1
|
Schott BH, Voetlause JC, Amoah JL, Kratzenberg A, Belz M, Knipper T, Timäus C, Beskow C, Sweeney-Reed CM, Wiltfang J, Radenbach K. Establishment of a teaching hospital-based dementia consultation service for rurally-based regional district general hospitals. Front Public Health 2022; 10:849161. [PMID: 36530727 PMCID: PMC9751594 DOI: 10.3389/fpubh.2022.849161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 11/14/2022] [Indexed: 12/04/2022] Open
Abstract
Objective The treatment of patients with dementia poses a considerable challenge to regional district general hospitals, particularly in rural areas. Here we report the establishment and initial evaluation of a dementia-specific consultation service provided by a teaching hospital-based Psychiatry Department to regional district general hospitals in surrounding smaller towns. Methods The consultation service was provided to patients with pre-existing or newly suspected dementia, who were in acute hospital care for concurrent conditions. An evaluation of 61 consultations - 49 on-site and 12 via telemedicine - was performed to assess the needs of the participating hospitals and the specific nature of the referrals to the consultation service. Results Suspected dementia or cognitive dysfunction was the primary reason for consultation requests (>50% of cases). Other common requests concerned suspected delirium, behavioral symptoms, and therapeutic recommendations. During the consultations, a diagnosis of dementia was reached in 52.5% of cases, with other common diagnoses including delirium and depression. Recommendations related to pharmacotherapy were given in 54.1% of consultations. Other recommendations included referral for outpatient neurological or psychiatric follow-up, further diagnostic assessment, or assessment in a memory clinic. Geriatric psychiatric inpatient treatment was recommended in only seven cases (11.5 %). Conclusion Our initial evaluation demonstrates the feasibility of providing a dementia-specific consultation service in rural areas. The service has the potential to reduce acute transfers to inpatient geriatric psychiatry and enables older patients with dementia or delirium to be treated locally by helping and empowering rurally-based regional hospitals to manage these problems and associated complications.
Collapse
Affiliation(s)
- Björn H. Schott
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany,German Center for Neurodegenerative Diseases, Göttingen, Germany,Leibniz Institute for Neurobiology, Magdeburg, Germany,Center for Behavioral Brain Sciences, Otto von Guericke University Magdeburg, Magdeburg, Germany,Björn H. Schott
| | | | - Juliana Lisa Amoah
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Alexander Kratzenberg
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany,German Center for Neurodegenerative Diseases, Göttingen, Germany
| | - Michael Belz
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Tobias Knipper
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Charles Timäus
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Carmen Beskow
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Catherine M. Sweeney-Reed
- Center for Behavioral Brain Sciences, Otto von Guericke University Magdeburg, Magdeburg, Germany,Deptartment of Neurology, Neurocybernetics and Rehabilitation, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany,German Center for Neurodegenerative Diseases, Göttingen, Germany,Department of Medical Sciences, Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Katrin Radenbach
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany,*Correspondence: Katrin Radenbach
| |
Collapse
|
2
|
Telemedical care and quality of life in patients with schizophrenia and bipolar disorder: results of a randomized controlled trial. BMC Psychiatry 2021; 21:318. [PMID: 34187420 PMCID: PMC8243575 DOI: 10.1186/s12888-021-03318-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/09/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Schizophrenia and bipolar disorder are serious psychiatric disorders with a high disease burden, a high number of years of life lived with disability and a high risk for relapses and re-hospitalizations. Besides, both diseases are often accompanied with a reduced quality of life (QoL). A low level of quality of life is one predictor for relapses. This study examines whether a telemedical care program can improve QoL. METHODS Post stationary telemedical care of patients with severe psychiatric disorders" (Tecla) is a prospective controlled randomized intervention trial to implement and evaluate a telemedical care concept for patients with schizophrenia and bipolar disorder. Participants were randomized to an intervention or a control group. The intervention group received telemedical care including regular, individualized telephone calls and SMS-messages. QoL was measured with the German version of the WHOQOL-BREF. Effects of telemedicine on QoL after 6 months and treatment*time interactions were calculated using linear regressions (GLM and linear mixed models). RESULTS One hundred eighteen participants were recruited, thereof 57.6% men (n = 68). Participants were on average 43 years old (SD 13). The treatment*time interaction was not significant. Hence, treatment had no significant effect either. Instead, gender is an influencing factor. Further analysis showed that social support, the GAF-level and QoL-values at baselines were significant determinants for the improvement of QoL. CONCLUSION The telemedicine care concept Tecla was not significant for QoL in patients with severe psychiatric disorders. More important for the QoL is the general social support and the level of global functioning of the patients. TRIAL REGISTRATION German Clinical Trials Register, DRKS00008548, registered 21 May 2015 - retrospectively registered, https://www.drks.de/drks_web/setLocale_EN.do.
