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1.
Nurs Clin North Am ; 54(4): 585-593, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31703783

RESUMO

The trajectory of human development follows a predictable course of milestones. As genomic research has brought us more understanding of the brain, the etiology of mental illness is progressing from psychodynamic origins postulated by Freud in 1960 to organic pathways and epigenetic derivations. Humans develop on normal pathways that can be derailed by poverty, illness, and trauma. When infants begin life from a healthy perspective, conditions that may follow such as a mental disorder may be moderated by healthy starts. In this paper, selected developmental theories and mental disorders are presented; then their interface is discussed. Implications for nursing are outlined.


Assuntos
Desenvolvimento Humano/fisiologia , Saúde Mental , Transtornos do Humor/epidemiologia , Teoria Psicológica , Humanos , Transtornos do Humor/diagnóstico
2.
Adv Exp Med Biol ; 1192: 251-261, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31705498

RESUMO

Mood disorders include all types of depression and bipolar disorder, and mood disorders are sometimes called affective disorders. We will discuss newly developing two issues in affective disorders in children and adolescents. Those are the new diagnostic challenges using neuroimaging techniques in affective disorders and the introduction of disruptive mood dysregulation disorder (DMDD). During the 1980s, mental health professionals began to recognize symptoms of mood disorders in children and adolescents, as well as adults. However, children and adolescents do not necessarily have or exhibit the same symptoms as adults. It is more difficult to diagnose mood disorders in children, especially because children are not always able to express how they feel. Child mental health professionals believe that mood disorders in children and adolescents remain one of the most underdiagnosed mental health problems. We are currently trying to introduce the new diagnostic technique-machine learning in children and adolescents with MDD. We will discuss the current progress in the clinical application of machine learning for MDD. After that, we would also discuss a new challenging diagnosis-DMDD. We are still suffering from a lack of evidence when trying to treat the patients with DMDD. In addition, there are some debates about the diagnostic validity of DMDD. We will explain the current situation of DMDD studies and the future directions in the study of DMDD.


Assuntos
Aprendizado de Máquina , Transtornos do Humor/psicologia , Adolescente , Adulto , Transtornos de Deficit da Atenção e do Comportamento Disruptivo , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Criança , Depressão , Emoções , Humanos , Transtornos do Humor/diagnóstico , Neuroimagem
3.
Ideggyogy Sz ; 72(9-10): 337-341, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31625700

RESUMO

Background - Modern health worries (MHWs) are asso-ciated with various indicators of negative affect, conspiracy theories, and paranormal beliefs in healthy individuals. Purpose - The current pilot study aimed to assess MHWs and indicators of negative affect in patients with affective disorders (N = 66), as well as the possible associations between MHWs and paranoid and schizophrenic tendencies. Results - Compared to somatic patients, psychiatric patients showed higher levels of MHWs, somatosensory amplification, health anxiety, and somatic symptoms. Medium level associations between MHWs and paranoid (r = 0.35, p < 0.01) and schizophrenic (r = 0.37, p < 0.01) tendencies were also revealed. Somatosensory amplification (ß = 0.452, p < 0.001) and paranoia (ß = 0.281, p < 0.01) significantly contributed to MHWs in multiple linear regression analysis (R2 = 0.323, p < 0.001). Discussion - High (i.e. pathological) levels of negative affect can impact a number of related characteristics. Non-pathological paranoid tendencies might contribute to MHWs. The identification of paranoid tendencies seems to be relevant for the treatment of psychiatric patients exhibiting MHWs. Conclusion - Patients with affective disorders are characterized by higher levels of modern health worries, health anxiety, and somatosensory amplification. Modern health worries are associated with paranoid tendencies.


