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Tu EN, Manley H, Saunders KEA, Creswell C. Systematic Review and Meta-Analysis: Risks of Anxiety Disorders in Offspring of Parents With Mood Disorders. J Am Acad Child Adolesc Psychiatry 2024; 63:407-421. [PMID: 37453607 DOI: 10.1016/j.jaac.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To examine the risk of anxiety disorders in offspring of parents with mood disorders. METHOD We conducted a systematic review and meta-analysis. We searched 4 electronic databases (Medline, Embase, PsycINFO, and Web of Science [core collection]) to identify cross-sectional and cohort studies that examined the association between parental mood disorders (including bipolar disorder and unipolar depression) and risk of anxiety disorders in offspring. Pooled risk ratios (RRs) of overall and specific anxiety disorders were synthesized using a random effects model. Subgroup analyses and meta-regression were performed to identify moderation factors. RESULTS A total of 35 studies were included in the final analysis. Our results showed higher risks of all types of anxiety disorders in the offspring of parents with mood disorders (any anxiety disorder, RR = 1.82, 95% CI = 1.47-2.26), except for agoraphobia (RR = 1.08, 95% CI = 0.56-2.08), and with an especially elevated risk of panic disorder (RR = 3.07, 95% CI = 2.19-4.32). Subgroup analysis demonstrated no significant difference between the risks of anxiety disorders across the offspring of parents with bipolar disorder as opposed to unipolar depression. The absence of anxiety disorders in control parents, younger offspring age, and specific parent/offspring sex were associated with higher RRs for some anxiety disorders in offspring of parents with mood disorders. CONCLUSION Our findings suggest a robust relationship between parental mood disorders and offspring anxiety disorders, and highlight the potential value of prevention and early intervention for anxiety disorders in this context. DIVERSITY & INCLUSION STATEMENT We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. STUDY PREREGISTRATION INFORMATION Anxiety Disorders in Offspring of Parents with Mood Disorders: A Systematic Review; https://www.crd.york.ac.uk/prospero/; CRD42021215058.
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Affiliation(s)
- En-Nien Tu
- University of Oxford, United Kingdom; Chang Gung Memorial Hospital, Keelung, Taiwan, and Chang Gung University, Taiwan
| | | | - Kate E A Saunders
- University of Oxford, United Kingdom; Queen's University, Kingston, Canada, and Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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Kajee N, Montero-Marin J, Saunders KEA, Myall K, Harriss E, Kuyken W. Mindfulness training in healthcare professions: A scoping review of systematic reviews. Med Educ 2024. [PMID: 38234144 DOI: 10.1111/medu.15293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/10/2023] [Accepted: 11/17/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE The effectiveness of mindfulness training (MT) on mental health and wellbeing in different groups and contexts is well-established. However, the effect of MT on different healthcare professionals' (HCPs) mental health and wellbeing needs to be synthesised, along with a focus on outcomes that are specifically relevant to healthcare settings. The aim of this study is to summarise the effect of MT interventions on HCPs' mental health and wellbeing, to explore its effect on communication skills and to identify potential gaps in the literature. METHODS A scoping review of systematic reviews (SRs) investigating MT interventions in HCPs was conducted. A comprehensive systematic search was conducted from database inception to 22 February 2023 on Ovid MEDLINE, Ovid Embase, Scopus, Cochrane (CENTRAL), EBSCHOhost CINAHL, Ovid PsycINFO, Web of Science (Core Collection), OpenGrey, TRIP Database and Google Scholar. Snowballing of reference lists and hand-searching were utilised. Risk of bias and quality of included SRs were assessed using the ROBIS and AMSTAR2 tools. RESULTS Sixteen SRs were included in this review. We found substantial evidence for MT interventions improving mental health and wellbeing across different HCPs, with the exception of burnout, where evidence is mixed. There is a paucity of SRs evaluating communication skills other than empathy. However, the available evidence is suggestive of improvements in self-reported empathy. Details of MT fidelity and dosage are largely absent in the SRs, as is study populations from representative EDI samples. CONCLUSIONS Synthesis of SRs suggests that MT improves mental health and wellbeing in HCPs. The exception is burnout, where results are inconclusive. Insufficient data exists to evaluate effects of MT on the full spectrum of communication skills. Other HCPs than medicine and nursing are inadequately represented. Further research is required that considers the specific target population of HCPs and MT curriculum, and reports on fidelity, dosage and the effects on communication skills.
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Affiliation(s)
- Nabeela Kajee
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK, OX3 7JX
| | - Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK, OX3 7JX
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiology and Public Health, CIBERESP), Madrid, Spain, 28029
| | - Kate E A Saunders
- Associate Professor, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK, OX3 7JX
| | - Kearnan Myall
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK, OX3 7JX
| | - Elinor Harriss
- Outreach and Enquiry Services Manager, Bodleian Health Care Libraries, University of Oxford, UK, OX3 7JX
| | - Willem Kuyken
- Professor, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK, OX3 7JX
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Bisdounis L, Saunders KEA, McGowan NM, Espie CA, Kyle SD. A reply to Sit et al. Neurosci Biobehav Rev 2024; 156:105472. [PMID: 37981230 DOI: 10.1016/j.neubiorev.2023.105472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/30/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Lampros Bisdounis
- Sir Jules Thorn Sleep and Circadian Neuroscience institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Department of Psychiatry, Warneford Hospital, University of Oxford, United Kingdom.
| | - Kate E A Saunders
- Department of Psychiatry, Warneford Hospital, University of Oxford, United Kingdom; Oxford NHS Foundation Trust, Warneford Hospital, University of Oxford, United Kingdom
| | - Niall M McGowan
- Sir Jules Thorn Sleep and Circadian Neuroscience institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Department of Psychiatry, Warneford Hospital, University of Oxford, United Kingdom
| | - Colin A Espie
- Sir Jules Thorn Sleep and Circadian Neuroscience institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Simon D Kyle
- Sir Jules Thorn Sleep and Circadian Neuroscience institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
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King N, Rivera D, Cunningham S, Pickett W, Harkness K, McNevin SH, Milanovic M, Byun J, Khanna A, Atkinson J, Saunders KEA, Duffy A. Mental health and academic outcomes over the first year at university in international compared to domestic Canadian students. J Am Coll Health 2023; 71:2663-2672. [PMID: 34606410 DOI: 10.1080/07448481.2021.1982950] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/20/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To compare risk factors and associated mental health and academic outcomes between international and domestic students. PARTICIPANTS Canadian university undergraduate students. METHODS Electronic surveys were completed at university entry and the end of first year. Surveys assessed demographics, risk factors, symptoms of mental disorders, and access to support. Academic outcomes were obtained from university databases. RESULTS International students had comparable or lower rates of clinically significant anxiety, depression, and insomnia. Domestic female students reported the highest screening rates for common mental disorders. However, international students were more likely to report having attempted suicide. International students felt less connected to the university community and had lower academic performance. Psychosocial risk factor profiles and proportions accessing mental health services were similar. CONCLUSIONS The scope of mental health need appears more similar than different between international and domestic students; however, international students may benefit from targeted academic and social support initiatives.
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Affiliation(s)
- N King
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - D Rivera
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - S Cunningham
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - W Pickett
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - K Harkness
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - S H McNevin
- Department of Psychiatry, Division of Student Mental Health, Queen's University, Kingston, ON, Canada
| | - M Milanovic
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - J Byun
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - A Khanna
- Student Wellness Services, Queen's University, Kingston, ON, Canada
| | - J Atkinson
- Faculty of Arts and Science, Queen's University, Kingston, ON, Canada
| | - K E A Saunders
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - A Duffy
- Department of Psychiatry, Division of Student Mental Health, Queen's University, Kingston, ON, Canada
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Blamey H, Harrison CH, Roddick A, Malhotra T, Saunders KEA. Simulated virtual on-call training programme for improving non-specialised junior doctors' confidence in out-of-hours psychiatry: quantitative assessment. BJPsych Bull 2023; 47:287-295. [PMID: 36073524 PMCID: PMC10764820 DOI: 10.1192/bjb.2022.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 05/25/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS AND METHOD To investigate whether a psychiatry-specific virtual on-call training programme improved confidence of junior trainees in key areas of psychiatry practice. The programme comprised one 90 min lecture and a 2 h simulated on-call shift where participants were bleeped to complete a series of common on-call tasks, delivered via Microsoft Teams. RESULTS Thirty-eight trainees attended the lecture, with a significant improvement in confidence in performing seclusion reviews (P = 0.001), prescribing psychiatric medications for acute presentations (P < 0.001), working in section 136 suites (places of safety) (P = 0.001) and feeling prepared for psychiatric on-call shifts (P = 0.002). Respondents reported that a virtual on-call practical session would be useful for their training (median score of 7, interquartile range 5-7.75). Eighteen participants completed the virtual on-call session, with significant improvement in 9 out of the 10 tested domains (P < 0.001). CLINICAL IMPLICATIONS The programme can be conducted virtually, with low resource requirements. We believe it can improve trainee well-being, patient safety, the delivery of training and induction of rotating junior doctors during the COVID-19 pandemic and it supports the development and delivery of practical training in psychiatry.
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Affiliation(s)
- Helen Blamey
- John Radcliffe Hospital, Oxford, UK
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
| | - Charlotte H. Harrison
- John Radcliffe Hospital, Oxford, UK
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
| | - Alistair Roddick
- John Radcliffe Hospital, Oxford, UK
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
| | | | - Kate E. A. Saunders
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, Oxford, UK
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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Bisdounis L, Saunders KEA, McGowan NM, Espie CA, Kyle SD. ERRATUM TO: Psychological and behavioural interventions in bipolar disorder that target sleep and circadian rhythms: a systematic review of randomised controlled trials. Neurosci Biobehav Rev 2023:105322. [PMID: 37454881 DOI: 10.1016/j.neubiorev.2023.105322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Lampros Bisdounis
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Department of Psychiatry, Warneford Hospital, University of Oxford, United Kingdom.
| | - Kate E A Saunders
- Department of Psychiatry, Warneford Hospital, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Niall M McGowan
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Department of Psychiatry, Warneford Hospital, University of Oxford, United Kingdom
| | - Colin A Espie
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Simon D Kyle
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
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McGagh D, McGowan N, Hinds C, Saunders KEA, Coates LC. Actigraphy-derived physical activity levels and circadian rhythm parameters in patients with psoriatic arthritis: relationship with disease activity, mood, age and BMI. Ther Adv Musculoskelet Dis 2023; 15:1759720X231174989. [PMID: 37435529 PMCID: PMC10331082 DOI: 10.1177/1759720x231174989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/24/2023] [Indexed: 07/13/2023] Open
Abstract
Background Psoriatic arthritis (PsA) is associated with sleep disturbance, depression and a lifetime risk of obesity and cardiovascular disease. To date, there have been no studies investigating the relationship between objectively-measured physical activity (PA) levels and circadian rhythm disturbance with disease activity, daily symptoms and mood in patients with PsA. Objective This pilot study aimed to investigate the relationship between disease activity, daily symptoms and mood on PA and circadian rhythm in PsA. Design A prospective cohort study recruiting adults with PsA from rheumatology clinics at a single centre in the UK. Methods Participants wore an actigraph and recorded their symptoms and mood on a daily basis via a smartphone app for 28 days. Time spent in sedentary, light and moderate-to-vigorous physical activity (MVPA) and parameters reflecting the circadian rhythm of the rest-activity pattern were derived. This included the onset time of the least active 5-h (L5) and most active 10-h (M10) daily consecutive periods and the relative amplitude (RA). The relationship factors between baseline clinical status, daily symptoms, PA and circadian measures were examined using linear mixed effect regression models. Results Nineteen participants (8/19 female) were included. Participants with active PsA spent 63.87 min (95% CI: 18.5-109.3, p = 0.008) more in inactivity and 30.78 min (95% CI: 0.4-61.1, p = 0.047) less in MVPA per day compared to those in minimal disease activity (MDA). Age, body mass index and disease duration were also associated with PA duration. Participants with worse functional impairment had an M10 onset time 1.94 h (95% CI: 0.05-3.39, p = 0.011) later than those with no reported functional impairment. No differences were detected for L5 onset time or RA. Higher scores for positive mood components such as feeling energetic, cheerful and elated were associated with less time in inactivity and greater time spent in MVPA overall. Conclusion Our study highlights differences in PA and circadian rest-activity pattern timing based on disease activity, disability and daily mood in PsA. Reduced PA levels in patients with active disease may contribute to the observed increased risk of cardiovascular and metabolic sequelae, with further studies exploring this need.
