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Gu Y, Andargoli AE, Mackelprang JL, Meyer D. Design and implementation of clinical decision support systems in mental health helpline Services: A systematic review. Int J Med Inform 2024; 186:105416. [PMID: 38552266 DOI: 10.1016/j.ijmedinf.2024.105416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/27/2024] [Accepted: 03/17/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Clinical Decision Support Systems (CDSSs) are electronic systems used to conduct assessments based on patient characteristics and to offer treatment recommendations for clinicians to consider during their decision-making processes. CDSSs are needed by mental health helpline services to optimise service delivery for clients and counsellors, while also collecting the data needed for the administration of the service. The aim of this systematic review was to provide a comprehensive overview of the design and implementation of CDSSs in mental health helpline services, to identify current issues in their design and implementation, and to provide recommendations that may address any identified issues. MATERIALS AND METHODS Keywords related to mental health, helplines and CDSS were searched in three databases in April 2022 and September 2023. In total, 21 articles published between 1987 and 2023 met the inclusion criteria. RESULTS The objectives of the mental health helplines services included in this study included suicide risk reduction, diagnosis, treatment and monitoring of mental health disorders, and support of clinicians or counsellors in making better and more accurate decisions by incorporating real-time data analysis. All included studies demonstrated co-design activities, however, the level and degree of end-user involvement differed across the studies. The factors that impact CDSS implementation success depend on the design and implementation approach, user experience and context. CDSS evaluations in the included studies assessed reliability, utility, user friendlessness, cost-effectivenessand participant satisfaction. Few studies considered data privacy and integration issues. CONCLUSION More interactive methods should be adopted during the design of CDSSs for mental health helpline services. Increased frequency and intensity of user participation in system design, that goes beyond providing feedback on research materials, enables user opinions to be fully understood and addressed. Comprehensive frameworks should be developed to guide requirements gathering, system design and system evaluation practices. These factors are interrelated and may impact implementation success. From the outset therefore, the design of a CDSS in the mental health helpline domain should consider the full system development cycle.
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Affiliation(s)
- Yueming Gu
- Swinburne University of Technology, Melbourne, Australia.
| | | | | | - Denny Meyer
- Swinburne University of Technology, Melbourne, Australia
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Kong Y, Guo QH, Zhou L, He L, Zeng Y, Du X, Dong JZ, Jiang C, Wang JG, Ma CS. Digital computerised cognitive training for preventing cognitive decline among hypertensive patients: a study protocol for a multicentre randomised controlled trial (DELIGHT trial). BMJ Open 2024; 14:e079305. [PMID: 38423771 PMCID: PMC10910859 DOI: 10.1136/bmjopen-2023-079305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/26/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Mild cognitive impairment (MCI) is an important intervenable stage for the prevention of dementia. Hypertension is associated with impaired cognition, and when combined with MCI, it may lead to a poor prognosis. Digital computerised cognitive training (CCT) has recently become a potential instrument for improving cognition, but evidence for its efficacy remains limited. This study aims to evaluate the efficacy of a digital adaptive CCT intervention in older patients with hypertension and MCI. METHODS AND ANALYSIS The multicentre, double-blinded, randomised, actively -controlled clinical trial will recruit 200 older (≥60 years) patients with hypertension and MCI from 11 hospitals across China. Participants will be randomly assigned in a 1:1 ratio to the intervention group (multidomain adaptative CCT) and active control group (non-adaptive cognitive training) for 12-week cognitive training for 30 min/day and 5 days/week. Those who have completed their 12-week training in the intervention group will be rerandomised into the continuation and discontinuation training groups. All participants will be followed up to 24 weeks. Neuropsychological assessments and structural and functional 7.0 T MRI will be obtained at baseline and at 12-week and 24-week follow-up. The primary outcome is the possible improvement of global cognitive function at 12 weeks, as measured by the Basic Cognitive Aptitude Tests. Secondary and exploratory endpoints include the major cognitive domain function improvement, self-efficacy, mental health, quality of life and MRI measurements of the brain. ETHICS AND DISSEMINATION The trial has been approved by the institutional review board of Beijing Anzhen Hospital and thereafter by all other participating centres. Trial findings will be disseminated in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER NCT05704270.
