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Walsh RFL, Maddox MA, Smith LT, Liu RT, Alloy LB. Social and circadian rhythm dysregulation and suicide: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 158:105560. [PMID: 38272337 PMCID: PMC10982958 DOI: 10.1016/j.neubiorev.2024.105560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024]
Abstract
This systematic review of 52 studies provides a quantitative synthesis of the empirical literature on social and circadian rhythm correlates of suicidal thoughts and behaviors (STB). Small-to-medium pooled effect sizes were observed for associations between evening chronotype and STB and suicidal ideation (SI), although the pooled effect size diminished when accounting for publication bias. Three studies employed longitudinal designs and suggested eveningness was predictive of future STB, with a small-to-medium effect size. Social rhythm irregularity was also a significant correlate of STB with pooled effect sizes in the medium range. Overall circadian rhythm disruption was not associated with STB, although certain circadian rhythm metrics, including mean daytime activity, circadian rhythm sleep-wake disorder diagnosis, and actigraphy-assessed amplitude were associated with STB. Pooled effect sizes for these indices were in the medium to large range. There is a need for additional longitudinal research on actigraphy-based circadian parameters and objective markers of circadian phase (i.e., dim-light melatonin onset) to gain a clearer understanding of associations of endogenous circadian function and STB beyond that which can be captured via self-report.
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Affiliation(s)
- Rachel F L Walsh
- Department of Psychology and Neuroscience, Temple University, USA.
| | | | - Logan T Smith
- Department of Psychology and Neuroscience, Temple University, USA
| | - Richard T Liu
- Department of Psychiatry, Massachusetts General Hospital, USA; Department of Psychiatry, Harvard Medical School, USA; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, USA
| | - Lauren B Alloy
- Department of Psychology and Neuroscience, Temple University, USA
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2
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Smith EG, Howard A, Schultz M, Li M, Salvatore P, O'Shea BA. Predicting suicidal ideation in psychiatrically hospitalized veterans using the death/suicide Implicit Association Test: A prospective cohort study. Suicide Life Threat Behav 2023; 53:994-1009. [PMID: 37752832 DOI: 10.1111/sltb.12998] [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: 09/02/2022] [Revised: 08/12/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION We investigated whether the Death/Suicide Implicit Association Test (D/S-IAT) predicted suicidal ideation (SI) in psychiatric inpatients. METHODS One hundred eighty veterans admitted for either SI or suicidal behavior (SB) (the primary sample) (N = 90) or alcohol detoxification (N = 90) completed the D/S-IAT and scales measuring SI. Correlation and regression coefficients were measured between the D/S-IAT (as a full-scale or dichotomized score [D > 0]) and self-reported current or imminent SI (over the next 1-3 days). RESULTS In the primary sample, the full-scale D/S-IAT was significantly correlated with the intensity of current SI (r = 0.22, p = 0.04) and especially with wishes to be dead (r = 0.35, p < 0.001). The intensity of imminent SI was significantly predicted by the full-scale (p = 0.02) and dichotomized D/S-IAT score (p = 0.05) in a multiple regression model. However, no significant associations were observed when both the D/S-IAT score and current (present/absent) or imminent SI (occurred/did not occur) were dichotomous measures. In participants receiving alcohol detoxification, the D/S-IAT significantly predicted only wishes to be dead (r = 0.33, p < 0.001). CONCLUSION The full-scale D/S-IAT score predicted the current intensity of wishes to be dead in both inpatient samples, and current and imminent SI in participants admitted for SI/SB. The dichotomized D/S-IAT score did not predict the simple occurrence of SI.
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Affiliation(s)
- Eric G Smith
- Department of Veterans Affairs, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Departments of Psychiatry and Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alexandra Howard
- Department of Veterans Affairs, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Mark Schultz
- Department of Veterans Affairs, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Mingfei Li
- Department of Veterans Affairs, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts, USA
| | - Paola Salvatore
- Department of Veterans Affairs, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- International Consortium for Bipolar and Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Brian A O'Shea
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
- School of Psychology, University of Nottingham, Nottingham, UK
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3
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Salvatore P, Indic P, Khalsa HK, Tohen M, Baldessarini RJ, Maggini C. Circadian Activity Rhythms and Psychopathology in Major Depressive Episodes. Psychopathology 2023; 57:1-9. [PMID: 37499644 DOI: 10.1159/000530768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/17/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Identifying suicidal risk based on clinical assessment is challenging. Suicidal ideation fluctuates, can be downplayed or denied, and seems stigmatizing if divulged. In contrast, vitality is foundational to subjectivity in being immediately conscious before reflection. Including its assessment may improve detection of suicidal risk compared to relying on suicidal ideation alone. We hypothesized that objective motility measures would be associated with vitality and enhance assessment of suicidal risk. METHODS We evaluated 83 adult-psychiatric outpatients with a DSM-5 bipolar (BD) or major depressive disorder (MDD): BD-I (n = 48), BD-II (20), and MDD (15) during a major depressive episode. They were actigraphically monitored continuously over 3 weekdays and self-rated their subjective states at regular intervals. We applied cosinor analysis to actigraphic data and analyzed associations of subjective psychopathology measures with circadian activity parameters. RESULTS Actigraphic circadian mesor, amplitude, day- and nighttime activity were lower with BD versus MDD. Self-rated vitality (wish-to-live) was significantly lower, self-rated suicidality (wish-to-die) was higher, and their difference was lower, with BD versus MDD. There were no other significant diagnostic differences in actigraphic sleep parameters or in self-rated depression, dysphoria, or anxiety. By linear regression, the difference between vitality and passive suicidal ideation was strongly positively correlated with mesor (p < 0.0001), daytime activity (p < 0.0001), and amplitude (p = 0.001). CONCLUSIONS Higher circadian activity measures reflected enhanced levels of subjective vitality and were associated with lesser suicidal ideation. Current suicidal-risk assessment might usefully include monitoring of motility and vitality in addition to examining negative affects and suicidal thinking.