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Affiliation(s)
- Dylan McGagh
- Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences, University of Oxford, The Botnar
Research Centre, Old Road, Headington, Oxford, OX3 7LD, UK
| | - Niall McGowan
- Sleep and Circadian Neuroscience Institute,
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford,
Oxfordshire, UK
- Department of Psychiatry, University of Oxford,
Oxford, UK
| | - Chris Hinds
- Oxford Digital Phenotyping Laboratory, Big Data
Institute, University of Oxford, Oxford, UK
| | - Kate E. A. Saunders
- Department of Psychiatry, University of Oxford,
Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford
Hospital, Oxford, UK
| | - Laura C. Coates
- Nuffield Department of Orthopaedics,
Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford,
UK
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Gordon-Smith K, Saunders KEA, Morton T, Savage J, South M, Geddes J, Craddock N, Jones I, Jones L. User perspectives on long-term remote active electronic self-monitoring of mood symptoms in bipolar spectrum disorders. J Affect Disord 2023; 324:325-333. [PMID: 36584706 DOI: 10.1016/j.jad.2022.12.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND User feedback is crucial in the development of electronic self-monitoring tools for bipolar spectrum disorders (BSD). Previous studies have examined user experiences in small samples self-monitoring over relatively short time periods. We aimed to explore the experiences of a large sample of individuals with BSD engaged in long-term remote active electronic self-monitoring. METHODS An online survey, containing closed and open questions, was sent to participants with BSD enrolled on the Bipolar Disorder Research Network (BDRN) True Colours mood-monitoring system. Questions related to experiences of using True Colours, including viewing mood graphs, and sharing data with healthcare professionals (HCPs) and/or family/friends. RESULTS Response rate was 62.7 % (n = 362). 88.4 % reported finding using True Colours helpful. Commonly reported benefits were having a visual record of mood changes, patterns/triggers and identifying early warning signs. Limitations included questions not being comprehensive or revealing anything new. One third had shared their graphs, with 89.9 % finding it helpful to share with HCPs and 78.7 % helpful to share with family/friends. Perceived benefits included aiding communication and limitations included lack of interest/understanding from others. LIMITATIONS Responder bias may be present. Findings may not be generalisable to all research cohorts. CONCLUSIONS The majority of participants valued long-term self-monitoring. Personalisation and ease of use were important. A potential challenge is continued use when mood is long-term stable, highlighting the need for measures to be sensitive to small changes. Sharing self-monitoring data with HCPs may enhance communication of the lived experience of those with BSD. Future research should examine HCPs' perspectives.
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Affiliation(s)
| | - Kate E A Saunders
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | | | | | - Matthew South
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - John Geddes
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Nick Craddock
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Ian Jones
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Lisa Jones
- Psychological Medicine, University of Worcester, UK.
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Wu Y, Goodwin GM, Lyons T, Saunders KEA. Identifying psychiatric diagnosis from missing mood data through the use of log-signature features. PLoS One 2022; 17:e0276821. [PMCID: PMC9671309 DOI: 10.1371/journal.pone.0276821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 10/13/2022] [Indexed: 11/19/2022] Open
Abstract
The availability of mobile technologies has enabled the efficient collection of prospective longitudinal, ecologically valid self-reported clinical questionnaires from people with psychiatric diagnoses. These data streams have potential for improving the efficiency and accuracy of psychiatric diagnosis as well predicting future mood states enabling earlier intervention. However, missing responses are common in such datasets and there is little consensus as to how these should be dealt with in practice. In this study, the missing-response-incorporated log-signature method achieves roughly 74.8% correct diagnosis, with f1 scores for three diagnostic groups 66% (bipolar disorder), 83% (healthy control) and 75% (borderline personality disorder) respectively. This was superior to the naive model which excluded missing data and advanced models which implemented different imputation approaches, namely, k-nearest neighbours (KNN), probabilistic principal components analysis (PPCA) and random forest-based multiple imputation by chained equations (rfMICE). The log-signature method provided an effective approach to the analysis of prospectively collected mood data where missing data was common and should be considered as an approach in other similar datasets. Because of treating missing responses as a signal, its superiority also highlights that missing data conveys valuable clinical information.
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Affiliation(s)
- Yue Wu
- Mathematical Institute, University of Oxford, Oxford, United States of America
- Alan Turing Institute, London, United Kingdom
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
- * E-mail:
| | - Guy M. Goodwin
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Terry Lyons
- Mathematical Institute, University of Oxford, Oxford, United States of America
- Alan Turing Institute, London, United Kingdom
| | - Kate E. A. Saunders
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
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Lewis KJS, Gordon‐Smith K, Saunders KEA, Dolman C, South M, Geddes J, Craddock N, Di Florio A, Jones I, Jones L. Mental health prior to and during the COVID-19 pandemic in individuals with bipolar disorder: Insights from prospective longitudinal data. Bipolar Disord 2022; 24:658-666. [PMID: 35315963 PMCID: PMC9111192 DOI: 10.1111/bdi.13204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Many studies have examined the impact of COVID-19 on the mental health of the public, but few have focused on individuals with existing severe mental illness with longitudinal data before and during the pandemic. AIMS To investigate the impact of the COVID-19 pandemic on the mental health of people with bipolar disorder (BD). METHODS In an ongoing study of people with BD who used an online mood monitoring tool, True Colours, 356 participants provided weekly data on their mental health. Symptoms of depression, mania, insomnia, and suicidal thoughts were compared in 2019 and 2020. From May 2020, participants also provided weekly data on the effect of the COVID-19 pandemic on anxiety, coping strategies, access to care, and medications. RESULTS On average, symptoms of depression, mania, insomnia, and suicidal thoughts did not significantly differ in 2020 compared to 2019, but there was evidence of heterogeneity. There were high rates of anxiety about the pandemic and its impact on coping strategies, which increased to over 70% of responders in January 2021. A significant proportion of participants reported difficulty accessing routine care (27%) and medications (21%). CONCLUSIONS Although mood symptoms did not significantly increase during the pandemic overall, we observed heterogeneity among our BD sample and other impacted areas. Individuals' unique histories and psychosocial circumstances are key and should be explored in future qualitative studies. The significant impacts of the pandemic may take time to manifest, particularly among those who are socioeconomically disadvantaged, highlighting the need for further long-term prospective studies.
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Affiliation(s)
- Katie J. S. Lewis
- National Centre for Mental HealthMRC Centre for Neuropsychiatric Genetics and GenomicsDivision of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
| | | | - Kate E. A. Saunders
- Department of PsychiatryWarneford Hospital, Oxford UniversityOxfordUK
- Oxford Health NHS Foundation TrustWarneford HospitalOxfordUK
| | - Clare Dolman
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and NeurosciencesKing's College LondonLondonUK
| | - Matthew South
- Department of PsychiatryWarneford Hospital, Oxford UniversityOxfordUK
- Oxford Health NHS Foundation TrustWarneford HospitalOxfordUK
| | - John Geddes
- Department of PsychiatryWarneford Hospital, Oxford UniversityOxfordUK
- Oxford Health NHS Foundation TrustWarneford HospitalOxfordUK
| | - Nick Craddock
- National Centre for Mental HealthMRC Centre for Neuropsychiatric Genetics and GenomicsDivision of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
| | - Arianna Di Florio
- National Centre for Mental HealthMRC Centre for Neuropsychiatric Genetics and GenomicsDivision of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
| | - Ian Jones
- National Centre for Mental HealthMRC Centre for Neuropsychiatric Genetics and GenomicsDivision of Psychological Medicine and Clinical NeurosciencesCardiff UniversityCardiffUK
| | - Lisa Jones
- Psychological MedicineUniversity of WorcesterWorcesterUK
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Bolton S, Joyce DW, Gordon-Smith K, Jones L, Jones I, Geddes J, Saunders KEA. Psychosocial markers of age at onset in bipolar disorder: a machine learning approach. BJPsych Open 2022; 8:e133. [PMID: 35844202 PMCID: PMC9344222 DOI: 10.1192/bjo.2022.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bipolar disorder is a chronic and severe mental health disorder. Early stratification of individuals into subgroups based on age at onset (AAO) has the potential to inform diagnosis and early intervention. Yet, the psychosocial predictors associated with AAO are unknown. AIMS We aim to identify psychosocial factors associated with bipolar disorder AAO. METHOD Using data from the Bipolar Disorder Research Network UK, we employed least absolute shrinkage and selection operator regression to identify psychosocial factors associated with bipolar disorder AAO. Twenty-eight factors were entered into our model, with AAO as our outcome measure. RESULTS We included 1022 participants with bipolar disorder (μ = 23.0, s.d. ± 9.86) in our model. Six variables predicted an earlier AAO: childhood abuse (β = -0.2855), regular cannabis use in the year before onset (β = -0.2765), death of a close family friend or relative in the 6 months before onset (β = -0.2435), family history of suicide (β = -0.1385), schizotypal personality traits (β = -0.1055) and irritable temperament (β = -0.0685). Five predicted a later AAO: the average number of alcohol units consumed per week in the year before onset (β = 0.1385); birth of a child in the 6 months before onset (β = 0.2755); death of parent, partner, child or sibling in the 6 months before onset (β = 0.3125); seeking work without success for 1 month or more in the 6 months before onset (β = 0.3505) and a major financial crisis in the 6 months before onset (β = 0.4575). CONCLUSIONS The identified predictor variables have the potential to help stratify high-risk individuals into likely AAO groups, to inform treatment provision and early intervention.
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Affiliation(s)
- Sorcha Bolton
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK
| | - Dan W Joyce
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, UK
| | | | - Lisa Jones
- Department of Psychological Medicine, University of Worcester, UK
| | - Ian Jones
- National Centre for Mental Health, Cardiff University, UK
| | - John Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, UK
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, UK
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Lindsay JAB, McGowan NM, King N, Rivera D, Li M, Byun J, Cunningham S, Saunders KEA, Duffy A. Psychological predictors of insomnia, anxiety and depression in university students: potential prevention targets. BJPsych Open 2022; 8:e86. [PMID: 35438069 PMCID: PMC9059737 DOI: 10.1192/bjo.2022.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/18/2022] [Accepted: 03/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Perfectionism, low self-esteem and external locus of control are psychological constructs linked to insomnia, anxiety and depression. Examining how these constructs impact mental health and serve as risk factors for the development of clinically significant symptoms may help direct psychological support resources and preventative measures for university students. AIMS To longitudinally examine associations between the aforementioned psychological constructs and symptoms of insomnia, anxiety and depression in a large representative sample of first-year university students. METHOD Electronic surveys including validated measures of the predictors and outcomes were emailed to all first-year undergraduate students at entry to a major Canadian university, and followed up on at conclusion of the academic year. RESULTS Compared with healthy sleepers, students screening positive for insomnia had lower self-esteem, higher self-evaluative perfectionism and increased external locus of control (all P < 0.001). Self-evaluative perfectionism (standardised β = 0.13, P < 0.01), self-esteem (β = -0.30, P < 0.001) and external locus of control (β = 0.07, P = 0.02) measured at entry were significantly associated with insomnia symptoms at follow-up. Insomnia symptoms at entry were strong predictors of symptoms of depression (β = 0.15, P < 0.001) and anxiety (β = 0.16, P < 0.001) at follow-up, even after controlling for baseline symptoms of those disorders. CONCLUSIONS Perfectionism, low self-esteem and external locus of control may predispose the development of insomnia symptoms in university students. In turn, insomnia symptoms appear to be robust predictors for depressive and anxiety symptoms. Sleep may be an important prevention target in university students.