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Affiliation(s)
- Yu Kong
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Office of Beijing Cardiovascular Diseases Prevention, Chaoyang Qu, Beijing, China
- Heart Health Research Center, Beijing, China
| | - Qian Hui Guo
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Geonomics, Shanghai Key Laboratory of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Le Zhou
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Office of Beijing Cardiovascular Diseases Prevention, Chaoyang Qu, Beijing, China
| | - Liu He
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Office of Beijing Cardiovascular Diseases Prevention, Chaoyang Qu, Beijing, China
- Heart Health Research Center, Beijing, China
| | - Yong Zeng
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Office of Beijing Cardiovascular Diseases Prevention, Chaoyang Qu, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Office of Beijing Cardiovascular Diseases Prevention, Chaoyang Qu, Beijing, China
- Heart Health Research Center, Beijing, China
- University of New South Wales, Sydney, New South Wales, Australia
| | - Jian Zeng Dong
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Office of Beijing Cardiovascular Diseases Prevention, Chaoyang Qu, Beijing, China
| | - Chao Jiang
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Office of Beijing Cardiovascular Diseases Prevention, Chaoyang Qu, Beijing, China
| | - Ji Guang Wang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Geonomics, Shanghai Key Laboratory of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chang Sheng Ma
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Office of Beijing Cardiovascular Diseases Prevention, Chaoyang Qu, Beijing, China
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Almathami HKY, Win KT, Vlahu-Gjorgievska E. Empirical Evidence of Internal and External Factors Influencing Users' Motivation Toward Teleconsultation Use. Telemed J E Health 2024; 30:141-156. [PMID: 37343179 DOI: 10.1089/tmj.2022.0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
Introduction: The use of teleconsultation systems has increased in recent years, which has improved patients' access to health care providers and enabled seamless interaction between them. The literature points out several factors that either facilitate or impede the use of teleconsultation. However, there is a lack of studies that provide empirical evidence of factors that influence consumers' motivation toward the use of teleconsultation systems. Aim and Objective: This study aimed to provide empirical evidence of the internal and external factors that influence consumers' motivation toward the use of teleconsultation systems. Methods: A cross-sectional survey was used to collect data from consumers who used a real-time teleconsultation system called the Sehha application in Saudi Arabia between March 13 and June 14, 2021. SPSS 27.0.1 was used for descriptive analysis. Results: Four hundred eighty-five participants completed the survey, 471 of whom were included in the analysis. The findings confirmed that internal and external factors exert an influence on consumers' motivation toward the use of teleconsultation systems. The findings indicated that the presence of factors such as saving time, saving cost, accessibility to health care, ease-of-use, reliable internet access, availability of devices, and appropriate places during the online connection would increase consumers' motivation toward teleconsultation systems use. Also, the findings indicated that users' familiarity with systems similar to teleconsultation systems, users' perception of teleconsultation convenience, the influence of others on users' decision to use teleconsultation, and user's skills and confidence in using teleconsultation easily, and their trust in the teleconsultation system would also increase their motivation to use it. Furthermore, the findings showed that demographic factors, including age, gender, level of education, and employment status, did not influence users' motivation toward the use of teleconsultation Conclusions: This study provided empirical evidence of a variety of internal and external factors that exert an influence on consumers' motivation toward the use of teleconsultation systems.
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Affiliation(s)
- Hassan Khader Y Almathami
- Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
- College of Computers and Information Systems, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Khin Than Win
- Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Elena Vlahu-Gjorgievska
- Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
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Van Dooren M, De Croon R, Swillen A, Verbert K. Bridging the Communication Gap Between People With Cognitive Impairments and Their Caregivers Using mHealth Apps: User-Centered Design and Evaluation Study With People With 22q11 Deletion Syndrome. JMIR Hum Factors 2023; 10:e44290. [PMID: 37585257 PMCID: PMC10468703 DOI: 10.2196/44290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND In families with children with cognitive impairments, both parents and children experience tension and have questions because of a lack of communication and adequate information. Therefore, there is a great need to develop tools that can help bridge the communication gap between patients and caregivers by stimulating conversations and providing psychoeducational tools. mHealth apps show great potential in this context. OBJECTIVE The objective of this research is to discover the specific ways young people with cognitive impairments and their families interact with mHealth apps in the context of bridging the communication gap. This newly discovered information leads to potentially more impactful mHealth interventions in the future. Therefore, this paper documents the design and development of a mHealth app for a specific group of people with cognitive impairments-people with 22q11 deletion syndrome (22q11 DS)-and their caregivers, as well as key learnings from the evaluation of this app. METHODS An iterative, user-centered design approach is used to design and develop the app. Design and evaluation happens in 2 phases. During the design phase, feedback is gathered from 2 medical experts and 3 human computer interaction (HCI) experts using a low-fidelity paper prototype. During the evaluation phase, feedback is gathered from 8 families with a child with 22q11 DS using a fully working proof of concept. This phase consists of a semistructured interview, a 2-4-week trial period, and a concluding semistructured interview. RESULTS The evaluation results of the fully working proof of concept led to design recommendations related to four different topics: (1) overcoming usage barriers, (2) stimulating conversation through a mHealth app, (3) providing information, and (4) bringing continual added value. Results are presented according to six different categories obtained in a thematic analysis: (1) feedback about the app "as is," (2) difficulties, (3) comparison between physical and digital tool, (4) extensions, (5) intention, and (6) other. CONCLUSIONS In this research, the need for apps that help bridge the communication gap between a person with cognitive impairment and their caregiver is confirmed. All participating families express their gratitude and mention the added value for other families. Therefore, it is highly encouraged for clinics and institutions to take action and develop an app to be used in practice. Furthermore, considerations when developing for people with 22q11 DS, or more broadly, people with cognitive impairments, are proposed. First, one should keep design principles in mind to overcome usage barriers. Next, recognition is a key concept when stimulating conversations through mobile apps. Third, information should be provided by a trusted source, and more than just clinical information can be considered valuable. Finally, having the possibility of using a digital tool that can be personalized brings continual added value.