Assuntos
Ansiedade , Atitude Frente a Saúde , Depressão , Transtornos do Humor/psicologia , Humanos , Transtornos do Humor/diagnóstico , Projetos Piloto , Inquéritos e Questionários
4.
IEEE J Biomed Health Inform ; 23(6): 2302-2316, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31502995

RESUMO

Mood disorders affect more than 300 million people worldwide and can cause devastating consequences. Elderly people and patients with neurological conditions are particularly susceptible to depression. Gait and body movements can be affected by mood disorders, and thus they can be used as a surrogate sign, as well as an objective index for pervasive monitoring of emotion and mood disorders in daily life. Here we review evidence that demonstrates the relationship between gait, emotions and mood disorders, highlighting the potential of a multimodal approach that couples gait data with physiological signals and home-based monitoring for early detection and management of mood disorders. This could enhance self-awareness, enable the development of objective biomarkers that identify high risk subjects and promote subject-specific treatment.


Assuntos
Emoções/fisiologia , Análise da Marcha , Transtornos do Humor/fisiopatologia , Adulto , Idoso , Marcha/fisiologia , Humanos , Transtornos do Humor/complicações , Transtornos do Humor/diagnóstico , Doenças do Sistema Nervoso/complicações , Fenótipo
5.
Psychiatr Danub ; 31(Suppl 3): 434-437, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488767

RESUMO

The notion of "mixity" of the dysphoric phases of the bipolarity includes the most insidious symptoms of the bipolar spectrum of mood disorders: the overlapping between depression-restlessness-irritability-grief-tension-anxiety can cause worsening of the mood disorders and in the most acute phases may cause increased risk of major behavioural disruption including murder and suicide. The early utilization of the rating scale on mixed states, "GT-MSRS", which can demonstrate the level of "mixity" of the mood disorder, can prevent this.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Transtornos do Humor/diagnóstico , Transtornos do Humor/psicologia , Ansiedade/psicologia , Depressão/psicologia , Pesar , Homicídio/psicologia , Humanos , Humor Irritável , Agitação Psicomotora/psicologia , Suicídio/psicologia
6.
Psychiatr Danub ; 31(Suppl 3): 486-489, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488777

RESUMO

Mixed states are often underdiagnosed, with important consequences in terms of worsening prognosis, frequent admission to the hospital, higher suicide risk and poorer quality of life. For this reason, we analyzed retrospective data from patients admitted in the Psychiatric Hospital from January 1st to April 30th 2019 to identify clinical features of the mixed states by administering the G.T. MSRS scale. Within the 90 subjects of the sample, the large majority (75%) met criteria for mixed state. Of those only 16 were discharged with a diagnosis of Affective Disorder, however 26 (30.9%) were prescribed a mood stabilizer. This study shows that there is a high prevalence of mixed states in the inpatient unit admission, which is demonstrated both from the prescription of mood stabilizers, and confirmed by the diagnosis of mixed states rated with the scale. The scale can be a useful instrument to detect early in the course if the hospitalization the presence of mixed state, in order to guide a tailored psychopharmacological treatment, and improve prognosis.


Assuntos
Pacientes Internados/psicologia , Transtornos do Humor/diagnóstico , Transtornos do Humor/psicologia , Unidade Hospitalar de Psiquiatria , Humanos , Transtornos do Humor/tratamento farmacológico , Prognóstico , Qualidade de Vida , Estudos Retrospectivos
7.
Psychopharmacology (Berl) ; 236(10): 3063-3079, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31359117