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Affiliation(s)
| | | | - Nathan King
- Department of Public Health Sciences, Queen's University, Canada
| | - Daniel Rivera
- Department of Pharmacology and Toxicology, University of Toronto, Canada; and Department of Psychiatry, Queen's University, Canada
| | - Melanie Li
- Department of Biology, Queen's University, Canada
| | - Jin Byun
- Faculty of Health Sciences, Queen's University, Canada
| | - Simone Cunningham
- Department of Biomedical and Molecular Sciences, Queen's University, Canada
| | | | - Anne Duffy
- Department of Psychiatry, University of Oxford, UK; and Department of Psychiatry, Queen's University, Canada
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13
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McGowan NM, Kim DS, de Andres Crespo M, Bisdounis L, Kyle SD, Saunders KEA. Hypnotic and Melatonin/Melatonin-Receptor Agonist Treatment in Bipolar Disorder: A Systematic Review and Meta-Analysis. CNS Drugs 2022; 36:345-363. [PMID: 35305257 DOI: 10.1007/s40263-022-00911-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a chronic relapsing-remitting psychiatric disorder. Sleep and circadian rhythm disturbances persist during acute mood episodes of the disorder and during euthymia. However, the treatment potential of hypnotic agents that might be used to manage sleep disturbance in BD is not well understood. Similarly, melatonin and medications with a melatonin-receptor agonist mechanism of action may have chronotherapeutic potential for treating people with the disorder, but the impact of these substances on sleep and circadian rhythms and core symptoms in BD is unclear. OBJECTIVE Our aim was to conduct a systematic review and meta-analysis evaluating the current evidence for hypnotic and melatonin/melatonin-receptor agonist pharmacotherapy for symptoms of sleep disturbance, mania, and depression in patients with BD. METHODS AMED, Embase, MEDLINE and PsychINFO databases were searched for studies published in English from the date of inception to 31 October 2021. Studies included in this review were randomised controlled trials (RCTs) and non-controlled/non-randomised studies for BD that examined hypnotic medications selected based on a common pattern of usage for treating insomnia (i.e. chloral, clomethiazole, diphenhydramine, doxepin, doxylamine, promethazine, suvorexant, zaleplon, zolpidem, zopiclone, and eszopiclone) and melatonin and the melatonin-receptor agonist drugs ramelteon and agomelatine. Risk of bias was assessed using the RoB2 and AXIS tools. Pooled effect sizes for RCT outcomes were estimated using random-effects models. RESULTS A total of eleven studies (six RCTs and five experimental feasibility studies) involving 1279 participants were included. Each study examined melatonin or melatonin-receptor agonists. No studies of hypnotics were found that fulfilled the review inclusion criteria. Pilot feasibility studies suggested beneficial treatment effects for symptoms of sleep disturbance, depression, and mania. However, the pooled effect of the two available RCT studies assessing sleep quality via Pittsburgh Sleep Quality Index scores was not statistically significant (g = - 0.04 [95% CI - 0.81 to 0.73]) and neither was the pooled effect for depressive symptoms (four studies; g = - 0.10 [95% CI - 0.27 to 0.08]). Some RCT evidence suggests ramelteon might prevent relapse into depression in BD. The largest efficacy signal detected was for manic symptoms (four studies; g = - 0.44 [95% CI - 1.03 to 0.14]) but there was substantial heterogeneity between studies and patient characteristics. In the two RCTs assessing manic symptoms during acute mania, adjunctive melatonin demonstrated superior treatment effects versus placebo. CONCLUSIONS There is a paucity of studies examining pharmacological interventions for sleep and circadian rhythm disturbance in BD. Few studies assessed sleep-related symptoms, and none quantitatively examined endogenous melatonin patterns or other circadian rhythms. Melatonin may be a promising candidate for the adjunctive treatment of bipolar mania. However, dose-finding studies and studies with larger sample sizes are needed to confirm its efficacy. We recommend parallel monitoring of sleep and circadian rhythms in future trials. Chronobiology-informed trial designs are needed to improve the quality of future studies. PROTOCOL REGISTRATION PROSPERO (CRD42020167528).
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Affiliation(s)
- Niall M McGowan
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK. .,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - David S Kim
- Medical Sciences Division, Clinical Medical School, The John Radcliffe Hospital, University of Oxford Academic Centre, Oxford, UK
| | - Marta de Andres Crespo
- Medical Sciences Division, Clinical Medical School, The John Radcliffe Hospital, University of Oxford Academic Centre, Oxford, UK
| | - Lampros Bisdounis
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kate E A Saunders
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.,Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
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14
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Bisdounis L, Saunders KEA, Farley HJ, Lee CK, McGowan NM, Espie CA, Kyle SD. Psychological and behavioural interventions in bipolar disorder that target sleep and circadian rhythms: A systematic review of randomised controlled trials. Neurosci Biobehav Rev 2022; 132:378-390. [PMID: 34871635 DOI: 10.1016/j.neubiorev.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/18/2021] [Accepted: 12/01/2021] [Indexed: 01/10/2023]
Abstract
Sleep and circadian disruptions are prominent symptoms of bipolar disorder (BD) and potential targets for adjunctive interventions. The aim of this review was to appraise the effectiveness of psychological and behavioural interventions in BD that target sleep and circadian rhythms, as reported by randomised controlled trials. Nineteen studies met the inclusion/exclusion criteria. They were summarised via narrative synthesis and meta-analysis wherever appropriate. Six studies delivered bright light therapy, five interpersonal and social rhythm therapy, two blue-light blocking glasses, one cognitive behavioural therapy for insomnia, one total sleep deprivation, and four combination treatments. More than half of the studies (N = 10, 52 %) did not measure sleep or circadian rhythms despite being the principal target of the intervention. Overall, the evidence base for the effectiveness of these interventions was limited. There was a small number of studies for each intervention, and a lack of consistency in protocols and outcomes. Meta-analysis was possible for the effect of bright light therapy on depression, revealing a medium-to-large post-treatment effect (Nc = 6; g=-0.74 [95 % CI=-1.05 to -0.42], p < 0.001).
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Affiliation(s)
- Lampros Bisdounis
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom; Department of Psychiatry, Warneford Hospital, University of Oxford, United Kingdom.
| | - Kate E A Saunders
- Department of Psychiatry, Warneford Hospital, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Hannah J Farley
- Clinical Medical School, Medical Sciences Division, Academic Centre, John Radcliffe Hospital, University of Oxford, United Kingdom
| | - Charlotte K Lee
- Clinical Medical School, Medical Sciences Division, Academic Centre, John Radcliffe Hospital, University of Oxford, United Kingdom
| | - Niall M McGowan
- Department of Psychiatry, Warneford Hospital, University of Oxford, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
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15
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Bandyopadhyay S, Georgiou I, Bligh E, Coyle C, Pancharatnam R, Saunders KEA. SPICE-19: a 3-Month Prospective Cohort Study of 640 Medical Students and Foundation Doctors. Med Sci Educ 2021; 31:1621-1637. [PMID: 34306817 PMCID: PMC8294310 DOI: 10.1007/s40670-021-01349-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 05/04/2023]
Abstract
INTRODUCTION There is paucity of data around the support that medical students have been provided with, need to be provided with, and would like to be provided with during the COVID-19 pandemic. This study sought to explore the effects of the COVID-19 pandemic on medical students and establish the support they require. METHODS A prospective, observational, multicentre study was conducted in 2020. All medical students and interim foundation year 1 doctors were eligible to participate. RESULTS Six hundred forty individuals participated from 32 medical schools. Participants reported a drop in their mood following the onset of the pandemic (p < 0.001). This drop in mood was evident in both May and August. Participants did have an improved mood in August compared to May (p < 0.001). There was a significant decrease in pandemic disease-anxiety (13.8/20 to 12.4/20, p < 0.001) and consequence-anxiety (6.3/10 to 6.0/10, p < 0.001) between May and August. Nineteen percent of participants (n = 111/596, 19%) had not received the support they needed from their university by August. The most common area of support that our participants needed and had not received from their medical schools by August was support with course material (n = 58/111, 52%). 'Clinical knowledge' was thought to have been affected by the greatest number of participants in both May and August. CONCLUSION Medical students' mental well-being has been adversely affected during the COVID-19 pandemic. Our findings have actionable implications that can better protect medical students as they acclimatise to a working environment that has been radically changed by COVID-19. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at (10.1007/s40670-021-01349-0).
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Affiliation(s)
- Soham Bandyopadhyay
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, UK
| | | | - Emily Bligh
- Faculty of Medicine, Dentistry & Health, University of Sheffield Medical School, Sheffield, UK
| | - Conor Coyle
- St George’s, University of London, Cranmer Terrace, London, UK
| | - Rohan Pancharatnam
- The University of Buckingham Medical School, The University of Buckingham, Milton Keynes, UK
| | - Kate E. A. Saunders
- Department of Psychiatry, Warneford Hospital, University of Oxford, Warneford Lane, Oxford, UK
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Abstract
BACKGROUND People with personality disorder experience long waiting times for access to psychological treatments, resulting from a limited availability of long-term psychotherapies and a paucity of evidence-based brief interventions. Mentalisation-based treatment (MBT) is an efficacious therapeutic modality for personality disorder, but little is known about its viability as a short-term treatment. AIMS We aimed to evaluate mental health, client satisfaction and psychological functioning outcomes before and after a 10-week group MBT programme as part of a stepped-care out-patient personality disorder service. METHOD We examined routinely collected pre-post treatment outcomes from 176 individuals (73% female) aged 20-63 years, attending a dedicated out-patient personality disorder service, who completed MBT treatment. Participants completed assessments examining mentalising capacity, client satisfaction, emotional reactivity, psychiatric symptom distress and social functioning. RESULTS Post-MBT outcomes suggested increased mentalising capacity (mean difference 5.1, 95% CI 3.4-6.8, P < 0.001) and increased client satisfaction with care (mean difference 4.3, 95% CI 3.3-5.2, P < 0.001). Post-MBT emotional reactivity (mean difference -6.3, 95% CI -8.4 to -4.3, P < 0.001), psychiatric symptom distress (mean difference -5.2, 95% CI -6.8 to -3.7, P < 0.001) and impaired social functioning (mean difference -0.7, 95% CI -1.2 to -0.3, P = 0.002) were significantly lower than pre-treatment. Improved mentalising capacity predicted improvements in emotional reactivity (β = -0.56, P < 0.001) and social functioning (β = -0.35, P < 0.001). CONCLUSIONS Short-term MBT as a low-intensity treatment for personality disorder was associated with positive pre-post treatment changes in social and psychological functioning. MBT as deployed in this out-patient service expands access to personality disorder treatment.
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Affiliation(s)
- Niall M McGowan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Nandana Syam
- Clinical Medical School, Medical Sciences Division, Academic Centre, John Radcliffe Hospital, University of Oxford, UK
| | - Debra McKenna
- Oxfordshire Complex Needs Service, Oxford Health NHS Foundation Trust, Oxford, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Steve Pearce
- Oxfordshire Complex Needs Service, Oxford Health NHS Foundation Trust, Oxford, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK; and NIHR Oxford Health Biomedical Research Centre, Oxford, UK
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Xu N, Shinohara K, Saunders KEA, Geddes JR, Cipriani A. Effect of lithium on circadian rhythm in bipolar disorder: A systematic review and meta-analysis. Bipolar Disord 2021; 23:445-453. [PMID: 33650218 DOI: 10.1111/bdi.13070] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/23/2021] [Accepted: 02/21/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Circadian rhythm disruption is commonly reported in patients with bipolar disorder. Lithium has been suggested to have effects on the circadian clock, the biological basis of the circadian rhythm. The objective of the current review was to review systematically the existing studies on the effect of lithium on circadian rhythm in patients with bipolar disorder. METHODS We systematically searched the scientific literature up to September 2020 for experimental or observational studies which measured circadian rhythm in bipolar patients taking lithium (in comparison with placebo or other active treatments) and carried out a meta-analysis. Circadian rest-activity was our primary outcome, but we also collected data about sleep quality and chronotype (Morningness-Eveningness). The protocol was registered in PROSPERO (CRD42018109790). RESULTS Four observational studies (n = 668) and one experimental study (n = 29) were included. Results from the meta-analysis suggest a potential association between lithium and shifts towards morningness (standardized mean difference [SMD]: 0.42, 95% confidence interval [CI]: -0.05 to 0.90). One cohort study with 21 days of follow-up found that patients treated with lithium had significantly larger amplitude (0.68, 0.01 to 1.36) when compared to anticonvulsants. CONCLUSION This review highlights the insufficient evidence to inform us about the effect of lithium on circadian rhythm. However, we found that chronotype can be a potential target for further exploration of biomarkers or biosignatures of lithium treatment in patients with bipolar disorder. Further studies with prospective and longitudinal study design, adopting actigraphy to monitor daily circadian rest-activity changes are needed.
