Download to Heal: Navigating the Pixelated Path of Digital Therapeutics in Psychiatric Care.

Digital therapeutics have evolved rapidly with technological advances in healthcare. Despite their increasing use, gaps remain in understanding their regulatory frameworks, integration, and efficacy for conditions like substance use disorder, insomnia, attention deficit hyperactivity disorder, and post-traumatic stress disorder. This study evaluates FDA-approved digital therapeutics and explores their potential to revolutionize psychiatric treatments amid ongoing technological and regulatory changes. We conducted a comprehensive review of major databases, focusing on articles published up to January 2024 on FDA-approved digital therapeutics. We excluded non-English articles and those lacking empirical data or focusing on non-FDA-approved therapeutics. Our analysis covered regulatory compliance, clinical outcomes, and integration with traditional treatments. The review of nine FDA-cleared digital therapeutics revealed benefits like improved treatment accessibility and potential reductions in healthcare costs. For example, Somryst, a cognitive-behavioral therapy-based treatment for insomnia, showed that over 40 percent of users overcame chronic insomnia, and 60 percent experienced improvements without adverse effects. However, challenges remain, including low provider adoption, inadequate insurance coverage, and high user dropout rates. While digital therapeutics enhance accessibility, they face regulatory challenges, reimbursement issues, and the need for robust clinical evidence. Success depends on collaboration among stakeholders to demonstrate value, ensure safety, and integrate them into existing healthcare systems.

Divergent Mortality Patterns Associated With Dementia in the United States: 1999-2020.

Objective: To analyze contemporary trends of dementia and dementia-related mortality in the United States between 1999 and 2020 categorized by demographic and regional attributes.Methods: A retrospective cohort analysis was conducted using mortality data from individuals aged 35 years to ≥85 years, where dementia/Alzheimer disease was recorded as a contributing or underlying cause of death. Data were extracted from the US Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database for the years 1999-2020. Mortality rates adjusted for age due to dementia (annual age-adjusted mortality rate [AAMR]) per 10,000 individuals in the United States were categorized by gender, racial and ethnic groups, and geographic regions.Results: Results revealed 6,601,680 deaths related to dementia between 1999 and 2020. Among these, 85.5% were non-Hispanic (NH) white, 8% NH black, 4.34% Hispanic or Latino, 1.6% NH Asian or Pacific Islander, and 0.3% NH American Indian or Alaska Native adults. The overall AAMR was 17.49, with women experiencing a higher AAMR of 18.19 compared to men (16.05). Ethnic disparities were evident, with NH black adults having the highest AAMR (18.23), followed by NH white (18.09) and Hispanic adults (12.7). Over the study period, the overall AAMR increased from 10.86 in 1999 to 21.42 in 2020, with a notable 18.4% rise in the AAMR from 1999 to 2001. From 2001 to 2020, the average percent change of the AAMR was 1.0%. This upward trend in mortality was observed for both men and women and across all ethnicities.Conclusions: The study spanning 1999-2020 revealed concerning trends in dementia-related mortality in the United States. There is a critical need for targeted health care policy initiatives aimed at mitigating the increasing dementia burden.Prim Care Companion CNS Disord 2024;26(4):24m03724. Author affiliations are listed at the end of this article.

"My sister wants to kill me": A case report and systematic review of literature of co-occurring multiple sclerosis and psychosis.

Background: Multiple sclerosis (MS) is a neurological disorder with demyelination of neuronal matter, especially of white matter, with multiple episodes occurring temporally. It has been associated with multiple neurological and psychiatric sequelae. Depression and other affective symptoms are commonly associated with MS. Previous research has also suggested that psychotic symptoms may co-occur with MS as well. Material and Methods: A case report was prepared on the patient admitted to the inpatient unit. Subsequently, a systematic literature review of literature was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model on three databases. Search terms included (MS OR multiple sclerosis) AND (Psychosis OR schizophrenia OR schizoaffective disorder OR psychotic OR hallucination OR delusion). Results: The literature review led to an initial discovery of 2711 hits on PubMed, 1276 hits on PsycINFO, and 5429 hits on Embase. Some patients were diagnosed with MS at an earlier age with a later onset of psychosis, while some were initially diagnosed with psychosis (or schizophrenia) first and subsequently with MS. Psychotic symptoms observed included persecutory delusions, lack of insight, delusions of reference, auditory hallucinations, grandiose delusions, and passivity. The commonly prescribed antipsychotics included risperidone, olanzapine, quetiapine, and aripiprazole. The presence of co-occurring psychosis in MS patients underscores the need for a comprehensive evaluation of symptoms. Conclusion: This case highlights the importance of conducting a magnetic resonance imaging (MRI) brain not only for initial onset psychosis but also for any sudden changes in patients who have had a relatively stable course. Moreover, psychosis can affect treatment adherence in MS, making it all the more critical to identify and manage it promptly.

