Pub Date : 2021-11-01DOI: 10.1097/HRP.0000000000000310
Melanie Nisenson, Vanessa Lin, Meredith Gansner
Abstract: Digital phenotyping (DP) provides opportunities to study child and adolescent psychiatry from a novel perspective. DP combines objective data obtained from digital sensors with participant-generated "active data," in order to understand better an individual's behavior and environmental interactions. Although this new method has led to advances in adult psychiatry, its use in child psychiatry has been more limited. This review aims to demonstrate potential benefits of DP methodology and passive data collection by reviewing studies specifically in child and adolescent psychiatry. Twenty-six studies were identified that collected passive data from four different categories: accelerometer/actigraph data, physiological data, GPS data, and step count. Study topics ranged from the associations between manic symptomology and cardiac parameters to the role of daily emotions, sleep, and social interactions in treatment for pediatric anxiety. Reviewed studies highlighted the diverse ways in which objective data can augment naturalistic self-report methods in child and adolescent psychiatry to allow for more objective, ecologically valid, and temporally resolved conclusions. Though limitations exist-including a lack of participant adherence and device failure and misuse-DP technology may represent a new and effective method for understanding pediatric cognition, behavior, disease etiology, and treatment efficacy.
{"title":"Digital Phenotyping in Child and Adolescent Psychiatry: A Perspective.","authors":"Melanie Nisenson, Vanessa Lin, Meredith Gansner","doi":"10.1097/HRP.0000000000000310","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000310","url":null,"abstract":"<p><strong>Abstract: </strong>Digital phenotyping (DP) provides opportunities to study child and adolescent psychiatry from a novel perspective. DP combines objective data obtained from digital sensors with participant-generated \"active data,\" in order to understand better an individual's behavior and environmental interactions. Although this new method has led to advances in adult psychiatry, its use in child psychiatry has been more limited. This review aims to demonstrate potential benefits of DP methodology and passive data collection by reviewing studies specifically in child and adolescent psychiatry. Twenty-six studies were identified that collected passive data from four different categories: accelerometer/actigraph data, physiological data, GPS data, and step count. Study topics ranged from the associations between manic symptomology and cardiac parameters to the role of daily emotions, sleep, and social interactions in treatment for pediatric anxiety. Reviewed studies highlighted the diverse ways in which objective data can augment naturalistic self-report methods in child and adolescent psychiatry to allow for more objective, ecologically valid, and temporally resolved conclusions. Though limitations exist-including a lack of participant adherence and device failure and misuse-DP technology may represent a new and effective method for understanding pediatric cognition, behavior, disease etiology, and treatment efficacy.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39225570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1097/HRP.0000000000000307
Varsha Radhakrishnan, Matthew C Johnson, Marta D Herschkopf, Marshall Forstein, Fabien M Saleh, Elizabeth R Dunn
{"title":"Acting Out or Acting In: A Case of Dangerous, Sexual, Self-Injurious Behavior.","authors":"Varsha Radhakrishnan, Matthew C Johnson, Marta D Herschkopf, Marshall Forstein, Fabien M Saleh, Elizabeth R Dunn","doi":"10.1097/HRP.0000000000000307","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000307","url":null,"abstract":"","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39290248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1097/HRP.0000000000000298
Daniel Talmasov, Sean M Kelly, Ariane Lewis, Adrienne D Taylor, Lindsey Gurin
History of Present Illness A 62-year-old man with a past medical history of asthma and opioid use disorder on methadone developed respiratory symptoms in mid-March, which progressed to subacute respiratory failure by early April. He was diagnosed with COVID-19 by nasopharyngeal RT-PCR and admitted to an academic New York City hospital. The patient was intubated for hypoxemia, sedated with propofol and fentanyl, and admitted to themedical intensive care unit (MICU). Laboratory testing revealed elevated serum levels of D-dimer at 1143 ng/mL (reference level <500 ng/mL), C-reactive protein at 73.70 mg/L (reference level <8 mg/L), and ferritin at 554 ng/mL, together reflecting a pattern of elevated inflammatory markers associated with severe COVID-19 infection. The patient’s prolonged hospital course was complicated by numerous infections, including methicillin-resistant Staphylococcus aureus bacteremia (hospital day 8), vancomycinresistant Enterococus bacteremia (hospital day 13), multidrugresistant Enterobacter pneumonia (hospital day 14), and a Pseudomonas-positive urinary tract infection (hospital day 17), all of which were treated with multiple courses of antibiotics. Attempts to wean sedation and ventilatory support were complicated by the above infections and,when sedationwasweaned, by ventilator dyssynchrony and agitation, resulting in the uptitration of propofol and maintenance on mechanical ventilation. Because of a need for prolonged respiratory support, the patient required tracheostomy on hospital day 10. By hospital day 14, the patient had developed acute kidney injury with creatinine elevated to 2.1 mg/dL, from a baseline 0.8 mg/dL at time of admission.