RESUMO

Social Signal Transduction Theory of Depression is a biologically plausible, multi-level theory that describes neural, physiologic, molecular, and genomic mechanisms that link experiences of social-environmental adversity with internal biological processes that drive depression pathogenesis, maintenance, and recurrence. Central to this theory is the hypothesis that interpersonal stressors involving social threat (e.g., social conflict, evaluation, rejection, isolation, and exclusion) upregulate inflammatory processes that can induce several depressive symptoms, including sad mood, anhedonia, fatigue, psychomotor retardation, and social-behavioral withdrawal. The original article describing this formulation (Psychol Bull 140:774-815, 2014) addressed critical questions involving depression onset and recurrence, as well as why depression is strongly predicted by early life stress and comorbid with anxiety disorders and certain physical disease conditions, such as asthma, rheumatoid arthritis, chronic pain, and cardiovascular disease. Here, we extend the theory to help explain sex differences in depression prevalence, which is a defining feature of this disorder. Central to this extension is research demonstrating that ovarian hormone fluctuations modulate women's susceptibility to stress, brain structure and function, and inflammatory activity and reactivity. These effects are evident at multiple levels and are highly context-dependent, varying as a function of several factors including sex, age, reproductive state, endogenous versus exogenous hormones, and hormone administration mode and dose. Together, these effects help explain why women are at greater risk for developing inflammation-related depressed mood and other neuropsychiatric, neurodevelopmental, and neurodegenerative disorders during the reproductive years, especially for those already at heightened risk for depression or in the midst of a hormonal transition period.


Assuntos
Transtorno Depressivo Maior/imunologia , Hormônios Esteroides Gonadais/imunologia , Transtornos do Humor/imunologia , Caracteres Sexuais , Transdução de Sinais/fisiologia , Estresse Psicológico/imunologia , Encéfalo/imunologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Inflamação/diagnóstico , Inflamação/imunologia , Inflamação/psicologia , Masculino , Transtornos do Humor/diagnóstico , Transtornos do Humor/psicologia , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia
8.
Acta Med Okayama ; 73(3): 189-195, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31235965

RESUMO

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a recently-discovered autoimmune disorder in which antibodies target NMDAR in the brain. The number of reported cases of anti-NMDAR encephalitis has increased rapidly. Anti-NMDAR encephalitis can be mistakenly diagnosed as psychiatric disorders because many patients present with prominent psychiatric symptoms and visit psychiatric institutions first. Thus, psychiatrists should cultivate a better understanding of anti-NMDAR encephalitis. In this review, we present the mechanisms, epidemiology, symptoms and clinical course, diagnostic tests, treatment and outcomes of patients with anti-NMDAR encephalitis. Furthermore, we discuss the diversity of clinical spectra of anti-NMDAR encephalitis, and demonstrate a differential diagnosis of psychiatric disease from the perspective of psychiatry.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/terapia , Encefalite Antirreceptor de N-Metil-D-Aspartato/diagnóstico , Encefalite Antirreceptor de N-Metil-D-Aspartato/epidemiologia , Diagnóstico Diferencial , Humanos , Transtornos do Humor/diagnóstico
9.
Psychiatry Res ; 276: 232-238, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31121529

RESUMO

Neuropsychological assessments have provided the field of psychiatry with important information about patients. As an assessment tool, a neuropsychological battery can be useful in a clinical setting; however, implementation as standard clinical care in an inpatient unit has not been extensively evaluated. A computerized cognitive battery was administered to 103 current young adult inpatients (19.2 ±â€¯3.1 years; 72% female) with affective disorder. Neurocognitive tasks included Verbal Recognition Memory (VRM), Attention Switching (AST), Paired Association Learning (PAL), and Rapid Visual Processing (RVP). Patients also completed a computerized self-report questionnaire evaluating subjective impressions of their cognition. Hierarchical cluster analysis determined three neurocognitive subgroups: cluster 1 (n = 17) showed a more impaired neurocognitive profile on three of the four variables compared to their peers in cluster 2 (n = 59), and cluster 3 (n = 27), who had the most impaired attentional shifting. Two of the four neurocognitive variables were significantly different between all three cluster groups (verbal learning and sustained attention). Overall group results showed an association between poorer sustained attention and increased suicidal ideation. These findings strengthen the idea that neurocognitive profiles may play an important role in better understanding the severity of illness in young inpatients with major psychiatric disorders.