A Complex Presentation: Psychosis in a Patient Diagnosed With Lennox-Gastaut Syndrome.

Lennox-Gastaut syndrome (LGS) is a form of severe childhood epilepsy, with most children experiencing seizures before reaching the age of eight. Typically, patients have multiple types of seizures, making an accurate diagnosis challenging. While it can be secondary to other causes, often, it is idiopathic. Over time, children develop cognitive impairment, leading to intellectual disability. The mainstay of treatment and management is seizure control. However, management remains challenging due to the complexity of the syndrome, as it is associated with multiple seizure types, intellectual deterioration, and other psychiatric comorbidities. We present the case of a 19-year-old male diagnosed with LGS and treated with various available therapies, who demonstrated multiple breakthrough seizures, significant neurocognitive disabilities, and behavior challenges. Additionally, the patient displayed psychotic features of auditory hallucinations, aggression, and attempts at self-mutilation, a rare clinical presentation in LGS.

Sleep disruptions and the pathway to psychosis: An in-depth case and literature review.

Key Clinical Message: The case highlights an unusual presentation where sleep issues preceded psychotic symptoms, implying link between disrupted sleep and psychosis onset. Earlier symptoms were viewed as depression but may have signaled psychosis exacerbated by insomnia. Abstract: Sleep disorders, prevalent yet frequently overlooked in individuals with psychotic disorders, have significant associations with the onset and severity of psychosis. Here we describe the case of a patient who first presented with insomnia, but whose condition improved with the use of risperidone and was diagnosed with first-episode psychosis. Multiple studies emphasize the critical relationship between sleep disturbances and psychosis, particularly in the lead-up to first-episode psychosis. Structural abnormalities in the brain, notably the thalamus, combined with neurotransmitter imbalances involving dopamine and acetylcholine, seem pivotal in this interrelation. The connection between dopamine, sleep disturbances, and psychosis, specifically the role of D2 dopamine receptors, highlights a potential pathway bridging sleep irregularities with psychosis. The study underscores the need for further research to delineate the relationship between sleep disturbances and psychosis and to assess the efficacy of various therapeutic interventions targeting both conditions.

Exploring the Psychiatric Manifestations of Primary Sjögren's Syndrome: A Narrative Review.

Background: Primary Sjögren's syndrome (pSS) is recognized for its autoimmune origin. Its hallmark symptoms, dry eyes and mouth, result from glandular inflammation. Prior literature indicates that pSS not only affects the peripheral system but also involves the central nervous system (CNS), giving rise to various neuropsychiatric symptoms. However, there is limited published research on the psychiatric comorbidities in individuals with pSS. Methods: A comprehensive search was conducted on PubMed and Google Scholar for this narrative review. The search spanned from inception until August 2023. Its aim was to locate studies focusing on the psychiatric manifestations of pSS and the potential underlying mechanisms. Results: The most commonly reported psychiatric complications among these individuals are depression and cognitive dysfunction. Other psychiatric manifestations that have been reported in pSS individuals include anxiety, sleep disorders, psychosis, catatonia, bipolar disorder, and obsessive-compulsive disorder. Conclusion: In conclusion, patients with pSS often display multiple psychiatric symptoms. These symptoms can significantly impair functioning and reduce quality of life. Hence, prompt diagnosis and management are crucial.

The importance of rapid assessment tools in evaluating mental health in emergency departments among patients with chronic diseases.

