Observation of telepsychiatry service in a teaching hospital of eastern Nepal during COVID-19 pandemic

Considering the geographical complexity and adversity, online communication and consultation are viable method in Nepal. The COVID-19 pandemic has accelerated the already starting trend of use of these technologies in medicine. In BPKIHS, telemedicine efforts were already initiated; lockdown rather warranted its maximum use. Here is an account of the observation made in telepsychiatry service provided by a consultant psychiatrist of its department of psychiatry. It is an institute-based observation noted for all the telepsychiatry consultations in 9 random duty days of the COVID-19 pandemic. Basic necessary information was noted down in a semi-structured proforma, like: socio-demographic, clinical information and advice provided. There were 104 subjects; 73 follow-up and 31 new: 60 male and 44 female cases. Clients of multi-ethnic groups were the most from urban, then semi-urban and least from rural areas. More consultations were for young age-groups and from nearby districts of Sunsari. Mood, somatic (sleep), anxiety were the top presenting complaints and 8/104 clients had suicidal symptoms. Maximum follow-up cases were improving. The most common diagnoses were: Mood (Depression and Bipolar), Anxiety, Psychosis and Substance use disorders. Most common treatment advices included: Antidepressants, Antipsychotics, Benzodiazepines and Counseling/psycho-education. Telepsychiatry is a viable method of delivering service even during the pandemic.

Mediators of relations of obesity treatment-associated changes in mood and weight: extending cross-sectional research

Significant cross-sectional associations between mood and weight have been made in women; however, data on associated longitudinal effects and their psychological and behavioral mechanisms are required to inform obesity treatments that mostly have limited success beyond the very short term. Women participating in behavioral obesity treatments were assessed on psychological and behavioral measures, and weight change over 12 months. A treatment focused on physical activity and self-regulation (n = 67) had significantly better improvements than a treatment centered around weight-loss education (n = 64) on measures of mood (overall mood, depression, anxiety), self-regulation, emotional eating, eating behaviors, physical activity, and weight in women with obesity. Incorporating a lagged variable design, 12-month weight loss was significantly predicted (separately) by changes in overall negative mood, depression, and anxiety. When changes in measures of self-regulation, emotional eating, and eating behaviors were sequentially entered as mediators, mood change–weight change relationships were rendered non-significant. Significant mediation paths were: mood change→self-regulation change→weight change, and mood change→self-regulation change→eating behavior change→weight change. They were unaffected by the treatment group. Findings contributed to both theory and obesity intervention architectures via a design sensitive to the dynamic psychological and behavioral changes occurring within weight-loss processes.

Abstract 13206: Blood Pressure Apps: Do They Educate the Lay Public About Risk Factors?

Introduction: Hypertension affects 108 million Americans. To help track and manage hypertension, there are many free and popular mobile health apps that track BP. Hypothesis: BP tracking mobile health apps have many downloads but do not fully educate the public about hypertension risk factors. Methods: “Blood Pressure” as a search term was used in the Google Play and Apple iOS stores to identify the most popular, free BP tracking apps aimed at the lay public. The top 10 most popular, free apps on each store were evaluated for educating the lay public on hypertension risk factors. Inclusion criteria: top 10 free blood pressure (BP) apps, by highest number of downloads on Google Play and highest rating (out of five stars) on Apple iOS Store (no available data on iOS downloads). Exclusion criteria: non-English, requiring a wearable device, primary purpose other BP tracking. Results: Of top 20 apps: BP log: 19/20, BP ranges: 13/20, height: 5/20, weight: 8/20, BMI: 3/20, race: 1/20, gender: 4/20, age: 6/20, diet: 1/20, exercise: 1/20, medication: 4/20, diabetes: 1/20, FBS: 1/20, goals: 3/20, mood/depression: 1/20. 2 apps mentioned the American Heart Association (AHA). None of the apps had information on cvriskcalculator.com, family history, cholesterol, LDL, triglycerides, HbA1c, and alcohol use. Conclusion: Most free and popular BP apps monitor BP but largely ignore hypertension risk factors such as cholesterol, LDL, triglycerides, alcohol intake, mood/depression, race, and gender. Furthermore, 7/20 apps do not uniformly educate patients that a normal BP is <120/<80, in accordance with the AHA and ACC guidelines. More collaboration may be needed between physicians and software developers to educate and meet the needs of our hypertensive patients in America.

Perceptions and opinions on a computerised Behavioural Activation Programme for the treatment of depression in young people: A Thematic Analysis (Preprint)

BACKGROUND Depression is one of the leading causes of illness and disability in young people, with approximately twenty percent having experienced a depressive episode by the age of eighteen. Behavioural Activation (BA), a NICE recommended treatment for adults with depression has also shown preliminary evidence with young people. BA may have the potential to be adapted and delivered in a computerised format to address the barriers often associated with young people accessing support. However, in the development of new treatments, the limited effectiveness of some programmes has been attributed to a failure to tailor interventions to patients and practices. It is therefore essential that those for whom an intervention is being designed are involved in its development. OBJECTIVE This qualitative work explored the views and preferences of young people and healthcare professionals regarding the development of a new computerised BA therapy for young people with low mood/depression to ensure it was suitable for the target user. METHODS Semi-structured focus groups and individual interviews were conducted with young people (both those with experience of accessing support and those without) and healthcare professionals regarding the development of a new computerised BA therapy for young people with low mood/depression. Data were analysed using Thematic Analysis. RESULTS Twenty-seven individuals who were a combination of healthcare professionals and young people participated. Rich information pertaining to the important components of a new therapy including its content, presentation and delivery were collected. CONCLUSIONS Variations in perspectives highlighted the need to adopt a systemic approach in therapy development with the opinions of young people, both with experience of accessing mental health support and those without, and healthcare professionals incorporated.

