Improving the diagnostic process in mental health conditions via imaging

Main Category: Mental Health
Also Included In: Psychology / Psychiatry
Article Date: 19 Aug 2013 - 0:00 PDT Current ratings for:
Improving the diagnostic process in mental health conditions via imaging

What are some of the most troubling numbers in mental health? Six to 10 - the number of years it can take to properly diagnose a mental health condition. Dr. Elizabeth Osuch, a Researcher at Lawson Health Research Institute and a Psychiatrist at London Health Sciences Centre and the Department of Psychiatry at Western University, is helping to end misdiagnosis by looking for a 'biomarker' in the brain that will help diagnose and treat two commonly misdiagnosed disorders.

Major Depressive Disorder (MDD), otherwise known as Unipolar Disorder, and Bipolar Disorder (BD) are two common disorders. Currently, diagnosis is made by patient observation and verbal history. Mistakes are not uncommon, and patients can find themselves going from doctor to doctor receiving improper diagnoses and prescribed medications to little effect.

Dr. Osuch looked to identify a 'biomarker' in the brain which could help optimize the diagnostic process. She examined youth who were diagnosed with either MDD or BD (15 patients in each group) and imaged their brains with an MRI to see if there was a region of the brain which corresponded with the bipolarity index (BI). The BI is a diagnostic tool which encompasses varying degrees of bipolar disorder, identifying symptoms and behavior in order to place a patient on the spectrum.

What she found was the activation of the putamen correlated positively with BD. This is the region of the brain that controls motor skills, and has a strong link to reinforcement and reward. This speaks directly to the symptoms of bipolar disorder. "The identification of the putamen in our positive correlation may indicate a potential trait marker for the symptoms of mania in bipolar disorder," states Dr. Osuch.

In order to reach this conclusion, the study approached mental health research from a different angle. "The unique aspect of this research is that, instead of dividing the patients by psychiatric diagnoses of bipolar disorder and unipolar depression, we correlated their functional brain images with a measure of bipolarity which spans across a spectrum of diagnoses." Dr. Osuch explains, "This approach can help to uncover a 'biomarker' for bipolarity, independent of the current mood symptoms or mood state of the patient."

Moving forward Dr. Osuch will repeat the study with more patients, seeking to prove that the activation of the putamen is the start of a trend in large numbers of patients. The hope is that one day there could be a definitive biological marker which could help differentiate the two disorders, leading to a faster diagnosis and optimal care.

In using a co-relative approach, a novel method in the field, Dr. Osuch uncovered results in patients that extend beyond verbal history and observation. These results may go on to change the way mental health is diagnosed, and subsequently treated, worldwide.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Improving results of cataract surgery by looking at outcomes important to patients

Main Category: Eye Health / Blindness
Article Date: 31 Jul 2013 - 1:00 PDT Current ratings for:
Improving results of cataract surgery by looking at outcomes important to patients

Special issue of Optometry and Vision Science focuses on patient-reported outcome measures

Cataract surgery can lead to good results from a clinical standpoint yet have poor outcomes from the patient's point of view, reports a study, "Analyzing Patient-Reported Outcomes to Improve Cataract Care", appearing in the August issue of Optometry and Vision Science, official journal of the American Academy of Optometry. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Using well-designed and validated tools to assess patient-reported outcomes can lead to new insights for improving the results of cataract care, suggests the study by Mats Lundström, MD, PhD, of Lund University and Ulf Stenevi, MD, PhD, of Sahlgren's University Hospital, Sweden. Their paper is part of a special theme issue on "Measuring the Patient's Perspective" in optometry research and clinical practice.

Study Compares Clinical and Patient-Reported Outcomes of Cataract Surgery

Using a nationwide registry, Drs Lundström and Stenevi evaluated clinical and patient-reported outcome measures in nearly 10,000 cataract surgeries performed in Sweden between 2001 and 2011. For example, a major clinical outcome measure after cataract surgery is visual acuity. But improved visual acuity may not always reflect patient ratings of change in vision from before to after the procedure - especially in performing everyday functional tasks.

Not surprisingly, a comparison of the two sets of outcomes found that patient-reported measures were affected by clinical measures. Factors affecting patient-reported outcomes included visual acuity in both the operated and nonoperated eyes, change in visual acuity in the operated eye, and any other eye-related conditions ("ocular comorbidity").

However, more useful information was gained by looking at factors related to better or worse patient-reported outcomes. For example, patients who reported better visual function before surgery or who had poor visual acuity in the nonoperated eye were more likely to have poorer patient-reported outcomes after cataract surgery.

Implications for Decisions about Cataract Care

Ocular comorbidity was also related to worse patient-reported outcomes. These findings may indicate that, as in other chronic diseases, "some patients are too healthy and some too sick to benefit" from cataract surgery, Drs Lundström and Stenevi write. "It is possible that patients who are very satisfied with their vision and have no problems in performing daily life activities should not have cataract surgery at present."

The study also looked at situations where the clinical outcomes were good but patient-reported outcomes were poor - which happened in about seven percent of cataract surgeries. In many of these cases, poor near vision after the procedure was a major contributor to patient dissatisfaction.

There's a growing emphasis on patient-reported outcomes and quality of life in assessing various medical or surgical treatments. But there's been little attention to linking patient-reported outcomes to clinical outcomes in an attempt to improve health care. Age-related cataract is a good model for quality outcome studies: it is a very common, progressive condition that affects daily life and activities, and one for which surgical treatment is effective.

