The emerging story of emerging technologies in neuropsychiatry.

The growth of new technologies in health care is exponential, and the impact of such rapid technological innovation on health care delivery is substantial. This review describes two emerging technologies-mobile applications and wearable technologies-and uses a virtual case report to illustrate the impact of currently available technologies on the health care experience of a patient with neuropsychiatric illness.

El crecimiento de las nuevas tecnologías en la atención de salud es exponencial y el impacto de esta rápida innovación tecnológica en las prestaciones de atención médica es sustancial. Esta revision describe dos tecnologías emergentes - las aplicaciones móviles y las tecnologías portátiles - y emplea un reporte de caso virtual para ilustrar el impacto de las tecnologías actualmente disponibles en la experiencia de la atención de salud de un paciente con patología neuropsiquiátrica.

La croissance des nouvelles technologies dans le domaine de la santé est exponentielle et l'impact d'une innovation technologique aussi rapide sur les prestations de santé est considérable. Cet article décrit deux technologies récentes, les applications mobiles et les technologies «portables¼, et présente une étude de cas virtuelle illustrant l'impact des technologies actuellement disponibles sur l'expérience thérapeutique d'un patient atteint d'une maladie neuropsychiatrique.

Patient-Centered Electroconvulsive Therapy Care: A Call to Action.

We present our experience applying the IOM's "10 Simple Rules" to our ECT Service at a major teaching hospital in order to achieve patient-centered care. We encourage all ECT providers to partner with their patients in engaging family members and significant others in each aspect of ECT care, especially the ECT treatment itself.

Collecting mortality data to drive real-time improvement in suicide prevention.

OBJECTIVES: To evaluate the use of government mortality records compared with internally collected data to drive quality improvement in suicide prevention programs using suicide mortality data from the Perfect Depression Care initiative. METHODS: Perfect Depression Care (PDC) is a quality improvement suicide prevention initiative within the Behavioral Health Services (BHS) division of the Henry Ford Health System. Eligible subjects were all patients who received services from BHS, were members of the health maintenance organization, and had a medical group physician during the 11-year study period. Mortality data were collected internally and from government-collected death records, and were linked to treatment utilization data from the medical record. RESULTS: The mean suicide rate was 96.6 per 100,000 during the 2-year baseline period (1999- 2000) and declined to 19.1 per 100,000 during the initiative (2002-2009) using both sources of data combined. We observed a similar statistically significant (P <.001) reduction in the suicide death rate using both the internal and government data sources. There were no significant differences between the 2 sources of data in the mean suicide rates for the baseline and intervention periods (P >.05). The data sources did differ in the capture of unique suicide deaths. CONCLUSIONS: Internally collected data were an effective measure of suicide deaths in the PDC initiative. A combination of internal and government-collected records may be most effective for future suicide prevention programs.

Neuroanatomy of pathological laughing and crying: a report of the American Neuropsychiatric Association Committee on Research.

Pathological laughing and crying (PLC) is a clinical condition that occurs in patients with various neurological disorders. It is characterized by the presence of episodic and contextually inappropriate or merely exaggerated outbursts of laughter and/or crying without commensurate feelings. This review provides an in depth analysis of the neuroanatomy of lesions seen in patients with this clinical condition, discusses the relevant functional neuroimaging and electrophysiological stimulation studies in human subjects, and summarizes the current treatment options. It concludes with a presentation of the remaining questions and directions for future research.

Building a system of perfect depression care in behavioral health.

BACKGROUND: Depression, a common, serious disorder, may result in suicide in up to 10% of afflicted persons. METHODS: In 2001, the Division of Behavioral Health Services of the Henry Ford Health System (Detroit) launched an initiative to completely redesign depression care delivery using the Six Aims and the Ten Rules from the Institute of Medicine report Crossing the Quality Chasm. This "Perfect Depression Care" initiative, whose key goal was the elimination of suicide, entailed performance improvement activities in four domains-partnership with patients, clinical care (planned care model), access, and information flow. RESULTS: The rate of suicide in the patient population decreased by 75% (p = .007), from approximately 89 per 100,000 at baseline (2000) to approximately 22 per 100,000 for the four-year follow-up interval (the average rate for 2002-2005). DISCUSSION: This sustained reduction in suicide rate suggests that the process improvements implemented as part of the Perfect Depression Care initiative substantially improved the care of persons with depression. The initiative is the prototype for a comprehensive redesign of behavioral health care. Work is under way to "perfect" the care of persons with anxiety or psychotic disorders, and similar care systems are being developed for violence prevention and medication safety, with a particular focus on perfecting communication between providers. Pursuing perfection is no longer a project or initiative but a principle driving force embedded in the fabric of our care.

The value of quantitative electroencephalography in clinical psychiatry: a report by the Committee on Research of the American Neuropsychiatric Association.

The authors evaluate quantitative electroencephalography (qEEG) as a laboratory test in clinical psychiatry and describe specific techniques, including visual analysis, spectral analysis, univariate comparisons to normative healthy databases, multivariate comparisons to normative healthy and clinical databases, and advanced techniques that hold clinical promise. Controversial aspects of each technique are discussed, as are broader areas of criticism, such as commercial interests and standards of evidence. The published literature is selectively reviewed, and qEEG's applicability is assessed for disorders of childhood (learning and attentional disorders), dementia, mood disorders, anxiety, panic, obsessive-compulsive disorder, and schizophrenia. Emphasis is placed primarily on studies that use qEEG to aid in clinical diagnosis, and secondarily on studies that use qEEG to predict medication response or clinical course. Methodological problems are highlighted, the availability of large databases is discussed, and specific recommendations are made for further research and development. As a clinical laboratory test, qEEG's cautious use is recommended in attentional and learning disabilities of childhood, and in mood and dementing disorders of adulthood.

Implications of herbal alternative medicine for electroconvulsive therapy.

OBJECTIVES: To clarify the implications of herbal alternative medicine use during electroconvulsive therapy (ECT). BACKGROUND: A substantial proportion of patients with mental disorders report frequent use of herbal alternative medicines. Our current understanding of the biology of such remedies suggests that they may have implications for ECT practice. METHODS: We conducted electronic literature searches using Medline (via PubMed), Cochrane Database of Systematic Reviews, ACP Journal Club, PsychINFO, Database of Abstracts of Reviews of Effects, and Cochrane Central Register of Controlled Trials from their inception to April 2003. The search items were five selected herbal alternative medicines (Ginkgo biloba, ginseng, St. John's wort, valerian, kava-kava) in combination with the terms "drug interaction," "adverse effects," "side effects," "adverse drug reactions," "safety," and "toxicity." All data were included regardless of whether they were case reports, case series, clinical trials, or reviews. RESULTS: Our literature review revealed several potential effects of herbal alternative medicines upon ECT outcome. CONCLUSIONS: The growing use of herbal alternative medicine by patients with psychiatric illness may have implications for ECT practice. Our current knowledge is sparse and incomplete, however, indicating the need for more research.