Assuntos
Pacientes Internados/psicologia , Transtornos do Humor/diagnóstico , Testes Neuropsicológicos/normas , Padrão de Cuidado , Adolescente , Atenção , Análise por Conglomerados , Cognição , Feminino , Humanos , Masculino , Memória , Transtornos do Humor/psicologia , Índice de Gravidade de Doença , Adulto Jovem
10.
J Neurol ; 266(8): 2027-2034, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31115673

RESUMO

BACKGROUND: Disease burden in myasthenia gravis (MG) and in other autoimmune disorders is often determined by common accompanying symptoms such as fatigue, sleepiness and mood disturbances. Many MG patients have a second autoimmune disease, but it is unclear whether autoimmune comorbidities add to the severity of fatigue, sleepiness and mood disturbances. METHODS: We ascertained the presence of autoimmune comorbidities in 69 well-characterized MG patients. To assess fatigue, sleepiness and mood disturbances, we applied the Fatigue Severity Scale (FSS), the Fatigue Impact Scale (FIS), the Epworth Sleepiness Scale (ESS), as well as the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) to all patients. RESULTS: Thirteen MG patients had concomitant autoimmune thyroid disease (AITD), including 1 patient with rheumatoid arthritis as third autoimmune disease. Fatigue (68.1%), excessive daytime sleepiness (14.5%), moderate-severe depression (20.3%) and anxiety (26.1%) were common, but MG patients with and without autoimmune comorbidities had similar FSS, FIS, ESS, BDI and STAI scores. The presence of autoimmune comorbidities was not associated with altered clinical and immunological MG characteristics, but MG patients with autoimmune comorbidities have more often been treated with corticosteroids than patients without autoimmune comorbidities (92.3% vs. 60.7%; p = 0.03). CONCLUSIONS: While many MG patients were affected by fatigue, sleepiness, depression and anxiety, the present study does not suggest that coexisting autoimmune diseases substantially contribute to the magnitude of these cumbersome comorbid symptoms. However, the higher frequency of steroid treatment may have counterbalanced the effects of the autoimmune comorbidity.


Assuntos
Doenças Autoimunes/diagnóstico , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Fadiga/diagnóstico , Transtornos do Humor/diagnóstico , Miastenia Gravis/diagnóstico , Sonolência , Adolescente , Adulto , Afeto/fisiologia , Doenças Autoimunes/sangue , Doenças Autoimunes/imunologia , Comorbidade , Distúrbios do Sono por Sonolência Excessiva/sangue , Distúrbios do Sono por Sonolência Excessiva/imunologia , Fadiga/sangue , Fadiga/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/sangue , Transtornos do Humor/imunologia , Miastenia Gravis/sangue , Miastenia Gravis/imunologia , Polissonografia/tendências , Adulto Jovem
11.
Med Clin North Am ; 103(4): 651-667, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31078198

RESUMO

Windows of vulnerability for depression have been associated with increased sensitivity to hormonal changes experienced by some women during the luteal phase, postpartum, and/or menopause. Increased awareness has resulted in greater adoption of screening tools for mood and behavioral changes and tailored therapies. This article discusses study results and controversies surrounding therapies uniquely designed for menopause-related depression.


Assuntos
Antidepressivos/uso terapêutico , Terapia de Reposição de Estrogênios/estatística & dados numéricos , Menopausa/fisiologia , Transtornos do Humor/etiologia , Adulto , Feminino , Fogachos/tratamento farmacológico , Fogachos/etiologia , Humanos , Transtornos do Humor/diagnóstico , Transtornos do Humor/terapia , Saúde da Mulher
12.
Dev Psychopathol ; 31(3): 1067-1083, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31109387