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Affiliation(s)
- Ni Xu
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Kiyomi Shinohara
- Departmens of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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18
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Abstract
OBJECTIVE Bipolar disorder (BD) is a chronic mental health disorder with significant morbidity and mortality. Age at onset (AAO) may be a key variable in delineating more homogeneous subgroups of BD patients. However, no known research has systematically assessed how BD age-at-onset subgroups should be defined. METHODS We systematically searched the following databases: Cochrane Central Register of Controlled Trials, PsycINFO, MEDLINE, Embase, CINAHL, Scopus, Proquest Dissertations and Theses, Google Scholar and BIOSIS Previews. Original quantitative English language studies investigating AAO in BD were sought. RESULTS A total of 9454 unique publications were identified. Twenty-one of these were included in data analysis (n = 22981 BD participants). Fourteen of these studies (67%, n = 13626 participants) found a trimodal AAO distribution: early-onset (µ = 17.3, σ = 1.19, 45% of sample), mid-onset (µ = 26.0, σ = 1.72, 35%), and late-onset (µ = 41.9, σ = 6.16, 20%). Five studies (24%, n = 1422 participants) described a bimodal AAO distribution: early-onset (µ = 24.3, σ = 6.57, 66% of sample) and late-onset (µ = 46.3, σ = 14.15, 34%). Two studies investigated cohort effects on BD AAO and found that when the sample was not split by cohort, a trimodal AAO was the winning model, but when separated by cohort a bimodal distribution fit the data better. CONCLUSIONS We propose that the field conceptualises bipolar disorder age-at-onset subgroups as referring broadly to life stages. Demarcating BD AAO groups can inform treatment and provide a framework for future research to continue to investigate potential mechanisms of disease onset.
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Affiliation(s)
- Sorcha Bolton
- Department of PsychiatryUniversity of OxfordWarneford HospitalOxfordUK
| | - Jeremy Warner
- University of Oxford Medical SchoolJohn Radcliffe HospitalOxfordUK
| | - Eli Harriss
- Bodleian Health Care LibrariesUniversity of OxfordOxfordUK
| | - John Geddes
- Department of PsychiatryUniversity of OxfordWarneford HospitalOxfordUK,Oxford Health NHS Foundation TrustWarneford HospitalOxfordUK
| | - Kate E. A. Saunders
- Department of PsychiatryUniversity of OxfordWarneford HospitalOxfordUK,Oxford Health NHS Foundation TrustWarneford HospitalOxfordUK
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19
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Saunders KEA, Jones T, Perry A, Di Florio A, Craddock N, Jones I, Gordon-Smith K, Jones L. The influence of borderline personality traits on clinical outcomes in bipolar disorder. Bipolar Disord 2021; 23:368-375. [PMID: 32654345 DOI: 10.1111/bdi.12978] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Systematic reviews suggest comorbid borderline personality disorder is present in approximately 20% of individuals who have bipolar disorder, but current diagnostic systems demonstrate a move towards dimensional rather than categorical approaches to classifying personality pathology. We aimed to examine the presence and severity of borderline personality traits in bipolar I and bipolar II disorder, and to explore associations between the presence/severity of borderline personality traits and clinical outcomes in bipolar disorder. METHODS Borderline personality traits were measured in 1447 individuals with DSM-IV bipolar disorder (1008 bipolar I disorder and 439 bipolar II disorder) using the Borderline Evaluation of Severity over Time (BEST) questionnaire. Lifetime clinical outcomes were assessed via Schedules for Clinical Assessment in Neuropsychiatry (SCAN) semi-structured interview and clinical case notes. RESULTS Borderline personality traits were common in both bipolar disorder groups, with 86.2% participants reporting at least one trait. These included traits that overlap with (eg mood instability) and those that are distinct from the symptoms of bipolar disorder (eg fear of abandonment). Borderline personality traits were significantly more frequent and more severe in bipolar II disorder compared to bipolar I disorder. More severe borderline traits, and even the presence of a single borderline personality trait, were significantly associated with younger age of bipolar disorder onset and higher prevalence of lifetime alcohol misuse in both bipolar disorder groups. CONCLUSIONS The presence of comorbid borderline personality traits should be considered in the management of all patients with bipolar disorder irrespective of whether criteria for a categorical borderline personality disorder diagnosis are met.
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Affiliation(s)
- Kate E A Saunders
- University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Tomos Jones
- Victorian Institute of Forensic Mental Health, Thomas Embling Hospital, Fairfield, Victoria, Australia
| | - Amy Perry
- Psychological Medicine, University of Worcester, Worcester, UK
| | - Arianna Di Florio
- Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Nick Craddock
- Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Ian Jones
- Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Lisa Jones
- Psychological Medicine, University of Worcester, Worcester, UK
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20
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Norton EJ, Georgiou I, Fung A, Nazari A, Bandyopadhyay S, Saunders KEA. Personal protective equipment and infection prevention and control: a national survey of UK medical students and interim foundation doctors during the COVID-19 pandemic. J Public Health (Oxf) 2021; 43:67-75. [PMID: 33094815 PMCID: PMC7665616 DOI: 10.1093/pubmed/fdaa187] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The adequacy of personal protective equipment (PPE) and infection prevention and control (IPC) training in UK medical students and interim Foundation Year 1 (FiY1) doctors during the COVID-19 pandemic is unknown, as is its impact on COVID-19-related anxiety. METHODS Cross-sectional, multi-centre study analysing self-reported adequacy of PPE and IPC training and correlation to a modified pandemic anxiety scale. Participants were current medical students and FiY1 doctors in the UK. Data were collected by an online survey. RESULTS Participants reported that they received insufficient PPE information (43%) and IPC training (56%). Significantly, fewer participants identifying as women or BAME/mixed ethnicity reported receiving sufficient PPE information, compared with those identifying as men and White British/White Other, respectively. COVID-19-related anxiety was significantly higher in those without sufficient reported PPE or IPC training, in women compared with men, and in FiY1 doctors compared with medical students. CONCLUSIONS With medical students currently volunteering in and imminently returning to hospitals in an educational capacity, levels of self-reported PPE and IPC training are sub-optimal. Better training is paramount to avoid harm to patients and healthcare professionals and to reduce COVID-19-related anxiety among medical students and FiY1 doctors.
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Affiliation(s)
- Emma Jane Norton
- West Suffolk NHS Foundation Trust, Bury St Edmunds, UK.,Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Ioannis Georgiou
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, UK
| | - Alex Fung
- University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Armin Nazari
- University of Dundee School of Medicine, Ninewells Hospital & Medical School, Dundee, UK
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21
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Abstract
PURPOSE OF REVIEW We review the recent evidence suggesting that circadian rhythm disturbance is a common unaddressed feature of borderline personality disorder (BPD); amelioration of which may confer substantial clinical benefit. We assess chronobiological BPD studies from a mechanistic and translational perspective and highlight opportunities for the future development of this hypothesis. RECENT FINDINGS The emerging circadian phenotype of BPD is characterised by a preponderance of comorbid circadian rhythm sleep-wake disorders, phase delayed and misaligned rest-activity patterns and attenuated amplitudes of usually well-characterised circadian rhythms. Such disturbances may exacerbate symptom severity, and specific maladaptive personality dimensions may produce a liability towards extremes in chronotype. Pilot studies suggest intervention may be beneficial, but development is limited. Endogenous and exogenous circadian rhythm disturbances appear to be common in BPD. The interface between psychiatry and chronobiology has led previously to novel efficacious strategies for the treatment of psychiatric disorders. We believe that better characterisation of the circadian phenotype in BPD will lead to a directed biological target for treatment in a condition where there is a regrettable paucity of accessible therapies.
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Affiliation(s)
- Niall M McGowan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford, UK
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22
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Bandyopadhyay S, Georgiou I, Baykeens B, Gillespie CS, de Andres Crespo M, Bashir MT, Handa A, Saunders KEA. P79 Medical students’ mood adversely affected by COVID-19 pandemic: An interim analysis from the SPICE-19 prospective cohort study of 2075 medical students and interim foundation doctors. BJS Open 2021. [PMCID: PMC8083556 DOI: 10.1093/bjsopen/zrab032.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Currently, we can only speculate on what the effects of the COVID-19 pandemic have been on medical students and interim foundation year doctors. In order to support them appropriately both now and, in the future, it is imperative that we understand the impact it has had upon them. This study assessed the effects of the COVID-19 pandemic on medical students and interim foundation year doctors across the United Kingdom (UK), and the support that they received and sought. Methods A prospective, observational, multicentre study was conducted. All medical students and interim foundation year doctors were eligible to participate. The data analysis was carried out as detailed a priori in the protocol. Findings A total of 2075 individuals participated in the SPICE-19 survey from 33 medical schools. There was a significant (p < 0.0001) decrease in participants’ mood when comparing their mood before the pandemic to during the pandemic. Social distancing and more time at home/with family were the factors that negatively and positively respectively impacted the mood of the greatest number of participants. All areas of life included in the survey were found to have been significantly more negatively impacted than positively impacted (p < 0.0001). 931 participants wanted more support from their university. Participants were mainly seeking support with exam preparation, course material, and financial guidance. Discussion Medical and foundation schools need to prepare adequate and effective support. If no action is taken, there may be a knock-on effect on workforce planning and the health of our future workforce. When medical students return to their universities, there is likely to be need for enhanced wellbeing support, adaptations in the short-term and long-term strategies for medical education, and provision of financial guidance.
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Affiliation(s)
- Soham Bandyopadhyay
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ioannis Georgiou
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Bibire Baykeens
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Conor S Gillespie
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Marta de Andres Crespo
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Mohammad Talha Bashir
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ashok Handa
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Kate E A Saunders
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
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King N, Pickett W, McNevin SH, Bowie CR, Rivera D, Keown-Stoneman C, Harkness K, Cunningham S, Milanovic M, Saunders KEA, Goodday S, Duffy A. Mental health need of students at entry to university: Baseline findings from the U-Flourish Student Well-Being and Academic Success Study. Early Interv Psychiatry 2021; 15:286-295. [PMID: 32048460 DOI: 10.1111/eip.12939] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/19/2019] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Abstract
AIM Transition to university is associated with unique stressors and coincides with the peak period of risk for onset of mental illness. Our objective in this analysis was to estimate the mental health need of students at entry to a major Canadian university. METHODS After a student-led engagement campaign, all first year students were sent a mental health survey, which included validated symptom rating scales for common mental disorders. Rates of self-reported lifetime mental illness, current clinically significant symptoms and treatment stratified by gender are reported. The likelihood of not receiving treatment among those symptomatic and/or with lifetime disorders was estimated. RESULTS Fifty-eight per cent of all first-year students (n = 3029) completed the baseline survey, of which 28% reported a lifetime mental disorder. Moreover, 30% of students screened positive for anxiety symptoms, 28% for depressive symptoms, and 18% for sleep problems with high rates (≅45%) of associated impairment. Only 8.5% of students indicated currently receiving any form of treatment. Females were more likely to report a lifetime diagnosis, anxiety and depressive symptoms, as well as current treatment. Over 25% of students reported lifetime suicidal thoughts and 6% suicide attempt(s). Current weekly binge drinking (25%) and cannabis use (11%) were common, especially in males. CONCLUSIONS There is limited systematically collected data describing the mental health needs of young people at entry to university. Findings of this study underscore the importance of timely identification of significant mental health problems as part of a proactive system of effective student mental health care.
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Affiliation(s)
- Nathan King
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - William Pickett
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Steven H McNevin
- Division of Student Mental Health, Queen's University, Kingston, Ontario, Canada
| | - Chris R Bowie
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Daniel Rivera
- Life Sciences, Queen's University, Kingston, Ontario, Canada
| | | | - Kate Harkness
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Simone Cunningham
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Melissa Milanovic
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Sarah Goodday
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Anne Duffy
- Department of Psychiatry, Division of Student Mental Health, Queen's University, Kingston, Ontario, Canada
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24
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Georgiou I, Hounat A, Park JJ, Gillespie C, Bandyopadhyay S, Saunders KEA. The Factors That Influenced Medical Students' Decision to Work Within the NHS During the COVID-19 Pandemic-A National, Cross-sectional Study. J Occup Environ Med 2021; 63:296-301. [PMID: 33350663 DOI: 10.1097/jom.0000000000002113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Medical students across the United Kingdom helped the National Health Service (NHS) with the increased workload caused by the COVID-19 pandemic. This study was conducted to better understand the implications of COVID-19 on the intricate relationship between the psychological wellbeing of students and working within the NHS. METHOD This was a cross-sectional, national UK study analyzing the self-reported pandemic anxiety scale (PAS) of participants during the pandemic, using an online questionnaire. RESULTS 25.2% of participants worked within the NHS. Working significantly reduced anxiety levels of participants. Concerns around the training and information provided on personal protective equipment (PPE) (odds ratio [OR] 2.57, 95% confidence interval [CI] OR: 1.93, 3.43) (P < 0.001) and Ethnicity (OR 2.15, 95% CI OR: 1.54, 2.99) (P < 0.001) were the most significant covariates affecting the likelihood of working. CONCLUSION Working during the pandemic was influenced by age, ethnicity, and information surrounding PPE. On average those who worked experienced less anxiety and were more cheerful and energetic.
