Ecological momentary assessment of depressive symptoms using the mind.me application: Convergence with the Patient Health Questionnaire-9 (PHQ-9).

Ecological momentary assessment (EMA) for mental disorders, using application-based (app) technology capable of passive and ambient data collection, has been insufficiently evaluated and validated with rigorous, adequately-powered, high-quality studies. Herein, we sought to validate the mind.me application for the assessment of depressive symptoms in adults. Adults (ages 18-65) who self-identified as having clinically significant depressive symptoms [i.e. Patient Health Questionnaire 9 (PHQ-9) ≥ 5] utilized the mind.me app-a mobile phone technology that collects data passively and continuously, and is capable of integrating broad multimodal data [e.g., location variance (e.g. GPS), behavioural (e.g. social network activity), and communication data (e.g. SMS texting, phone calls)]. The primary outcome was predictive accuracy (i.e. convergent validity with depressive symptom measurement, as captured by the PHQ-9). 200 subjects were enrolled in the study (mean age 46 ± 12.71). The average PHQ-9 score was 12.8 ± 6.9. The predictive accuracy of the mind.me app was 0.91 ± 0.06. The sensitivity was 0.98 and the specificity was 0.93. The mind.me app was rated by 200 users as highly usable and informative to their illness. The mind.me app exhibits robust predictive accuracy in detecting depressive symptoms in adults with clinically relevant depressive symptoms. The mind.me app more specifically demonstrates convergence with the PHQ-9.

What is bipolar disorder? A disease model of dysregulated energy expenditure.

Advances in the understanding and management of bipolar disorder (BD) have been slow to emerge. Despite notable recent developments in neurosciences, our conceptualization of the nature of this mental disorder has not meaningfully progressed. One of the key reasons for this scenario is the continuing lack of a comprehensive disease model. Within the increasing complexity of modern research methods, there is a clear need for an overarching theoretical framework, in which findings are assimilated and predictions are generated. In this review and hypothesis article, we propose such a framework, one in which dysregulated energy expenditure is a primary, sufficient cause for BD. Our proposed model is centered on the disruption of the molecular and cellular network regulating energy production and expenditure, as well its potential secondary adaptations and compensatory mechanisms. We also focus on the putative longitudinal progression of this pathological process, considering its most likely periods for onset, such as critical periods that challenges energy homeostasis (e.g. neurodevelopment, social isolation), and the resulting short and long-term phenotypical manifestations.

Expert Consensus on Screening and Assessment of Cognition in Psychiatry.

During the past two decades, it has been amply documented that neuropsychiatric disorders (NPDs) disproportionately account for burden of illness attributable to chronic non-communicable medical disorders globally. It is also likely that human capital costs attributable to NPDs will disproportionately increase as a consequence of population aging and beneficial risk factor modification of other common and chronic medical disorders (e.g., cardiovascular disease). Notwithstanding the availability of multiple modalities of antidepressant treatment, relatively few studies in psychiatry have primarily sought to determine whether improving cognitive function in MDD improves patient reported outcomes (PROs) and/or is cost effective. The mediational relevance of cognition in MDD potentially extrapolates to all NPDs, indicating that screening for, measuring, preventing, and treating cognitive deficits in psychiatry is not only a primary therapeutic target, but also should be conceptualized as a transdiagnostic domain to be considered regardless of patient age and/or differential diagnosis.

Efficacy of antidepressants on measures of workplace functioning in major depressive disorder: A systematic review.

INTRODUCTION: Work-related disability and productivity loss in Major Depressive Disorder (MDD) are critical determinants of patient quality of life and contribute significantly to the human and economic costs of MDD. Notwithstanding the return to work and pre-morbid levels of functioning as a critical therapeutic objective among individuals with MDD, it is unclear whether antidepressant treatment significantly and reliably improves measures of workplace functioning. Herein, we investigate to what extent antidepressant treatment improves workplace functioning among adults with MDD. METHODS: We conducted a systematic review of randomized, double-blind, placebo-controlled or active comparator clinical trials primarily or secondarily investigating the efficacy of antidepressant agents on subjective ratings of workplace functioning and/or measures of work absence. RESULTS: Thirteen placebo-controlled and four active comparator clinical trials reported on the efficacy of agomelatine, bupropion, desvenlafaxine, duloxetine, fluoxetine, levomilnacipran, paroxetine, sertraline, venlafaxine, or vortioxetine on subjective measures of workplace impairment. Overall, antidepressant treatment improved standardized measures of workplace functioning (e.g., Sheehan Disability Scale-work item). One placebo-controlled trial of agomelatine and one clinical trial comparing the efficacy of vortioxetine to that of venlafaxine had mixed results on measures of work absence. LIMITATIONS: Included interventional trials evaluated work-related disability as a secondary outcome using subjective rating scales. CONCLUSION: Extant data suggest that antidepressant treatment improves workplace outcomes in MDD. The capability of antidepressants in improving measures of workplace functioning should be considered in cost-benefit analyses to better inform cost-modelling studies pertaining to antidepressant therapy.