RESUMO

Emotion dysregulation is a risk factor for the development of a variety of psychopathologic outcomes. In children, irritability, or dysregulated negative affect, has been the primary focus, as it predicts later negative outcomes even in very young children. However, dysregulation of positive emotion is increasingly recognized as a contributor to psychopathology. Here we used an exploratory factor analysis and defined four factors of emotion dysregulation: irritability, excitability, sadness, and anhedonia, in the preschool-age psychiatric assessment collected in a sample of 302 children ages 3-5 years enriched for early onset depression. The irritability and excitability factor scores defined in preschoolers predicted later diagnosis of mood and externalizing disorders when controlling for other factor scores, social adversity, maternal history of mood disorders, and externalizing diagnoses at baseline. The preschool excitability factor score predicted emotion lability in late childhood and early adolescence when controlling for other factor scores, social adversity, and maternal history. Both excitability and irritability factor scores in preschoolers predicted global functioning into the teen years and early adolescence, respectively. These findings underscore the importance of positive, as well as negative, affect dysregulation as early as the preschool years in predicting later psychopathology, which deserves both further study and clinical consideration.


Assuntos
Nível de Alerta/fisiologia , Emoções/fisiologia , Humor Irritável/fisiologia , Transtornos do Humor/diagnóstico , Adolescente , Afeto/fisiologia , Sintomas Afetivos , Pré-Escolar , Feminino , Humanos , Masculino , Transtornos do Humor/psicologia , Adulto Jovem
13.
Psicothema (Oviedo) ; 31(2): 210-217, mayo 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-185228

RESUMO

Background: Aberrant salience (AS), related to classical delusional mood and self-disturbances, may be one of the keys to early detection of psychosis, before abnormal assignment of significance. As adolescence is a critical period in development of the self and there are few instruments for evaluating AS, validation of the Aberrant Salient Inventory (ASI) is proposed for use in the general adolescent population. Methods: A sample of 4,523 participants, 53.6% women, from 11 to 18 years of age (M = 14.31, SD = 1.66), from 29 schools in Western Andalusia (Spain) were evaluated collectively. Results: Good fit was found in the answers, and the original five-factor structure of the inventory was replicated. Reliability (ordinal alpha) was adequate both for the total (.95) and for the factors (.74. to .85). Invariance across sex, adequate indicators of concurrent (ideas of reference) and divergent (negative symptoms) validity, and sensitivity of .88 were found. Conclusions: The results suggest the ASI for use in the general adolescent population, and show that 7% of the sample could be at risk of beginning psychosis


Antecedentes: la Saliencia Aberrante (SA), relacionada con el estado de ánimo delirante clásico y las perturbaciones de self, puede ser una de las claves para la detección temprana de la psicosis, antes de la asignación anormal de significados. Como la adolescencia es un período crítico en el desarrollo del yo y los instrumentos para evaluar la SA son pocos, se propone la validación del Inventario de Saliencia Aberrante (ASI) para su uso en población general adolescente. Método: participaron 4.523 sujetos, 53,6% mujeres, de 11 a 18 años de edad (M = 14.31, SD = 1.66) de 29 centros escolares de Andalucía Occidental (España). Resultados: se encontró un buen ajuste en las respuestas y se replicó la estructura original de cinco factores del inventario. La fiabilidad (alfa ordinal) fue adecuada tanto para el total (.95) como para los factores (de .74. a .85). Se halló invarianza a través del sexo, indicadores adecuados de validez concurrente (ideas de referencia) y divergente (síntomas negativos), y sensibilidad de .88. Conclusiones: se sugiere el interés del ASI para su uso en población general adolescente, y se muestra que el 7% de los participantes podrían estar en riesgo de psicosis


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Delusões/diagnóstico , Autoavaliação Diagnóstica , Transtornos do Humor/diagnóstico , Estudos Transversais , Instituições Acadêmicas , Autorrelato
14.
Psychiatry Res ; 275: 315-325, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953877