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Affiliation(s)
| | - Robin De Croon
- Department of Computer Science, KU Leuven, Leuven, Belgium
| | - Ann Swillen
- Department of Human Genetics, KU Leuven, Leuven, Belgium
- Center for Human Genetics, University Hospital Gasthuisberg Leuven, Leuven, Belgium
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Almathami HKY, Win KT, Vlahu-Gjorgievska E. Development and validation of a new tool to identify factors that influence users' motivation toward the use of teleconsultation systems: A modified Delphi study. Int J Med Inform 2021; 157:104618. [PMID: 34741893 DOI: 10.1016/j.ijmedinf.2021.104618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/03/2021] [Accepted: 10/09/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Healthcare providers have improved consumer access to healthcare services by the adoption of information communication technology and the use of telemedicine. With the current COVID-19 pandemic, consumers are shifting to remote teleconsultation. There are several studies regarding consumers' acceptance and satisfaction with telemedicine among healthcare providers and a few among patients at healthcare facilities. However, studies about patients' motivation toward the use of teleconsultation systems are very few. AIM The aim of this study was to validate an instrument of a newly developed framework to identify factors that motivate patients to use a teleconsultation system. METHOD This study used a modified eDelphi method incorporating content validity index and content validity ratio procedures to validate the instrument among fifteen experts from different disciplines. The eDelphi consisted of three rounds to review each item's relevance, clarity, importance and the overall validity of the instrument. RESULT The result showed a significant level of agreement among experts for individual items' relevance, clarity and importance. For relevance, all items had excellent I-CVI above 0.889, except one item with I-CVI = 0.78, which is still acceptable. For clarity, all items had an excellent I-CVI > 0.889, except one with I-CVI = 0.667. For importance, most items had CVR above the threshold value of 0.778, except 5 items. Also, the result showed moderate to high content validity of the overall instrument (S-CVI/UA = 0.694; S-CVI/Ave = 0.996). DISCUSSION These findings support the validity and reliability of the developed instrument, which can be used to identify factors that motivated patients to use a teleconsultation system. Future testing of the instrument should be conducted with a larger population that uses a teleconsultation system. CONCLUSION An instrument was developed to identify factors that motivated consumers to use teleconsultation, using a modified eDelphi method among experts. The eDelphi method consisted of three rounds and the results showed that the instrument is a valid and reliable tool.
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Affiliation(s)
- Hassan Khader Y Almathami
- Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia; College of Computers and Information Systems, Umm Al-Qura University, Makkah, Saudi Arabia.
| | - Khin Than Win
- Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Elena Vlahu-Gjorgievska
- Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
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Campbell LE, Swaab L, Freeman EE, McCormack L, Simon TJ, Angkustsiri K, McCabe KL. The Importance of Understanding Individual Differences of Emotion Regulation Abilities in 22q11.2 Deletion Syndrome. J Autism Dev Disord 2021; 52:3076-3087. [PMID: 34251567 DOI: 10.1007/s10803-021-05172-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/29/2022]
Abstract
Chromosome 22q11.2 deletion syndrome (22q11DS) is characterised by a complex behavioural phenotype including anxiety, attention-deficit/hyperactivity disorder and psychosis. In the current study, we aimed at improving our understanding of the heterogeneity of behavioural characteristics in a group of 129 young people (aged 4-22) with a confirmed 22q11.2 microdeletion and 116 age and gender matched typically developing controls. Half the participants with 22q11DS had behaviour characterised by emotion dysregulation. A cluster analyses, of the participants with 22q11DS, revealed four groups characterised by intact emotion regulation; predominantly internalizing problems; both internalizing and externalizing problems; and predominantly externalizing difficulties. Importantly, it was found that young people with 22q11DS whose emotion dysregulation was characterised by externalizing problems had the poorest levels of functioning. As our understanding of 22q11DS improves, it is becoming increasingly clear that we need a better understanding of how individual differences and psychosocial factors contribute to, and interact with one another, to result in the observable individual differences in the 22q11DS behavioural phenotype.
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Affiliation(s)
- L E Campbell
- School of Psychological Science, University of Newcastle, Newcastle, Australia. .,Priority Research Centre GrowUpWell, University of Newcastle, University Drive, Callaghan, Newcastle, NSW, 2320, Australia.
| | - L Swaab
- School of Psychological Science, University of Newcastle, Newcastle, Australia
| | - E E Freeman
- School of Psychological Science, University of Newcastle, Newcastle, Australia.,Priority Research Centre Brain and Mental Health Research, University of Newcastle, Newcastle, Australia
| | - L McCormack
- School of Psychological Science, University of Newcastle, Newcastle, Australia
| | - T J Simon
- Department of Psychiatry and Behavioural Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA.,M.I.N.D. Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - K Angkustsiri
- M.I.N.D. Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA.,Department of Pediatrics, Section of Developmental &, Behavioral Pediatrics University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
| | - K L McCabe
- Department of Psychiatry and Behavioural Sciences, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA.,M.I.N.D. Institute, University of California Davis, 2825 50th Street, Sacramento, CA, 95817, USA
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Gough N, Brkan L, Subramaniam P, Chiuccariello L, De Petrillo A, Mulsant BH, Bowie CR, Rajji TK. Feasibility of remotely supervised transcranial direct current stimulation and cognitive remediation: A systematic review. PLoS One 2020; 15:e0223029. [PMID: 32092069 PMCID: PMC7039434 DOI: 10.1371/journal.pone.0223029] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/08/2020] [Indexed: 01/02/2023] Open
Abstract
With technological advancements and an aging population, there is growing interest in delivering interventions at home. Transcranial Direct Current Stimulation (tDCS) and Cognitive Remediation (CR) as well as Cognitive Training (CT) have been widely studied, but mainly in laboratories or hospitals. Thus, the objectives of this review are to examine feasibility and the interventions components to support the domiciliary administration of tDCS and CR. We performed a systematic search of electronic databases, websites and reference lists of included articles from the first date available until October 31, 2018. Articles included had to meet the following criteria: original work published in English using human subjects, majority of tDCS or CR intervention administered remotely. A total of 39 studies were identified (16 tDCS, 23 CR/CT, 5 using both tDCS & CT). Four studies were single case studies and two were multiple case studies. The remaining 33 studies had a range of 9-135 participants. Five tDCS and nine CR/CT studies were double blind randomized controlled trials. Most studies focused on schizophrenia (8/39) and multiple sclerosis (8/39). Literature examined suggests the feasibility of delivering tDCS or CR/CT remotely with the support of information and communication technologies.