{"title":"Altered Mental Status in Patients Hospitalized with COVID-19: Perspectives from Neurologic and Psychiatric Consultants.","authors":"Daniel Talmasov, Sean M Kelly, Ariane Lewis, Adrienne D Taylor, Lindsey Gurin","doi":"10.1097/HRP.0000000000000298","DOIUrl":"10.1097/HRP.0000000000000298","url":null,"abstract":"History of Present Illness A 62-year-old man with a past medical history of asthma and opioid use disorder on methadone developed respiratory symptoms in mid-March, which progressed to subacute respiratory failure by early April. He was diagnosed with COVID-19 by nasopharyngeal RT-PCR and admitted to an academic New York City hospital. The patient was intubated for hypoxemia, sedated with propofol and fentanyl, and admitted to themedical intensive care unit (MICU). Laboratory testing revealed elevated serum levels of D-dimer at 1143 ng/mL (reference level <500 ng/mL), C-reactive protein at 73.70 mg/L (reference level <8 mg/L), and ferritin at 554 ng/mL, together reflecting a pattern of elevated inflammatory markers associated with severe COVID-19 infection. The patient’s prolonged hospital course was complicated by numerous infections, including methicillin-resistant Staphylococcus aureus bacteremia (hospital day 8), vancomycinresistant Enterococus bacteremia (hospital day 13), multidrugresistant Enterobacter pneumonia (hospital day 14), and a Pseudomonas-positive urinary tract infection (hospital day 17), all of which were treated with multiple courses of antibiotics. Attempts to wean sedation and ventilatory support were complicated by the above infections and,when sedationwasweaned, by ventilator dyssynchrony and agitation, resulting in the uptitration of propofol and maintenance on mechanical ventilation. Because of a need for prolonged respiratory support, the patient required tracheostomy on hospital day 10. By hospital day 14, the patient had developed acute kidney injury with creatinine elevated to 2.1 mg/dL, from a baseline 0.8 mg/dL at time of admission.","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575114/pdf/hrp-29-422.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38962192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1097/HRP.0000000000000308
Christina L Macenski, Matthew P Hamel, Christopher J McDougle, Robyn P Thom
Learning objectives: After participating in this activity, learners should be better able to:• Outline and discuss strategies to mitigate problematic social media use in psychiatric disorders• Identify solutions to encourage healthy use.
Abstract: Social media has been found to contribute to a variety of different psychiatric disorders, with recent research showing a complex relationship between social media use and mental health outcomes. This article outlines how the strategies that social media sites utilize to increase user engagement can differentially affect individuals with psychiatric disorders, and proposes solutions that may promote more healthy use. With these aims in view, the article (1) delineates the strategies, often unrecognized, that social media sites use to increase user engagement, (2) highlights how these strategies can affect individuals with psychiatric disorders, and (3) proposes novel solutions to encourage healthy use. The first step to creating innovative and universal interventions is to understand the challenges faced by individuals with psychiatric disorders when using social media.