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Affiliation(s)
- Ioannis Georgiou
- University of Aberdeen, Aberdeen (Mr Georgiou); School of Medicine, University of Dundee, Dundee (Mr Hounat); Edinburgh Medical School, University of Edinburgh, Edinburgh (Mr Park), Scotland; School of Medicine, University of Liverpool, Liverpool (Mr Gillespie); Nuffield Department of Surgical Sciences (Dr Bandyopadhyay); Department of Psychiatry, Warneford Hospital (Dr Saunders), University of Oxford, Oxford, UK
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25
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McGowan NM, Nichols M, Bilderbeck AC, Goodwin GM, Saunders KEA. Blood pressure in bipolar disorder: evidence of elevated pulse pressure and associations between mean pressure and mood instability. Int J Bipolar Disord 2021; 9:5. [PMID: 33521889 PMCID: PMC7847910 DOI: 10.1186/s40345-020-00209-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) is associated with excess and premature cardiovascular mortality. Elevated blood pressure (BP) is a leading contributor to cardiovascular risk. However, few studies have examined BP in BD in comparison to other psychiatric disorders. Furthermore, the association between BP and mood instability is not presently clear despite increasing interest in repurposing existing antihypertensive medications as possible novel BD treatments. Thus we examined BP differences between BD and borderline personality disorder (BPD), a disorder with a similar symptom profile through chronic mood instability. METHODS A total of 106 adults (38 BD, 25 BPD, and 43 healthy controls), evaluated in the Automated Monitoring of Symptom Severity (AMoSS) study, completed a week-long home blood pressure monitoring assessment and ecological momentary assessment of mood. We examined group-wise differences in mean BP and BP variability and their association with mood instability. RESULTS BD individuals had a significantly wider resting pulse pressure (40.8 ± 7.4, mmHg) compared to BPD (35.7 ± 5.3, mmHg, P = 0.03) and control participants (37.3 ± 6.3, mmHg, P = 0.036). Systolic BP was negatively associated with sad mood instability, and all measures of mean BP (systolic, diastolic, and mean arterial pressure) were negatively associated with positive mood instability. CONCLUSIONS This study demonstrates BP differences between BD and healthy and clinical controls that are within a normotensive range. Early pulse pressure widening may be a modifiable pathophysiological feature of BD that confers later cardiovascular risk. BP may be an important transdiagnostic predictor of mood instability and a potential explicit treatment target.
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Affiliation(s)
- Niall M McGowan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - Molly Nichols
- Academic Centre, John Radcliffe Hospital, Oxford University Clinical School, Oxford, OX3 9DU, UK
| | - Amy C Bilderbeck
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford, OX3 7JX, UK
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26
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Gillett G, McGowan NM, Palmius N, Bilderbeck AC, Goodwin GM, Saunders KEA. Digital Communication Biomarkers of Mood and Diagnosis in Borderline Personality Disorder, Bipolar Disorder, and Healthy Control Populations. Front Psychiatry 2021; 12:610457. [PMID: 33897487 PMCID: PMC8060643 DOI: 10.3389/fpsyt.2021.610457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Remote monitoring and digital phenotyping harbor potential to aid clinical diagnosis, predict episode course and recognize early signs of mental health crises. Digital communication metrics, such as phone call and short message service (SMS) use may represent novel biomarkers of mood and diagnosis in Bipolar Disorder (BD) and Borderline Personality Disorder (BPD). Materials and Methods: BD (n = 17), BPD (n = 17) and Healthy Control (HC, n = 21) participants used a smartphone application which monitored phone calls and SMS messaging, alongside self-reported mood. Linear mixed-effects regression models were used to assess the association between digital communications and mood symptoms, mood state, trait-impulsivity, diagnosis and the interaction effect between mood and diagnosis. Results: Transdiagnostically, self-rated manic symptoms and manic state were positively associated with total and outgoing call frequency and cumulative total, incoming and outgoing call duration. Manic symptoms were also associated with total and outgoing SMS frequency. Transdiagnostic depressive symptoms were associated with increased mean incoming call duration. For the different diagnostic groups, BD was associated with increased total call frequency and BPD with increased total and outgoing SMS frequency and length compared to HC. Depression in BD, but not BPD, was associated with decreased total and outgoing call frequency, mean total and outgoing call duration and total and outgoing SMS frequency. Finally, trait-impulsivity was positively associated with total call frequency, total and outgoing SMS frequency and cumulative total and outgoing SMS length. Conclusion: These results identify a general increase in phone call and SMS communications associated with self-reported manic symptoms and a diagnosis-moderated decrease in communications associated with depression in BD, but not BPD, participants. These findings may inform the development of clinical tools to aid diagnosis and remote symptom monitoring, as well as informing understanding of differential psychopathologies in BD and BPD.
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Affiliation(s)
- George Gillett
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital, The Cairns Library IT Corridor Level 3, Oxford, United Kingdom.,Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Niall M McGowan
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Niclas Palmius
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Amy C Bilderbeck
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom.,P1vital Products, Manor House, Howbery Business Park, Wallingford, United Kingdom
| | - Guy M Goodwin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Kate E A Saunders
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
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27
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Carl JR, Miller CB, Henry AL, Davis ML, Stott R, Smits JAJ, Emsley R, Gu J, Shin O, Otto MW, Craske MG, Saunders KEA, Goodwin GM, Espie CA. Efficacy of digital cognitive behavioral therapy for moderate-to-severe symptoms of generalized anxiety disorder: A randomized controlled trial. Depress Anxiety 2020; 37:1168-1178. [PMID: 32725848 DOI: 10.1002/da.23079] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/09/2020] [Accepted: 07/01/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is an efficacious intervention for generalized anxiety disorder (GAD). Digital CBT may provide a scalable means of delivering CBT at a population level. We investigated the efficacy of a novel digital CBT program in those with GAD for outcomes of anxiety, worry, depressive symptoms, sleep difficulty, wellbeing, and participant-specific quality of life. METHODS This online, two-arm parallel-group superiority randomized controlled trial compared digital CBT with waitlist control in 256 participants with moderate-to-severe symptoms of GAD. Digital CBT (Daylight), was delivered using participants' own smartphones. Online assessments took place at baseline (Week 0; immediately preceding randomization), mid-intervention (Week 3; from randomization), post-intervention (Week 6; primary endpoint), and follow-up (Week 10). RESULTS Overall, 256 participants were randomized and intention-to-treat analysis found Daylight reduced symptoms of anxiety compared with waitlist control at post-intervention, reflecting a large effect size (adjusted difference [95% CI]: 3.22 [2.14, 4.31], d = 1.08). Significant improvements were found for measures of worry; depressive symptoms, sleep difficulty, wellbeing, and participant-specific quality of life. CONCLUSION Digital CBT (Daylight) appears to be safe and efficacious for symptoms of anxiety, worry, and further measures of mental health compared with waitlist control in individuals with GAD.
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Affiliation(s)
- Jenna R Carl
- Big Health Inc., San Francisco, California.,Big Health Inc., London, UK
| | - Christopher B Miller
- Big Health Inc., San Francisco, California.,Big Health Inc., London, UK.,Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Alasdair L Henry
- Big Health Inc., San Francisco, California.,Big Health Inc., London, UK.,Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Michelle L Davis
- Big Health Inc., San Francisco, California.,Big Health Inc., London, UK
| | - Richard Stott
- Big Health Inc., San Francisco, California.,Big Health Inc., London, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Jasper A J Smits
- Department of Psychology, The University of Texas at Austin, Austin, Texas
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
| | - Jenny Gu
- Big Health Inc., San Francisco, California.,Big Health Inc., London, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Olivia Shin
- Big Health Inc., San Francisco, California.,Big Health Inc., London, UK
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Michelle G Craske
- Anxiety and Depression Research Centre (ADRC), University of California, Los Angeles, California
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Colin A Espie
- Big Health Inc., San Francisco, California.,Big Health Inc., London, UK.,Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
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28
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Bandyopadhyay S, Moudgil-Joshi J, Norton EJ, Haq M, Saunders KEA. Motivations, barriers, and social media: a qualitative study of uptake of women into neurosurgery. Br J Neurosurg 2020; 36:19-25. [PMID: 33215936 DOI: 10.1080/02688697.2020.1849555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore how social media could be utilised to influence an individual's motivation to pursue a neurosurgical career, an emerging topic area. The focus of this study was on women interested in neurosurgery. SUMMARY BACKGROUND DATA Women are significantly under-represented in neurosurgery. 18% of all neurosurgeons - including 8% of consultants - are women. Most previous studies have used quantitative methods that are not best suited to gaining an in-depth understanding of the barriers that women face in pursuing a career in neurosurgery, or what would enable more women to go into the speciality. METHODS In this qualitative study, individual semi-structured interviews were conducted until data saturation was achieved. Participants were women pre-neurosurgical trainees. The interview data was examined through a thematic analysis involving open and axial coding. RESULTS Thirty women participated in the study. Four overarching themes were identified: (1) mentorship, (2) testimony from other women doing neurosurgery, (3) social media as a means of increasing interest in neurosurgery as a career choice, and (4) real-life exposure to the speciality. CONCLUSION There is scope to further improve uptake of women into neurosurgical training in the UK. Motivations and barriers to women pursuing neurosurgery should be addressed openly through early experience, role models and mentorship. Social media can help facilitate these opportunities, disseminate information and inspiration, and has the potential to undo societal biases.
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Affiliation(s)
- Soham Bandyopadhyay
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Emma Jane Norton
- West Suffolk NHS Foundation Trust, Bury St Edmunds, UK.,Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Makinah Haq
- GKT School of Medical Education, King's College London, London, UK
| | - Kate E A Saunders
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
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29
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Abstract
IMPORTANCE Existing therapeutic options are insufficient to tackle the disease burden of depression, and new treatments are sorely needed. Defining new psychotherapeutic targets is challenging given the paucity of coherent mechanistic explanations for depression. OBJECTIVE To assess whether mood homeostasis (ie, the stabilization of one's mood by engaging in mood-modifying activities) is a possible new therapeutic target by testing the hypothesis that people with low (vs high) mean mood and people with (vs without) a history of depression have impaired mood homeostasis. DESIGN, SETTING, AND PARTICIPANTS The quantitative association between mood and daily activities was computed in 2 large case-control studies based on the 58sec data set (collected from December 1, 2012, to May 31, 2014, and analyzed from April 1 to 30, 2019), and the World Health Organization Study on Global Aging and Adult Health (WHO SAGE) data set (collected from January 1, 2007, to December 31, 2010, and analyzed from June 1 to 30, 2019). The 58sec data set consists of self-enrolled participants from high-income countries. The WHO SAGE data set consists of nationally representative participants in low- and middle-income countries recruited via cluster sampling. MAIN OUTCOMES AND MEASURES The main outcome (defined before data analysis) was the difference in mood homeostasis between people with high vs low mean mood (58sec data) and between people with vs without a history of depression (WHO SAGE data). RESULTS A total of 28 212 participants from the 58sec data set (65.8% female; mean [SD] age, 28.1 [9.0] years) and 30 116 from the WHO SAGE data set (57.0% female; mean [SD] age, 57.8 [14.7] years) were included, for an overall study population of 58 328 participants. Mood homeostasis was significantly lower in people with low (vs high) mean mood (0.63 [95% CI, 0.45 to 0.79] vs 0.96 [95% CI, 0.96 to 0.98]; P < .001) and in people with (vs without) a history of depression (0.03 [95% CI, -0.26 to 0.24] vs 0.68 [95% CI, 0.55 to 0.75]; P < .001). In dynamic simulations, lower mood homeostasis led to more depressive episodes (11.8% vs 3.8% yearly risk; P < .001) that lasted longer (4.19 vs 2.90 weeks; P = .006). CONCLUSIONS AND RELEVANCE In this study, mood homeostasis appeared to have been impaired in people with low mood and in those with a history of depression. Mood homeostasis may therefore provide new insights to guide the development of treatments for depression.