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Affiliation(s)
- Nicole Gough
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Lea Brkan
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Ponnusamy Subramaniam
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Health Psychology Program & Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Lina Chiuccariello
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Alessandra De Petrillo
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Benoit H. Mulsant
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Christopher R. Bowie
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
| | - Tarek K. Rajji
- Division of Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Almathami HKY, Win KT, Vlahu-Gjorgievska E. Barriers and Facilitators That Influence Telemedicine-Based, Real-Time, Online Consultation at Patients' Homes: Systematic Literature Review. J Med Internet Res 2020; 22:e16407. [PMID: 32130131 PMCID: PMC7059083 DOI: 10.2196/16407] [Citation(s) in RCA: 333] [Impact Index Per Article: 83.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/25/2019] [Accepted: 12/15/2019] [Indexed: 12/11/2022] Open
Abstract
Background Health care providers are adopting information and communication technologies (ICTs) to enhance their services. Telemedicine is one of the services that rely heavily on ICTs to enable remote patients to communicate with health care professionals; in this case, the patient communicates with the health care professional for a follow-up or for a consultation about his or her health condition. This communication process is referred to as an e-consultation. In this paper, telemedicine services refer to health care services that use ICTs, which enable patients to share, transfer, and communicate data or information in real time (ie, synchronous) from their home with a care provider—normally a physician—at a clinical site. However, the use of e-consultation services can be positively or negatively influenced by external or internal factors. External factors refer to the environment surrounding the system as well as the system itself, while internal factors refer to user behavior and motivation. Objective This review aims to investigate the barriers and the facilitators that influence the use of home consultation systems in the health care context. This review also aims to identify the effectiveness of Home Online Health Consultation (HOHC) systems in improving patients’ health as well as their satisfaction with the systems. Methods We conducted a systematic literature review to search for articles—empirical studies—about online health consultation in four digital libraries: Scopus, Association for Computing Machinery, PubMed, and Web of Science. The database search yielded 2518 articles; after applying the inclusion and exclusion criteria, the number of included articles for the final review was 45. A qualitative content analysis was performed to identify barriers and facilitators to HOHC systems, their effectiveness, and patients’ satisfaction with them. Results The systematic literature review identified several external and internal facilitators and barriers to HOHC systems that were used in the creation of a HOHC framework. The framework consists of four requirements; the framework also consists of 17 facilitators and eight barriers, which were further categorized as internal and external influencers on HOHC. Conclusions Patients from different age groups and with different health conditions benefited from remote health services. HOHC via video conferencing was effective in delivering online treatment and was well-accepted by patients, as it simulated in-person, face-to-face consultation. Acceptance by patients increased as a result of online consultation facilitators that promoted effective and convenient remote treatment. However, some patients preferred face-to-face consultation and showed resistance to online consultation. Resistance to online consultation was influenced by some of the identified barriers. Overall, the framework identified the facilitators and barriers that positively and negatively influenced the uptake of HOHC systems, respectively.
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Affiliation(s)
- Hassan Khader Y Almathami
- Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia.,College of Computers and Information Systems, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Khin Than Win
- Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Elena Vlahu-Gjorgievska
- Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
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Cognitive deficits in childhood, adolescence and adulthood in 22q11.2 deletion syndrome and association with psychopathology. Transl Psychiatry 2020; 10:53. [PMID: 32066691 PMCID: PMC7026075 DOI: 10.1038/s41398-020-0736-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/02/2020] [Accepted: 01/13/2020] [Indexed: 11/19/2022] Open
Abstract
22q11.2 Deletion Syndrome (22q11.2DS) is associated with high risk of psychiatric disorders and cognitive impairment. It remains unclear to what extent key cognitive skills are associated with psychopathology, and whether cognition is stable over time in 22q11.2DS. 236 children, adolescents and adults with 22q11.2DS and 106 typically developing controls were recruited from three sites across Europe. Measures of IQ, processing speed, sustained attention, spatial working memory and psychiatric assessments were completed. Cognitive performance in individuals was calculated relative to controls in different age groups (children (6-9 years), adolescents (10-17 years), adults (18+ years)). Individuals with 22q11.2DS exhibited cognitive impairment and higher rates of psychiatric disorders compared to typically developing controls. Presence of Autism Spectrum Disorder symptoms was associated with greater deficits in processing speed, sustained attention and working memory in adolescents but not children. Attention deficit hyperactivity disorder in children and adolescents and psychotic disorder in adulthood was associated with sustained attention impairment. Processing speed and working memory were more impaired in children and adults with 22q11.2DS respectively, whereas the deficit in sustained attention was present from childhood and remained static over developmental stages. Psychopathology was associated with cognitive profile of individuals with 22q11.2DS in an age-specific and domain-specific manner. Furthermore, magnitude of cognitive impairment differed by developmental stage in 22q11.2DS and the pattern differed by domain.
