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29/09/2015 Mood Disorder: Introduction Richard Morriss Professor of Psychiatry University of Nottingham Why Now? • £30bn NHS funding gap by 2020 requires transformational change • 25% people with mood disorder receive first line treatment • Demand for more flexible, person-centred care and selfmanagement • Advances in computer science and bio-engineering • Rapid growth in smart technologies • Britain is ready for digital mental health 1 29/09/2015 Years lived lost due to disability in the world in 2010 Vos T et al Lancet 2012 Rank order 1. Low back pain 11. Osteoarthrosis 2. Major depressive disorder 12. Drug use disorders 3. Iron deficiency anaemia 13. Hearing loss 4. Neck pain 14. Asthma 5. COPD 15. Alcohol use disorders 6. Other musculoskeletal 16. Schizophrenia 7. Anxiety 17. Road injury 8. Migraine 18. Bipolar disorder 9. Diabetes mellitus 19. Dysthymia 10.Falls 20. Epilepsy Mortality (suicide in young – 3rd highest cause of death 15-49), older 2x SMR CVS, renal (not just lithium) & respiratory disease Osby, U. et al. Arch Gen Psychiatry 2001;58:844-850. Copyright restrictions may apply. 2 29/09/2015 Depression • 2 weeks of depressed mood or loss of interest and pleasure almost every day and all day plus 3 or 4: change in sleep pattern and unrefreshed change in appetite/weight loss of energy slowed down or agitated poor concentration/ ability to decide decreased confidence, self-worth excessive guilt thoughts of death or suicide Types of depression • Major depression. 2 weeks, more severe • Dysthymia. 2 years persistent, mild (2-5 symptoms). • Bipolar depression • Depression with psychosis. • Seasonal affective disorder. Seasonal pattern • Adjustment disorder to life change. 3 29/09/2015 Bipolar Disorder • Bipolar disorder is a cyclical mood disorder • Abnormally elevated mood or irritability alternates with depressed mood – bipolar I – at least one manic or mixed episode – bipolar II – at least one major depressive episode and at least one hypomanic episode Clinical features of Bipolar Disorder Presentation Key features Mania Elevated, expansive or irritable mood With or without psychotic symptoms Marked impairment in functioning Hypomania Elevated, expansive or irritable mood Less impairment of functioning Depression Mild, moderate or severe With or without psychotic symptoms Rapid cycling At least four episodes in 1 year Mixed states Manic and depressive features present during same episode Treatments for depression relatively ineffective in bipolar disorder and vice versa 4 29/09/2015 Each person’s course of illness is unique 101108 101808 200401 200701 201101 202506 202606 202710 203415 203816 204316 204406 205310 205523 206023 206123 300212 300304 300404 300504 300604 300704 300904 301710 301921 302021 302121 302510 303504 -5 5 0 -5 5 0 -5 5 0 -5 LIFE Scores:TAU 0 5 -5 0 5 100601 0 50 0 50 0 50 0 50 0 50 0 50 Time (weeks) Depression Mania Link with creativity • Mark Twain, Edgar Allen Poe, Walt Whitman, Sylvia Plath, Tennessee Williams, Ernest Hemingway, Viriginia Woolf, Ezra Pound, Charles Mingus, Gustav Mahler, Paul Gauguin, Georgia O'Keeffe, Jackson Pollack, Vincent van Gogh. • Ozzy Osbourne, Jean-Claude Van Damme, Axl Rose, Sinéad O'Conner, Peter Gabriel, Kurt Cobain, Stephen Fry, Russell Brand, Catherine Zeta Jones, John Cleese, Spike Milligan etc. 5 29/09/2015 Key Challenges to address • Already 60,000 apps for mental health • Earlier user involvement and needs-led design briefs • Social inequalities: 25% poorest households have no internet access • Privacy, trust, consent and data security • Limited research evidence of clinical effectiveness • Developing appropriate, agile research methods for evaluation 11 Key Challenges to address (2) • Developing robust business models for digital products • Identifying and translating research innovations in computer science and engineering to benefit mental healthcare • Regulation and quality control for mHealth apps • Scalability and implementation: from local to national • Interoperability – connectivity of apps and m-health with NHS N3, EPR, clinician decision support systems • Clinicians – tend to be older, did not grow up with m-Health 12 6