Collapse
|
3
|
Bischoff M, Howland V, Klinger-König J, Tomczyk S, Schmidt S, Zygmunt M, Heckmann M, van den Berg N, Bethke B, Corleis J, Günther S, Liutkus K, Stentzel U, Neumann A, Penndorf P, Ludwig T, Hammer E, Winter T, Grabe HJ. Save the children by treating their mothers (PriVileG-M-study) - study protocol: a sequentially randomized controlled trial of individualized psychotherapy and telemedicine to reduce mental stress in pregnant women and young mothers and to improve Child's health. BMC Psychiatry 2019; 19:371. [PMID: 31775668 PMCID: PMC6880484 DOI: 10.1186/s12888-019-2279-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/10/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND As early as pregnancy, maternal mental stress impinges on the child's development and health. Thus, this may cause enhanced risk for premature birth, lowered fetal growth, and lower fetal birth weight as well as enhanced levels of the stress hormone cortisol and lowered levels of the bonding hormone oxytocin. Maternal stress further reduces maternal sensitivity for the child's needs which impairs the mother-child-interaction and bonding. Therefore, prevention and intervention studies on mental stress are necessary, beginning prenatally and applying rigorous research methodology, such as randomized controlled trials, to ensure high validity. METHODS A randomized controlled trial is used to assess the impact of psychotherapy and telemedicine on maternal mental stress and the child's mental and physical health. Mentally stressed pregnant women are randomized to an intervention (IG) and a not intervened control group. The IG receives an individualized psychotherapy starting prenatal and lasting for 10 months. Afterwards, a second randomization is used to investigate whether the use of telemedicine can stabilize the therapeutic effects. Using ecological momentary assessments and video recordings, the transfer into daily life, maternal sensitivity and mother-child-bonding are assessed. Psycho-biologically, the synchronicity of cortisol and oxytocin levels between mother and child are assessed as well as the peptidome of the colostrum and breast milk, which are assumed to be essential for the adaptation to the extra-uterine environment. All assessments are compared to an additional control group of healthy women. Finally, the results of the study will lead to the development of a qualification measure for health professionals to detect mental stress, to treat it with low-level interventions and to refer those women with high stress levels to mental health professionals. DISCUSSION The study aims to prevent the transgenerational transfer of psychiatric and somatic disorders from the mother to her child. The effects of the psychotherapy will be stabilized through telemedicine and long-term impacts on the child's and mothers' mental health are enhanced. The combination of psychotherapy, telemedicine and methodologies of ecological momentary assessment, video recording and bio banking are new in content-related and methodological manner. TRIAL REGISTRATION German Clinical Trials Register: DRKS00017065. Registered 02 May 2019. World Health Organization, Universal Trial Number: U1111-1230-9826. Registered 01 April 2019.