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Kates WR, Mariano MA, Antshel KM, Chandra S, Gamble H, Giordano M, MacMaster E, Mattar M, St Fleur D, Faraone SV, Fremont WP. Trajectories of psychiatric diagnoses and medication usage in youth with 22q11.2 deletion syndrome: a 9-year longitudinal study. Psychol Med 2019; 49:1914-1922. [PMID: 30226117 DOI: 10.1017/s0033291718002696] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chromosome 22q11.2 deletion syndrome (22q11DS) is associated with high rates of psychiatric disorders, including schizophrenia in up to 30% of individuals with the syndrome. Despite this, we know relatively little about trajectories and predictors of persistence of psychiatric disorders from middle childhood to early adulthood. Accordingly, we followed youth over four timepoints, every 3 years, to assess long-term trajectories of attention-deficit hyperactivity disorder (ADHD), anxiety, mood, and psychosis-spectrum disorders (PSDs), as well as medication usage. METHODS Eighty-seven youth with 22q11DS and 65 controls between the ages of 9 and 15 years at the first timepoint (T1; mean age 11.88 ± 2.1) were followed for 9 years (mean age of 21.22 ± 2.01 years at T4). Baseline cognitive, clinical, and familial predictors of persistence were identified for each class of psychiatric disorders. RESULTS Baseline age and parent-rated hyperactivity scores predicted ADHD persistence [area under curve (AUC) = 0.81]. The presence of family conflict predicted persistence of anxiety disorders (ADs) whereas parent ratings of child internalizing symptoms predicted persistence of both anxiety and mood disorders (MDs) (AUC = 0.84 and 0.83, respectively). Baseline prodromal symptoms predicted persistent and emergent PSDs (AUC = 0.83). Parent-reported use of anti-depressants/anxiolytics increased significantly from T1 to T4. CONCLUSIONS Psychiatric, behavioral, and cognitive functioning during late childhood and early adolescence successfully predicted children with 22q11DS who were at highest risk for persistent psychiatric illness in young adulthood. These findings emphasize the critical importance of early assessments and interventions in youth with 22q11DS.
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Affiliation(s)
- Wendy R Kates
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse, New York,USA
| | - Margaret A Mariano
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse, New York,USA
| | - Kevin M Antshel
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse, New York,USA
| | - Shanel Chandra
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse, New York,USA
| | - Hilary Gamble
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse, New York,USA
| | - Mark Giordano
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse, New York,USA
| | - Eric MacMaster
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse, New York,USA
| | - Mirabelle Mattar
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse, New York,USA
| | - Diane St Fleur
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse, New York,USA
| | - Stephen V Faraone
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse, New York,USA
| | - Wanda P Fremont
- Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse, New York,USA
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11
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Fiksinski AM, Breetvelt EJ, Lee YJ, Boot E, Butcher N, Palmer L, Chow EWC, Kahn RS, Vorstman JAS, Bassett AS. Neurocognition and adaptive functioning in a genetic high risk model of schizophrenia. Psychol Med 2019; 49:1047-1054. [PMID: 30064532 DOI: 10.1017/s0033291718001824] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Identifying factors that influence the functional outcome is an important goal in schizophrenia research. The 22q11.2 deletion syndrome (22q11DS) is a unique genetic model with high risk (20-25%) for schizophrenia. This study aimed to identify potentially targetable domains of neurocognitive functioning associated with functional outcome in adults with 22q11DS. METHODS We used comprehensive neurocognitive test data available for 99 adults with 22q11DS (n = 43 with schizophrenia) and principal component analysis to derive four domains of neurocognition (Verbal Memory, Visual and Logical Memory, Motor Performance, and Executive Performance). We then investigated the association of these neurocognitive domains with adaptive functioning using Vineland Adaptive Behavior Scales data and a linear regression model that accounted for the effects of schizophrenia status and overall intellectual level. RESULTS The regression model explained 46.8% of the variance in functional outcome (p < 0.0001). Executive Performance was significantly associated with functional outcome (p = 0.048). Age and schizophrenia were also significant factors. The effects of Executive Performance on functioning did not significantly differ between those with and without psychotic illness. CONCLUSION The findings provide the impetus for further studies to examine the potential of directed (early) interventions targeting Executive Performance to improve long-term adaptive functional outcome in individuals with, or at high risk for, schizophrenia. Moreover, the neurocognitive test profiles may benefit caregivers and clinicians by providing insight into the relative strengths and weaknesses of individuals with 22q11DS, with and without psychotic illness.
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Affiliation(s)
- A M Fiksinski
- Department of Psychiatry,Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht,Utrecht,The Netherlands
| | - E J Breetvelt
- Clinical Genetics Research Program, Centre for Addiction and Mental Health,Toronto, Ontario,Canada
| | - Y J Lee
- Clinical Genetics Research Program, Centre for Addiction and Mental Health,Toronto, Ontario,Canada
| | - E Boot
- Clinical Genetics Research Program, Centre for Addiction and Mental Health,Toronto, Ontario,Canada
| | - N Butcher
- Clinical Genetics Research Program, Centre for Addiction and Mental Health,Toronto, Ontario,Canada
| | - L Palmer
- The Dalglish Family 22q Clinic for 22q11.2 Deletion Syndrome,Toronto General Hospital,University Health Network,Toronto, Ontario,Canada
| | - E W C Chow
- Clinical Genetics Research Program, Centre for Addiction and Mental Health,Toronto, Ontario,Canada
| | - R S Kahn
- Department of Psychiatry,Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht,Utrecht,The Netherlands
| | - J A S Vorstman
- Department of Psychiatry,Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht,Utrecht,The Netherlands
| | - A S Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health,Toronto, Ontario,Canada
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12
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Swillen A, Moss E, Duijff S. Neurodevelopmental outcome in 22q11.2 deletion syndrome and management. Am J Med Genet A 2018; 176:2160-2166. [PMID: 29696780 PMCID: PMC6202262 DOI: 10.1002/ajmg.a.38709] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/22/2018] [Accepted: 03/23/2018] [Indexed: 01/25/2023]
Abstract
The 22q11.2 deletion syndrome (22q11.2 DS) places affected individuals at an increased risk for neurodevelopmental/cognitive, behavioral and social-emotional difficulties. Poor cognitive functioning and intellectual disabilities, attention and executive functioning deficits, learning disorders, emotional dysregulation and impairments in social processing are common among individuals with 22q11.2 DS. Identifying risk and protective/resilience factors that can be detected in early life and can predict neurodevelopmental outcomes for people with 22q11.2 DS is of significant clinical relevance and might allow for early detection and intervention. Given the focus of this review, we will discuss the possible contributing factors that influence the neurodevelopmental outcome in 22q1.2 DS, the cognitive phenotype in 22q11.2 DS, the different developmental trajectories across life span, and the implications for clinical practice and management.