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Affiliation(s)
- Maxime Taquet
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Jordi Quoidbach
- Department of People Management and Organisation, ESADE (Escuela Superior de Administración y Dirección de Empresas) Business School, Barcelona, Spain
| | - James J. Gross
- Department of Psychology, Stanford University, Stanford, California
| | - Kate E. A. Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom,Oxford Health NHS (National Health Service) Foundation Trust, Oxford, United Kingdom
| | - Guy M. Goodwin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom,Oxford Health NHS (National Health Service) Foundation Trust, Oxford, United Kingdom
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30
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Henry AL, Miller CB, Emsley R, Sheaves B, Freeman D, Luik AI, Littlewood DL, Saunders KEA, Kanady JC, Carl JR, Davis ML, Kyle SD, Espie CA. Insomnia as a mediating therapeutic target for depressive symptoms: A sub-analysis of participant data from two large randomized controlled trials of a digital sleep intervention. J Sleep Res 2020; 30:e13140. [PMID: 32810921 PMCID: PMC8150672 DOI: 10.1111/jsr.13140] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 01/04/2023]
Abstract
Insomnia predicts the onset of depression, commonly co-presents with depression and often persists following depression remission. However, these conditions can be challenging to treat concurrently using depression-specific therapies. Cognitive behavioural therapy for insomnia may be an appropriate treatment to improve both insomnia and depressive symptoms. We examined the effects of a fully-automated digital cognitive behavioural therapy intervention for insomnia (Sleepio) on insomnia and depressive symptoms, and the mediating role of sleep improvement on depressive symptoms in participants from two randomized controlled trials of digital cognitive behavioural therapy for insomnia. We also explored potential moderators of intervention effects. All participants met criteria for probable insomnia disorder and had clinically significant depressive symptomatology (PHQ-9 ≥ 10; n = 3,352). Individuals allocated to treatment in both trials were provided access to digital cognitive behavioural therapy. Digital cognitive behavioural therapy significantly improved insomnia (p < .001; g = 0.76) and depressive symptoms (p < .001; g = 0.48) at post-intervention (weeks 8-10), and increased the odds (OR = 2.9; 95% CI = 2.34, 3.65) of clinically significant improvement in depressive symptoms (PHQ-9 < 10). Improvements in insomnia symptoms at mid-intervention mediated 87% of the effects on depressive symptoms at post-intervention. No variables moderated effectiveness outcomes, suggesting generalizability of these findings. Our results suggest that effects of digital cognitive behavioural therapy for insomnia extend to depressive symptoms in those with clinically significant depressive symptomatology. Insomnia may, therefore, be an important therapeutic target to assist management of depressive symptoms.
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Affiliation(s)
- Alasdair L Henry
- Big Health Inc., San Francisco, California, USA.,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Christopher B Miller
- Big Health Inc., San Francisco, California, USA.,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Bryony Sheaves
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Donna L Littlewood
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | | | | | | | | | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Colin A Espie
- Big Health Inc., San Francisco, California, USA.,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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31
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Duffy A, Keown-Stoneman C, Goodday S, Horrocks J, Lowe M, King N, Pickett W, McNevin SH, Cunningham S, Rivera D, Bisdounis L, Bowie CR, Harkness K, Saunders KEA. Predictors of mental health and academic outcomes in first-year university students: Identifying prevention and early-intervention targets. BJPsych Open 2020; 6:e46. [PMID: 32381150 PMCID: PMC7331085 DOI: 10.1192/bjo.2020.24] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although there is growing interest in mental health problems in university students there is limited understanding of the scope of need and determinants to inform intervention efforts. AIMS To longitudinally examine the extent and persistence of mental health symptoms and the importance of psychosocial and lifestyle factors for student mental health and academic outcomes. METHOD Undergraduates at a Canadian university were invited to complete electronic surveys at entry and completion of their first year. The baseline survey measured important distal and proximal risk factors and the follow-up assessed mental health and well-being. Surveys were linked to academic grades. Multivariable models of risk factors and mental health and academic outcomes were fit and adjusted for confounders. RESULTS In 1530 students surveyed at entry to university 28% and 33% screened positive for clinically significant depressive and anxiety symptoms respectively, which increased to 36% and 39% at the completion of first year. Over the academic year, 14% of students reported suicidal thoughts and 1.6% suicide attempts. Moreover, there was persistence and overlap in these mental health outcomes. Modifiable psychosocial and lifestyle factors at entry were associated with positive screens for mental health outcomes at completion of first year, while anxiety and depressive symptoms were associated with lower grades and university well-being. CONCLUSIONS Clinically significant mental health symptoms are common and persistent among first-year university students and have a negative impact on academic performance and well-being. A comprehensive mental health strategy that includes a whole university approach to prevention and targeted early-intervention measures and associated research is justified.
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Affiliation(s)
- A Duffy
- Department of Psychiatry, Division of Student Mental Health, Queen's University, Kingston, Canada; and Department of Psychiatry, University of Oxford, UK
| | - C Keown-Stoneman
- Dalla Lana School of Public Health, University of Toronto, Canada
| | - S Goodday
- Department of Psychiatry, University of Oxford, UK
| | - J Horrocks
- Department of Mathematics and Statistics, University of Guelph, Canada
| | - M Lowe
- Department of Mathematics and Statistics, University of Guelph, Canada
| | - N King
- Department of Public Health Sciences, Queen's University, Canada
| | - W Pickett
- Department of Public Health Sciences, Queen's University, Canada
| | - S H McNevin
- Department of Psychiatry, Division of Student Mental Health, Queen's University, Canada
| | - S Cunningham
- Department of Psychology, Queen's University, Canada
| | - D Rivera
- Department of Psychiatry, Division of Student Mental Health, Queen's University, Canada
| | - L Bisdounis
- Department of Psychiatry, University of Oxford, UK
| | - C R Bowie
- Department of Psychology, Queen's University, Canada
| | - K Harkness
- Department of Psychology, Queen's University, Canada
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32
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McDonald K, Smith T, Broadbent M, Patel R, Geddes JR, Saunders KEA. Prevalence and incidence of clinical outcomes in patients presenting to secondary mental health care with mood instability and sleep disturbance. Eur Psychiatry 2020; 63:e59. [PMID: 32336304 PMCID: PMC7355164 DOI: 10.1192/j.eurpsy.2020.39] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Mood instability and sleep disturbance are common symptoms in people with mental illness. Both features are clinically important and associated with poorer illness trajectories. We compared clinical outcomes in people presenting to secondary mental health care with mood instability and/or sleep disturbance with outcomes in people without either mood instability or sleep disturbance. METHODS Data were from electronic health records of 31,391 patients ages 16-65 years presenting to secondary mental health services between 2008 and 2016. Mood instability and sleep disturbance were identified using natural language processing. Prevalence of mood instability and sleep disturbance were estimated at baseline. Incidence rate ratios were estimates for clinical outcomes including psychiatric diagnoses, prescribed medication, and hospitalization within 2-years of presentation in persons with mood instability and/or sleep disturbance compared to individuals without either symptom. RESULTS Mood instability was present in 9.58%, and sleep disturbance in 26.26% of patients within 1-month of presenting to secondary mental health services. Compared with individuals without either symptom, those with mood instability and sleep disturbance showed significantly increased incidence of prescription of any psychotropic medication (incidence rate ratios [IRR] = 7.04, 95% confidence intervals [CI] 6.53-7.59), and hospitalization (IRR = 5.32, 95% CI 5.32, 4.67-6.07) within 2-years of presentation. Incidence rates of most clinical outcomes were considerably increased among persons with both mood instability and sleep disturbance, relative to persons with only one symptom. CONCLUSIONS Mood instability and sleep disturbance are present in a wide range of mental disorders, beyond those in which they are conventionally considered to be symptoms. They are associated with poor outcomes, particularly when they occur together. The poor prognosis associated with mood instability and sleep disorder may be, in part, because they are often treated as secondary symptoms. Mood instability and sleep disturbance need better recognition as clinical targets for treatment in their own right.
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Affiliation(s)
- Keltie McDonald
- Department of Psychiatry, University of Oxford, Warneford Hospital, OxfordOX3 7JX, United Kingdom.,Division of Psychiatry, UCL, London, W1T 7NF, UK
| | - Tanya Smith
- Oxford Health NHS Foundation Trust, OxfordOX3 7JX, United Kingdom
| | - Matthew Broadbent
- South London and Maudsley NHS Foundation Trust, Biomedical Research Center Nucleus, LondonSE5 8AF, United Kingdom
| | - Rashmi Patel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, LondonWC2R 2LS, United Kingdom
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, OxfordOX3 7JX, United Kingdom.,Oxford Health NHS Foundation Trust, OxfordOX3 7JX, United Kingdom
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, OxfordOX3 7JX, United Kingdom.,Oxford Health NHS Foundation Trust, OxfordOX3 7JX, United Kingdom
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Gu J, Miller CB, Henry AL, Espie CA, Davis ML, Stott R, Emsley R, Smits JAJ, Craske M, Saunders KEA, Goodwin G, Carl JR. Efficacy of digital cognitive behavioural therapy for symptoms of generalised anxiety disorder: a study protocol for a randomised controlled trial. Trials 2020; 21:357. [PMID: 32326980 PMCID: PMC7181570 DOI: 10.1186/s13063-020-4230-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/04/2020] [Indexed: 12/28/2022] Open
Abstract
Background Generalised anxiety disorder (GAD) is a chronic and disabling condition with considerable personal and economic impact. Cognitive behavioural therapy (CBT) is a recommended psychological therapy for GAD; however, there are substantial barriers to accessing treatment. Digital CBT, in particular smartphone-delivered CBT, has the potential to improve accessibility and increase dissemination of CBT. Despite the emerging evidence of smartphone-based psychological interventions for reducing anxiety, effect size scores are typically smaller than in-person interventions, and there is a lack of research assessing the efficacy of smartphone-delivered digital interventions specifically for GAD. Methods In the DeLTA trial (DigitaL Therapy for Anxiety), we plan to conduct a parallel-group superiority randomised controlled trial examining the efficacy of a novel smartphone-based digital CBT intervention for GAD compared to a waitlist control. We aim to recruit 242 adults (aged 18 years or above) with moderate-to-severe symptoms of GAD. This trial will be conducted entirely online and will involve assessments at baseline (week 0; immediately preceding randomisation), mid-intervention (week 3), post-intervention (week 6; primary end point) and follow-up (week 10). The primary objective is to evaluate the efficacy of the intervention on GAD symptom severity compared to a waitlist control at post-intervention. Secondary objectives are to examine between-group effects on GAD at follow-up, and to examine the following secondary outcomes at both post-intervention and follow-up: 1) worry; 2) depressive symptoms; 3) wellbeing; 4) quality of life; and 5) sleep difficulty. Discussion This trial will report findings on the initial efficacy of a novel digital CBT intervention for GAD. Results have the potential to contribute towards the evidence base for digital CBT for GAD and increase the dissemination of CBT. Trial registration ISRCTN, ISRCTN12765810. Registered on 11 January 2019.