Collapse
Affiliation(s)
- M. Bischoff
- Department of Health and Prevention, Institute of Psychology, University Greifswald, Greifswald, Germany
| | - V. Howland
- Department of Neonatology and Paediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - J. Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - S. Tomczyk
- Department of Health and Prevention, Institute of Psychology, University Greifswald, Greifswald, Germany
| | - S. Schmidt
- Department of Health and Prevention, Institute of Psychology, University Greifswald, Greifswald, Germany
| | - M. Zygmunt
- Clinic and Polyclinic for Obstetrics and Gynecology, University Medicine Greifswald, Greifswald, Germany
| | - M. Heckmann
- Department of Neonatology and Paediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - N. van den Berg
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - B. Bethke
- Department of Health, Nursing and Administration, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - J. Corleis
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - S. Günther
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - K. Liutkus
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - U. Stentzel
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - A. Neumann
- Department of Health, Nursing and Administration, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - P. Penndorf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - T. Ludwig
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - E. Hammer
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - T. Winter
- Integrated Research Biobank, University Medicine Greifswald, Greifswald, Germany
| | - H. J. Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| |
Collapse
|
4
|
Bright CE. Integrative Review of Mobile Phone Contacts and Medication Adherence in Severe Mental Illness. J Am Psychiatr Nurses Assoc 2018; 24:209-222. [PMID: 29457508 DOI: 10.1177/1078390318754986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Poor medication adherence is a significant problem in individuals with severe mental illness (SMI). About 50% of people with SMI become nonadherent to treatment in the first month following discharge from the hospital. OBJECTIVE This study examined literature in the past decade (2006-2016) on the use of mobile phone contacts in individuals with SMI to improve medication adherence post hospital discharge. DESIGN This integrative review used the search terms texting, text messaging, SMS, cell/mobile phone, medication adherence, medication compliance, and mental illness. Databases (CINAHL, PubMed, PsycINFO, and Scopus) and manual searching of reference lists were done. The main inclusion criteria were the use of mobile phone contacts on medication adherence in individuals with SMI. Adults 18 years and older, studies conducted from 2006 to 2016, and studies conducted in English were also criteria for inclusion. Only five studies met criteria for inclusion. RESULTS Outcomes from the review showed that mobile phone contacts have been used to improve medication adherence in individuals with SMI and able to provide the four types of social support (instrumental, informational, emotional, and, appraisal). When phone contacts especially text messaging was used as an adjunct to other interventions, it yielded better medication adherence than when used alone. However, results on medication adherence rates were mixed in participants on both psychiatric and nonpsychiatric medications. CONCLUSION Although mobile phone contacts are a promising tool to enhance medication adherence after hospital discharge, its effectiveness to increase medication adherence in this population remains inconclusive.
Collapse
Affiliation(s)
- Cordellia E Bright
- 1 Cordellia E. Bright, MHA, BSN, RN, PhD Candidate, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
5
|
Berrouiguet S, Baca-García E, Brandt S, Walter M, Courtet P. Fundamentals for Future Mobile-Health (mHealth): A Systematic Review of Mobile Phone and Web-Based Text Messaging in Mental Health. J Med Internet Res 2016; 18:e135. [PMID: 27287668 PMCID: PMC4920962 DOI: 10.2196/jmir.5066] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/30/2016] [Indexed: 01/02/2023] Open
Abstract
Background Mobile phone text messages (short message service, SMS) are used pervasively as a form of communication. Almost 100% of the population uses text messaging worldwide and this technology is being suggested as a promising tool in psychiatry. Text messages can be sent either from a classic mobile phone or a web-based application. Reviews are needed to better understand how text messaging can be used in mental health care and other fields of medicine. Objective The objective of the study was to review the literature regarding the use of mobile phone text messaging in mental health care. Methods We conducted a thorough literature review of studies involving text messaging in health care management. Searches included PubMed, PsycINFO, Cochrane, Scopus, Embase and Web of Science databases on May 25, 2015. Studies reporting the use of text messaging as a tool in managing patients with mental health disorders were included. Given the heterogeneity of studies, this review was summarized using a descriptive approach. Results From 677 initial citations, 36 studies were included in the review. Text messaging was used in a wide range of mental health situations, notably substance abuse (31%), schizophrenia (22%), and affective disorders (17%). We identified four ways in which text messages were used: reminders (14%), information (17%), supportive messages (42%), and self-monitoring procedures (42%). Applications were sometimes combined. Conclusions We report growing interest in text messaging since 2006. Text messages have been proposed as a health care tool in a wide spectrum of psychiatric disorders including substance abuse, schizophrenia, affective disorders, and suicide prevention. Most papers described pilot studies, while some randomized clinical trials (RCTs) were also reported. Overall, a positive attitude toward text messages was reported. RCTs reported improved treatment adherence and symptom surveillance. Other positive points included an increase in appointment attendance and in satisfaction with management and health care services. Insight into message content, preventative strategies, and innovative approaches derived from the mental health field may be applicable in other medical specialties.