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Affiliation(s)
- Ann Swillen
- Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Edward Moss
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sasja Duijff
- University Medical Centre Utrecht, Utrecht, The Netherlands
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13
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Abstract
OBJECTIVE While individuals with 22q11.2 deletion syndrome (22q11DS) are at increased risk for a variety of functional impairments and psychiatric disorders, including psychosis, not all individuals with 22q11DS experience negative outcomes. Efforts to further understand which childhood variables best predict adult functional outcomes are needed, especially those that investigate childhood executive functioning abilities. METHODS This longitudinal study followed 63 individuals with 22q11DS and 43 control participants over 9 years. Childhood executive functioning ability was assessed using both rater-based and performance-based measures and tested as predictors of young adult outcomes. RESULTS Childhood global executive functioning abilities and parent report of child executive functioning abilities were the most consistent predictors of young adult outcomes. The study group moderated the relationship between child executive functioning and young adult outcomes for several outcomes such that the relationships were stronger in the 22q11DS sample. CONCLUSION Rater-based and performance-based measures of childhood executive functioning abilities predicted young adult outcomes in individuals with and without 22q11DS. Executive functioning could be a valuable target for treatment in children with 22q11DS for improving not only childhood functioning but also adult outcomes. (JINS, 2018, 24, 905-916).
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14
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Mariano MA, Tang K, Kurtz M, Kates WR. Examining the durability of a hybrid, remote and computer-based cognitive remediation intervention for adolescents with 22q11.2 deletion syndrome. Early Interv Psychiatry 2018; 12:686-693. [PMID: 27629273 PMCID: PMC5352536 DOI: 10.1111/eip.12367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/14/2016] [Indexed: 11/30/2022]
Abstract
AIM Schizophrenia and 22q11.2 deletion syndrome (22q11DS) share similar patterns of cognitive deficits. Up to 30% of those with 22q11DS develop schizophrenia during early adulthood. As cognitive decline has recently been found to predict onset of psychosis in adolescents with 22q11DS, early interventions such as cognitive remediation (CR) during adolescence are warranted. This paper investigates the durability of a remote, computerized, CR programme for youth with 22q11DS. Our aim was to determine if the positive effects of CR persisted 6 months beyond intervention completion. METHODS A longitudinal design with 21 participants serving as their own controls was used. Youth were seen for neurocognitive assessments at pre-treatment, after the targeted 8-month intervention, at post-treatment, and 6 months after for follow-up. During the intervention, cognitive coaches met remotely with participants for CR via video conferencing three times a week, and offered task-specific strategies. To determine if intervention improvements held across the 6-month follow-up period, neurocognitive measures were statistically examined with repeated measures analysis of variances from pre-treatment through follow-up. RESULTS Our CR intervention proved durable. Post-treatment improvements comprising cognitive flexibility, executive function, reaction time and working memory were maintained over the follow-up period. CONCLUSIONS Results confirm previous research regarding the durability of CR treatment and extend these findings to youth with 22q11DS. The present study may serve to inform early intervention efforts focused on cognitive and functionally relevant rehabilitation goals for youth with 22q11DS and suggests that 22q11DS can potentially serve as a suitable model for examining the trajectory preceding psychosis.
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Affiliation(s)
- Margaret A Mariano
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, New York, USA
| | - Kerri Tang
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, New York, USA
| | - Matthew Kurtz
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA.,Program in Neuroscience and Behavior, Wesleyan University, Middletown, Connecticut, USA
| | - Wendy R Kates
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, New York, USA
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15
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Arango C, Díaz-Caneja CM, McGorry PD, Rapoport J, Sommer IE, Vorstman JA, McDaid D, Marín O, Serrano-Drozdowskyj E, Freedman R, Carpenter W. Preventive strategies for mental health. Lancet Psychiatry 2018; 5:591-604. [PMID: 29773478 DOI: 10.1016/s2215-0366(18)30057-9] [Citation(s) in RCA: 282] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/14/2022]
Abstract
Available treatment methods have shown little effect on the burden associated with mental health disorders. We review promising universal, selective, and indicated preventive mental health strategies that might reduce the incidence of mental health disorders, or shift expected trajectories to less debilitating outcomes. Some of these interventions also seem to be cost-effective. In the transition to mental illness, the cumulative lifetime effect of multiple small effect size risk factors progressively increases vulnerability to mental health disorders. This process might inform different levels and stages of tailored interventions to lessen risk, or increase protective factors and resilience, especially during sensitive developmental periods. Gaps between knowledge, policy, and practice need to be bridged. Future steps should emphasise mental health promotion, and improvement of early detection and interventions in clinical settings, schools, and the community, with essential support from society and policy makers.