Eye Tracking as a Tool to Identify Mood in Aphasia: A Feasibility Study

Background. Persons with aphasia often present with low mood/depression, which can negatively affect their quality of life. The validity and reliability of existing depression measures for aphasia have been called into question. Eye tracking in nonstroke populations is reliable in identifying low mood/depression. Depressed persons are biased to negative emotions compared with nondepressed persons and have an absence of bias to positive emotions. However, nondepressed persons may be biased to positive emotions. Objective. To examine the feasibility of using eye tracking to measure mood in persons with aphasia. Methods. We recruited 22 persons with chronic aphasia and 12 healthy controls. Participants completed 2 self-report measures of mood. They also viewed faces that showed happy, sad, and neutral facial expressions during eye tracking. We analyzed 2 eye tracking indices: initial gaze orientation and gaze maintenance to happy, sad, and neutral faces. Results. For initial gaze orientation, participants with aphasia fixated faster on emotional faces compared with healthy controls but directed their gaze less often to happy faces compared with healthy controls. For gaze maintenance components, the duration of first fixation and total fixation duration were shorter on sad faces for participants with aphasia compared with healthy controls. Conclusion. Use of eye tracking with faces representing different mood states is feasible in persons with aphasia. Although there were some similarities, participants with aphasia had different gaze patterns to emotional faces compared with healthy controls. Further research is needed to establish whether this is a valid and reliable method of mood assessment.

The effect of nutrition on older people's mental health

In the context of a rapidly ageing population, with an increasing prevalence of mood disorders and a greater incidence of physical illness in older adults, it is imperative that their healthcare needs are effectively addressed. Nutritional vulnerability increases in later life for various reasons, related to the physiological impact of ageing as well as social and economic challenges. Specific nutrients and overall diet quality may impact on mood. Depression and anxiety in turn impact on interest in and ability to eat and may further distort intake and exacerbate symptoms. Whether working with older adults living at home or in the care setting, nurses need to be aware of and able to identify, refer and support those who need help. This article aims to raise awareness and provides some practical guidance for nurses working with older adults experiencing mood disorders.

Alterations of Expression of the Serotonin 5-HT4 Receptor in Brain Disorders

The serotonin 4 receptor, 5-HT4R, represents one of seven different serotonin receptor families and is implicated in a variety of physiological functions and their pathophysiological variants, such as mood and depression or anxiety, food intake and obesity or anorexia, or memory and memory loss in Alzheimer’s disease. Its central nervous system expression pattern in the forebrain, in particular in caudate putamen, the hippocampus and to lesser extent in the cortex, predispose it for a role in executive function and reward-related actions. In rodents, regional overexpression or knockdown in the prefrontal cortex or the nucleus accumbens of 5-HT4R was shown to impact mood and depression-like phenotypes, food intake and hypophagia; however, whether expression changes are causally involved in the etiology of such disorders is not clear. In this context, more data are emerging, especially based on PET technology and the use of ligand tracers that demonstrate altered 5-HT4R expression in brain disorders in humans, confirming data stemming from post-mortem tissue and preclinical animal models. In this review, we would like to present the current knowledge of 5-HT4R expression in brain regions relevant to mood/depression, reward and executive function with a focus on 5-HT4R expression changes in brain disorders or caused by drug treatment, at both the transcript and protein levels.

Mood (Affective) Disorders

Descriptions of mood disorders go back to the time of Hippocrates. Mood disorders are primarily characterized by depressed and/or elevated (manic) moods. The essential feature of mood disorders is an episode that is a distinct and persistent change from a person’s typical mood (depression or mania), accompanied by other depressive and manic symptoms, lasting 2 weeks for a major depressive episode and 1 week for a manic episode. Such episodes typically remit and recur over the course of time. Manic episodes define bipolar disorder. Severe depression without manic episodes is diagnosed as major depressive disorder. Mood disorders present a 10- to 30-fold risk for suicide. Effective treatments for mood disorders include medications, brain stimulation modalities, and psychotherapy.

Music listening as a potential aid in reducing emotional eating: An exploratory study

Emotional Eating (EE) is understood as a maladaptive self-regulation strategy to satisfy emotional needs instead of hunger. Consequently, EE has been associated with negative health consequences. Enjoyment of food and music share similar neural activations in the brain and are both used by people for regulating affect. This suggests that music listening could potentially be a healthier alternative to EE. The present study was designed to investigate associations between EE, disordered mood, and music-related mood regulation. A total of 571 participants completed measures of EE, music listening strategies, and disordered mood. Associations between seven different music listening strategies and EE were examined, and also whether these regulation strategies were associated with depression, anxiety, and stress. Finally, we explored associations between music listening and EE in people with low and high (non-clinical) levels of disordered mood (depression, anxiety, and stress). The findings of this research indicated that music listening for discharge (releasing anger or sadness through music that expresses these same emotions) and EE were positively associated with one another. In addition, EE and the music listening strategies of entertainment, diversion or mental work were associated in people with low levels of disordered mood. When disordered mood was high, EE was higher, but was not associated with music listening strategies. These associations point towards the possibility of some music listening strategies being useful as healthier alternatives for EE.