RESUMO

Prodromal symptoms of bipolar disorder (BD) and early onset schizophrenia spectrum disorder (EOSSD) overlap. To date, there has been no study directly comparing the prodromal stage of both disorders. Thus, the current study is aimed at determining which prodromal symptom clusters differentiate BD and EOSSD. One hundred twenty one adolescents (33 BD-1, 30 EOSSD, 58 healthy controls) were evaluated for the presence of 79 prodromal symptoms, divided into 7 prodromal symptom clusters. Great than 2 subsyndromal manic symptoms and ADHD comorbidity were significantly more specific for BD than schizophrenia; brief limited intermittent psychotic symptoms (BLIPS) were more likely to be part of EOSSD. In contrast, attenuated psychotic symptoms, and negative symptoms were not specifically related to the diagnosis of EOSSD. In conclusion, subsyndromal manic symptoms, BLIPS, and ADHD might be useful for predicting the trajectory of an emerging affective disorder versus schizophrenia and thus valuable for early detection, and intervention strategies.


Assuntos
Transtorno Bipolar/diagnóstico , Diagnóstico Precoce , Transtornos do Humor/diagnóstico , Sintomas Prodrômicos , Esquizofrenia/diagnóstico , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno Bipolar/psicologia , Comorbidade , Feminino , Humanos , Masculino , Transtornos do Humor/psicologia , Negativismo , Transtornos Psicóticos/psicologia , Síndrome
15.
Psicothema ; 31(2): 210-217, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31013247

RESUMO

BACKGROUND: Aberrant salience (AS), related to classical delusional mood and self-disturbances, may be one of the keys to early detection of psychosis, before abnormal assignment of significance. As adolescence is a critical period in development of the self and there are few instruments for evaluating AS, validation of the Aberrant Salient Inventory (ASI) is proposed for use in the general adolescent population. METHODS: A sample of 4,523 participants, 53.6% women, from 11 to 18 years of age (M = 14.31, SD = 1.66), from 29 schools in Western Andalusia (Spain) were evaluated collectively. RESULTS: Good fit was found in the answers, and the original five-factor structure of the inventory was replicated. Reliability (ordinal alpha) was adequate both for the total (.95) and for the factors (.74. to .85). Invariance across sex, adequate indicators of concurrent (ideas of reference) and divergent (negative symptoms) validity, and sensitivity of .88 were found. CONCLUSIONS: The results suggest the ASI for use in the general adolescent population, and show that 7% of the sample could be at risk of beginning psychosis.


Assuntos
Delusões/diagnóstico , Autoavaliação Diagnóstica , Transtornos do Humor/diagnóstico , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Linguagem , Masculino , Instituições Acadêmicas , Autorrelato
16.
Med Hypotheses ; 126: 69-77, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31010503

RESUMO

The current diagnostic classification systems in psychiatry have been developed primarily for evidence-based clinical decision making with both categorical and dimensional approaches having their own advantages and disadvantages. Efforts have been made to improve these classification systems, and we are now at the point where we must expand beyond the one-dimensionality of these systems. In this paper, we propose that psychiatric disorders can be arranged in a three-dimensional classification system according to the degree of dysfunctions on three specific axes in a way that is similar to the arrangement of chemical elements according to their atomic weights in Mendeleyev's periodic table. For the three axes, we chose externalization, drive, and attention to represent the three-dimensional descriptions of mental health, namely, well-being in social, motivational, and cognitive areas, respectively. Throughout the paper, we explain our reasons for choosing these three axes and compare our hypothesis with categorical diagnostic systems as well as Cloninger's dimensional diagnostic system using personality disorders, affective disorders, and schizophrenia as the specific diagnostic samples.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Transtornos Mentais/classificação , Transtornos Mentais/diagnóstico , Transtornos Mentais/fisiopatologia , Mães , Psiquiatria/normas , Adulto , Algoritmos , Atenção , Cognição , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Homeostase , Humanos , Lactente , Recém-Nascido , Saúde Mental , Transtornos do Humor/diagnóstico , Motivação , Relações Pais-Filho , Personalidade , Transtornos da Personalidade/classificação , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/fisiopatologia , Psiquiatria/métodos , Esquizofrenia/diagnóstico , Comportamento Social
17.
J Med Internet Res ; 21(4): e11029, 2019 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-30994461