The new study helps vision care professionals in understanding how patient-reported outcome measures might be used to improve on the results of cataract surgery from the patient's perspective. For example, Drs Lundström and Stenevi suggest that surgery could be delayed or not performed in patients who feel they aren't having a lot of problems with daily activities - perhaps especially if they have good near vision.

The special theme issue presents 20 papers on topics related to the use of patient-reported outcomes in vision care. "These papers focus on new tools that are being increasingly used to assess the patient's perspective on a wide range of important conditions, problems, and outcomes," comments Anthony Adams, OD, PhD, Editor-in-Chief of Optometry and Vision Science. "These measures allow us to rigorously measure the outcomes important to patients, and to do so in a very meaningful way."

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Optometry & Vision Science: August 2013 - Volume 90 - Issue 8 - p 754-759

Lundström, Mats*; Stenevi, Ulf*

Abstract - Analyzing Patient-Reported Outcomes to Improve Cataract Care

Purpose: The purpose of this study was to analyze three models of how patient-reported outcome measures can be connected to clinical outcome measures in cataract surgery to identify opportunities for improvement of quality of care.

Methods: Three models were used to analyze the following questions: Is there a relationship between clinical parameters and patient-reported outcomes? (1) Is there a relationship between clinical parameters and a good or poor patient-reported outcome? (2) When and why do clinical and patient-reported outcomes diverge? (3) The study material to exemplify these models consisted of follow-up data on cataract extractions collected by the Swedish National Cataract Register in 2008 to 2011. Patient-reported outcome was measured using the Catquest-9SF questionnaire. A total of 9707 pairs of questionnaires completed before and after a cataract extraction were analyzed together with clinical data.

Results: Factors related to any change in patient-reported outcomes after surgery were the preoperative self-assessed visual function, the preoperative visual acuity in both eyes, the postoperative visual acuity, and ocular comorbidity. Factors related to poor patient-reported outcomes after surgery were good preoperative self-assessed visual functions, poor preoperative visual acuity in the better eye, ocular comorbidity, surgical complications, and large refractive deviation. Poor near vision after surgery was the main factor noted in situations where the clinical outcome was good and the patient-reported outcome was poor. Analyses 2 and 3 were the most useful analyses to give ideas for clinical improvement work.

Conclusions: The best models to give ideas for improved quality of care by using a patient questionnaire in our study were analyzing the risk factors for a poor patient-reported outcome and analyzing the factors associated with disagreement between clinical outcomes and patient-reported outcomes.

Wolters Kluwer Health

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Improving drug acceptance and compliance in pediatric populations

Main Category: Pediatrics / Children's Health
Also Included In: Compliance
Article Date: 28 Jul 2013 - 0:00 PDT Current ratings for:
Improving drug acceptance and compliance in pediatric populations

Despite major advances in the pharmaceutical treatment of disease, many children reject medicines due to an aversion to bitter taste. As such, bitterness presents a key obstacle to the acceptance and effectiveness of beneficial drugs by children worldwide.

A new review, published online ahead of print in Clinical Therapeutics, addresses this critical problem by highlighting recent advances in the scientific understanding of bitter taste, with special attention to the sensory world of children.

Written by an interdisciplinary team of leading taste scientists from the Monell Chemical Senses Center, Florida State University, and the University of Washington, the paper focuses on applying this knowledge to improve drug acceptance and compliance in pediatric populations.

Several biological factors highlight the importance of understanding bitter taste to the successful formulation of pediatric medications. Bitter taste is thought to have evolved as a protection against toxins, as many poisons taste bitter. Because of this, it is very difficult to disguise or mask bitterness.

Compounding this problem is the fact that children, who are especially sensitive to bitterness, cannot swallow pills or tablets, which encapsulate bitterness in adult formulations.

The state-of-the-science review summarizes current knowledge on how bitter taste works from a biological perspective. In addition, the paper provides a comprehensive overview of methods used to assess taste responses in children. The authors point out critical gaps in the existing understanding of how best to measure bitterness in children, whose cognitive and perceptual abilities differ from those of adults.

"The problems associated with pediatric drug formulations are enormous and can hinder optimal therapeutic outcomes," said lead author Julie Mennella, PhD, a developmental psychobiologist at Monell. "Both the complexity of bitter taste and the unique sensory world of children contribute to this critical issue."

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Mennella is the co-chair, and authors Alan Spector from Florida State University and Susan Coldwell of the University of Washington are members of the Taste and Flavor Working Group of the Pediatric Formulation Initiative at the Eunice Kennedy Schriver National Institute of Child Health and Human Development.

The Pediatric Formulation Initiative (PFI) was formed to address the lack of appropriate formulations in children and to identify mean to improve pediatric formulations, as mandated by the Best Pharmaceuticals for Children Act of 2002 and 2007. The PFI began in 2005 with the formation of three working groups: Scientific, Economics, and Taste and Flavor, to identify issues, gather information, and consider possible ways to overcome barriers to the development of successful pediatric drug formulations.

Danielle Reed from the Monell Center is also a co-author on the paper. Research reported in the publication was supported in part by The National Institute on Deafness and Other Communication Disorders of the National Institutes of Health under awards number DC01187 and P30 DC011735. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Monell Chemical Senses Center

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