eHealth tools for assessing psychomotor activity in schizophrenia: a systematic review

Objective: Psychomotor abnormalities are relevant symptoms in the clinical presentation of schizophrenia, and assessing them could facilitate monitoring. New technologies can measure psychomotor activity objectively and continuously, but evidence on the topic is scarce. Our aim is to systematically review the existing evidence about eHealth tools for assessing psychomotor activity in patients diagnosed with schizophrenia. Method: We performed a systematic search of the PubMed and Embase databases and identified 15 relevant articles on eHealth tools for assessing psychomotor activity in schizophrenia. Results: eHealth devices accurately assessed psychomotor activity and were well accepted. Abnormalities in psychomotor activity helped differentiate between different subtypes of schizophrenia. Abnormal increases in psychomotor activity were correlated with acute presentations, while lower activity was associated with relapses, deterioration, and negative symptoms. Conclusion: Actigraphy is still the preferred eHealth device in research settings, but mobile applications have great potential. Further studies are needed to explore the possibilities of psychomotor monitoring and mobile health applications for preventing relapses in schizophrenia. eHealth could be useful for monitoring psychomotor activity, which might help prevent relapses.

Factores de riesgo de la conducta suicida asociados a trastornos depresivos y ansiedad / Suicide risk factors related to depressive and anxiety disorders

Introducción El suicidio es una de las 10 principales causas de muerte a nivel mundial. La conducta suicida es resultado de la interrelación de factores psicopatológicos (depresión, psicosis, drogas), sociales (aislamiento, situación laboral), biólogicos (heredabilidad del 50%, hipofunción serotoninérgica) y ambientales (sucesos estresantes, situaciones de maltrato). El objetivo de este trabajo es valorar el riesgo de intentos de suicidio con presencia de trastornos de ansiedad, depresión mayor y depresión comórbida con ansiedad. Método Se reclutaron 505 pacientes con historia de intentos de suicidio y 277 pacientes sin ella, como controles, en tres hospitales generales de Madrid, España. Se realizó una regresión logística utilizando como variable dependiente la existencia o no de historia de intentos de suicidio, como variables independientes el diagnóstico y los factores de riesgo vinculados a los intentos de suicidio según la literatura médica. Resultado El modelo clasificó correctamente el 80% de los pacientes. El riesgo de suicido fue mayor en pacientes con depresión (OR=3.4; IC 95%=1.8-4.8) y con comorbilidad ansiedad-depresión (OR=4.3; IC 95%=2.4-7.8) a diferencia de los pacientes no diagnosticados con éstos. Los pacientes que no tenían hijos presentaron un riesgo de intentos de suicidio mayor respecto a quienes sí los tenían (OR=3.8; IC 95%=2.3-6.2). La edad del paciente menor de 35 años y la historia familiar de conducta suicida incrementó el riesgo de intento de suicidio (OR=2.2; IC 95%=1.1-4.5). Conclusiones La comorbilidad depresión-ansiedad es un factor de riesgo para la conducta suicida más importante que estas condiciones por separado u otros diagnósticos, esta asociación confiere mayor riesgo que otros factores como la historia familiar de conducta suicida, el no tener hijos o la edad menor a 35 años. Los clínicos deben prestar atención a pacientes con depresión y ansiedad comórbidas en presencia de factores de riesgo para la conducta suicida.

Introduction Suicide is among the most prevalent causes of death in the world. A history of past suicide attempts is the most important of all the risk factors to show suicidal behavior (attempts and completed suicides). The objective of this study is to assess the effect of anxiety disorders, major depressive disorder, and comorbid major depression with anxiety on the risk for suicide attempts. Methods We recruited 505 patients with a history of suicide attempts and a control group of 277 patients without a history of suicide attempt from three hospitals in Madrid, Spain. We performed a logistic regression analysis using a progressive elimination method with the presence or absence of a history of suicide attempts as the dependent variable. As independent variables we included the diagnosis (anxiety, major depression, anxiety comorbid with major depression, and other diagnoses) and other risk factors for suicide attempts recognized in the literature. Results The regression model correctly classified more than 80% of the patients. Patients with depression (OR=3.4; CI 95%=1.8-4.8) and with anxiety-depression comorbidity (OR=4.3; CI 95%=2.4-7.8) had higher risk for suicide attempt compared to patients with other diagnoses. Patients without children had a higher risk for suicide attempt than those with children (OR=3.8; 95% CI=2.3-6.2), while patients with a family history of suicide had a higher risk than those without it (OR=2.2; 95% CI=1.1-4.5). Conclusions In clinical populations, the comorbidity of depression and anxiety is a higher risk factor for suicide attempts than having either condition separately or having other diagnoses. It also seems to be more important than other risk factors, such as family history.

Suicidal ideation and suicide attempts in bipolar disorder type I: an update for the clinician / Ideação suicida e tentativas de suicídio no transtorno afetivo bipolar tipo I: uma atualização para o clínico

OBJECTIVE: This article reviews the evidence for the major risk factors associated with suicidal behavior in bipolar disorder. METHOD: Review of the literature studies on bipolar disorder, suicidal behavior and suicidal ideation. RESULTS: Bipolar disorder is strongly associated with suicide ideation and suicide attempts. In clinical samples between 14-59 percent of the patients have suicide ideation and 25-56 percent present at least one suicide attempt during lifetime. Approximately 15 percent to 19 percent of patients with bipolar disorder die from suicide. The causes of suicidal behavior are multiple and complex. Some strong predictors of suicidal behavior have emerged in the literature such as current mood state, severity of depression, anxiety, aggressiveness, hostility, hopelessness, comorbidity with others Axis I and Axis II disorders, lifetime history of mixed states, and history of physical or sexual abuse. CONCLUSION: Bipolar disorder is the psychiatric condition associated with highest lifetime risk for suicide attempts and suicide completion. Thus it is important to clinicians to understand the major risk factors for suicidal behavior in order to choose better strategies to deal with this complex behavior.

OBJETIVO: O artigo revisa as evidências relacionadas aos principais fatores de risco associados ao comportamento suicida no transtorno bipolar. MÉTODO: Revisão de artigos da literatura em transtorno bipolar, tentativa de suicídio e ideação suicida. RESULTADOS: O transtorno bipolar está fortemente associado à presença de ideação suicida e a tentativas de suicídio. Em amostras clínicas, entre 14 por cento e 59 por cento dos pacientes apresentam ideação suicida e entre 25 por cento e 56 por cento têm pelo menos uma tentativa de suicídio ao longo da vida. Aproximadamente 15 por cento a 19 por cento dos pacientes com transtorno afetivo bipolar morrem por suicídio. As causas do comportamento suicida são múltiplas e complexas. Alguns preditores de comportamento suicida vêm sendo demonstrados consistentemente na literatura, tais como estado de humor atual, gravidade da depressão, ansiedade, agressividade, hostilidade, presença de comorbidades com outros transtornos do eixo I e eixo II, presença de estados mistos ao longo do curso da doença e história de abuso físico ou sexual. CONCLUSÃO: O transtorno bipolar é o transtorno psiquiátrico com maior risco ao longo da vida para tentativas de suicídio e suicídio completo. Sendo assim é importante para o clínico identificar os principais fatores de risco para comportamento suicida visando a escolha das melhores estratégias para lidar com esse comportamento complexo.