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Affiliation(s)
- Paola Salvatore
- International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Section of Psychiatry, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Premananda Indic
- International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA
- Department of Electrical Engineering, University of Texas at Tyler, Tyler, Texas, USA
| | - Harimandir K Khalsa
- International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Mauricio Tohen
- International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, New Mexico, USA
| | - Ross J Baldessarini
- International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlo Maggini
- International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, Massachusetts, USA
- Section of Psychiatry, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Abdul Karim M, Ouanes S, Reagu SM, Alabdulla M. Network analysis of anxiety and depressive symptoms among quarantined individuals: cross-sectional study. BJPsych Open 2021; 7:e222. [PMID: 34814965 PMCID: PMC8693910 DOI: 10.1192/bjo.2021.1060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The mental health burden of COVID-19 has been examined in different settings. Existing research has relied on the latent variable model in assessing COVID-19-related distress. Network theory provides an alternative framework wherein symptoms are conceptualised as causal, interconnected constituents rather than outcomes of mental disorders. AIMS To assess networks of self-reported anxiety and depressive symptoms among quarantined individuals. METHOD Consenting individuals in different quarantine centres in Qatar completed the Patient Health Questionnaire Anxiety and Depression Scale. We used partial correlation network methods to illustrate interactions of self-reported psychopathology. RESULTS Participants with COVID-19 were significantly older and had a significantly higher proportion of males. The most central node was COVID-19, followed by thoughts of self-harm. COVID-19 status was strongly positively connected to thoughts of self-harm, which was positively connected to psychomotor changes, which were connected to decreased concentration. COVID-19 status was also positively connected to feeling anxious, which was strongly connected to inability to concentrate, which was connected to feeling afraid. CONCLUSIONS COVID-19 was the most influential factor, with the highest number and strength of connections to psychopathology in a network of anxiety and depressive symptoms in a quarantine setting. Beyond the resolution of the infection, therapeutic interventions targeting psychomotor changes might prove beneficial in reducing suicidality among quarantined individuals with COVID-19. Follow-up with mental health services after COVID-19 infection is needed to restore psychological well-being. Further research is needed to understand the short- and long-term psychological effects of COVID-19, and the outcomes of different therapeutic interventions.
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Affiliation(s)
- Mustafa Abdul Karim
- Psychiatry Department, Hamad Medical Corporation, Qatar; and Weill Cornell Medicine, Qatar
| | - Sami Ouanes
- Psychiatry Department, Hamad Medical Corporation, Qatar
| | - Shuja M Reagu
- Psychiatry Department, Hamad Medical Corporation, Qatar
| | - Majid Alabdulla
- Psychiatry Department, Hamad Medical Corporation, Qatar; and College of Medicine, Qatar University, Qatar
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Abstract
Background: Substance use disorders are a highly prevalent group of chronic diseases with devastating individual and public health consequences. Current treatment strategies suffer from high rates of relapse, or return to drug use, and novel solutions are desperately needed. Realize Analyze Engage (RAE) is a digital, mHealth intervention that focusses on real time, objective detection of high-risk events (stress and drug craving) to deploy just-in-time supportive interventions. The present study aims to (1) evaluate the accuracy and usability of the RAE system and (2) evaluate the impact of RAE on patient centered outcomes. Methods: The first phase of the study will be an observational trial of N = 50 participants in outpatient treatment for SUD using the RAE system for 30 days. Accuracy of craving and stress detection algorithms will be evaluated, and usability of RAE will be explored via semi-structured interviews with participants and focus groups with SUD treatment clinicians. The second phase of the study will be a randomized controlled trial of RAE vs usual care to evaluate rates of return to use, retention in treatment, and quality of life. Anticipated findings and future directions: The RAE platform is a potentially powerful tool to de-escalate stress and craving outside of the clinical milieu, and to connect with a support system needed most. RAE also aims to provide clinicians with actionable insight to understand patients’ level of risk, and contextual clues for their triggers in order to provide more personalized recovery support.
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Murray G, Gottlieb J, Hidalgo MP, Etain B, Ritter P, Skene DJ, Garbazza C, Bullock B, Merikangas K, Zipunnikov V, Shou H, Gonzalez R, Scott J, Geoffroy PA, Frey BN. Measuring circadian function in bipolar disorders: Empirical and conceptual review of physiological, actigraphic, and self-report approaches. Bipolar Disord 2020; 22:693-710. [PMID: 32564457 DOI: 10.1111/bdi.12963] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Interest in biological clock pathways in bipolar disorders (BD) continues to grow, but there has yet to be an audit of circadian measurement tools for use in BD research and practice. PROCEDURE The International Society for Bipolar Disorders Chronobiology Task Force conducted a critical integrative review of circadian methods that have real-world applicability. Consensus discussion led to the selection of three domains to review-melatonin assessment, actigraphy, and self-report. RESULTS Measurement approaches used to quantify circadian function in BD are described in sufficient detail for researchers and clinicians to make pragmatic decisions about their use. A novel integration of the measurement literature is offered in the form of a provisional taxonomy distinguishing between circadian measures (the instruments and methods used to quantify circadian function, such as dim light melatonin onset) and circadian constructs (the biobehavioral processes to be measured, such as circadian phase). CONCLUSIONS Circadian variables are an important target of measurement in clinical practice and biomarker research. To improve reproducibility and clinical application of circadian constructs, an informed systematic approach to measurement is required. We trust that this review will decrease ambiguity in the literature and support theory-based consideration of measurement options.