Collapse
Affiliation(s)
- Sofian Berrouiguet
- Brest Medical University Hospital at Bohars, Adult Psychiatry, Brest, France.
| | | | | | | | | |
Collapse
|
6
|
Hajiabolhasani-Nargani Z, Najafi M, Mehrabi T. Effect of mobile parenting skills education on anxiety of the mothers with autistic children. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:572-576. [PMID: 28194195 PMCID: PMC5301062 DOI: 10.4103/1735-9066.197668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: The parents of autistic children suffer from anxiety and tension. Unawareness of parenting skills required for autistic children (parenting) doubles their anxiety. Researchers have recently considered research on mobile education, especially mobile text messages. The present study aimed to investigate the effect of mobile parenting skills education on the anxiety of mothers with autistic children. Materials and Methods: This is a clinical trial conducted on 64 mothers of children suffering from autism who had a medical file. The participants were recruited by convenient sampling in selected autism centers in Isfahan, Iran. Then, the participants were randomly assigned into two 32-subject groups of study and control. Spielberger Anxiety Inventory was adopted for the mothers. The book “Parenting skills for the mothers with autistic children” was distributed in the study and control group, and then, the study group underwent a structured mobile text messages education. Sixty text messages were sent daily to the participants in the study group for two months. Data were analyzed by Mann–Whitney, Chi-square, independent t-test, and paired t-test using Statistical Package for the Social Sciences version 16. Results: The obtained results showed a significant decrease in mothers’ anxiety mean score after intervention in the study group compared to control group (P = 0.04). There was also a significant reduction in mothers’ anxiety mean score after intervention, compared to before intervention (P < 0.001). Conclusions: Mobile parenting skills education, especially through text messages, could reduce the level of anxiety among the mothers with autistic children.
Collapse
Affiliation(s)
- Zahra Hajiabolhasani-Nargani
- Student Research Centre, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Najafi
- Department of Child and Adolescent Psychiatry, Faculty of Medical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tayebeh Mehrabi
- Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
7
|
Stentzel U, Grabe HJ, Strobel L, Penndorf P, Langosch J, Freyberger HJ, Hoffmann W, van den Berg N. Tecla: a telephone- and text-message based telemedical concept for patients with severe mental health disorders--study protocol for a controlled, randomized, study. BMC Psychiatry 2015; 15:273. [PMID: 26537570 PMCID: PMC4634903 DOI: 10.1186/s12888-015-0659-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/20/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Severe mental disorders like psychotic disorders including schizophrenia and schizoaffective disorders have a 12-month-prevalence of 2.6, bipolar disorders of 1.5% in Germany. The relapse risk is high; so many patients need intensive monitoring and lifelong treatment. A high medication adherence is essential for a successful treatment. But in practice, medication adherence is low and decreases over time. Telemedical care concepts might improve treatment and bridge gaps between in- and outpatient treatment. A telemedical care concept based on regular telephone calls and short text messages was developed. The primary objective is to assess whether regular telephone calls and text messages can improve the medication adherence of patients. Secondary objectives are the reduction of rehospitalization rates, the improvement of quality of life and of the severity of symptoms. METHODS/DESIGN The Tecla study (Post stationary telemedical care of patients with severe psychiatric disorders) is a two-armed prospective randomized controlled trial. The participants in the intervention group receive in addition to usual care regular telephone calls every 2 weeks and weekly text messages on patient-individual topics during a 6 months period. Patients in the control group receive only regular care. Inclusion criteria are a physician-diagnosed bipolar disorder, schizoaffective disorder or schizophrenia and a signed informed consent. Exclusion criteria are planned inpatient treatments within the next 6 months and being non-reachable by phone. After 3 and 6 months both groups receive follow up assessments. DISCUSSION The primary objective of this study is the medication adherence that is measured with the Medication Adherence Report Scale, German version (MARS-D). The MARS-D is a self-report with five items. Adherent behaviour is mostly overestimated using self-reports. The strength of the MARS-D is to detect non-adherent behaviour. The original Medication Adherence Report Scale in English language (MARS-5) was developed to encourage the patient to answer truthfully to the questions that are asked in a non-threatening and non-judgmental way to minimize social desirability bias in admitting non-adherent behaviour. TRIAL REGISTRATION This study is registered at 2015\05\21 at the German Clinical Trials Register DRKS00008548.
