Perspectives on illness-related stigma and electronically sharing psychiatric health information by people with multiple sclerosis.

BACKGROUND: Electronic medical records (EMRs) facilitate more integrated and comprehensive care. Despite this, EMRs are used less frequently in psychiatry compared to other medical disciplines, in part due to concerns regarding stigma surrounding mental health. This paper explores the willingness to share medical information among patients with multiple sclerosis (MS), who experience higher rates of psychiatric comorbidities compared to the general population, and the role that stigma plays in patient preferences. METHODS: MS patients were surveyed about their co-occurring psychiatric and non-psychiatric diagnoses, willingness to share their health information electronically among their treating doctors, and levels of self and societal stigma associated with their diagnoses. RESULTS: Participants were slightly more willing to share their non-psychiatric medical information vs. psychiatric information. Despite the presence of stigma decreasing patient willingness to share medical records, those with psychiatric co-occurring disorders, compared to those without, endorsed significantly greater willingness to electronically share their health records. The majority of diagnoses for which participants experienced the greatest difference in self vs. societal stigmas were psychiatric ones, including substance use, eating and mood disorders. Societal stigma strongly correlated with decreased non-psychiatric medication sharing, while self stigma was strongly correlated with decreased psychiatric medications sharing. LIMITATIONS: Standardized scales were not used to assess patient stigma and there is a potential lack of generalizability of results beyond patients with MS. CONCLUSIONS: These insights into patient preferences toward sharing their medical information should inform decisions to implement EMRs, particularly for patient populations experiencing higher than average levels of psychiatric comorbidities.

An Automated Mobile Mood Tracking Technology (Mood 24/7): Validation Study.

BACKGROUND: Electronic tracking has been utilized for a variety of health conditions. Previous studies have shown that there is higher adherence to electronic methods vs paper-and-pencil tracking modalities. Electronic tracking also ensures that there are no back-filled entries, where patients have-to appear compliant-entered their responses retrospectively just before their visits with their health care provider. On the basis of the recognition of an unmet need for a Web-based automated platform to track psychiatric outcomes, Johns Hopkins University partnered with Health Central (a subsidiary of Remedy Health Media LLC) to develop Mood 24/7, an electronic, mobile, automated, SMS-based mood tracker. This is a pilot study to validate the use of Mood 24/7 in anticipation of clinical trials to demonstrate the therapeutic benefit on patients' health outcomes of utilizing digital mood-tracking technology. OBJECTIVE: Mood 24/7 is an electronic mood-monitoring platform developed to accurately and efficiently track mood over time through automated daily SMS texts or emails. This study was designed to assess the accuracy and validity of Mood 24/7 in an outpatient psychiatric setting. METHODS: This pilot study involved a retrospective chart review for depressed outpatients (N=9) to compare their self-reported Mood 24/7 daily mood ratings with their psychiatrist's independent clinical mood assessment at the time of the patient's visit. Their mood ratings via Mood 24/7 were collected over 36 weeks. In addition, a mixed model analysis was applied to compare the weekly Montgomery-Åsberg Depression Rating Scale (MADRS) scores with Mood 24/7 scores over an average of 3 months. RESULTS: A 97.2% (315/324) digital mood reporting adherence was found over 36 weeks, and a significant correlation (r=0.86, P<.001) was observed between patients' Mood 24/7 scores and their psychiatrist's blinded clinical assessment of the patient's mood when seen in the clinic. In addition, a significant concordance (intraclass correlation of 0.69, 95% CI 0.33-0.91, P<.001) was observed in the mixed model analysis of the clinician-administered MADRS vs Mood 24/7 scores over time. CONCLUSIONS: Our chart review and mixed model analyses demonstrate that Mood 24/7 is a valid instrument for convenient, simple, noninvasive, and accurate longitudinal mood assessment in the outpatient clinical setting.

Dose-dependent inhibition of GCPII to prevent and treat cognitive impairment in the EAE model of multiple sclerosis.

There are no treatments for cognitive impairment in multiple sclerosis (MS). Novel treatments can be evaluated in experimental autoimmune encephalomyelitis (EAE), a mouse model of MS that displays both physical and cognitive impairments. Inhibition of the neuropeptidase glutamate carboxypeptidase II (GCPII) has previously been shown to ameliorate cognitive impairment in EAE, but dosing has not yet been optimized and only a prevention treatment paradigm has been explored. In the study described herein, the dose response of the GCPII inhibitor 2-(phosphonomethyl)pentanedioic acid (2-PMPA) was evaluated for preventing cognitive impairment in EAE mice. Mice were immunized and received daily injections of vehicle or 2-PMPA (10, 30, 100, or 300 mg/kg) from the time of immunization (i.e. day 0). Although no doses of the drug altered physical disease severity, the 100mg/kg dose was most efficacious at preventing cognitive impairments in Barnes maze performance. Dose-related increases in brain NAAG levels were observed in post-mortem analysis, confirming target engagement. Using the 100mg/kg dose, we subsequently evaluated 2-PMPA׳s ability to treat EAE-induced symptoms by commencing treatment after the onset of physical signs of EAE (i.e. day 14). Mice were immunized for EAE and received daily injections of vehicle or 100mg/kg 2-PMPA starting two weeks post-immunization. Significant improvements in both cognitive performance and increases in brain NAAG levels were observed. GCPII inhibition is a promising treatment for cognitive impairment in MS, and doses providing equivalent exposures to 100mg/kg 2-PMPA in mice should be evaluated in clinical studies for the prevention and/or treatment of MS-related cognitive impairment.