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Affiliation(s)
- Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Victoria, Australia
| | - John Gottlieb
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Chicago Psychiatry Associates, Chicago, IL, USA
| | - Maria Paz Hidalgo
- Laboratorio de Cronobiologia e Sono, Hospital de Porto Alegre, Porto Alegre, Brazil.,Graduate Program in Psychiatry and Behavioral Sciences, Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruno Etain
- Département de Psychiatrie et de Médecine Addictologique and INSERM UMRS 1144, Université de Paris, AP-HP, Groupe Hospitalo-universitaire AP-HP Nord, Paris, France
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Debra J Skene
- Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Corrado Garbazza
- Centre for Chronobiology, University of Basel, Basel, Switzerland.,Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Ben Bullock
- Centre for Mental Health, Swinburne University of Technology, Victoria, Australia
| | - Kathleen Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, USA
| | - Vadim Zipunnikov
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Haochang Shou
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Gonzalez
- Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Pierre A Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, Hopital Bichat - Claude Bernard, Paris, France.,Université de Paris, NeuroDiderot, France
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, ON, Canada
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Bertrand L, Bourguignon C, Beaulieu S, Storch KF, Linnaranta O. Suicidal Ideation and Insomnia in Bipolar Disorders: Idéation suicidaire et insomnie dans les troubles bipolaires. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:802-810. [PMID: 32856463 PMCID: PMC7564692 DOI: 10.1177/0706743720952226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) confers elevated suicide risk and associates with misaligned circadian rhythm. Real-time monitoring of objectively measured sleep is a novel approach to detect and prevent suicidal behavior. We aimed at understanding associations between subjective insomnia and actigraphy data with severity of suicidal ideation in BDs. METHODS This prospective cohort study comprised 76 outpatients with a BD aged 18 to 65 inclusively. Main measures included 10 consecutive days of wrist actigraphy; the Athens Insomnia Scale (AIS); the Montgomery-Åsberg Depression Rating Scale (MADRS); the Quick Inventory of Depressive Symptoms-16, self-rating (QIDS-SR-16); and the Columbia Suicide Severity Rating Scale. Diagnoses, medications, and suicide attempts were obtained from chart review. RESULTS Suicidal ideation correlated moderately with subjective insomnia (AIS with QIDS-SR-16 item 12 ρ =0.26, P = 0.03; MADRS item 10 ρ = 0.33, P = 0.003). Graphical sleep patterns showed that suicidal patients were enriched among the most fragmented sleep patterns, and this was confirmed by correlations of suicidal ideation with actigraphy data at 2 visits. Patients with lifetime suicide attempts (n = 8) had more varied objective sleep (a higher standard deviation of center of daily inactivity [0.64 vs. 0.26, P = 0.01], consolidation of daily inactivity [0.18 vs. 0.10, P = <0.001], sleep offset [3.02 hours vs. 1.90 hours, P = <0.001], and total sleep [105 vs. 69 minutes, P = 0.02], and a lower consolidation of daily inactivity [0.65 vs. 0.79, P = 0.03]). CONCLUSIONS Subjective insomnia, a nonstigmatized symptom, can complement suicidality screens. Longer follow-ups and larger samples are warranted to understand whether real-time sleep monitoring predicts suicidal ideation in patient subgroups or individually.
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Affiliation(s)
- Lia Bertrand
- Faculty of Medicine, 5620McGill University, Montreal, Quebec, Canada
| | - Clément Bourguignon
- Douglas Centre for Sleep and Biological Rhythms, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Integrated Program in Neuroscience, 5620McGill University, Montreal, Quebec, Canada
| | - Serge Beaulieu
- Douglas Centre for Sleep and Biological Rhythms, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada
| | - Kai-Florian Storch
- Douglas Centre for Sleep and Biological Rhythms, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada
| | - Outi Linnaranta
- Douglas Centre for Sleep and Biological Rhythms, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada.,National Institute for Health and Welfare, Helsinki, Finland
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Li P, Lim ASP, Gao L, Hu C, Yu L, Bennett DA, Buchman AS, Hu K. More random motor activity fluctuations predict incident frailty, disability, and mortality. Sci Transl Med 2020; 11:11/516/eaax1977. [PMID: 31666398 DOI: 10.1126/scitranslmed.aax1977] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 09/20/2019] [Indexed: 12/11/2022]
Abstract
Mobile healthcare increasingly relies on analytical tools that can extract meaningful information from ambulatory physiological recordings. We tested whether a nonlinear tool of fractal physiology could predict long-term health consequences in a large, elderly cohort. Fractal physiology is an emerging field that aims to study how fractal temporal structures in physiological fluctuations generated by complex physiological networks can provide important information about system adaptability. We assessed fractal temporal correlations in the spontaneous fluctuations of ambulatory motor activity of 1275 older participants at baseline, with a follow-up period of up to 13 years. We found that people with reduced temporal correlations (more random activity fluctuations) at baseline had increased risk of frailty, disability, and all-cause death during follow-up. Specifically, for 1-SD decrease in the temporal activity correlations of this studied cohort, the risk of frailty increased by 31%, the risk of disability increased by 15 to 25%, and the risk of death increased by 26%. These incidences occurred on average 4.7 years (frailty), 3 to 4.2 years (disability), and 5.8 years (death) after baseline. These observations were independent of age, sex, education, chronic health conditions, depressive symptoms, cognition, motor function, and total daily activity. The temporal structures in daily motor activity fluctuations may contain unique prognostic information regarding wellness and health in the elderly population.