Collapse
Affiliation(s)
- Ulrike Stentzel
- Institute for Community Medicine, University Medicine Greifswald, Ellernholzstraße 1-2, 17487, Greifswald, Germany.
| | - Hans-Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Ellernholzstraße 1-2, 17487, Greifswald, Germany.
| | - Lara Strobel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Ellernholzstraße 1-2, 17487, Greifswald, Germany.
| | - Peter Penndorf
- Institute for Community Medicine, University Medicine Greifswald, Ellernholzstraße 1-2, 17487, Greifswald, Germany.
| | - Jens Langosch
- Bethanien Hospital for Psychiatry, Psychosomatics and Psychotherapy, Gützkower Landstraße 69, 17489, Greifswald, Germany.
| | - Harald J Freyberger
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Ellernholzstraße 1-2, 17487, Greifswald, Germany.
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University Medicine Greifswald, Ellernholzstraße 1-2, 17487, Greifswald, Germany.
| | - Neeltje van den Berg
- Institute for Community Medicine, University Medicine Greifswald, Ellernholzstraße 1-2, 17487, Greifswald, Germany.
| |
Collapse
|
8
|
van den Berg N, Grabe HJ, Baumeister SE, Freyberger HJ, Hoffmann W. A Telephone- and Text Message-Based Telemedicine Concept for Patients with Mental Health Disorders: Results of a Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2015; 84:82-89. [PMID: 25721861 DOI: 10.1159/000369468] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 10/29/2014] [Indexed: 11/19/2022]
Abstract
Background: A telemedicine care concept based on telephone contacts and individualized text messages was developed for patients with mental disorders to continue treatment after therapy in a psychiatric day hospital. The primary objective of this study was to evaluate the effectiveness of the telemedicine interventions. Methods: The study had a 3-armed, randomized design with 2 intervention arms (intervention 1: telephone contacts; intervention 2: telephone contacts and short text messages; both took place over a period of 6 months and in addition to usual care), and a control group with usual care. Primary outcomes were 18-item Brief Symptom Inventory (BSI-18) scores for anxiety, depression and somatization. All participants were recruited from psychiatric day hospitals. The study was registered in the German Clinical Trials Register (DRKS00000662). Results: 113 participants were analyzed 6 months after starting the intervention. The average BSI-18 anxiety score after 6 months was -2.04 points lower in intervention group 2 than in the control group (p value: 0.042). The difference in BSI depression score between these two groups was marginally significant (p value: 0.1), with an average treatment effect of -1.73. In an exploratory sensitivity analysis restricted to the 75% of patients with the highest symptom scores at baseline, intervention group 1 yielded a significant effect for anxiety and depression compared to the control group (p = 0.036 and 0.046, respectively). Conclusions: Telemedicine provides a novel option in psychiatric ambulatory care with statistically significant effects on anxiety. A positive tendency was observed for depression, especially in cases with higher symptom load at baseline. © 2015 S. Karger AG, Basel.
Collapse
Affiliation(s)
- Neeltje van den Berg
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | | | | | | |
Collapse
|
9
|
Ye X, Bapuji SB, Winters SE, Struthers A, Raynard M, Metge C, Kreindler SA, Charette CJ, Lemaire JA, Synyshyn M, Sutherland K. Effectiveness of internet-based interventions for children, youth, and young adults with anxiety and/or depression: a systematic review and meta-analysis. BMC Health Serv Res 2014; 14:313. [PMID: 25037951 PMCID: PMC4110069 DOI: 10.1186/1472-6963-14-313] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 07/10/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The majority of internet-based anxiety and depression intervention studies have targeted adults. An increasing number of studies of children, youth, and young adults have been conducted, but the evidence on effectiveness has not been synthesized. The objective of this research is to systematically review the most recent findings in this area and calculate overall (pooled) effect estimates of internet-based anxiety and/or depression interventions. METHODS We searched five literature databases (PubMed, EMBASE, CINAHL, PsychInfo, and Google Scholar) for studies published between January 1990 and December 2012. We included studies evaluating the effectiveness of internet-based interventions for children, youth, and young adults (age <25 years) with anxiety and/or depression and their parents. Two reviewers independently assessed the risk of bias regarding selection bias, allocation bias, confounding bias, blinding, data collection, and withdrawals/dropouts. We included studies rated as high or moderate quality according to the risk of bias assessment. We conducted meta-analyses using the random effects model. We calculated standardized mean difference and its 95% confidence interval (95% CI) for anxiety and depression symptom severity scores by comparing internet-based intervention vs. waitlist control and internet-based intervention vs. face-to-face intervention. We also calculated pooled remission rate ratio and 95% CI. RESULTS We included seven studies involving 569 participants aged between 7 and 25 years. Meta-analysis suggested that, compared to waitlist control, internet-based interventions were able to reduce anxiety symptom severity (standardized mean difference and 95% CI = -0.52 [-0.90, -0.14]) and increase remission rate (pooled remission rate ratio and 95% CI =3.63 [1.59, 8.27]). The effect in reducing depression symptom severity was not statistically significant (standardized mean difference and 95% CI = -0.16 [-0.44, 0.12]). We found no statistical difference in anxiety or depression symptoms between internet-based intervention and face-to-face intervention (or usual care). CONCLUSIONS The present analysis indicated that internet-based interventions were effective in reducing anxiety symptoms and increasing remission rate, but not effective in reducing depression symptom severity. Due to the small number of higher quality studies, more attention to this area of research is encouraged. TRIAL REGISTRATION PROSPERO registration: CRD42012002100.
