RESUMO
Computational psychiatry, a relatively new yet prolific field that aims to understand psychiatric disorders with formal theories about the brain, has seen tremendous growth in the past decade. Despite initial excitement, actual progress made by computational psychiatry seems stagnant. Meanwhile, understanding of the human brain has benefited tremendously from recent progress in intracranial neuroscience. Specifically, invasive techniques such as stereotactic electroencephalography, electrocorticography, and deep brain stimulation have provided a unique opportunity to precisely measure and causally modulate neurophysiological activity in the living human brain. In this review, we summarize progress and drawbacks in both computational psychiatry and invasive electrophysiology and propose that their combination presents a highly promising new direction-invasive computational psychiatry. The value of this approach is at least twofold. First, it advances our mechanistic understanding of the neural computations of mental states by providing a spatiotemporally precise depiction of neural activity that is traditionally unattainable using noninvasive techniques with human subjects. Second, it offers a direct and immediate way to modulate brain states through stimulation of algorithmically defined neural regions and circuits (i.e., algorithmic targeting), thus providing both causal and therapeutic insights. We then present depression as a use case where the combination of computational and invasive approaches has already shown initial success. We conclude by outlining future directions as a road map for this exciting new field as well as presenting cautions about issues such as ethical concerns and generalizability of findings.
Assuntos
Simulação por Computador , Neurociências , Psiquiatria , Psiquiatria/instrumentação , Psiquiatria/métodos , Psiquiatria/tendências , Humanos , Neurociências/instrumentação , Neurociências/métodos , Neurociências/tendências , Crânio , Neurofisiologia/instrumentação , Neurofisiologia/métodos , Neurofisiologia/tendências , Depressão/fisiopatologia , Depressão/terapia , Modelos Neurológicos , Eletrofisiologia/instrumentação , AlgoritmosAssuntos
COVID-19/prevenção & controle , Tecnologia Digital/métodos , Psiquiatria/instrumentação , Vacinação/psicologia , Atitude Frente a Saúde , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Atenção à Saúde/métodos , Disparidades em Assistência à Saúde/economia , Humanos , Aprendizado de Máquina , Saúde Mental/estatística & dados numéricos , Aplicativos Móveis , Psiquiatria/tendências , SARS-CoV-2/genética , Segurança , Vacinação/estatística & dados numéricosRESUMO
Mental health issues during the perinatal period are common; up to 29% of pregnant and 15% of postpartum women meet psychiatric diagnostic criteria. Despite its ubiquity, little is known about the longitudinal trajectories of perinatal psychiatric illness. This paper describes a collaboration among six perinatal mental health services in Quebec, Canada, to create an electronic databank that captures longitudinal patient data over the course of the perinatal period. The collaborating sites met to identify research interests and to select a standardized set of variables to be collected during clinical appointments. Procedures were implemented for creating a databank that serves both research and clinical purposes. The resulting databank allows pregnant and postpartum patients to complete self-report questionnaires on medical and psychosocial variables during their intake appointment in conjunction with their clinicians who fill in relevant medical information. All participants are followed until 6 months postpartum. The databank represents an opportunity to examine illness trajectories and to study rare mental disorders and the relationship between biological and psychosocial variables.
Assuntos
Bases de Dados Factuais , Depressão Pós-Parto , Complicações na Gravidez , Psiquiatria , Adulto , Feminino , Humanos , Serviços de Saúde Mental/estatística & dados numéricos , Gravidez , Complicações na Gravidez/psicologia , Psiquiatria/instrumentação , QuebequeRESUMO
BACKGROUND: The Extended Strengths and Weaknesses Assessment of Normal Behavior (E-SWAN) reconceptualizes each diagnostic criterion for selected DSM-5 disorders as a behavior, which can range from high (strengths) to low (weaknesses). Initial development focused on Panic Disorder, Social Anxiety, Major Depression, and Disruptive Mood Dysregulation Disorder. METHODS: Data were collected from 523 participants (ages 6-17). Parents completed each of the four E-SWAN scales and traditional unidirectional scales addressing the same disorders. Distributional properties, Item Response Theory Analysis (IRT), and Receiver Operating Characteristic (ROC) curves were used to assess and compare the performance of E-SWAN and traditional scales. RESULTS: In contrast to the traditional scales, which exhibited truncated distributions, all four E-SWAN scales had symmetric distributions. IRT analyses indicate the E-SWAN subscales provided reliable information about respondents throughout the population distribution; traditional scales only provided reliable information about respondents at the high end of the distribution. Predictive value for DSM-5 diagnoses was comparable to prior scales. CONCLUSIONS: E-SWAN bidirectional scales can capture the full spectrum of the population distribution of behavior underlying DSM disorders. The additional information provided can better inform examination of inter-individual variation in population studies, as well as facilitate the identification of factors related to resiliency in clinical samples.