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Affiliation(s)
- Peng Li
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA. .,Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Andrew S P Lim
- Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Lei Gao
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Chelsea Hu
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL 60612, USA
| | - Kun Hu
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA. .,Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
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Rumble ME, McCall WV, Dickson DA, Krystal AD, Rosenquist PB, Benca RM. An exploratory analysis of the association of circadian rhythm dysregulation and insomnia with suicidal ideation over the course of treatment in individuals with depression, insomnia, and suicidal ideation. J Clin Sleep Med 2020; 16:1311-1319. [PMID: 32329435 DOI: 10.5664/jcsm.8508] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
STUDY OBJECTIVES Sleep disturbance is significantly associated with suicidal ideation. However, the majority of past research has examined the relationship between insomnia and suicidality. The current exploratory study examined the relationship of circadian rhythm dysregulation (eveningness, seasonality, and rhythmicity) with suicidality. METHODS We examined the association of insomnia, eveningness, seasonality, and rhythmicity with suicidal ideation in 103 participants with depression, insomnia, and suicidality within a larger 8-week double-blinded randomized control trial primarily examining whether cautious use of zolpidem extended-release or placebo reduced suicidal ideation. All participants additionally received an open-label selective serotonin reuptake inhibitor. Methodological strengths of the current analyses included consideration of multiple sleep-wake constructs, adjustment for relevant covariates, investigation of relationships over the course of treatment, and use of both self-report measures and objective measurement with actigraphy. RESULTS Over the course of treatment, self-reported eveningness and greater insomnia severity were independently correlated with greater suicidal ideation, whereas actigraphic delayed sleep timing was related to suicidal ideation at a trend level. At the end of treatment, those with greater suicidal ideation demonstrated lower actigraphic activity levels. There were no significant relationships between self-reported seasonality and actigraphic measures of sleep disturbance and suicidality. CONCLUSIONS Self-reported delays in sleep timing, objectively lower activity levels, and self-reported insomnia severity correlated independently with greater suicidal ideation in those with depression, insomnia, and suicidality. These exploratory findings highlight the need to consider sleep-wake constructs more broadly in those with suicidality in future research studies in order to improve more definitively both assessment and intervention efforts. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Reducing Suicidal Ideation through Insomnia Treatment; URL: https://clinicaltrials.gov/ct2/show/NCT01689909; Identifier: NCT01689909 Rumble ME, McCall MV, Dickson DA, Krystal AD, Rosenquist PB, Benca RM. An exploratory analysis of the association of circadian rhythm dysregulation and insomnia with suicidal ideation over the course of treatment in individuals with depression, insomnia, and suicidal ideation. J Clin Sleep Med. 2020;16(8):XXX-XXX.
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Affiliation(s)
| | | | | | - Andrew D Krystal
- University of California, San Francisco, California.,Duke University, Durham, North Carolina
| | | | - Ruth M Benca
- University of Wisconsin, Madison, Wisconsin.,University of California, Irvine, California
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Carreiro S, Chintha KK, Shrestha S, Chapman B, Smelson D, Indic P. Wearable sensor-based detection of stress and craving in patients during treatment for substance use disorder: A mixed methods pilot study. Drug Alcohol Depend 2020; 209:107929. [PMID: 32193048 PMCID: PMC7197459 DOI: 10.1016/j.drugalcdep.2020.107929] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/11/2020] [Accepted: 02/15/2020] [Indexed: 12/29/2022]
Abstract
AIMS To determine the accuracy of a wearable sensor to detect and differentiate episodes of self-reported craving and stress in individuals with substance use disorders, and to assess acceptability, barriers, and facilitators to sensor-based monitoring in this population. METHODS This was an observational mixed methods pilot study. Adults enrolled in an outpatient treatment program for a substance use disorder wore a non-invasive wrist-mounted sensor for four days and self-reported episodes of stress and craving. Continuous physiologic data (accelerometry, skin conductance, skin temperature, and heart rate) were extracted from the sensors and analyzed via various machine learning algorithms. Semi-structured interviews were conducted upon study completion, and thematic analysis was conducted on qualitative data from semi-structured interviews. RESULTS Thirty individuals completed the protocol, and 43 % (N = 13) were female. A total of 41 craving and 104 stress events were analyzed. The differentiation accuracies of the top performing models were as follows: stress vs. non-stress states 74.5 % (AUC 0.82), craving vs. no-craving 75.7 % (AUC 0.82), and craving vs. stress 76.8 % (AUC 0.8). Overall participant perception was positive, and acceptability was high. Emergent themes from the exit interviews included a perception of connectedness and increased mindfulness related to wearing the sensor, both of which were reported as helpful to recovery. Barriers to engagement included interference with other daily wear items, and perceived stigma. CONCLUSIONS Wearable sensors can be used to objectively differentiate episodes of craving and stress, and individuals in recovery from substance use disorder are accepting of continuous monitoring with these devices.
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Affiliation(s)
- Stephanie Carreiro
- Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School, Worcester, MA, United States.
| | | | - Sloke Shrestha
- Department of Electrical Engineering, University of Texas
at Tyler, Tyler, TX
| | - Brittany Chapman
- Department of Emergency Medicine, Division of Medical
Toxicology, University of Massachusetts Medical School, Worcester, MA
| | - David Smelson
- Department of Psychiatry, Division of Addiction Psychiatry,
University of Massachusetts Medical School, Worcester, MA
| | - Premananda Indic
- Department of Electrical Engineering, University of Texas
at Tyler, Tyler, TX
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11
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Foo JC, Sirignano L, Trautmann N, Kim J, Witt SH, Streit F, Frank J, Zillich L, Meyer-Lindenberg A, Ebner-Priemer U, Schilling C, Schredl M, Yamamoto Y, Gilles M, Deuschle M, Rietschel M. Association of Locomotor Activity During Sleep Deprivation Treatment With Response. Front Psychiatry 2020; 11:688. [PMID: 32792995 PMCID: PMC7385277 DOI: 10.3389/fpsyt.2020.00688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/30/2020] [Indexed: 11/13/2022] Open
Abstract
Disrupted circadian rhythms and sleep patterns are frequently observed features of psychiatric disorders, and especially mood disorders. Sleep deprivation treatment (SD) exerts rapid but transient antidepressant effects in depressed patients and has gained recognition as a model to study quick-acting antidepressant effects. It is of interest how locomotor activity patterns during SD might be associated with and potentially predict treatment response. The present study is an analysis of locomotor activity data, previously collected over a 24 h period, to examine the night of SD (Trautmann et al. 2018) as mood disorder patients suffering from a depressive episode (n = 78; after exclusions n = 59) underwent SD. In this exploratory analysis, the associations between response to SD, locomotor activity, and subjective mood during the 24 h period of SD were explored. Higher levels of activity overall were observed in non-responders (n = 18); in particular, non-responders moved more during the evening of SD until midnight and remained high thereafter. In contrast, activity in responders (n = 41) decreased during the evening and increased in the morning. Subjective mood was not found to be associated with locomotor activity. The window of data available in this analysis being limited, additional data from before and after the intervention are required to fully characterize the results observed. The present results hint at the possible utility of locomotor activity as a predictor and early indicator of treatment response, and suggest that the relationship between SD and locomotor activity patterns should be further investigated.
