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Black-Box: snapshots of daily life Time series analysis in a depressed elderly patient
2014 AAGP Annual Meeting Poster Number: EI 03
Black-Box: snapshots of daily life Time series analysis in a depressed elderly patient Silvia V. Dijk, Master degree; Richard Oude Voshaar, Prof MD PhD University Medical Centre Groningen, Groningen, Netherlands Introduction: In cognitive behavioral therapy (CBT), the effects of cognitions, behavior and surrounding factors on mood are systematically evaluated. In the elderly, CBT is an effective therapy for depression (Serfaty, 2009). However, in spite of successful treatment, many of the elderly keep struggling with residual symptoms. We hypothesize that in behavioral therapy the manner in which factors that in an individual patient determine their mood (whether in retrospect anamnestically or prospectively via a diary) are being evaluated, is too crude. Time series analysis (as used in econometrics) offers the possibility of identifying causal relations in meticulously executed and repeated measurements that would otherwise go unnoticed. PROBLEM Which factors influence the reduction or increase of residual depressive symptoms in an elderly patient in whom the depression is in partial remission? Methods: Measurements were obtained using a Psymate. The Psymate has been developed by the University of Maastricht and has been specifically designed to register when, what and where and under what circumstances specific emotions are being experienced. The device is a kind of palmtop the size of a mobile phone. At predetermined times the Psymate gives a signal on which the patient is requested to answer questions about their current situation: what are you doing? With whom? How do you feel? In our patient, a 76 year old woman who was referred for treatment of a moderate-severe depression, mood, motivation, self-confidence and context (activities and situational reports) were measured at three predetermined moments (08.30h, 14.30h and 20.30h). Method of analysis Data is analyzed using time series analysis. This method enables to discern causality of subtle repeated and relevant patterns on the mood of the patient. These analysis is highly useful to determine sequence of event relations. For instance: what event preceded a somber mood in the patient? Does a decrease in activity lead to a somber mood or is it the other way around? Is this relation mutual or are these variables unrelated? Results: The patient has used the Psymate for 43 days. As of day nineteen the patient gave maximal scores to her mood, these repeated results were not incorporated into the analysis. Over the first eighteen days 52 entries were incorporated into the time series analysis. * Activities deemed pleasurable or important by the patient were regarded highest by the patient. However, analysis showed no causality between positive affect and activities. * The sense “to matter” in company was shown to have a positive effect on self-confidence. * A modest relation was found between appreciation of an activity and being content afterwards. * An inverse relation was found to exist between fatigue and positive affect. Indirect effects After analysis of the data, different dynamic effects were found between the separate factors. Appreciation of an activity was shown to have an effect on affect via the variable “fatigue”. A reciprocal effect was found between fatigue and positive affect (Table 1 & figure 3). Conclusions: By disentangling the effect of appreciation of an activity (via fatigue) on affect, the patient was advised to purposely pursue the more valued activities to improve her mood. Using the conventional methods of CBT this relationship would probably not have been found. DISCUSSION Collection of frequent measurements (“snapshots”) aides the development of psychological interventions designed specifically to the needs of this patient. Snapshot measurements in an individual give insight into subtle patterns of reaction to environment, behavior and mental challenges that would not be picked up by retrospective questionnaires. Further research is needed to determine if this technique governs a generalizable advantage in the treatment of depressed elderly patients. Table 1. Correlation between variables Confidence Appreciation of activity Positive affect
Fatigue 0.42 0.41 0.33
Confidence 0.34 0,45
Appreciation of activity 0,17
Poster Number: EI 04
Adverse Childhood Experiences and Geriatric Depression: Results from the 2010 BRFSS Margaret A. Ege, MD1; Erick Messias, MD, MPH, PhD1; Puru Thapa, MD2; Lewis Krain, MD1,3 1
University of Arkansas for Medical Sciences, Little Rock, AR Arkansas State Hospital, Little Rock, AR 3 Central Arkansas Veteran’s Healthcare System, Little Rock, AR 2
Introduction: Adverse childhood experiences (ACEs), including physical, sexual, and emotional abuse, have been shown to result in a variety of poor outcomes including depression. The majority of research has examined the impact of such events on
