirements for manic and hypomanic episodes has been much debated. Whether the current criteria have achieved an optimum balance between sensitivity and specificity is still not clear. The ICD-11 definition of depressive episodes is substantially different, but the lack of empirical support for the changes has meant that the reliability and utility of bipolar depression are relatively low. Unlike the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), the ICD-11 has retained the category of mixed episodes. Although the concept of mixed episodes in the ICD-11 is not perfect, it appears to be more inclusive than the DSM-5 approach. Additionally, there are some uncertainties about the guidelines for the subtypes of BD and cyclothymic disorder. The initial results on the reliability and clinical utility of BD are promising, but the newly created diagnostic categories also appear to have some limitations. Although further improvement and research are needed, the focus should now be on facing the challenges of implementation, dissemination, and education and training in the use of these guidelines.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, UT, India
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3
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Saccaro LF, Amatori G, Cappelli A, Mazziotti R, Dell'Osso L, Rutigliano G. Portable technologies for digital phenotyping of bipolar disorder: A systematic review. J Affect Disord 2021; 295:323-338. [PMID: 34488086 DOI: 10.1016/j.jad.2021.08.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/30/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bias-prone psychiatric interviews remain the mainstay of bipolar disorder (BD) assessment. The development of digital phenotyping promises to improve BD management. We present a systematic review of the evidence about the use of portable digital devices for the identification of BD, BD types and BD mood states and for symptom assessment. METHODS We searched Web of KnowledgeSM, Scopus ®, IEEE Xplore, and ACM Digital Library databases (until 5/1/2021) for articles evaluating the use of portable/wearable digital devices, such as smartphone apps, wearable sensors, audio and/or visual recordings, and multimodal tools. The protocol is registered in PROSPERO (CRD42020200086). RESULTS We included 62 studies (2325 BD; 724 healthy controls, HC): 27 using smartphone apps, either for recording self-assessments (n = 10) or for passively gathering metadata (n = 7) or both (n = 10); 15 using wearable sensors for physiological parameters; 17 analysing audio and/or video recordings; 3 using multiple technologies. Two thirds of the included studies applied artificial intelligence (AI)-based approaches. They achieved fair to excellent classification performances. LIMITATIONS The included studies had small sample sizes and marked heterogeneity. Evidence of overfitting emerged, limiting generalizability. The absence of clear guidelines about reporting classification performances, with no shared standard metrics, makes results hardly interpretable and comparable. CONCLUSIONS New technologies offer a noteworthy opportunity to BD digital phenotyping with objectivity and high granularity. AI-based models could deliver important support in clinical decision-making. Further research and cooperation between different stakeholders are needed for addressing methodological, ethical and socio-economic considerations.
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Affiliation(s)
- Luigi F Saccaro
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy; Department of Clinical Neurosciences, Geneva University Hospital (HUG), Geneva, Switzerland
| | - Giulia Amatori
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Raffaele Mazziotti
- Institute of Neuroscience of the Italian National Research Council (CNR), Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Lhaksampa TC, Nanavati J, Chisolm MS, Miller L. Patient electronic communication data in clinical care: what is known and what is needed. Int Rev Psychiatry 2021; 33:372-381. [PMID: 33663312 DOI: 10.1080/09540261.2020.1856052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The novel coronavirus (COVID-19) and physical distancing guidelines around the world have resulted in unprecedented changes to normal routine and increased smartphone use to maintain social relationships and support. Reports of depressive and anxiety symptom are on the rise, contributing to suffering among people-especially adolescents and young adults-with pre-existing mental health conditions. Psychiatric care has shifted primarily to telehealth limiting the important patient nonverbal communication that has been part of in-person clinical sessions. Supplementing clinical care with patient electronic communication (EC) data may provide valuable information and influence treatment decision making. Research in the impact of patient EC data on managing psychiatric symptoms is in its infancy. This review aims to identify how patient EC has been used in clinical care and its benefits in psychiatry and research. We discuss smartphone applications used to gather different types of EC data, how data have been integrated into clinical care, and implications for clinical care and research.