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Affiliation(s)
- Jerome Clifford Foo
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lea Sirignano
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nina Trautmann
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jinhyuk Kim
- Department of Informatics, Graduate School of Integrated Science and Technology, Shizuoka University, Shizuoka, Japan
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Josef Frank
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lea Zillich
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ulrich Ebner-Priemer
- Department of Sport and Sport Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Claudia Schilling
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Schredl
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Yoshiharu Yamamoto
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Maria Gilles
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Deuschle
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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12
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Kim J, Marcusson-Clavertz D, Togo F, Park H. A Practical Guide to Analyzing Time-Varying Associations between Physical Activity and Affect Using Multilevel Modeling. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2018; 2018:8652034. [PMID: 30105083 PMCID: PMC6076963 DOI: 10.1155/2018/8652034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 05/15/2018] [Accepted: 05/24/2018] [Indexed: 11/29/2022]
Abstract
There is growing interest in within-person associations of objectively measured physical and physiological variables with psychological states in daily life. Here we provide a practical guide with SAS code of multilevel modeling for analyzing physical activity data obtained by accelerometer and self-report data from intensive and repeated measures using ecological momentary assessments (EMA). We review previous applications of EMA in research and clinical settings and the analytical tools that are useful for EMA research. We exemplify the analyses of EMA data with cases on physical activity data and affect and discuss the future challenges in the field.
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Affiliation(s)
- Jinhyuk Kim
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
| | - David Marcusson-Clavertz
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Department of Psychology, Lund University, Lund, Sweden
| | - Fumiharu Togo
- Educational Physiology Laboratory, Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Hyuntae Park
- Department of Health Care and Science, College of Health Science, Dong-A University, Busan, Republic of Korea
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13
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Kim S, Albert PS. Latent Variable Poisson Models for Assessing the Regularity of Circadian Patterns over Time. J Am Stat Assoc 2018; 113:992-1002. [PMID: 30956371 DOI: 10.1080/01621459.2017.1379402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Many researchers in biology and medicine have focused on trying to understand biological rhythms and their potential impact on disease. A common biological rhythm is circadian, where the cycle repeats itself every 24 hours. However, a disturbance of the circadian pattern may be indicative of future disease. In this article, we develop new statistical methodology for assessing the degree of disturbance or irregularity in a circadian pattern for count sequences that are observed over time in a population of individuals. We develop a latent variable Poisson modeling approach with both circadian and stochastic short-term trend (autoregressive latent process) components that allow for individual variation in the degree of each component. A parameterization is proposed for modeling covariate dependence on the proportion of these two model components across individuals. In addition, we incorporate covariate dependence in the overall mean, the magnitude of the trend, and the phase-shift of the circadian pattern. Innovative Markov chain Monte Carlo sampling is used to carry out Bayesian posterior computation. Several variations of the proposed models are considered and compared using the deviance information criterion. We illustrate this methodology with longitudinal physical activity count data measured in a longitudinal cohort of adolescents.
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Affiliation(s)
- Sungduk Kim
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Paul S Albert
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
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14
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Rumble ME, Dickson D, McCall WV, Krystal AD, Case D, Rosenquist PB, Benca RM. The relationship of person-specific eveningness chronotype, greater seasonality, and less rhythmicity to suicidal behavior: A literature review. J Affect Disord 2018; 227:721-730. [PMID: 29179142 PMCID: PMC5805608 DOI: 10.1016/j.jad.2017.11.078] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/11/2017] [Accepted: 11/11/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Epidemiological data have demonstrated seasonal and circadian patterns of suicidal deaths. Several reviews and meta-analyses have confirmed the relationship between sleep disturbance and suicidality. However, these reviews/meta-analyses have not focused on seasonal and circadian dysfunction in relation to suicidality, despite the common presence of this dysfunction in patients with mood disorders. Thus, the current literature review analyzed studies investigating person-specific chronotype, seasonality, and rhythmicity in relation to suicidal thoughts and behaviors. METHODS Study authors reviewed articles related to individual-level chronotype, seasonality, and rhythmicity and suicidality that were written in English and not case reports or reviews. RESULTS This review supports a relationship between an eveningness chronotype, greater seasonality, and decreased rhythmicity with suicidal thoughts and behaviors in those with unipolar depression, as well as in other psychiatric disorders and in children/adolescents. LIMITATIONS These findings need to be explored more fully in mood disordered populations and other psychiatric populations, in both adults and children, with objective measurement such as actigraphy, and with chronotype, seasonality, and rhythmicity as well as broader sleep disturbance measurement all included so the construct(s) most strongly linked to suicidality can be best identified. CONCLUSIONS Eveningness, greater seasonality, and less rhythmicity should be considered in individuals who may be at risk for suicidal thoughts and behaviors and may be helpful in further tailoring assessment and treatment to improve patient outcome.