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Affiliation(s)
- Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Centro de Investigación Biomédica en Red del área de Salud Mental (CIBERSAM), Madrid, Spain
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Centro de Investigación Biomédica en Red del área de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Patrick D McGorry
- Orygen, National Centre for Excellence in Youth Mental Health, and Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Judith Rapoport
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Iris E Sommer
- Department of Neuroscience, University Medical Center Groningen, Groningen, Netherlands
| | - Jacob A Vorstman
- Department of Psychiatry, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada; Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - David McDaid
- Department of Health Policy at the London School of Economics and Social Science, London, UK
| | - Oscar Marín
- Centre for Developmental Neurobiology, Institute of Psychiatry, Psychology and Neuroscience, and MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Elena Serrano-Drozdowskyj
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Centro de Investigación Biomédica en Red del área de Salud Mental (CIBERSAM), Madrid, Spain
| | - Robert Freedman
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - William Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, Baltimore, MD, USA
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16
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Buijs PCM, Bassett AS, Boot E. Non-pharmacological treatment of psychiatric disorders in individuals with 22q11.2 deletion syndrome; a systematic review. Am J Med Genet A 2018; 176:1742-1747. [PMID: 29363845 DOI: 10.1002/ajmg.a.38612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/22/2017] [Accepted: 12/26/2017] [Indexed: 11/05/2022]
Abstract
22q11.2 deletion syndrome (22q11.2DS) is associated with high rates of anxiety disorders, psychotic disorders, and other psychiatric conditions. In the general population, psychiatric disorders are treated with proven pharmacological and non-pharmacological therapies, such as cognitive behavioral therapy (CBT). To begin to assess the feasibility and efficacy of non-pharmacological therapies in 22q11.2DS, we performed a systematic search to identify literature on non-pharmacological interventions for psychiatric disorders in individuals with 22q11.2DS. Of 1,240 individual publications up to mid-2016 initially identified, 11 met inclusion criteria. There were five literature reviews, five publications reporting original research (two originating from a single study), and one publication not fitting either category that suggested adaptations to an intervention without providing scientific evidence. None of the original research involved direct study of the evidence-based non-pharmacological therapies available for psychiatric disorders. Rather, these four studies involved computer-based or group interventions aimed at improving neuropsychological deficits that may be associated with psychiatric disorders. Although the sample sizes were relatively small (maximum 28 participants in the intervention group), these reports documented the promising feasibility of these interventions, and improvements in domains of neuropsychological functioning, including working memory, attention, and social cognition. The results of this review underline the need for research into the feasibility and efficacy of non-pharmacological treatments of psychiatric disorders in individuals with 22q11.2DS to inform clinical care, using larger samples, and optimally, standard randomized, placebo-controlled, clinical trials methodology.
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Affiliation(s)
- Petra C M Buijs
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada.,Kenter Jeugdhulp, Child and Adolescent Mental Health Care, Santpoort-Noord, The Netherlands
| | - Anne S Bassett
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada.,Clinical Genetics Research Program and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Ontario, Canada.,Division of Cardiology, Department of Medicine, and Toronto General Research Institute, University Health Network, University Health Network, Toronto, Ontario, Canada
| | - Erik Boot
- The Dalglish Family 22q Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada.,De Hartekamp Groep, Centre for People with Intellectual Disability, Haarlem, The Netherlands
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17
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Murdaugh DL, King TZ, O’toole K. The efficacy of a pilot pediatric cognitive remediation summer program to prepare for transition of care. Child Neuropsychol 2017; 25:131-151. [DOI: 10.1080/09297049.2017.1391949] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Donna L. Murdaugh
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Tricia Z. King
- Department of Psychology and the Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Kathleen O’toole
- Department of Neuropsychology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
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18
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Antshel KM, Fremont W, Ramanathan S, Kates WR. Predicting Cognition and Psychosis in Young Adults With 22q11.2 Deletion Syndrome. Schizophr Bull 2017; 43:833-842. [PMID: 27798222 PMCID: PMC5472116 DOI: 10.1093/schbul/sbw135] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the extent to which the trajectories of intellectual, academic achievement, executive functioning, attention, working memory, and emotion recognition tests will be predictive of psychosis in young adults with 22q11.2 deletion syndrome (22q11DS). METHODS Eighty-two participants with 22q11DS were assessed for psychiatric disorders and neuropsychological functioning with validated instruments. Siblings and community controls were employed as comparison groups. RESULTS Individuals with 22q11DS differed significantly from siblings and controls in longitudinal trajectories of visual and auditory working memory as well as academic achievement. Longitudinal trajectories of cognitive set shifting, reading decoding, and emotion recognition predicted the presence of positive symptoms of psychosis in early adulthood. Cognitive set shifting improved at a slower rate for individuals with 22q11DS + psychosis than those without psychosis. Emotion recognition increased steadily in individuals without psychosis, whereas for those with psychosis, scores increased until approximately 15 years of age, at which point they began to decrease rapidly. A similar, but more subtle effect, was seen for reading decoding. CONCLUSIONS Our data are the first to go beyond IQ assessments in assessing longitudinal neuropsychological outcomes and risk for psychosis in 22q11DS. Individuals with 22q11DS who developed psychotic symptoms improved less appreciably and continued to demonstrate difficulties with cognitive flexibility relative to individuals with 22q11DS who did not have psychotic symptoms. Individuals with 22q11DS who developed psychosis had weaker reading skills in childhood and, after an initial improvement into adolescence, these individuals with psychosis had a decline in reading skills. In 22q11DS, cognitive deficits are both (a) traits that are preexisting and raise the risk for psychosis and (b) associated with the onset of psychotic symptoms. Future research should consider the extent to which cognitive set shifting and reading decoding are related to the Verbal IQ declines observed in the 22q11DS population.