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Affiliation(s)
- J Gu
- Big Health Inc., San Francisco, CA, USA, London, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - C B Miller
- Big Health Inc., San Francisco, CA, USA, London, UK. .,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - A L Henry
- Big Health Inc., San Francisco, CA, USA, London, UK.,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - C A Espie
- Big Health Inc., San Francisco, CA, USA, London, UK.,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - M L Davis
- Big Health Inc., San Francisco, CA, USA, London, UK
| | - R Stott
- Big Health Inc., San Francisco, CA, USA, London, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - R Emsley
- King's College London, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, & Neuroscience, London, UK
| | - J A J Smits
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - M Craske
- Anxiety and Depression Research Centre (ADRC), University of California, Los Angeles, CA, USA
| | - K E A Saunders
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - G Goodwin
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - J R Carl
- Big Health Inc., San Francisco, CA, USA, London, UK
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Duffy A, Saunders KEA, Malhi GS, Patten S, Cipriani A, McNevin SH, MacDonald E, Geddes J. Mental health care for university students: a way forward? Lancet Psychiatry 2019; 6:885-887. [PMID: 31324561 DOI: 10.1016/s2215-0366(19)30275-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/21/2019] [Accepted: 06/25/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Anne Duffy
- Division of Student Mental Health, Department of Psychiatry, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Kate E A Saunders
- Department of Psychiatry, Oxford University, Oxford, UK; Warneford Hospital, Oxford Health National Health Service Foundation Trust, Oxford, UK
| | - Gin S Malhi
- Department of Psychiatry, Royal North Shore Hospital and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Scott Patten
- Department of Community Health Sciences and Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Andrea Cipriani
- Department of Psychiatry, Oxford University, Oxford, UK; Warneford Hospital, Oxford Health National Health Service Foundation Trust, Oxford, UK
| | - Stephen H McNevin
- Division of Student Mental Health, Department of Psychiatry, Queen's University, Kingston, ON, K7L 3N6, Canada
| | | | - John Geddes
- Department of Psychiatry, Oxford University, Oxford, UK; Warneford Hospital, Oxford Health National Health Service Foundation Trust, Oxford, UK
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Atkinson LZ, Colbourne L, Smith A, Harmer CH, Nobre AC, Rendell J, Jones H, Hinds C, Mould A, Tunbridge EM, Cipriani A, Geddes JR, Saunders KEA, Harrison PJ. The Oxford study of Calcium channel Antagonism, Cognition, Mood instability and Sleep (OxCaMS): study protocol for a randomised controlled, experimental medicine study. Trials 2019; 20:120. [PMID: 30755265 PMCID: PMC6373140 DOI: 10.1186/s13063-019-3175-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 01/02/2019] [Indexed: 01/04/2023] Open
Abstract
Background The discovery that voltage-gated calcium channel genes such as CACNA1C are part of the aetiology of psychiatric disorders has rekindled interest in the therapeutic potential of L-type calcium channel (LTCC) antagonists. These drugs, licensed to treat hypertension and angina, have previously been used in bipolar disorder, but without clear results. Neither is much known about the broader effects of these drugs on the brain and behaviour. Methods The Oxford study of Calcium channel Antagonism, Cognition, Mood instability and Sleep (OxCaMS) is a high-intensity randomised, double-blind, placebo-controlled experimental medicine study on the effect of the LTCC antagonist nicardipine in healthy young adults with mood instability. An array of cognitive, psychiatric, circadian, physiological, biochemical and neuroimaging (functional magnetic resonance imaging and magnetoencephalography) parameters are measured during a 4-week period, with randomisation to drug or placebo on day 14. We are interested in whether nicardipine affects the stability of these measures, as well as its overall effects. Participants are genotyped for the CACNA1C risk polymorphism rs1006737. Discussion The results will clarify the potential of LTCC antagonists for repurposing or modification for use in psychiatric disorders in which cognition, mood and sleep are affected. Trial registration ISRCTN, ISRCTN33631053. Retrospectively registered on 8 June 2018 (applied 17 May 2018). Electronic supplementary material The online version of this article (10.1186/s13063-019-3175-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren Z Atkinson
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK.,Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Warneford Hospital, Oxford, UK
| | - Lucy Colbourne
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK.,Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Warneford Hospital, Oxford, UK
| | - Alexander Smith
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK
| | - Catherine H Harmer
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK.,Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Warneford Hospital, Oxford, UK
| | - Anna C Nobre
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Warneford Hospital, Oxford, UK.,Department of Experimental Psychology, University of Oxford, New Radcliffe House, Oxford, UK
| | - Jennifer Rendell
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK
| | - Helen Jones
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK
| | - Christopher Hinds
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Big Data Institute, University of Oxford, Old Road Campus, Oxford, UK
| | - Arne Mould
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK
| | - Elizabeth M Tunbridge
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK. .,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK.
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK. .,Oxford Health Foundation NHS Trust, Warneford Hospital, Oxford, UK. .,Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Warneford Hospital, Oxford, UK.
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Abstract
While psychological treatments have been shown to be effective in treating psychiatric disorders, the mechanism of their therapeutic effect is less well understood. An improved mechanistic understanding of psychiatric disorders and their treatments would enable refinement of existing interventions, and more targeted intervention and the development of new treatments. A major limitation in understanding the mechanism of effect in psychological treatments has been the challenge of capturing what happens outside of the clinical setting. The development of new digital technologies such as smartphones and wearables enables much more inter-session data to be collected. The rapid evolution of smartphones and wearable technologies, combined with the ubiquity of mobile networks means that is possible for patients to provide regular, longitudinal, and high-resolution data. This allows a previously inaccessible and untapped stream of a specific patient's behaviours, moods, activities, and thoughts to be quantified. Monitoring through such technologies may be of therapeutic value, improving self-awareness and promoting mentalization. Smartphones and wearable technologies can also be used to delivered therapies remotely. Digital technologies enable new insights to be gained into the lived experience of mental disorder enabling current treatments to be refined and personalised, as well as generating new targets for future treatment development. In this article we discuss how such technologies are improving our understanding of psychiatric disorder, informing psychological treatments before considering the future potential of such technologies. We will also consider the challenges and ethical concerns of such approaches.
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Affiliation(s)
| | - Kate E A Saunders
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
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Perez Arribas I, Goodwin GM, Geddes JR, Lyons T, Saunders KEA. A signature-based machine learning model for distinguishing bipolar disorder and borderline personality disorder. Transl Psychiatry 2018; 8:274. [PMID: 30546013 PMCID: PMC6293318 DOI: 10.1038/s41398-018-0334-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/18/2018] [Accepted: 09/07/2018] [Indexed: 12/03/2022] Open
Abstract
Mobile technologies offer new opportunities for prospective, high resolution monitoring of long-term health conditions. The opportunities seem of particular promise in psychiatry where diagnoses often rely on retrospective and subjective recall of mood states. However, deriving clinically meaningful information from the complex time series data these technologies present is challenging, and the current implications for patient care are uncertain. In this study, 130 participants with bipolar disorder (n = 48) or borderline personality disorder (n = 31) and healthy volunteers (n = 51) completed daily mood ratings using a bespoke smartphone app for up to 1 year. A signature-based learning method was used to capture the evolving interrelationships between the different elements of mood and exploit this information to classify participants' diagnosis and to predict subsequent mood. The three participant groups could be distinguished from one another on the basis of self-reported mood using the signature methodology. The methodology classified 75% of participants into the correct diagnostic group compared with 54% using standard approaches. Subsequent mood ratings were correctly predicted with >70% accuracy. Prediction of mood was most accurate in healthy volunteers (89-98%) compared to bipolar disorder (82-90%) and borderline personality disorder (70-78%). The signature method provided an effective approach to the analysis of mood data both in terms of diagnostic classification and prediction of future mood. It also highlighted the differing predictability and the overlap inherent within disorders. The three cohorts offered internally consistent but distinct patterns of mood interaction in their reporting which have the potential to enable more efficient and accurate diagnoses and thus earlier treatment.
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Affiliation(s)
- Imanol Perez Arribas
- 0000 0004 1936 8948grid.4991.5Mathematical Institute, University of Oxford, Oxford, UK
| | - Guy M. Goodwin
- 0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK ,0000 0004 0573 576Xgrid.451190.8Oxford Health NHS Foundation Trust, Oxford, UK
| | - John R. Geddes
- 0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK ,0000 0004 0573 576Xgrid.451190.8Oxford Health NHS Foundation Trust, Oxford, UK ,0000 0004 0397 2876grid.8241.fNIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Terry Lyons
- 0000 0004 1936 8948grid.4991.5Mathematical Institute, University of Oxford, Oxford, UK ,0000 0004 5903 3632grid.499548.dAlan Turing Institute, London, UK
| | - Kate E. A. Saunders
- 0000 0004 1936 8948grid.4991.5Department of Psychiatry, University of Oxford, Oxford, UK ,0000 0004 0573 576Xgrid.451190.8Oxford Health NHS Foundation Trust, Oxford, UK ,0000 0004 0397 2876grid.8241.fNIHR Oxford Health Biomedical Research Centre, Oxford, UK
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38
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Palmius N, Saunders KEA, Carr O, Geddes JR, Goodwin GM, De Vos M. Group-Personalized Regression Models for Predicting Mental Health Scores From Objective Mobile Phone Data Streams: Observational Study. J Med Internet Res 2018; 20:e10194. [PMID: 30348626 PMCID: PMC6231780 DOI: 10.2196/10194] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/29/2018] [Accepted: 06/10/2018] [Indexed: 11/29/2022] Open
Abstract
Background Objective behavioral markers of mental illness, often recorded through smartphones or wearable devices, have the potential to transform how mental health services are delivered and to help users monitor their own health. Linking objective markers to illness is commonly performed using population-level models, which assume that everyone is the same. The reality is that there are large levels of natural interindividual variability, both in terms of response to illness and in usual behavioral patterns, as well as intraindividual variability that these models do not consider. Objective The objective of this study was to demonstrate the utility of splitting the population into subsets of individuals that exhibit similar relationships between their objective markers and their mental states. Using these subsets, “group-personalized” models can be built for individuals based on other individuals to whom they are most similar. Methods We collected geolocation data from 59 participants who were part of the Automated Monitoring of Symptom Severity study at the University of Oxford. This was an observational data collection study. Participants were diagnosed with bipolar disorder (n=20); borderline personality disorder (n=17); or were healthy controls (n=22). Geolocation data were collected using a custom Android app installed on participants’ smartphones, and participants weekly reported their symptoms of depression using the 16-item quick inventory of depressive symptomatology questionnaire. Population-level models were built to estimate levels of depression using features derived from the geolocation data recorded from participants, and it was hypothesized that results could be improved by splitting individuals into subgroups with similar relationships between their behavioral features and depressive symptoms. We developed a new model using a Dirichlet process prior for splitting individuals into groups, with a Bayesian Lasso model in each group to link behavioral features with mental illness. The result is a model for each individual that incorporates information from other similar individuals to augment the limited training data available. Results The new group-personalized regression model showed a significant improvement over population-level models in predicting mental health severity (P<.001). Analysis of subgroups showed that different groups were characterized by different features derived from raw geolocation data. Conclusions This study demonstrates the importance of handling interindividual variability when developing models of mental illness. Population-level models do not capture nuances in how different individuals respond to illness, and the group-personalized model demonstrates a potential way to overcome these limitations when estimating mental state from objective behavioral features.
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Affiliation(s)
- Niclas Palmius
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom
| | - Oliver Carr
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health National Health Service Foundation Trust, University of Oxford, Oxford, United Kingdom
| | - Maarten De Vos
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Abstract
SummaryBipolar disorder is arguably a pivotal diagnosis in adult psychiatry bounded by schizophrenia on one side and unipolar depression on the other. It represents a wide spectrum of disorders, all sharing common features of elated and depressed mood. The early descriptions of symptom-free euthymia have long been dismissed and the chronic and enduring deficits associated with the disorder are beginning to be better understood. We review the current literature with regard to the course of the disorder, factors that may influence prognosis and common comorbidities.
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40
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Carr O, de Vos M, Saunders KEA. Heart rate variability in bipolar disorder and borderline personality disorder: a clinical review. Evid Based Ment Health 2017; 21:23-30. [PMID: 29223951 PMCID: PMC5800347 DOI: 10.1136/eb-2017-102760] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/07/2017] [Accepted: 08/30/2017] [Indexed: 12/27/2022]
Abstract
Heart rate variability (HRV) in psychiatric disorders has become an increasing area of interest in recent years following technological advances that enable non-invasive monitoring of autonomic nervous system regulation. However, the clinical interpretation of HRV features remain widely debated or unknown. Standardisation within studies of HRV in psychiatric disorders is poor, making it difficult to reproduce or build on previous work. Recently, a Guidelines for Reporting Articles on Psychiatry and Heart rate variability checklist has been proposed to address this issue. Here we assess studies of HRV in bipolar disorder and borderline personality disorder against this checklist and discuss the implication for ongoing research in this area.
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Affiliation(s)
- Oliver Carr
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Maarten de Vos
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Kate E A Saunders
- University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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41
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Saunders KEA. Diagnostic difficulty in bipolar disorder. BJPsych advances 2017. [DOI: 10.1192/apt.bp.115.015305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryBipolar disorder is a common mental disorder that can be challenging to diagnose. This brief article outlines how bipolar disorder is diagnosed and how it can be distinguished from other disorders with similar phenotypes.