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Affiliation(s)
- Tenzin C Lhaksampa
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Julie Nanavati
- Welch Medical Library, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Margaret S Chisolm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Leslie Miller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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5
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Miklowitz DJ, Weintraub MJ, Posta F, Walshaw PD, Frey SJ, Morgan-Fleming GM, Wilkerson CA, Denenny DM, Arevian AA. Development and Open Trial of a Technology-Enhanced Family Intervention for Adolescents at Risk for Mood Disorders. J Affect Disord 2021; 281:438-446. [PMID: 33360365 PMCID: PMC8068558 DOI: 10.1016/j.jad.2020.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/23/2020] [Accepted: 12/05/2020] [Indexed: 12/22/2022]
Abstract
AIM Integrating psychosocial interventions with mobile apps may increase treatment engagement among adolescents. We examined the user experience, uptake, and clinical effects of a mobile-enhanced family-focused therapy (FFT) among adolescents at risk for mood disorders. METHOD We created a mobile app containing 12 lesson plans corresponding to content of weekly FFT sessions, with modules concerning mood management, family communication and problem-solving. We pilot tested the app in an open trial of FFT (12 sessions in 18 weeks) for adolescents who had active depressive or hypomanic symptoms, a parent with mood disorder, and at least one parent who expressed high levels of criticism. Teens and parents made daily and weekly ratings of youths' moods, amount of parent/offspring criticism, and practice of FFT psychoeducational, communication or problem-solving skills. Independent evaluators interviewed adolescents at baseline and every 9 weeks over 27 weeks to measure symptom trajectories. RESULTS Participants were adolescents (n=22; mean age 15.4 ± 1.8 years; 45.5% female) and their 34 parents. Completion of requested app assessment and skill practices averaged 46%-65% among adolescents and parents over 18 weeks of treatment. Adolescents showed significant improvement in clinician-rated depression scores over 27 weeks (Cohen's d=1.58, 95% CI, 0.83 to 2.32) and reported reductions in the amount of perceived criticism expressed by parents. LIMITATIONS The uncontrolled design limits inferences about whether the mobile app augmented the effects of FFT on moods or family relationships. CONCLUSIONS Mobile applications may enhance users' responses to family therapy and provide clinicians with information regarding clinical status. Clinicaltrials.gov NCT03913013.
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Affiliation(s)
- David J. Miklowitz
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA,Corresponding author. (D.J. Miklowitz)
| | - Marc J. Weintraub
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | | | - Patricia D. Walshaw
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Samantha J. Frey
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | | | - Catherine A. Wilkerson
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Danielle M. Denenny
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Armen A. Arevian
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
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Grunze A, Born C, Fredskild MU, Grunze H. How Does Adding the DSM-5 Criterion Increased Energy/Activity for Mania Change the Bipolar Landscape? Front Psychiatry 2021; 12:638440. [PMID: 33679488 PMCID: PMC7930230 DOI: 10.3389/fpsyt.2021.638440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/25/2021] [Indexed: 02/05/2023] Open
Abstract
According to DSM-IV, the criterion (A) for diagnosing hypomanic/manic episodes is mood change (i.e., elevated, expansive or irritable mood). Criterion (A) was redefined in DSM-5 in 2013, adding increased energy/activity in addition to mood change. This paper examines a potential change of prevalence data for bipolar I or II when adding increased energy/activity to the criterion (A) for the diagnosis of hypomania/mania. Own research suggests that the prevalence of manic/hypomanic episodes drops by at least one third when using DSM-5 criteria. Whether this has positive or negative impact on clinical practice and research still needs further evaluation.
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Affiliation(s)
- Anna Grunze
- Psychiatrisches Zentrum Nordbaden, Wiesloch, Germany
| | | | - Mette U. Fredskild
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Palo Alto, CA, United States
| | - Heinz Grunze
- Psychiatrie Schwäbisch Hall & PMU, Nuremberg, Germany
- *Correspondence: Heinz Grunze
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