Assuntos
Transtornos Mentais/diagnóstico , Escalas de Graduação Psiquiátrica/normas , Psiquiatria/métodos , Psicometria/normas , Adolescente , Criança , Feminino , Humanos , Masculino , Psiquiatria/instrumentação , Psicometria/instrumentação , Psicometria/métodosRESUMO
BACKGROUND: As societies become more complex, larger populations suffer from insomnia. In 2014, the US Centers for Disease Control and Prevention declared that sleep disorders should be dealt with as a public health epidemic. However, it is hard to provide adequate treatment for each insomnia sufferer, since various behavioral characteristics influence symptoms of insomnia collectively. OBJECTIVE: We aim to develop a neural-net based unsupervised user clustering method towards insomnia sufferers in order to clarify the unique traits for each derived groups. Unlike the current diagnosis of insomnia that requires qualitative analysis from interview results, the classification of individuals with insomnia by using various information modalities from smart bands and neural-nets can provide better insight into insomnia treatments. METHODS: This study, as part of the precision psychiatry initiative, is based on a smart band experiment conducted over 6 weeks on individuals with insomnia. During the experiment period, a total of 42 participants (19 male; average age 22.00 [SD 2.79]) from a large university wore smart bands 24/7, and 3 modalities were collected and examined: sleep patterns, daily activities, and personal demographics. We considered the consecutive daily information as a form of images, learned the latent variables of the images via a convolutional autoencoder (CAE), and clustered and labeled the input images based on the derived features. We then converted consecutive daily information into a sequence of the labels for each subject and finally clustered the people with insomnia based on their predominant labels. RESULTS: Our method identified 5 new insomnia-activity clusters of participants that conventional methods have not recognized, and significant differences in sleep and behavioral characteristics were shown among groups (analysis of variance on rank: F4,37=2.36, P=.07 for the sleep_min feature; F4,37=9.05, P<.001 for sleep_efficiency; F4,37=8.16, P<.001 for active_calorie; F4,37=6.53, P<.001 for walks; and F4,37=3.51, P=.02 for stairs). Analyzing the consecutive data through a CAE and clustering could reveal intricate connections between insomnia and various everyday activity markers. CONCLUSIONS: Our research suggests that unsupervised learning allows health practitioners to devise precise and tailored interventions at the level of data-guided user clusters (ie, precision psychiatry), which could be a novel solution to treating insomnia and other mental disorders.
Assuntos
Medicina de Precisão/métodos , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Sono/fisiologia , Dispositivos Eletrônicos Vestíveis/efeitos adversos , Algoritmos , Índice de Massa Corporal , Análise por Conglomerados , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Psiquiatria/instrumentação , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Aprendizado de Máquina não Supervisionado/economia , Adulto JovemRESUMO
The breathtaking technological progress in the field of mobile computing, smartphones and wearables offers new opportunities for psychiatric research and therapy. Wearables enable not only the objective assessment of psychiatric symptoms in real time and everyday life but using continuous monitoring and analysis of relevant parameters can also define important situations, contexts and timing during which extended assessment strategies and real-life interventions can be implemented. The momentary effect of inner city green space exposure on well-being, motivational behavior feedback and geofencing for the detection of drinking episodes are used as examples to illustrate the core benefits of real-time analyses and feedback from wearables for psychiatric research and therapy.