{"title":"Challenges and Strategies to Mitigate Problematic Social Media Use in Psychiatric Disorders.","authors":"Christina L Macenski, Matthew P Hamel, Christopher J McDougle, Robyn P Thom","doi":"10.1097/HRP.0000000000000308","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000308","url":null,"abstract":"<p><strong>Learning objectives: </strong>After participating in this activity, learners should be better able to:• Outline and discuss strategies to mitigate problematic social media use in psychiatric disorders• Identify solutions to encourage healthy use.</p><p><strong>Abstract: </strong>Social media has been found to contribute to a variety of different psychiatric disorders, with recent research showing a complex relationship between social media use and mental health outcomes. This article outlines how the strategies that social media sites utilize to increase user engagement can differentially affect individuals with psychiatric disorders, and proposes solutions that may promote more healthy use. With these aims in view, the article (1) delineates the strategies, often unrecognized, that social media sites use to increase user engagement, (2) highlights how these strategies can affect individuals with psychiatric disorders, and (3) proposes novel solutions to encourage healthy use. The first step to creating innovative and universal interventions is to understand the challenges faced by individuals with psychiatric disorders when using social media.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39290246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract: Supervision of nonspecialist clinicians by trained mental health professionals is integral to developing capacity for providing mental health care in low-resource settings. Current supervision efforts in low-resource settings, however, are often variable in quality. Scant published literature addresses how supervision practices affect treatment outcomes; only a few studies have been published on evidence-based supervision methods. Additionally, in low-resource settings many systems-level obstacles exist in providing adequate mental health supervision to nonspecialist clinicians. This article seeks to address psychiatrists' role in providing supervision and promoting quality of care in low-resource settings. We review the literature on evidence-based supervision practices, address obstacles and current practices of providing high-quality mental health supervision in low-resource settings, and weave this knowledge with our experiences learning from the clinicians at Partners in Health in Haiti. We also discuss feasible strategies and provide recommendations for strengthening the supervision process in resource-limited settings.
{"title":"Enhancing Quality Supervision for the Delivery of Mental Health Care Through Nonspecialist Clinicians in Resource-Limited Settings.","authors":"Stephanie Collier, Rachel Meyen, Stephanie L Smith, Cidna Valentin, Fr Eddy Eustache","doi":"10.1097/HRP.0000000000000313","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000313","url":null,"abstract":"<p><strong>Abstract: </strong>Supervision of nonspecialist clinicians by trained mental health professionals is integral to developing capacity for providing mental health care in low-resource settings. Current supervision efforts in low-resource settings, however, are often variable in quality. Scant published literature addresses how supervision practices affect treatment outcomes; only a few studies have been published on evidence-based supervision methods. Additionally, in low-resource settings many systems-level obstacles exist in providing adequate mental health supervision to nonspecialist clinicians. This article seeks to address psychiatrists' role in providing supervision and promoting quality of care in low-resource settings. We review the literature on evidence-based supervision practices, address obstacles and current practices of providing high-quality mental health supervision in low-resource settings, and weave this knowledge with our experiences learning from the clinicians at Partners in Health in Haiti. We also discuss feasible strategies and provide recommendations for strengthening the supervision process in resource-limited settings.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39342288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1097/HRP.0000000000000319
J Alexander Scott, Laura Hirshbein
{"title":"Tell Me About It: The Historical Development of the Psychiatric Interview.","authors":"J Alexander Scott, Laura Hirshbein","doi":"10.1097/HRP.0000000000000319","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000319","url":null,"abstract":"","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39614655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1097/HRP.0000000000000316
John R Peteet
Abstract: The concept of identity is pervasive in psychology and culture, but clinicians have lacked a conceptual framework for addressing problems related to identity. After reviewing the development of identity, I distinguish four of the most common categories of such problems and consider approaches to each: identity diffusion, distorted identity, threats to identity, and difficulty integrating disparate aspects of one's identity. While making identity a focus of clinical attention can strengthen the alliance and place the treatment within a larger context, doing so raises moral questions about the clinician's role as an agent of validation or change.