Am J Geriatr Psychiatry 22:3, Supplement 1
S57
Black-Box: snapshots of daily life Time series analysis in a depressed elderly patient Silvia V. Dijk, Master degree; Richard Oude Voshaar, Prof MD PhD University Medical Centre Groningen, Groningen, Netherlands Introduction: In cognitive behavioral therapy (CBT), the effects of cognitions, behavior and surrounding factors on mood are systematically evaluated. In the elderly, CBT is an effective therapy for depression (Serfaty, 2009). However, in spite of successful treatment, many of the elderly keep struggling with residual symptoms. We hypothesize that in behavioral therapy the manner in which factors that in an individual patient determine their mood (whether in retrospect anamnestically or prospectively via a diary) are being evaluated, is too crude. Time series analysis (as used in econometrics) offers the possibility of identifying causal relations in meticulously executed and repeated measurements that would otherwise go unnoticed. PROBLEM Which factors influence the reduction or increase of residual depressive symptoms in an elderly patient in whom the depression is in partial remission? Methods: Measurements were obtained using a Psymate. The Psymate has been developed by the University of Maastricht and has been specifically designed to register when, what and where and under what circumstances specific emotions are being experienced. The device is a kind of palmtop the size of a mobile phone. At predetermined times the Psymate gives a signal on which the patient is requested to answer questions about their current situation: what are you doing? With whom? How do you feel? In our patient, a 76 year old woman who was referred for treatment of a moderate-severe depression, mood, motivation, self-confidence and context (activities and situational reports) were measured at three predetermined moments (08.30h, 14.30h and 20.30h). Method of analysis Data is analyzed using time series analysis. This method enables to discern causality of subtle repeated and relevant patterns on the mood of the patient. These analysis is highly useful to determine sequence of event relations. For instance: what event preceded a somber mood in the patient? Does a decrease in activity lead to a somber mood or is it the other way around? Is this relation mutual or are these variables unrelated? Results: The patient has used the Psymate for 43 days. As of day nineteen the patient gave maximal scores to her mood, these repeated results were not incorporated into the analysis. Over the first eighteen days 52 entries were incorporated into the time series analysis. * Activities deemed pleasurable or important by the patient were regarded highest by the patient. However, analysis showed no causality between positive affect and activities. * The sense “to matter” in company was shown to have a positive effect on self-confidence. * A modest relation was found between appreciation of an activity and being content afterwards. * An inverse relation was found to exist between fatigue and positive affect. Indirect effects After analysis of the data, different dynamic effects were found between the separate factors. Appreciation of an activity was shown to have an effect on affect via the variable “fatigue”. A reciprocal effect was found between fatigue and positive affect (Table 1 & figure 3). Conclusions: By disentangling the effect of appreciation of an activity (via fatigue) on affect, the patient was advised to purposely pursue the more valued activities to improve her mood. Using the conventional methods of CBT this relationship would probably not have been found. DISCUSSION Collection of frequent measurements (“snapshots”) aides the development of psychological interventions designed specifically to the needs of this patient. Snapshot measurements in an individual give insight into subtle patterns of reaction to environment, behavior and mental challenges that would not be picked up by retrospective questionnaires. Further research is needed to determine if this technique governs a generalizable advantage in the treatment of depressed elderly patients. Table 1. Correlation between variables Confidence Appreciation of activity Positive affect
Fatigue 0.42 0.41 0.33
Confidence 0.34 0,45
Appreciation of activity 0,17
Poster Number: EI 04
Adverse Childhood Experiences and Geriatric Depression: Results from the 2010 BRFSS Margaret A. Ege, MD1; Erick Messias, MD, MPH, PhD1; Puru Thapa, MD2; Lewis Krain, MD1,3 1
University of Arkansas for Medical Sciences, Little Rock, AR Arkansas State Hospital, Little Rock, AR 3 Central Arkansas Veteran’s Healthcare System, Little Rock, AR 2
Introduction: Adverse childhood experiences (ACEs), including physical, sexual, and emotional abuse, have been shown to result in a variety of poor outcomes including depression. The majority of research has examined the impact of such events on
Am J Geriatr Psychiatry 22:3, Supplement 1
S57