Assuntos
Psiquiatria , Dispositivos Eletrônicos Vestíveis , Humanos , Transtornos Mentais/diagnóstico , Psiquiatria/instrumentação , Psiquiatria/tendênciasRESUMO
The aim of is to explore whether by observing the fetus by 4D US it is possible to enter fetal behavior, emotions, mental status, consciousness, awareness and other states connected with fetal mind and ability of self-regulation. It is well known that fetal motoric activity is enabling the development of central and peripheral nervous system and the muscles. It is 4D US which enabled to investigate fetal movement patterns from the first trimester of pregnancy throughout the whole pregnancy. Based on the evaluation of fetal spontaneous motor activity by 4D US, a prenatal neurologic scoring test named Kurjak Antenatal Neurodevelopmental Test (KANET) was created. This test has been used to assess almost 2000 fetuses and our results have indicated that KANET has an ability to recognize normal, borderline, and abnormal behavior in fetuses from normal and abnormal pregnancies. The fetus is able to process tactile, vestibular, taste, olfactory, auditory and visual sensations. The fetus responds to painful stimuli with a wide spectrum of reactions. Important external signs of emotion are facial expressions. The existence of a wide range of facial expressions, including grimacing, smiling, crying, similar to emotional expressions in adults, has been revealed by 4D sonography in the 2nd and 3rd trimesters of pregnancy. It is questionable if mental, emotional and behavioral conditions of the fetus were covered in this paper and whether we are able to perceive the fetus as the patient who may develop communication or some other psychiatric disorders which we will be hopefully able to recognize prenatally. Although it seems as the speculation from the point of view of our recent diagnostic possibilities, it is apparent that the day when this will be a reality is rapidly approaching.
Assuntos
Feto/diagnóstico por imagem , Psiquiatria/instrumentação , Psiquiatria/tendências , Ultrassonografia Pré-Natal/tendências , Emoções , Expressão Facial , Feminino , Movimento Fetal , Humanos , GravidezAssuntos
Neurociências/tendências , Psiquiatria/tendências , Smartphone/tendências , Telemetria/tendências , Dispositivos Eletrônicos Vestíveis/tendências , Animais , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Neurociências/instrumentação , Neurociências/métodos , Psiquiatria/instrumentação , Psiquiatria/métodos , Telemetria/métodosRESUMO
Personalized medicine (PM) aims to establish a new approach in clinical decision-making, based upon a patient's individual profile in order to tailor treatment to each patient's characteristics. Although this has become a focus of the discussion also in the psychiatric field, with evidence of its high potential coming from several proof-of-concept studies, nearly no tools have been developed by now that are ready to be applied in clinical practice. In this paper, we discuss recent technological advances that can make a shift toward a clinical application of the PM paradigm. We focus specifically on those technologies that allow both the collection of massive as much as real-time data, i.e., electronic medical records and smart wearable devices, and to achieve relevant predictions using these data, i.e. the application of machine learning techniques.