Background: Rapid screening tools such as the WHO well-being Index (WWBI), Six-item screener (SIS), and the CLOX-1 test can be used to assess overall mental health and cognition, respectively. We sought to evaluate mental health with cognition in individuals with chronic diseases and stable vital signs presenting to the Emergency Department (ED). Methods: An observational study in the ED with 279 participants was conducted. Results: Chronic diseases were more prevalent among 51-70 years (43.4%) and diabetes was most common (58.8%). Fever (22.6%) and GI bleeding (32.6%) presentation were high. Participants with low WWBI had low SIS compared to the ones with higher scores (83.3% vs. 17.7%, p < 0.001) and also had low CLOX-1 compared to ones with high CLOX-1 (67.3% vs. 5%, <0.001). A positive correlation between WWBI with SIS (correlation coefficient = 0.305, p < 0.001) and CLOX-1 (0.441, <0.001). Regression analysis indicates a positive association between WWBI and the SIS (standardized regression coefficient = 0.187, 95%CI = 0.236-1.426, and p = 0.006) and CLOX 1 (0.338, 0.2-0.463, <0.001). Conclusion: In the ED, the evaluation of mental health even among cognitive impaired is feasible and crucial.

Pediatric anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis: Exploring psychosis, related risk factors, and hospital outcomes in a nationwide inpatient sample: A cross-sectional study.

OBJECTIVE: Our study aims to examine the risk factors for comorbid psychosis in pediatric patients hospitalized for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis and its impact on hospital outcomes. METHODS: We conducted a cross-sectional study using the nationwide inpatient sample (NIS 2018-2019). We included 3,405 pediatric inpatients (age 6-17 years) with a primary discharge diagnosis of anti-NMDAR encephalitis. We used binomial logistic regression model to evaluate the odds ratio (OR) of variables (demographic and comorbidities) associated with comorbid psychosis. RESULTS: The prevalence of comorbid psychosis in anti-NMDAR encephalitis inpatients was 5.3%, and majorly constituted of adolescents (72.2%) and females (58.3%). In terms of race, Blacks (OR 2.41), and Hispanics (OR 1.80) had a higher risk of comorbid psychosis compared to Whites. Among comorbidities, encephalitis inpatients with depressive disorders (OR 4.60), sleep-wake disorders (OR 3.16), anxiety disorders (OR 2.11), neurodevelopmental disorders (OR 1.95), and disruptive behavior disorders (OR 2.15) had a higher risk of comorbid psychosis. Anti-NMDAR encephalitis inpatients with comorbid psychosis had a longer median length of stay at 24.6 days (vs. 9.8 days) and higher median charges at $262,796 (vs. $135,323) compared to those without psychotic presentation. CONCLUSION: Adolescents, females, and Blacks with encephalitis have a higher risk of psychotic presentation leading to hospitalization for anti-NMDAR encephalitis. Identification of demographic predictors and comorbidities can aid in early recognition and intervention to optimize care and potentially reduce the healthcare burden.

Examining Risk Factors for Suicidality in Adolescents and Adults Experiencing Their First Episode of Psychosis.

This narrative review aimed to identify the risk factors associated with suicidality in adolescents and adults with first-episode psychosis. The review included studies that examined various factors such as psychiatric, familial, and social factors, as well as previous self-harm, suicidal ideation, and comorbid mental health disorders. A comprehensive literature search was conducted across three publicly available databases (Embase, American Psychological Association PsycINFO, and PubMed) using specific search terms related to first-episode psychosis, suicide, self-harm, and children/adolescents and adults. The inclusion criteria included original articles focusing on prospective and retrospective cohort trials, with substantial data on first-episode psychosis and self-harm, measuring both suicidal intent and outcome. Non-original studies, case reports, case series, non-English-language publications, and studies examining violence and self-harm related to substance-induced psychosis were excluded. After manual screening and removing duplicate articles, 13 articles met the established criteria for inclusion in this review. Included studies adhered to similar inclusion and exclusion criteria, had long-term follow-up, and assessed outcomes at least twice. The findings suggest that depressive symptoms, substance use disorders, previous self-harm or suicidal ideation, and longer duration of untreated psychosis are associated with an increased risk of suicidality. However, insights into psychosis and premorbid intellectual functioning did not show a direct association with suicidality.

Pathophysiological mechanisms of post-myocardial infarction depression: a narrative review.