Adaptation of the Barriers to Access to Care Evaluation (BACE) scale to the Brazilian social and cultural context / Adaptação da Escala de Avaliação das Barreiras ao Acesso ao Cuidado (BACE) para o contexto social e cultural brasileiro

INTRODUCTION: A significant gap between the number of individuals who need mental health care and the ones who actually have access to it has been consistently demonstrated in studies conducted in different countries. Recognizing the barriers to care and their contributions to delaying or preventing access to mental health services is a key step to improve the management of mental health care. The Barriers to Access to Care Evaluation (BACE) scale is a 30-item self-report instrument conceived to evaluate obstacles to proper mental health care. The main constraint in the investigation of these barriers in Brazil is the lack of a reliable instrument to be used in the Brazilian social and cultural context. OBJECTIVE: To describe the translation and adaptation process of the BACE scale to the Brazilian social and cultural context. METHOD: The translation and adaptation process comprised the following steps: 1) translation from English to Brazilian Portuguese by two authors who are Brazilian Portuguese native speakers, one of whom is a psychiatrist; 2) evaluation, comparison and matching of the two preliminary versions by an expert committee; 3) back-translation to English by a sworn translator who is an English native speaker; 4) correction of the back-translated version by the authors of the original scale; 5) modifications and final adjustment of the Brazilian Portuguese version. RESULTS AND CONCLUSION: The processes of translation and adaptation described in this study were performed by the authors and resulted in the Brazilian version of a scale to evaluate barriers to access to mental health care (AU)

INTRODUÇÃO: Uma lacuna significativa entre o número de indivíduos que necessitam de cuidado na área de saúde mental e aqueles que efetivamente têm acesso a ela tem sido consistentemente demonstrada em estudos realizados em diferentes países. Reconhecer as barreiras ao cuidado e suas contribuições no sentido de retardar e até impedir o acesso a serviços de saúde mental é um passo essencial para melhorar o manejo em saúde mental. A escala Barriers to Access to Care Evaluation (BACE) é um instrumento de autorrelato, composto de 30 itens, concebido para avaliar os obstáculos ao cuidado adequado em saúde mental. O principal empecilho na investigação dessas barreiras no Brasil é a inexistência de um instrumento confiável para ser utilizado no contexto social e cultural brasileiro. Objetivo: Descrever o processo de tradução e adaptação da escala BACE para o contexto social e cultural brasileiro. MÉTODO: O processo de tradução e adaptação incluiu os seguintes passos: 1) tradução do inglês para o português brasileiro por dois autores, falantes nativos de português brasileiro, sendo que um deles é psiquiatra; 2) avaliação, comparação e correspondência das duas versões preliminares por um comitê especialista; 3) retrotradução para inglês por um tradutor juramentado, falante nativo de inglês; 4) correção da versão retrotraduzida pelos autores da escala original; 5) alterações e ajustes finais da versão em português brasileiro. RESULTADOS E CONCLUSÃO: Os processos de tradução e adaptação aqui descritos foram realizados pelos autores e resultaram na versão brasileira de uma escala para avaliar as barreiras ao acesso ao cuidado em saúde mental (AU)

Hair cortisol and stressful life events retrospective assessment in crack cocaine users.

BACKGROUND: Some evidence suggests that altered hypothalamic-pituitary-adrenal (HPA) axis functioning in cocaine users might play a role in the pathophysiology of substance abuse. This study aimed to investigate the relationship between exposure to negative life events and cortisol hair concentrations in crack cocaine users during the 3 months prior to admission to a detoxification program. METHODS: A total of 23 treatment-seeking, crack cocaine-dependent women were selected for this study 1 week after admission to an inpatient treatment at a locked treatment facility. The Paykel Life Events Scale measured the occurrence of stressful life events 3 months before admission. Hair cortisol concentration was measured during these three previous months. RESULTS: The partial correlations, using severity of dependence as control variable, revealed that there is a positive association between hair cortisol concentration and the number of negative life events exposure 90 days (r = .56; p = .007) and 30 days (r = .42; p = .048) prior to admission at the hospital. One-way ANOVA suggests that hair cortisol levels and stress load significantly increase over 3 months prior to hospitalization. CONCLUSIONS: The results of this study indicate that there is a positive association between measures of long-term cumulative cortisol secretion and the number of stressful events reported by women receiving inpatient treatment for crack cocaine dependence. Therefore, this study suggests that stress load can be objectively quantified and noninvasively assessed. SCIENTIFIC SIGNIFICANCE: This study is the first to investigate HPA axis functioning using hair cortisol concentrations among crack cocaine-dependent users. It is a promising strategy to assess stress load in substance abusers.