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Affiliation(s)
- Meredith E Rumble
- Department of Psychiatry, University of Wisconsin, Madison, United States.
| | - Daniel Dickson
- Department of Psychiatry, University of Wisconsin, Madison, United States
| | - W Vaughn McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, United States
| | - Andrew D Krystal
- Department of Psychiatry, University of California, San Francisco, United States; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States
| | - Doug Case
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Peter B Rosenquist
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, United States
| | - Ruth M Benca
- Department of Psychiatry and Human Behavior, University of California, Irvine, United States
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15
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Li P, Morris CJ, Patxot M, Yugay T, Mistretta J, Purvis TE, Scheer FAJL, Hu K. Reduced Tolerance to Night Shift in Chronic Shift Workers: Insight From Fractal Regulation. Sleep 2017; 40:3836914. [PMID: 28838129 PMCID: PMC6317507 DOI: 10.1093/sleep/zsx092] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Study Objectives Healthy physiology is characterized by fractal regulation (FR) that generates similar structures in the fluctuations of physiological outputs at different time scales. Perturbed FR is associated with aging and age-related pathological conditions. Shift work, involving repeated and chronic exposure to misaligned environmental and behavioral cycles, disrupts circadian coordination. We tested whether night shifts perturb FR in motor activity and whether night shifts affect FR in chronic shift workers and non-shift workers differently. Methods We studied 13 chronic shift workers and 14 non-shift workers as controls using both field and in-laboratory experiments. In the in-laboratory study, simulated night shifts were used to induce a misalignment between the endogenous circadian pacemaker and the sleep-wake cycles (ie, circadian misalignment) while environmental conditions and food intake were controlled. Results In the field study, we found that FR was robust in controls but broke down in shift workers during night shifts, leading to more random activity fluctuations as observed in patients with dementia. The night shift effect was present even 2 days after ending night shifts. The in-laboratory study confirmed that night shifts perturbed FR in chronic shift workers and showed that FR in controls was more resilience to the circadian misalignment. Moreover, FR during real and simulated night shifts was more perturbed in those who started shift work at older ages. Conclusions Chronic shift work causes night shift intolerance, which is probably linked to the degraded plasticity of the circadian control system.
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Affiliation(s)
- Peng Li
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Christopher J Morris
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Melissa Patxot
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Tatiana Yugay
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Joseph Mistretta
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Taylor E Purvis
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Frank A J L Scheer
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Kun Hu
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
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16
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Actigraphic features of bipolar disorder: A systematic review and meta-analysis. Sleep Med Rev 2017; 33:58-69. [DOI: 10.1016/j.smrv.2016.05.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 12/21/2022]
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17
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Carreiro S, Wittbold K, Indic P, Fang H, Zhang J, Boyer EW. Wearable Biosensors to Detect Physiologic Change During Opioid Use. J Med Toxicol 2016; 12:255-62. [PMID: 27334894 DOI: 10.1007/s13181-016-0557-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/10/2016] [Accepted: 05/14/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Opioid analgesic use is a major cause of morbidity and mortality in the US, yet effective treatment programs have a limited ability to detect relapse. The utility of current drug detection methods is often restricted due to their retrospective and subjective nature. Wearable biosensors have the potential to improve detection of relapse by providing objective, real time physiologic data on opioid use that can be used by treating clinicians to augment behavioral interventions. METHODS Thirty emergency department (ED) patients who were prescribed intravenous opioid medication for acute pain were recruited to wear a wristband biosensor. The biosensor measured electrodermal activity, skin temperature and locomotion data, which was recorded before and after intravenous opioid administration. Hilbert transform analyses combined with paired t-tests were used to compare the biosensor data A) within subjects, before and after administration of opioids; B) between subjects, based on hand dominance, gender, and opioid use history. RESULTS Within subjects, a significant decrease in locomotion and increase in skin temperature were consistently detected by the biosensors after opioid administration. A significant change in electrodermal activity was not consistently detected. Between subjects, biometric changes varied with level of opioid use history (heavy vs. nonheavy users), but did not vary with gender or type of opioid. Specifically, heavy users demonstrated a greater decrease in short amplitude movements (i.e. fidgeting movements) compared to non-heavy users. CONCLUSION A wearable biosensor showed a consistent physiologic pattern after ED opioid administration and differences between patterns of heavy and non-heavy opioid users were noted. Potential applications of biosensors to drug addiction treatment and pain management should be studied further.
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Affiliation(s)
- Stephanie Carreiro
- Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01605, USA.
| | - Kelley Wittbold
- Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01605, USA
| | - Premananda Indic
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Hua Fang
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jianying Zhang
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Edward W Boyer
- Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01605, USA
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18
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Hu K, Riemersma - van der Lek RF, Patxot M, Li P, Shea SA, Scheer FAJL, Van Someren EJW. Progression of Dementia Assessed by Temporal Correlations of Physical Activity: Results From a 3.5-Year, Longitudinal Randomized Controlled Trial. Sci Rep 2016; 6:27742. [PMID: 27292543 PMCID: PMC4904193 DOI: 10.1038/srep27742] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/19/2016] [Indexed: 01/04/2023] Open
Abstract
Cross-sectional studies show that activity fluctuations in healthy young adults possess robust temporal correlations that become altered with aging, and in dementia and depression. This study was designed to test whether or not within-subject changes of activity correlations (i) track the clinical progression of dementia, (ii) reflect the alterations of depression symptoms in patients with dementia, and (iii) can be manipulated by clinical interventions aimed at stabilizing circadian rhythmicity and improving sleep in dementia, namely timed bright light therapy and melatonin supplementation. We examined 144 patients with dementia (70-96 years old) who were assigned to daily treatment with bright light, bedtime melatonin, both or placebos only in a 3.5-year double-blinded randomized clinical trial. We found that activity correlations at temporal scales <~2 hours significantly decreased over time and that light treatment attenuated the decrease by ~73%. Moreover, the decrease of temporal activity correlations positively correlated with the degrees of cognitive decline and worsening of mood though the associations were relatively weak. These results suggest a mechanistic link between multiscale activity regulation and circadian/sleep function in dementia patients. Whether temporal activity patterns allow unobtrusive, long-term monitoring of dementia progression and mood changes is worth further investigation.