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Affiliation(s)
- Kevin M Antshel
- Department of Psychology, Syracuse University, Syracuse, NY
- Department of Psychiatry and Behavioral Science, SUNY-Upstate Medical University, Syracuse, NY
| | - Wanda Fremont
- Department of Psychiatry and Behavioral Science, SUNY-Upstate Medical University, Syracuse, NY
| | - Seetha Ramanathan
- Department of Psychiatry and Behavioral Science, SUNY-Upstate Medical University, Syracuse, NY
- Hutchings Psychiatric Center, Syracuse, NY
| | - Wendy R Kates
- Department of Psychiatry and Behavioral Science, SUNY-Upstate Medical University, Syracuse, NY
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19
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Weinberger R, Yi J, Calkins M, Guri Y, McDonald-McGinn DM, Emanuel BS, Zackai EH, Ruparel K, Carmel M, Michaelovsky E, Weizman A, Gur RC, Gur RE, Gothelf D. Neurocognitive profile in psychotic versus nonpsychotic individuals with 22q11.2 deletion syndrome. Eur Neuropsychopharmacol 2016; 26:1610-8. [PMID: 27524298 DOI: 10.1016/j.euroneuro.2016.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/12/2016] [Accepted: 08/01/2016] [Indexed: 11/27/2022]
Abstract
The 22q11.2 deletion syndrome (22q11DS) is associated with increased rates of psychotic disorders and cognitive deficits, but large scale studies are needed to elucidate their interaction. The objective of this two-center study was to identify the neurocognitive phenotype of individuals with 22q11DS and psychotic disorders. We hypothesized that psychotic 22q11DS individuals compared to nonpsychotic deleted individuals would have more severe neurocognitive deficits, especially in executive function and social cognition. These deficits would be present when compared to IQ- matched individuals with Williams Syndrome (WS). Three groups were ascertained from the Tel Aviv and Philadelphia centers: 22q11DS individuals with a psychotic disorder (n=31), nonpsychotic 22q11DS (n=86) and typically-developing controls (TD, n=828). In Tel Aviv a group of individuals with WS (n=18) matched in IQ to the 22q11DS psychotic group was also included. The Penn Computerized Neurocognitive Battery (CNB) was used to assess a wide-range of cognitive functions and all patients underwent structured psychiatric evaluations. 22q11DS individuals performed poorly on all CNB domains compared to TD. Participants with 22q11DS and psychosis, compared to nonpsychotic 22q11DS, had more severe deficits in global neurocognitive performance (GNP), executive function, social cognition and episodic memory domains. The primary deficits were also significant when comparing the Tel Aviv 22q11DS psychotic group to IQ-matched individuals with WS. In conclusion, 22q11DS individuals with a psychotic disorder have specific neurocognitive deficits that are reliably identified cross nationality using the CNB. These cognitive dysfunctions should be further studied as potential endophenotypes of psychosis in 22q11DS and as targets for intervention.
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Affiliation(s)
| | - James Yi
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry, Children׳s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Monica Calkins
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA
| | - Yael Guri
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Donna M McDonald-McGinn
- Division of Human Genetics, The Children׳s Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA
| | - Beverly S Emanuel
- Division of Human Genetics, The Children׳s Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA
| | - Elaine H Zackai
- Division of Human Genetics, The Children׳s Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA
| | - Kosha Ruparel
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA
| | - Miri Carmel
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Elena Michaelovsky
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Abraham Weizman
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel; Research Unit, Geha Mental Health Center, Petah Tikva, Israel
| | - Ruben C Gur
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry, Children׳s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Raquel E Gur
- Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Philadelphia Pennsylvania, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry, Children׳s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Doron Gothelf
- Sackler Faculty of Medicine, Tel Aviv University, Israel; The Child Psychiatry Unit, Edmond and Lily Sapfra Children׳s Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
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20
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Abstract
22q11.2 Deletion syndrome (22q11.2DS) is a chromosomal microdeletion that affects approximately 40 to 50 genes and affects various organs and systems throughout the body. Detection is typically achieved by fluorescence in situ hybridization after diagnosis of one of the major features of the deletion or via chromosomal microarray or noninvasive prenatal testing. The physical phenotype can include congenital heart defects, palatal and pharyngeal anomalies, hypocalcemia/hypoparathyroidism, skeletal abnormalities, and cranial/brain anomalies, although prevalence rates of all these features are variable. Cognitive function is impaired to some degree in most individuals, with prevalence rates of greater than 90% for motor/speech delays and learning disabilities. Attention, executive function, working memory, visual-spatial abilities, motor skills, and social cognition/social skills are affected. The deletion is also associated with an increased risk for behavioral disorders and psychiatric illness. The early onset of psychiatric symptoms common to 22q11.2DS disrupts the development and quality of life of individuals with the syndrome and is also a potential risk factor for later development of a psychotic disorder. This review discusses prevalence, phenotypic features, and management of psychiatric disorders commonly diagnosed in children and adolescents with 22q11.2DS, including autism spectrum disorders, attention deficit/hyperactivity disorder, anxiety disorders, mood disorders, and schizophrenia/psychotic disorders. Guidelines for the clinical assessment and management of psychiatric disorders in youth with this syndrome are provided, as are treatment guidelines for the use of psychiatric medications.
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