{"title":"Approaching Identity Problems Common in Clinical Practice.","authors":"John R Peteet","doi":"10.1097/HRP.0000000000000316","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000316","url":null,"abstract":"<p><strong>Abstract: </strong>The concept of identity is pervasive in psychology and culture, but clinicians have lacked a conceptual framework for addressing problems related to identity. After reviewing the development of identity, I distinguish four of the most common categories of such problems and consider approaches to each: identity diffusion, distorted identity, threats to identity, and difficulty integrating disparate aspects of one's identity. While making identity a focus of clinical attention can strengthen the alliance and place the treatment within a larger context, doing so raises moral questions about the clinician's role as an agent of validation or change.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39614654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-01DOI: 10.1097/HRP.0000000000000320
Joshua L Roffman
{"title":"Note from the Editor in Chief.","authors":"Joshua L Roffman","doi":"10.1097/HRP.0000000000000320","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000320","url":null,"abstract":"","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39614653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1097/HRP.0000000000000309
Diego J Martino, Marina P Valerio
Abstract: The aim of this narrative review is to trace the origin of the concept of bipolar depression and to expose some of its limitations. Bipolar depression is a broad clinical construct including experiences ranging from traditional melancholic and psychotic episodes ascribed to "manic-depressive insanity," to another heterogeneous group of depressive episodes originally described in the context of binary models of unipolar depression (e.g., psychogenic depression, neurotic depression). None of the available empirical evidence suggests, however, that these subsets of "bipolar" depression are equivalent in terms of clinical course, disability, family aggregation, and response to treatment, among other relevant diagnostic validators. Therefore, the validity of the current concept of bipolar depression should be a matter of concern. Here, we discuss some of the potential limitations that this broad construct might entail in terms of pathophysiological, clinical, and therapeutic aspects. Finally, we propose a clinical research program for bipolar depression in order to delimit diagnostic entities based on empirical data, with subsequent validation by laboratory or neuroimaging biomarkers. This process will then aid in the development of more specific treatments.
{"title":"Bipolar Depression: A Historical Perspective of the Current Concept, with a Focus on Future Research.","authors":"Diego J Martino, Marina P Valerio","doi":"10.1097/HRP.0000000000000309","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000309","url":null,"abstract":"<p><strong>Abstract: </strong>The aim of this narrative review is to trace the origin of the concept of bipolar depression and to expose some of its limitations. Bipolar depression is a broad clinical construct including experiences ranging from traditional melancholic and psychotic episodes ascribed to \"manic-depressive insanity,\" to another heterogeneous group of depressive episodes originally described in the context of binary models of unipolar depression (e.g., psychogenic depression, neurotic depression). None of the available empirical evidence suggests, however, that these subsets of \"bipolar\" depression are equivalent in terms of clinical course, disability, family aggregation, and response to treatment, among other relevant diagnostic validators. Therefore, the validity of the current concept of bipolar depression should be a matter of concern. Here, we discuss some of the potential limitations that this broad construct might entail in terms of pathophysiological, clinical, and therapeutic aspects. Finally, we propose a clinical research program for bipolar depression in order to delimit diagnostic entities based on empirical data, with subsequent validation by laboratory or neuroimaging biomarkers. This process will then aid in the development of more specific treatments.</p>","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39223161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-01DOI: 10.1097/HRP.0000000000000311
Gabrielle Bossé Chartier, David Kealy
{"title":"Frame Trade-Offs: On Some Therapeutic Implications of Telepsychiatry.","authors":"Gabrielle Bossé Chartier, David Kealy","doi":"10.1097/HRP.0000000000000311","DOIUrl":"https://doi.org/10.1097/HRP.0000000000000311","url":null,"abstract":"","PeriodicalId":12915,"journal":{"name":"Harvard Review of Psychiatry","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39225571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}