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Affiliation(s)
- Kun Hu
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital; and Division of Sleep Medicine, Harvard Medical School, Boston, MA 02215, United States
| | - Rixt F. Riemersma - van der Lek
- Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Melissa Patxot
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital; and Division of Sleep Medicine, Harvard Medical School, Boston, MA 02215, United States
| | - Peng Li
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital; and Division of Sleep Medicine, Harvard Medical School, Boston, MA 02215, United States
| | - Steven A. Shea
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital; and Division of Sleep Medicine, Harvard Medical School, Boston, MA 02215, United States
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR 97239, United States
| | - Frank A. J. L. Scheer
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital; and Division of Sleep Medicine, Harvard Medical School, Boston, MA 02215, United States
| | - Eus J. W. Van Someren
- Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Depts. of Integrative Neurophysiology and Psychiatry GGZ inGeest, Center for Neurogenomics and Cognitive Research (CNCR), Neuroscience Campus Amsterdam, VU University and Medical Center, Amsterdam, The Netherlands
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Kim J, Nakamura T, Yamamoto Y. A momentary biomarker for depressive mood. In Silico Pharmacol 2016; 4:4. [PMID: 26979449 PMCID: PMC4792818 DOI: 10.1186/s40203-016-0017-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 02/15/2016] [Indexed: 01/11/2023] Open
Abstract
Many biomarkers from genetic, neuroimaging, and biological/biochemical measures have been recently developed in order to make a shift toward the objective evaluation of psychiatric disorders. However, they have so far been less successful in capturing dynamical changes or transitions in pathological states, such as those occurring during the course of clinical treatments or pathogenic processes of disorders. A momentary biomarker is now required for objective monitoring of such dynamical changes. The development of ecological momentary assessment (EMA) allows the assessment of dynamical aspects of diurnal/daily clinical conditions and subjective symptoms. Furthermore, a variety of validation studies on momentary symptoms assessed by EMA using behavioral/physiological/biochemical measures have demonstrated the possibility of evaluating momentary symptoms from such external objective measures. In this review, we introduce physical activity as a candidate biobehavioral biomarker for psychiatric disorders. We also mention its potential as a momentary biomarker for depressive mood. Finally, we address the continuous monitoring of the pathogenic processes and pathological states of depressive disorders based on physical activity, as well as its application in pharmacological animal studies.
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Affiliation(s)
- Jinhyuk Kim
- Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Psychosomatic Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Toru Nakamura
- Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yoshiharu Yamamoto
- Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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20
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Hadaeghi F, Hashemi Golpayegani MR, Murray G. Towards a complex system understanding of bipolar disorder: A map based model of a complex winnerless competition. J Theor Biol 2015; 376:74-81. [PMID: 25728789 DOI: 10.1016/j.jtbi.2015.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 02/06/2015] [Accepted: 02/17/2015] [Indexed: 12/20/2022]
Abstract
Bipolar disorder is characterized by repeated erratic episodes of mania and depression, which can be understood as pathological complex system behavior involving cognitive, affective and psychomotor disturbance. In order to illuminate dynamical aspects of the longitudinal course of the illness, we propose here a novel complex model based on the notion of competition between recurrent maps, which mathematically represent the dynamics of activation in excitatory (Glutamatergic) and inhibitory (GABAergic) pathways. We assume that manic and depressive states can be considered stable sub attractors of a dynamical system through which the mood trajectory moves. The model provides a theoretical framework which can account for a number of complex phenomena of bipolar disorder, including intermittent transition between the two poles of the disorder, rapid and ultra-rapid cycling of episodes and manicogenic effects of antidepressants.
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Affiliation(s)
- Fatemeh Hadaeghi
- Complex Systems and Cybernetics Control Laboratory, Biomedical Engineering Faculty, Amirkabir University of Technology, Tehran, Iran
| | - Mohammad Reza Hashemi Golpayegani
- Complex Systems and Cybernetics Control Laboratory, Biomedical Engineering Faculty, Amirkabir University of Technology, Tehran, Iran.
| | - Greg Murray
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
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21
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Abstract
The challenging problems presented by noisy biological oscillators have led to the development of a great variety of methods for accurately estimating rhythmic parameters such as period and amplitude. This chapter focuses on wavelet-based methods, which can be quite effective for assessing how rhythms change over time, particularly if time series are at least a week in length. These methods can offer alternative views to complement more traditional methods of evaluating behavioral records. The analytic wavelet transform can estimate the instantaneous period and amplitude, as well as the phase of the rhythm at each time point, while the discrete wavelet transform can extract the circadian component of activity and measure the relative strength of that circadian component compared to those in other frequency bands. Wavelet transforms do not require the removal of noise or trend, and can, in fact, be effective at removing noise and trend from oscillatory time series. The Fourier periodogram and spectrogram are reviewed, followed by descriptions of the analytic and discrete wavelet transforms. Examples illustrate application of each method and their prior use in chronobiology is surveyed. Issues such as edge effects, frequency leakage, and implications of the uncertainty principle are also addressed.
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Affiliation(s)
- Tanya L Leise
- Department of Mathematics and Statistics, Amherst College, Amherst, Massachusetts, USA.
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22
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De Crescenzo F, Armando M, Mazzone L, Ciliberto M, Sciannamea M, Figueroa C, Janiri L, Quested D, Vicari S. The use of actigraphy in the monitoring of methylphenidate versus placebo in ADHD: a meta-analysis. ACTA ACUST UNITED AC 2013; 6:49-58. [PMID: 24287735 DOI: 10.1007/s12402-013-0122-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 11/18/2013] [Indexed: 11/25/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. There is an increasing need to find objective measures and markers of the disorder in order to assess the efficacy of the therapy and to improve follow-up strategies. Actigraphy is an objective method for recording motor activity and sleep parameters using small, computerized, watch-like devices worn on the body, and it has been used in many clinical trials to assess methylphenidate efficacy and adverse effects in ADHD. Our article aim is to systematically review and perform a meta-analysis of the current evidence on the role of actigraphy in both the detection of changes in activity and in sleep patterns in randomized clinical trials that compared methylphenidate against placebo in the treatment of ADHD. A comprehensive literature search of PubMed/MEDLINE, Scopus, Embase, Cochrane Library, CINHAL and PsycINFO databases was carried out to find randomized clinical trials comparing methylphenidate versus placebo in children with ADHD, using actigraphic measures as an outcome. No start date limit was used and the search was updated until June 2013. The primary outcome measures were 'total sleep time' and daytime 'activity mean'. As secondary outcomes, we analyzed 'sleep onset latency', 'sleep efficiency' and 'wake after sleep onset'. Eight articles comprising 393 patients were included in the analysis. Children with ADHD using MPH compared to placebo have a significant difference of a large effect with a diminishing value in the activity mean. For the total sleep time, we found a significant and large effect in the decrease in sleep in MPH group. This study shows that MPH may effectively reduce mean activity in ADHD children, but it may negatively affect total sleep time.