Collapse
Affiliation(s)
- Xibiao Ye
- Centre for Healthcare Innovation Evaluation Platform, Winnipeg Regional Health Authority, 200-1155 Concordia Avenue, Winnipeg, Manitoba R2K 2M9, Canada
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sunita Bayyavarapu Bapuji
- Centre for Healthcare Innovation Evaluation Platform, Winnipeg Regional Health Authority, 200-1155 Concordia Avenue, Winnipeg, Manitoba R2K 2M9, Canada
| | - Shannon Elizabeth Winters
- Centre for Healthcare Innovation Evaluation Platform, Winnipeg Regional Health Authority, 200-1155 Concordia Avenue, Winnipeg, Manitoba R2K 2M9, Canada
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON N6G 1H1, Canada
- Mental Health Crisis Response Centre, Winnipeg Regional Health Authority, 817 Bannatyne Avenue, Winnipeg MB R3E 0W4, Canada
| | - Ashley Struthers
- Centre for Healthcare Innovation Evaluation Platform, Winnipeg Regional Health Authority, 200-1155 Concordia Avenue, Winnipeg, Manitoba R2K 2M9, Canada
| | - Melissa Raynard
- Concordia Hospital Library, University of Manitoba, 1095 Concordia Avenue, Winnipeg, Manitoba R2N 3S8, Canada
| | - Colleen Metge
- Centre for Healthcare Innovation Evaluation Platform, Winnipeg Regional Health Authority, 200-1155 Concordia Avenue, Winnipeg, Manitoba R2K 2M9, Canada
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sara Adi Kreindler
- Centre for Healthcare Innovation Evaluation Platform, Winnipeg Regional Health Authority, 200-1155 Concordia Avenue, Winnipeg, Manitoba R2K 2M9, Canada
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Catherine Joan Charette
- Centre for Healthcare Innovation Evaluation Platform, Winnipeg Regional Health Authority, 200-1155 Concordia Avenue, Winnipeg, Manitoba R2K 2M9, Canada
| | | | - Margaret Synyshyn
- Manitoba Adolescent Treatment Centre, 120 Tecumseh St, Winnipeg, Manitoba R3E 2A9, Canada
| | - Karen Sutherland
- Manitoba Adolescent Treatment Centre, 120 Tecumseh St, Winnipeg, Manitoba R3E 2A9, Canada
| |
Collapse
|
10
|
Telemonitoring with respect to mood disorders and information and communication technologies: overview and presentation of the PSYCHE project. BIOMED RESEARCH INTERNATIONAL 2014; 2014:104658. [PMID: 25050321 PMCID: PMC4094725 DOI: 10.1155/2014/104658] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 06/04/2014] [Accepted: 06/08/2014] [Indexed: 12/15/2022]
Abstract
This paper reviews what we know about prediction in relation to mood disorders from the perspective of clinical, biological, and physiological markers. It then also presents how information and communication technologies have developed in the field of mood disorders, from the first steps, for example, the transition from paper and pencil to more sophisticated methods, to the development of ecological momentary assessment methods and, more recently, wearable systems. These recent developments have paved the way for the use of integrative approaches capable of assessing multiple variables. The PSYCHE project stands for Personalised monitoring SYstems for Care in mental HEalth.