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Abstract
Objective This paper aims to identify periods of depression using geolocation movements recorded from mobile phones in a prospective community study of individuals with bipolar disorder (BD). Methods Anonymized geographic location recordings from 22 BD participants and 14 healthy controls (HC) were collected over 3 months. Participants reported their depressive symptomatology using a weekly questionnaire (QIDS-SR16). Recorded location data were preprocessed by detecting and removing imprecise data points and features were extracted to assess the level and regularity of geographic movements of the participant. A subset of features were selected using a wrapper feature selection method and presented to 1) a linear regression model and a quadratic generalized linear model with a logistic link function for questionnaire score estimation; and 2) a quadratic discriminant analysis classifier for depression detection in BD participants based on their questionnaire responses. Results HC participants did not report depressive symptoms and their features showed similar distributions to nondepressed BD participants. Questionnaire score estimation using geolocation-derived features from BD participants demonstrated an optimal mean absolute error rate of 3.73, while depression detection demonstrated an optimal (median ± IQR) F1 score of 0.857 ± 0.022 using five features (classification accuracy: 0.849 ± 0.016; sensitivity: 0.839 ± 0.014; specificity: 0.872 ± 0.047). Conclusion These results demonstrate a strong link between geographic movements and depression in bipolar disorder. Significance To our knowledge, this is the first community study of passively recorded objective markers of depression in bipolar disorder of this scale. The techniques could help individuals monitor their depression and enable healthcare providers to detect those in need of care or treatment.
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Saunders KEA, Goodwin GM, Rogers RD. Insensitivity to the Magnitude of Potential Gains or Losses When Making Risky Choices: Women With Borderline Personality Disorder Compared With Bipolar Disorder and Controls. J Pers Disord 2016; 30:530-44. [PMID: 26623536 DOI: 10.1521/pedi_2015_29_216] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Poor decision-making is a feature of borderline personality disorder (BPD) and bipolar disorder (BD). Twenty women with BPD, 20 women with BD, and 20 healthy females completed a risky choice task. Those with BPD exhibited altered processing of information about potential gains and losses, with a bias toward large compared to small gains, large compared to small losses, and a tendency to choose outcomes with a negative expected value. This failure to use explicit reinforcement signals was not observed in those with BD. Difficulties using reward information to make decisions may impair day-to-day function. Such impairments offer new treatment targets in BPD.
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Affiliation(s)
- Kate E A Saunders
- University Department of Psychiatry, Warneford Hospital, Oxford, U. K
| | - Guy M Goodwin
- University Department of Psychiatry, Warneford Hospital, Oxford, U. K
| | - Robert D Rogers
- University Department of Psychiatry, Warneford Hospital, Oxford, U. K.,School of Psychology, Bangor University, Gwynedd, U.K
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Saunders KEA, Goodwin GM, Rogers RD. Borderline personality disorder, but not euthymic bipolar I disorder, is associated with prolonged post-error slowing in sensorimotor performance. J Affect Disord 2016; 198:163-70. [PMID: 27016660 DOI: 10.1016/j.jad.2016.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 02/17/2016] [Accepted: 03/07/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) and bipolar disorder (BD) are common psychiatric diagnoses. Impulsivity and affective instability are prominent features of both illnesses, complicate treatment and are associated with poor clinical outcomes. Yet, little is known about sensorimotor control in these populations, whether they differ in their speed and accuracy of performance, and their ability to restore efficient performance following errors. METHODS Twenty females with DSM-IV BPD, 20 females with DSM-IV BD and 20 age- and cognitive-ability matched healthy control participants completed a simple, brief reaction time task in which two single-attribute stimuli were mapped to distinct motor responses. RESULTS Inspection of response latencies and errors showed that both the BPD and BD participants were able to respond as quickly and accurately as controls, reducing reaction times gently prior to errors, but that BPD participants showed prolonged post-error slowing (PES) before resuming normative levels of speed and accuracy. LIMITATIONS BD and BPD participants were taking psychotropic medication. CONCLUSIONS These findings suggest that BPD and BD individuals can achieve normative speed-accuracy trade-offs; but that only BPD individuals exhibit differentially slowed recovery following errors, indicating a specific impartment in basic sensorimotor control.
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Affiliation(s)
- Kate E A Saunders
- University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, United Kingdom.
| | - Guy M Goodwin
- University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, United Kingdom.
| | - Robert D Rogers
- School of Psychology, Bangor University, Adeilad Brigantia, Penrallt Road, Gwynedd, North Wales LL57 2AS, United Kingdom.
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Abstract
Bipolar disorder is a common mental disorder which is relapsing and remitting in nature. Subsyndromal symptoms are common and associated with poorer outcomes. Management of the disorder can be challenging and depends on the polarity and severity of the mood episode.
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Affiliation(s)
- Kate E A Saunders
- Clinical Researcher and Honorary Consultant Psychiatrist in the Oxford University Department of Psychiatry, Warneford Hospital, Oxford
| | - John R Geddes
- Head of Department and Professor of Epidemiological Psychiatry in the Oxford University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX
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Saunders KEA, Cipriani A, Rendell J, Attenburrow MJ, Nelissen N, Bilderbeck AC, Vasudevan SR, Churchill G, Goodwin GM, Nobre AC, Harmer CJ, Harrison PJ, Geddes JR. Oxford Lithium Trial (OxLith) of the early affective, cognitive, neural and biochemical effects of lithium carbonate in bipolar disorder: study protocol for a randomised controlled trial. Trials 2016; 17:116. [PMID: 26936776 PMCID: PMC4776410 DOI: 10.1186/s13063-016-1230-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite lithium's being the most effective drug for bipolar disorder and in clinical use for decades, we still know very little about its early effects relevant to its mode of action. METHODS/DESIGN The Oxford Lithium Trial is a double-blind, randomised, placebo-controlled study of 6-week lithium treatment in participants with bipolar disorder and mood instability. Its aim is to identify early clinical, neurocognitive and biological effects. Participants (n = 40) will undergo an intensive battery of multi-modal investigations, including remote monitoring of mood, activity and physiology, as well as cognitive testing, fMRI and magnetoencephalography, together with biochemical and gene expression measurements to assess renal, inflammatory and circadian effects. DISCUSSION The findings derived from this trial may be of value in predicting subsequent therapeutic response or side effects, not only relevant to the use of lithium but also providing a potential signature to help in more rapid evaluation of novel mood stabilisers. In this respect, OxLith is a step towards the development of a valid experimental medicine model for bipolar disorder. TRIAL REGISTRATION ISRCTN91624955 . Registered on 22 January 2015.
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Affiliation(s)
- Kate E A Saunders
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Andrea Cipriani
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Jennifer Rendell
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Mary-Jane Attenburrow
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Natalie Nelissen
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Amy C Bilderbeck
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Sridhar R Vasudevan
- Department of Pharmacology, Oxford University, Mansfield Road, Oxford, OX1 3QT, United Kingdom.
| | - Grant Churchill
- Department of Pharmacology, Oxford University, Mansfield Road, Oxford, OX1 3QT, United Kingdom.
| | - Guy M Goodwin
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Anna C Nobre
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Catherine J Harmer
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Paul J Harrison
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - John R Geddes
- Department of Psychiatry, Oxford University, Oxford Health NHS Foundation Trust , Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
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Saunders KEA, Goodwin GM, Rogers RD. Borderline personality disorder, but not euthymic bipolar disorder, is associated with a failure to sustain reciprocal cooperative behaviour: implications for spectrum models of mood disorders. Psychol Med 2015; 45:1591-1600. [PMID: 25697732 DOI: 10.1017/s0033291714002475] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) and bipolar disorder (BD) have overlapping clinical presentations and symptoms - sources of persistent clinical confusion. Game-theory can characterize how social function might be sub-optimal in the two disorders and move the field beyond the anecdotal description of clinical history. Here, we tested the hypothesis that BPD and BD can be distinguished on the basis of diminished reciprocal altruism in iterated Prisoner's Dilemma (PD) games. METHOD Twenty females with BPD, 20 females with euthymic BD and 20 healthy (non-clinical) females, matched for age and cognitive ability, were assessed for Axis-I and personality disorders, and completed psychometric measures of state affect, impulsivity and hostility. Participants completed two iterated PD games and a test of gaze-cueing. RESULTS In the PD games, BPD participants failed to show statistically stable preferences to cooperate with social partners (playing tit-for-tat) and made significantly fewer cooperative responses compared to BD or controls (ANOVA main effect p = 0.03, post-hoc Tukey p < 0.05 for both comparisons). BPD participants were also less likely to sustain cooperation following experiences involving mutual cooperation than the other groups. Neither BPD nor BD participants demonstrated impairments in shifting visual attention on the basis of other peoples' gaze. CONCLUSIONS These data indicate that BPD is (selectively) associated with difficulties in establishing, and then maintaining, reciprocal cooperation, involving altruism. These difficulties are not seen in euthymic BD. Our data support the differentiation of BPD from BD and offer fresh insights into the social difficulties experienced by individuals with diagnoses of BPD.
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Affiliation(s)
- K E A Saunders
- University Department of Psychiatry,University of Oxford,Warneford Hospital,Oxford,UK
| | - G M Goodwin
- University Department of Psychiatry,University of Oxford,Warneford Hospital,Oxford,UK
| | - R D Rogers
- University Department of Psychiatry,University of Oxford,Warneford Hospital,Oxford,UK
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48
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Affiliation(s)
- Kate E A Saunders
- Centre for Suicide Research, Oxford University Department of Psychiatry, Warneford Hospital, Oxford, UK
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49
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Abstract
BACKGROUND Mood instability is a common reason for psychiatric referral. Very little is known about how patients with unstable mood experience assessment and diagnosis. AIMS To investigate the experiences of assessment and diagnosis among patients with mood instability and to suggest improvements to this process. METHOD Qualitative study, gathering data through individual interviews with 28 people experiencing mood instability and receiving a psychiatric assessment in secondary care. RESULTS Participants described the importance of receiving an explanation for their symptoms; the value of a good interpersonal relationship with their clinician(s); being listened to and acknowledged; and being involved in and informed about clinical decisions. These needs were not, however, consistently met. Receiving a psychiatric diagnosis, including a diagnosis of bipolar disorder or borderline personality disorder, evoked both positive and negative responses among participants, relating to stigma, personal understanding and responsibility, prognosis and treatment. CONCLUSIONS Patients with mood instability seek explanation for their symptoms and difficulties, empathetic care and consistent support as much as cure. Clinicians may incorrectly assume what patients' attitudes towards diagnosis are, a mismatch which may hamper the development of a strong therapeutic relationship. Clear, patient-centred communication, which acknowledges the patient's experience, may result in greater patient engagement and satisfaction.
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Affiliation(s)
- Amy C Bilderbeck
- Amy C. Bilderbeck, BA, MA, DPhil, Kate E. A. Saunders, BM, BCh, MA, MRCPsych, Jonathan Price, DPhil, MRCPsych, Guy M. Goodwin, FMedSci, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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Saunders KEA, Hawton K. Clinical assessment and crisis intervention for the suicidal bipolar disorder patient. Bipolar Disord 2013; 15:575-83. [PMID: 23565916 DOI: 10.1111/bdi.12065] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 10/27/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Suicidal behaviour is common in people suffering with bipolar disorder, and suicide is a leading cause of death in this group. Our aim in this review is to provide an overview of key assessment and management strategies, highlight research findings relevant to suicide prevention, and identify important areas for future research. METHODS We reviewed the published literature regarding the risk factors for and management of suicida\l behaviour in individuals with bipolar disorder using the Pubmed and PsychINFO databases. Where available, we focused our search on systematic reviews. RESULTS Suicide is usually associated with a depressive phase, although mixed affective states also convey increased risk. All individuals with bipolar disorder should have an up-to-date crisis management plan which outlines the action to be taken should suicidal behaviour emerge. Timely clinical assessment is essential in ensuring that those at high risk are identified. This should include mental state examination, consideration of risk factors, and evaluation of issues such as access to means, preparatory acts before suicide, and also protective factors. While pharmacological approaches are the mainstay of management, less specific measures, such as the removal of access to means, are also important in ensuring safety in the acute situation. Intensifying the clinical support of both patients and relatives, and the sharing of risk information with other health agencies are essential in management. Specific psychological treatments are likely to be helpful in preventing crises, although the evidence base is limited. CONCLUSIONS The aetiology of suicidal behaviour in bipolar disorder is multifactorial and requires proactive crisis planning and management. A range of issues need to be addressed in the assessment of at-risk patients. Determining the efficacy of interventions specific to reducing suicidality in bipolar disorder should be a research priority.
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Affiliation(s)
- Kate E A Saunders
- Centre for Suicide Research, Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, UK
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