Myocardial infarction (MI) can have significant physical and mental consequences. Depression is a prevalent psychiatric condition after MI which can reduce the quality of life and increase the mortality rates of patients. However, the connection between MI and depression has remained under-appreciated. This review examines the potential connection between depression and MI by overviewing the possible pathophysiologic mechanisms including dysregulation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, coagulation system dysfunction, inflammation, environmental factors, as well as, genetic factors. Furthermore, depression can be an adverse event of medications used for MI treatment including beta-blockers, statins, or anti-platelet agents. The need for early detection and management of depression in patients with MI is, therefore, crucial for improving their overall prognosis. Adherence to treatments and regular follow-up visits can ensure the best response to treatment.

Psychiatric Comorbidities and Risk of Somatic Symptom Disorders in Posttraumatic Stress Disorder: A Cross-Sectional Inpatient Study.

ABSTRACT: Nearly 90% of Americans are exposed to a traumatic event at some point in their lives, and over 8% of those individuals will develop posttraumatic stress disorder (PTSD). Our study examined the demographic differences and psychiatric comorbidities in inpatients with PTSD with and without somatic symptom disorders (SSDs), using data from the Nationwide Inpatient Sample for 2018 and 2019. Our sample included 12,760 adult patients with a primary diagnosis of PTSD, which was further subdivided based on a codiagnosis of SSD. We used a logistic regression model to determine the odds ratio (OR) of association for SSD and identify demographic predictors and comorbid risk factors in inpatients with PTSD. The prevalence of SSD in inpatients with PTSD was 0.43%, and it was more commonly seen in women and Caucasians. Personality disorders (OR, 5.55; p < 0.001) and anxiety disorders (OR, 1.93; p = 0.018) were found to increase the likelihood of codiagnoses of SSD in inpatients with PTSD. These findings support the need for a systematic, modular approach that includes evidence-based interventions to treat at-risk populations.

Treatment Modalities for Chronic Pain in Elderly Patients With Depression: A Systematic Review.

Objective: To review the best pharmacologic and nonpharmacologic interventions in the management of chronic pain in elderly patients with depression.Data Sources: A systematic review of the literature was performed following the PRISMA guidelines and using PubMed. Articles published from 2010 to 2020 were included in the search. Search terms included (major depressive disorder OR MDD OR unipolar depression) AND (chronic pain) AND (elderly).Study Selection: The PubMed search identified 540 articles. All studies were in English and included reports about pain and depression in elderly individuals aged ≥ 65 years.Data Extraction: Articles were reviewed in 2 phases: abstract review followed by full-text review.Results: Abstracts were reviewed for relevance, and a total of 37 articles were identified for full-text review. In this phase, articles not meeting the elderly age criteria (≥ 65 years) or not discussing any treatment modalities were excluded. Nine papers were included after full-text review. The results showed co-occurrence of chronic pain and depression in 13% of the elderly population. Common pain symptoms were related to cancer, back pain, and arthritis.Conclusions: The findings emphasize the importance of individualized assessment of chronic pain in elderly patients with mood disorders such as depression. Since chronic pain and depression are independent risk factors for suicide, it is crucial to complete a thorough history and physical examination and to apply relevant screening tools for both depression and pain.

A comparative study of caregiver burden in psychiatric illness and chronic medical illness.

BACKGROUND: Caregivers of individuals suffering from psychiatric illness are at risk of being subjected to mental health consequences such as depression, anxiety and burnout. Community-based studies proved that 18-47% of caregivers land in depression. The caregiver burden can be quantified into objective, subjective and demand burdens. There is paucity of data comparing the caregiver burden of psychiatric patients and that of chronic medical illness patients. AIMS AND OBJECTIVES: (1) To compare the caregiver burden in psychiatric illness and chronic medical illness. (2) To study the association of caregiver burden with demographic factors like age, gender, duration of caregiving. MATERIALS AND METHODS: The study included two groups of caregivers, each of 50 members. Group 1 consisted of caregivers of psychiatric patients and group 2 consisted of caregivers of chronic medical illness patients. The Montgomery Borgatta Caregiver Burden scale was used to assess the burden in terms of objective, subjective and demand burdens. RESULTS AND CONCLUSION: The caregiver burden scores in the caregivers of psychiatric patients were significantly higher than that of chronic medical illness (P<0.0001). The caregiver burden was found to increase with the duration of illness as well as with the age of caregiver. The caregiver burden in the sample population was less as the objective and demand burden did not cross the reference higher value in the given scale, whereas the emotional impact given by the subjective burden was on higher side.