RESUMO

BACKGROUND: Virtually, all organisms on Earth have their own circadian rhythm, and humans are no exception. Circadian rhythms are associated with various human states, especially mood disorders, and disturbance of the circadian rhythm is known to be very closely related. Attempts have also been made to derive clinical implications associated with mood disorders using the vast amounts of digital log that is acquired by digital technologies develop and using computational analysis techniques. OBJECTIVE: This study was conducted to evaluate the mood state or episode, activity, sleep, light exposure, and heart rate during a period of about 2 years by acquiring various digital log data through wearable devices and smartphone apps as well as conventional clinical assessments. We investigated a mood prediction algorithm developed with machine learning using passive data phenotypes based on circadian rhythms. METHODS: We performed a prospective observational cohort study on 55 patients with mood disorders (major depressive disorder [MDD] and bipolar disorder type 1 [BD I] and 2 [BD II]) for 2 years. A smartphone app for self-recording daily mood scores and detecting light exposure (using the installed sensor) were provided. From daily worn activity trackers, digital log data of activity, sleep, and heart rate were collected. Passive digital phenotypes were processed into 130 features based on circadian rhythms, and a mood prediction algorithm was developed by random forest. RESULTS: The mood state prediction accuracies for the next 3 days in all patients, MDD patients, BD I patients, and BD II patients were 65%, 65%, 64%, and 65% with 0.7, 0.69, 0.67, and 0.67 area under the curve (AUC) values, respectively. The accuracies of all patients for no episode (NE), depressive episode (DE), manic episode (ME), and hypomanic episode (HME) were 85.3%, 87%, 94%, and 91.2% with 0.87, 0.87, 0.958, and 0.912 AUC values, respectively. The prediction accuracy in BD II patients was distinctively balanced as high showing 82.6%, 74.4%, and 87.5% of accuracy (with generally good sensitivity and specificity) with 0.919, 0.868, and 0.949 AUC values for NE, DE, and HME, respectively. CONCLUSIONS: On the basis of the theoretical basis of chronobiology, this study proposed a good model for future research by developing a mood prediction algorithm using machine learning by processing and reclassifying digital log data. In addition to academic value, it is expected that this study will be of practical help to improve the prognosis of patients with mood disorders by making it possible to apply actual clinical application owing to the rapid expansion of digital technology.


Assuntos
Ritmo Circadiano/fisiologia , Aprendizado de Máquina/normas , Transtornos do Humor/diagnóstico , Estudos de Coortes , Feminino , Humanos , Masculino , Fenótipo , Estudos Prospectivos
18.
J Affect Disord ; 252: 130-134, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30981056

RESUMO

OBJECTIVE: Mood and anxiety disorders typically begin in adolescence or early adulthood, but those at the age of highest risk are among those least likely to access mental health services. However, they may be more likely than other demographic groups to seek help online. The goal of the present study was to investigate the online help- and information-seeking activity of young people newly diagnosed with mood and anxiety disorders in order to better understand how digital resources might serve this population. METHOD: Participants, aged 15 to 35, with a diagnosis of a mood or anxiety disorder were eligible if they had received their first mental health diagnosis within 24 months. Participants were interviewed with the Pathways to Care Questionnaire, which inquires about online activity prior to one's first interaction with mental healthcare providers. RESULTS: Forty people participated (depression n = 30, bipolar disorder n = 5, generalized anxiety disorder n = 5); average age 21 years (SD=3.2), 60% female. Eighty-one percent reported seeking help and/or information about their symptoms online. The gap between symptom onset and in-person help seeking was 91.90 weeks (SD=133.7). Most participants (85%) reported they would be open to communicating with a mental health professional online. CONCLUSION: A majority of young people experiencing clinically-significant symptoms seek help online. However, the gap between symptom onset and treatment initiation remains unacceptably long. Better strategies are needed to translate young people's interest in online resources into meaningful care, whether through web-based services or facilitated pathways to traditional treatment.