Collapse
|
11
|
Barekatain M, Maracy MR, Rajabi F, Baratian H. Aftercare services for patients with severe mental disorder: A randomized controlled trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2014; 19:240-5. [PMID: 24949032 PMCID: PMC4061646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 10/26/2013] [Accepted: 12/01/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although evidences emphasize on the importance of aftercare programs to achieve continuity of care, different studies have revealed controversial results about the outcome. The objective of this study was to investigate the effect of aftercare program on outcome measures of patients with severe mental disorders. MATERIALS AND METHODS Of a total 123 eligible patients with severe mental disorders, 61 patients were randomly assigned to the intervention group and 62 patients to the control group. The interventions included follow-up phone calls, home visits, and psychoeducation for families. Assessments were performed on hospital admission, discharge and the following 3(rd), 6(th) and 12(th) month. Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), and the World Health Organization Quality of Life Questionnaire (WHO-QOL) were used. Data were analyzed through Chi square, t-test, Mann-Whitney-U, and Repeated Measures Analysis of Co-Variance. RESULTS Mean of the HDRS scores revealed significant difference between the two groups when HDRS scores on the admission day were controlled (P = 0.028). The level of functioning was significantly different between the two groups based on the sequential assessments of GAF (P = 0.040). One year after the onset of trial, the number of psychiatric readmissions were significantly different between the two groups (P = 0.036). CONCLUSION Readmission rates could be reduced by aftercare services, through the first year, after discharge of patients with severe mental disorders. On the other hand, higher levels of functioning would be expected after one year.
Collapse
Affiliation(s)
- Majid Barekatain
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Rajabi
- Department of Psychiatry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hajar Baratian
- Department of Psychology, Khorasgan Branch, Islamic Azad University, Isfahan, Iran,Address for correspondence: Miss Hajar Baratian, Department of Psychology, Khorasgan Branch, Islamic Azad University, Nour Hospital, Ostandari Street, Isfahan, Iran. E-mail:
| |
Collapse
|
12
|
Use of mental health telemetry to enhance identification and predictive value of early changes during augmentation treatment of major depression. J Clin Psychopharmacol 2013; 33:775-81. [PMID: 24100787 DOI: 10.1097/jcp.0b013e31829e8359] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Standard clinical trial methodology in depression does not allow for careful examination of early changes in symptom intensity. The purpose of this study was to use daily "Mental Health Telemetry" (MHT) to prospectively record change in depressive and anxiety symptoms for depressed patients receiving augmentation treatment, and determine the extent and predictive capacity of early changes. We report results of a 6-week, open-label study of the addition of quetiapine XR (range, 50-300 mg) for adult patients (n = 26) with major depressive disorder who were nonresponsive to antidepressant treatment. In addition to regular study visits, all participants completed daily, wirelessly transmitted self-report ratings of symptoms on a Smartphone. Daily and 3-day moving average mean scores were calculated, and associations between early symptom change and eventual response to treatment were determined. Improvement in depressive and anxiety symptoms was identified as early as day 1 of treatment. Of the total decline in depression severity over 6 weeks, 9% was present at day 1, 28% at day 2, 39% at days 3 and 4, 65% at day 7, and 80% at day 10. Self-report rating of early improvement (≥20%) in depressive symptoms at day 7 significantly predicted responder status at week 6 (P = 0.03). Clinician-rated depressive and anxiety symptoms only became significantly associated with responder status at day 14. In conclusion, very early changes in depressive symptoms were identified using MHT, early changes accounted for most of total change, and MHT-recorded improvement as early as day 7 significantly predicted response to treatment at study end point.
Collapse
|
13
|
|
14
|
Natrielli DG, Natrielli DG, Enokibara M. The use of telemedicine with patients in clinical practice: the view of medical psychology. SAO PAULO MED J 2013; 131:62-3. [PMID: 23538598 PMCID: PMC10852068 DOI: 10.1590/s1516-31802013000100011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 04/21/2012] [Accepted: 06/12/2012] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Décio Gilberto Natrielli
- MD. Scientific Coordinator, Multidisciplinary Committee of Medical Psychology, Associação Paulista de Medicina (APM), São Paulo, Brazil.