Assuntos
Medicina de Precisão/métodos , Psiquiatria/métodos , Humanos , Aprendizado de Máquina , Sistemas Computadorizados de Registros Médicos , Medicina de Precisão/instrumentação , Psiquiatria/instrumentação , Dispositivos Eletrônicos VestíveisRESUMO
No field in science and medicine today remains untouched by Big Data, and psychiatry is no exception. Proteomics is a Big Data technology and a next generation biomarker, supporting novel system diagnostics and therapeutics in psychiatry. Proteomics technology is, in fact, much older than genomics and dates to the 1970s, well before the launch of the international Human Genome Project. While the genome has long been framed as the master or "elite" executive molecule in cell biology, the proteome by contrast is humble. Yet the proteome is critical for life-it ensures the daily functioning of cells and whole organisms. In short, proteins are the blue-collar workers of biology, the down-to-earth molecules that we cannot live without. Since 2010, proteomics has found renewed meaning and international attention with the launch of the Human Proteome Project and the growing interest in Big Data technologies such as proteomics. This article presents an interdisciplinary technology foresight analysis and conceptualizes the terms "environtome" and "social proteome". We define "environtome" as the entire complement of elements external to the human host, from microbiome, ambient temperature and weather conditions to government innovation policies, stock market dynamics, human values, political power and social norms that collectively shape the human host spatially and temporally. The "social proteome" is the subset of the environtome that influences the transition of proteomics technology to innovative applications in society. The social proteome encompasses, for example, new reimbursement schemes and business innovation models for proteomics diagnostics that depart from the "once-a-life-time" genotypic tests and the anticipated hype attendant to context and time sensitive proteomics tests. Building on the "nesting principle" for governance of complex systems as discussed by Elinor Ostrom, we propose here a 3-tiered organizational architecture for Big Data science such as proteomics. The proposed nested governance structure is comprised of (a) scientists, (b) ethicists, and (c) scholars in the nascent field of "ethics-of-ethics", and aims to cultivate a robust social proteome for personalized medicine. Ostrom often noted that such nested governance designs offer assurance that political power embedded in innovation processes is distributed evenly and is not concentrated disproportionately in a single overbearing stakeholder or person. We agree with this assessment and conclude by underscoring the synergistic value of social and biological proteomes to realize the full potentials of proteomics science for personalized medicine in psychiatry in the present era of Big Data.
Assuntos
Medicina de Precisão , Proteoma , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/metabolismo , Transtornos Mentais/terapia , Proteômica/instrumentação , Proteômica/métodos , Psiquiatria/instrumentação , Psiquiatria/métodosRESUMO
Psychiatric disorders are linked to a variety of biological, psychological, and contextual causes and consequences. Laboratory studies have elucidated the importance of several key physiological and behavioral biomarkers in the study of psychiatric disorders, but much less is known about the role of these biomarkers in naturalistic settings. These gaps are largely driven by methodological barriers to assessing biomarker data rapidly, reliably, and frequently outside the clinic or laboratory. Mobile health (mHealth) tools offer new opportunities to study relevant biomarkers in concert with other types of data (e.g., self-reports, global positioning system data). This review provides an overview on the state of this emerging field and describes examples from the literature where mHealth tools have been used to measure a wide array of biomarkers in the context of psychiatric functioning (e.g., psychological stress, anxiety, autism, substance use). We also outline advantages and special considerations for incorporating mHealth tools for remote biomarker measurement into studies of psychiatric illness and treatment and identify several specific opportunities for expanding this promising methodology. Integrating mHealth tools into this area may dramatically improve psychiatric science and facilitate highly personalized clinical care of psychiatric disorders.
Assuntos
Transtornos Mentais/fisiopatologia , Telemedicina , Comportamento , Biomarcadores/metabolismo , Humanos , Transtornos Mentais/diagnóstico , Psiquiatria/instrumentação , Psiquiatria/métodos , Projetos de Pesquisa , Telemedicina/instrumentação , Telemedicina/métodosRESUMO
The repetitive transcranial magnetic stimulation (TMS) opens new therapeutic options in neuropsychiatric disorders. The use of rTMS in depressive disorders has been most preferably investigated in clinical trials. In Germany, the application of rTMS outside of clinical trials is already increasingly common, not only for depression. Our nationwide survey in psychiatric hospitals was used to detect the current state of the application of rTMS in clinical practice, and should serve as a basis for the development of quality standards.