Assuntos
Comportamento de Busca de Ajuda , Internet , Serviços de Saúde Mental/estatística & dados numéricos , Transtornos do Humor/diagnóstico , Transtornos do Humor/terapia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Tempo para o Tratamento/estatística & dados numéricos , Adolescente , Adulto , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Feminino , Humanos , Masculino , Transtornos do Humor/psicologia , Inquéritos e Questionários , Adulto Jovem
19.
Nord J Psychiatry ; 73(2): 111-117, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30870046

RESUMO

The presence of comorbid conditions associated with paediatric obsessive-compulsive disorder (OCD) is reported to range from 50 to 80% and to have an impact on treatment outcome. Accurate identification of comorbid psychiatric disorders is necessary in order to provide personalised care. Reliable and valid diagnostic interviews are essential in the process of establishing the correct diagnoses. The objective of this study was to evaluate the convergent and divergent validity of four diagnose categories generated by the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL). The diagnose categories were: anxiety, depression, attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). The K-SADS-PL was applied in a clinical sample of youth aged 7-17 years (N = 269), who were participants in the Nordic long-term OCD-treatment study (NordLOTS). Youth and parents completed measures to evaluate symptoms of anxiety, depression, ADHD, and ODD. Convergent and divergent validity of K-SADS-PL anxiety diagnosis was supported based on both anxiety self- and parent-reports. Similarly, support was found for convergent and divergent validity of ADHD and ODD diagnoses. For depressive disorder, support for convergent validity was found based on the depression self-report. Support for divergent validity of depression was found based on both the depression self- and parent-reports. Results of the present study suggest that the K-SADS-PL generates valid diagnoses of comorbid anxiety disorders, depression disorders, ODD, and ADHD in children and adolescents with OCD.


Assuntos
Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/epidemiologia , Escalas de Graduação Psiquiátrica/normas , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Adolescente , Criança , Comorbidade , Feminino , Humanos , Estudos Longitudinais , Masculino , Transtorno Obsessivo-Compulsivo/psicologia , Psicometria , Reprodutibilidade dos Testes , Psicologia do Esquizofrênico
20.
J Affect Disord ; 250: 284-288, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30875670

RESUMO

BACKGROUND: Recent reports have suggested a relationship between affective disorder including depression and bipolar disorder (BP) and frontotemporal dementia (FTD). TAR DNA binding protein (TDP) -43 is a protein found in the brain and peripheral fluid of patients with FTD. To examine a possible association between affective disorders and FTD, serum levels of TDP-43 were evaluated in late-life patients with major depressive episode (MDE). METHODS: The subjects were 74 late-life (≥50 years old) inpatients with DSM-IV or -5 MDE (58 had major depressive disorders and 16 had BP) and 58 healthy subjects. Patients were recruited from Juntendo Koshigaya Hospital, Saitama, Japan, between January 2005 and May 2017. Serum TDP-43 levels were measured using an ELISA kit. RESULTS: Serum levels of TDP-43 were significantly higher in the MDE group than the control group independent of age and sex. LIMITATIONS: All patients were on antidepressant medication. CONCLUSIONS: Our finding suggests that some depressive patients may be in a prodromal stage of FTD or very-early stage of FTD comorbid with depression.


Assuntos
Proteínas de Ligação a DNA/sangue , Transtorno Depressivo Maior/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Transtorno Depressivo Maior/diagnóstico , Manual Diagnóstico e Estatístico de Transtornos Mentais , Ensaio de Imunoadsorção Enzimática , Feminino , Demência Frontotemporal/sangue , Demência Frontotemporal/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/sangue , Transtornos do Humor/diagnóstico
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