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Affiliation(s)
- Franco De Crescenzo
- Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00100, Rome, Italy,
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23
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Kim J, Nakamura T, Kikuchi H, Sasaki T, Yamamoto Y. Co-variation of depressive mood and locomotor dynamics evaluated by ecological momentary assessment in healthy humans. PLoS One 2013; 8:e74979. [PMID: 24058642 PMCID: PMC3773004 DOI: 10.1371/journal.pone.0074979] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 08/13/2013] [Indexed: 12/19/2022] Open
Abstract
Computerized ecological momentary assessment (EMA) is widely accepted as a “gold standard” method for capturing momentary symptoms repeatedly experienced in daily life. Although many studies have addressed the within-individual temporal variations in momentary symptoms compared with simultaneously measured external criteria, their concurrent associations, specifically with continuous physiological measures, have not been rigorously examined. Therefore, in the present study, we first examined the variations in momentary symptoms by validating the associations among self-reported symptoms measured simultaneously (depressive mood, anxious mood, and fatigue) and then investigated covariant properties between the symptoms (especially, depressive mood) and local statistics of locomotor activity as the external objective criteria obtained continuously. Healthy subjects (N = 85) from three different populations (adolescents, undergraduates, and office workers) wore a watch-type computer device equipped with EMA software for recording the momentary symptoms experienced by the subjects. Locomotor activity data were also continuously obtained by using an actigraph built into the device. Multilevel modeling analysis confirmed convergent associations by showing positive correlations among momentary symptoms. The increased intermittency of locomotor activity, characterized by a combination of reduced activity with occasional bursts, appeared concurrently with the worsening of depressive mood. Further, this association remained statistically unchanged across groups regardless of group differences in age, lifestyle, and occupation. These results indicate that the temporal variations in the momentary symptoms are not random but reflect the underlying changes in psychophysiological variables in daily life. In addition, our findings on the concurrent changes in depressive mood and locomotor activity may contribute to the continuous estimation of changes in depressive mood and early detection of depressive disorders.
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Affiliation(s)
- Jinhyuk Kim
- Graduate School of Education, the University of Tokyo, Tokyo, Japan
| | - Toru Nakamura
- Graduate School of Education, the University of Tokyo, Tokyo, Japan
| | - Hiroe Kikuchi
- Department of Psychosomatic Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tsukasa Sasaki
- Graduate School of Education, the University of Tokyo, Tokyo, Japan
| | - Yoshiharu Yamamoto
- Graduate School of Education, the University of Tokyo, Tokyo, Japan
- * E-mail:
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Salvatore P, Indic P, Murray G, Baldessarini RJ. Biological rhythms and mood disorders. DIALOGUES IN CLINICAL NEUROSCIENCE 2013. [PMID: 23393414 PMCID: PMC3553575 DOI: 10.31887/dcns.2012.14.4/psalvatore] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Integration of several approaches concerning time and temporality can enhance the pathophysiological study of major mood disorders of unknown etiology. We propose that these conditions might be interpreted as disturbances of temporal profile of biological rhythms, as well as alterations of time-consciousness. Useful approaches to study time and temporality include philological suggestions, phenomenological and psychopathological conceptualizatíons, clinical descriptions, and research on circadian and ultradían rhythms, as well as nonlinear dynamics approaches to their analysis.
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Affiliation(s)
- Paola Salvatore
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Boston, Massachusetts, USA
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Salvatore P, Baldessarini RJ, Khalsa HMK, Indic P, Maggini C, Tohen M. Negative Affective Features in 516 Cases of First Psychotic Disorder Episodes: Relationship to Suicidal Risk. ACTA ACUST UNITED AC 2013; 2. [PMID: 24288656 DOI: 10.4172/2167-1044.1000131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Plausible candidates of psychopathological phenomena that may associate with or anticipate suicidal risk, include negative affects, including admixtures of dysphoria, depression and anxiety described mainly in nonpsychotic disorders. We ascertained the distribution of such affective features in various first-episode psychotic disorders and correlated these and other clinical and antecedent features with intake suicidal status. METHODS We evaluated 516 adult subjects in first-lifetime episodes of various DSM-IV-TR psychotic disorders. Blinded, protocol-guided, assessments of clinical features ascertained in SCID examinations, self- and family reports and clinical records supported analyses of associations of suicide attempts at first-psychotic episodes with antecedent and intake clinical characteristics, including negative affects and diagnoses, using standard bivariate and multivariate methods. RESULTS Negative affective features in various combinations were prevalent (90%) and at >75% in both affective and nonaffective psychotic disorders; anxious depression was most common (22%). We identified antecedent and intake clinical factors preliminarily associated with suicide attempts. Factors remaining independently associated in multivariate logistic modelling (ranked by OR) were: (a) prior suicide attempt, (b) prior aggressive assault, (c) bipolar-mixed state or psychotic major depression diagnosis, (d) prior dysphoria, (e) intake dysphoric-anxiousdepression, (f) prior impulsivity, (g) previous affective instability, (h) previous nonpsychotic depression, (i) previous decline in vital drive, and (j) prior sleep disturbances. CONCLUSIONS Various types and combinations of negative affective features (especially anxious depression with and without dysphoria) were prevalent across nonaffective as well as affective first psychotic episodes and strongly associated with suicide attempts. These findings extend previous observations in nonpsychotic disorders.
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Affiliation(s)
- Paola Salvatore
- Department of Psychiatry and Neuroscience Program, Harvard Medical School, Boston, MA, USA ; Section of Psychiatry, Department of Neuroscience, University of Parma, Parma, Italy
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