Assuntos
Transtornos Mentais/terapia , Psiquiatria/instrumentação , Estimulação Magnética Transcraniana/estatística & dados numéricos , Alemanha , Humanos , Psiquiatria/estatística & dados numéricosAssuntos
Acessibilidade aos Serviços de Saúde , Saúde Mental/tendências , Aplicativos Móveis/tendências , Psiquiatria/métodos , Saúde Pública/métodos , Autocuidado/métodos , Telemedicina/tendências , Ensaios Clínicos como Assunto , Depressão/prevenção & controle , Depressão/psicologia , Depressão/terapia , Países em Desenvolvimento , Humanos , Aplicativos Móveis/estatística & dados numéricos , Projetos Piloto , Psiquiatria/instrumentação , Saúde Pública/instrumentação , Autocuidado/instrumentação , Smartphone/estatística & dados numéricos , Smartphone/provisão & distribuição , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/reabilitação , Transtornos de Estresse Pós-Traumáticos/terapia , Telemedicina/instrumentaçãoRESUMO
In many developed countries, telepsychiatry has become facilitating technology in mental health care system especially in underserved areas. In a developing country like Thailand, telepsychiatry is a novel technology in which mental health care personnel should understand both administrative and clinical issues. In this article, the author has reviewed benefits and challenges of implementing telepsychiatry in Thailand. Benefits of telepsychiatry include reducing costs, improving accessibility and reducing psychiatric stigmas while challenges can be classified as man, machine and environment challenges. The author concludes that telepsychiatry in Thailand needs further studies, especially in feasibility and cost-efficiency domains in the hope that this technology will improve quality of mental health care in near future.
Assuntos
Psiquiatria/métodos , Telemedicina/métodos , Humanos , Psiquiatria/economia , Psiquiatria/instrumentação , Telemedicina/economia , Telemedicina/instrumentação , TailândiaRESUMO
BACKGROUND AND OBJECTIVES: Instrumentation in correction operations for spinal deformities carries a 0.5-5% risk of injuring the spinal cord. The wake-up test is used for early detection of these injuries. In this study we compared the effects of propofol and midazolam during wake-up test in scoliosis surgery. METHODS: Thirty patients were randomly assigned as group P and group M. Anesthesia was induced with propofol 2.5 mg kg-1 for group P or midazolam 0.5 mg kg-1 for group M with remifentanil 0.5 µg kg-1 and cisatracurium 0.15 mg kg-1 for both groups. At the maintenance of anesthesia O2/air and infusions of remifentanil and cisatracurium were used. In group P, propofol 6-10 mg kg-1 h-1 and in group M, midazolam 0.5 mg mg kg-1 were preferred. Approximately 15 min before the wake-up test, all drugs were discontinued. At the wake-up test, anesthesiologist asked the patients to open their eyes and squeeze his/her hand at every 30 s until the patients responded. Then patients were told to wiggle their toes. Hemodynamic parameters, time of eye-opening, appropriate movement upon verbal command were evaluated. BIS frequency throughout the operation was recorded. RESULTS: The eye opening time was 9 ± 2.15 min in group P and 7 ± 3.15 min in group M. Motor movement time was 12 ± 2.55 min in group P and 21.25 ± 3.93 min in group M. CONCLUSION: Propofol provided better wake-up conditions and conducted a better neurologic assessment within the same BIS values than midazolam.
JUSTIFICATIVA E OBJETIVOS: A instrumentação em cirurgias de correção de deformidades da coluna vertebral tem risco de 0,5 a 5% de lesionar a medula espinhal. O teste de despertar é usado para a detecção precoce dessas lesões. Neste estudo comparamos os efeitos de propofol e midazolam durante o teste de despertar em cirurgia de escoliose. MÉTODOS: Trinta pacientes foram designados de forma aleatória para os grupos P e M. A anestesia foi induzida com propofol (2,5 mg kg-1) no grupo P ou midazolam (0,5 mg kg-1) no grupo M, com remifentanil (0,5 µg kg-1) e cisatracúrio (0,15 mg kg-1) em ambos os grupos. A manutenção da anestesia foi feita com O2/ar e infusões de remifentanil e cisatracúrio. Nos grupos P e M, respectivamente, doses de propofol (6-10 mg kg-1 h-1) e de midazolam (0,5 mg mg kg-1) foram preferidas. Aproximadamente 15 min antes do teste de despertar, todos os medicamentos foram interrompidos. No teste de despertar, o anestesiologista pedia ao paciente que abrisse os olhos e apertasse sua mão a cada 30 s até que o paciente respondesse. Depois, o paciente era solicitado a mexer os dedos dos pés. Os parâmetros hemodinâmicos, o tempo de abertura dos olhos e o movimento apropriado sob comando verbal foram avaliados. A frequência do BIS foi registrada durante toda a cirurgia. RESULTADOS: O tempo de abertura dos olhos foi de 9 ± 2,15 min no grupo P e de 7 ± 3,15 min no grupo M. O tempo de movimento motor foi de 12 ± 2,55 min no grupo P e de 21,25 ± 3,93 min no grupo M. CONCLUSÃO: Propofol proporcionou melhores condições de despertar e possibilitou uma melhor avaliação neurológica dentro dos mesmos valores do BIS que midazolam.