| | - Mailu Enokibara
- MD. Resident, Department of Psychiatry, Centro de Atenção Integrada a Saúde Mental (CAISM), Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil.
| |
Collapse
|
15
|
A short message service (SMS)-based strategy for enhancing adherence to antipsychotic medication in schizophrenia. Psychiatry Res 2012; 200:89-95. [PMID: 22901437 DOI: 10.1016/j.psychres.2012.07.034] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 06/08/2012] [Accepted: 07/24/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim of this study was to assess the impact of a short message service (SMS)-based strategy on adherence to antipsychotic treatment. METHODS A multicentre, randomised, open-label, controlled, 6-month study with clinically stabilised outpatients with schizophrenia was conducted. The patients assigned to the intervention received daily SMS reminders to take their medication for 3 months. Self-reported medication adherence was determined using the Morisky Green Adherence Questionnaire (MAQ). Secondary outcomes were severity of illness, attitude towards medication, insight into illness and health-related quality of life. RESULTS A total of 254 patients were analysed. A significantly greater improvement in adherence was observed among patients receiving SMS text messages compared with the control group. The mean change in MAQ total score from baseline to month 3 was -1.0 (95% confidence interval (CI) -1.02, -0.98) and -0.7 (95%CI -0.72, -0.68), respectively (P=0.02). Greater improvement in negative, cognitive and global clinical symptoms at month 3 was observed. Attitude towards medication also significantly improved across the study in the intervention group versus the controls. CONCLUSIONS An SMS-based intervention seems feasible and acceptable for enhancing medication adherence. Further studies are needed to confirm whether this kind of intervention could be a complementary strategy to optimise adherence in schizophrenia.
Collapse
|
16
|
Hampel H, Prvulovic D, Teipel S, Jessen F, Luckhaus C, Frölich L, Riepe MW, Dodel R, Leyhe T, Bertram L, Hoffmann W, Faltraco F. The future of Alzheimer's disease: the next 10 years. Prog Neurobiol 2011; 95:718-28. [PMID: 22137045 DOI: 10.1016/j.pneurobio.2011.11.008] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Alzheimer's disease (AD) is a fast growing world-wide epidemic. AD is a genetically complex, slowly progressive, and irreversible neurodegenerative disease of the brain. During decades of asymptomatic progression multiple interactive systems, pathways and molecular mechanisms (e.g. protein processing, aberrant signaling, inflammation and immune system, lipid transport, endocytosis, apoptosis, oxidative damage and response to stress, tau pathology, neuron and synapse loss, energy metabolism), contribute to the development of the early clinical prodromal stage with episodic memory deficits and to further decline and loss of general cognitive functioning during the final syndromal dementia stage. The non-mendelian genetically complex "sporadic" AD type is the most common form of dementia affecting people usually over the age of 65. Despite considerable progress of AD research in recent years and evolving paradigm shifts in both pathophysiological concepts as well as in diagnostic criteria fundamental challenges have not yet been resolved. The strong age-related incidence, the recent failure and complete lack of disease-modifying or preventive therapy that may delay onset or substantially affect the pathophysiology of AD, result in an enormous burden posed both on individuals, their families and care givers, and the societies at large, and these call for urgent concerted worldwide measures. Based on the meeting of the German Task Force on Alzheimer's Disease (GTF-AD) in Paris on July 19th 2011, the present position paper provides an overview on the current state and future developments in epidemiology, pathophysiology, disease conceptualization, diagnostic criteria and their use in research and clinical practice, as well as preventive and symptomatic therapeutic approaches. Particular emphasis is placed on a discussion of the different approaches to diagnostics and therapy taken by preventive/public health medicine, methodologically advanced academic research propagating the use of sophisticated biomarkers, and everyday clinical practice focusing on patient-centered care. During the next 10 years, major advances both in early detection as well as in therapy and comprehensive AD care seem mandatory. These still unmet needs call for ever more concerted and focused efforts in research across the world to combat the erupting and as yet uncontrolled epidemic of AD.
Collapse
Affiliation(s)
- Harald Hampel
- Department of Psychiatry, Psychosomatic Medicine & Psychotherapy, Goethe University, Frankfurt, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Freyberger HJ, Schneider W. Einfluss des Internet auf die Psychotherapie. PSYCHOTHERAPEUT 2011. [DOI: 10.1007/s00278-011-0872-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|