Assuntos
Humanos , Pesquisa Biomédica/métodos , Delírio/diagnóstico , Geriatria/métodos , Psiquiatria/métodos , Pesquisa Biomédica/instrumentação , Delírio/classificação , Geriatria/instrumentação , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Psiquiatria/instrumentaçãoRESUMO
Social media tools such as blogs, microblogs, social networking sites, podcasts, and video-sharing sites are now ubiquitous. These tools enable instantaneous interactions with a global community of individuals, including medical professionals, learners, and patients. An understanding of social media tools and how they can be used by psychiatrists is increasingly important. This review defines some relevant social media terms and addresses challenges specific to the use of social media in psychiatry. Focused primarily on Twitter, one of the most commonly used social media tools, the review describes how Twitter is being used in non-psychiatric medical fields and highlights four current and/or potential uses of Twitter in psychiatry: (1) patient care and advocacy, (2) lifelong learning, (3) research data collection and collaboration, and (4) scholarly recognition and impact.
Assuntos
Blogging , Disseminação de Informação/métodos , Administração dos Cuidados ao Paciente/métodos , Psiquiatria , Mídias Sociais/instrumentação , Comportamento Cooperativo , Difusão de Inovações , Humanos , Psiquiatria/instrumentação , Psiquiatria/métodos , Rede SocialRESUMO
During the latter half of the 19th century, a device known popularly as the "Utica crib" became widely used in asylums and state hospitals across North America. The design varied to an extent between institutions but generally consisted of an enclosed, rectangular box made from combinations of wood slats or metal screening, with a hinged lid that could be latched closed on one side. The box was large enough to allow a person to lie straight inside with the lid closed. It has generally been described as no more than a restraint device used to confine patients in a recumbent position. In this article, I resituate the Utica crib in its broader historical context, focusing on the key role it played in the boundary debates faced by North American alienists. Particular attention is paid to the challenge from British alienists with regard to the nonrestraint movement and the attack from neurologists concerning the purported expertise of alienists.
Assuntos
Leitos/história , Institucionalização/história , Psiquiatria/história , História do Século XIX , História do Século XX , Imobilização , América do Norte , Psiquiatria/instrumentaçãoRESUMO
BACKGROUND: Depressive symptoms occur frequently in Dutch society. Recently a new method for treating depressive symptoms was introduced in the Netherlands. The method, known as 'multi-moment non-invasive neurostimulation' (MNNS), involves presenting patients with a series of photographs, each picture having a positive valence. The purpose of this method is to improve the mood of patients. So far, however, the method has not been thoroughly tested. AIM: To conduct a pilot study designed to compare the effectiveness of MNNS pictures with pictures from the International Affective Pictures System (IAPS) by means of a double-blind randomised controlled trial. METHOD: Thirty-three patients with depressive symptoms were randomly assigned to two groups, one representing the experimental condition (MNNS) and the other the control condition (IAPS). Patients were treated for six weeks in one mood-inductive session per week. The severity of the patients' depressive symptoms was assessed before the mood-induction treatment began and again at one week and at three months after the final session. RESULTS: Each group showed a significant reduction in depressive symptoms. There were no significant differences between the MNNS condition and the control condition with regard to the reduction of depressive symptoms over time. CONCLUSION: There was a marked reduction in the depressive symptoms of the patients of both groups which had received short-term treatments involving the viewing of pictures with a positive valence. This reduction was still apparent three months after the treatment. The positive pictures presented in the MNNS method were found to be just as effective in reducing depressive symptoms as the positive pictures presented by the IAPS.