Developments in electronic health (e-Health) interventions for psychotic patients have been possible since the growing access and use of internet and electronic devices in past 10 years (Bonet et al. 2017). However, before proceeding further on develop these interventions; limited knowledge exists about the impact of internet and new technologies on the mental health of these psychotic patients. The aim of this study is to assess the benefits and risks of new technologies usage in a survey of patients diagnosed with psychotic disorders. We analyzed the relationship between experiences and opinions about internet and demographic and clinical characteristics of the sample and patterns of use of these technologies. Structured questionnaire was designed. This questionnaire was divided in three parts: 1) clinical and demographic information, 2) access and use of technologies, and 3) experiences and opinions about internet. In total, 97 patients diagnosed with psychotic disorder participated in this cross-sectional study. Mean age of the sample was 37.06 (SD=12.9), 72.2% of participants were male, 84.5% were single and 60.8% had achieved secondary education. Main diagnoses in the sample were First Episode of Psychosis (45.4%) and Schizophrenia (34%) and 64.9% of patients had a length of illness lower than 72 months The percentage of patients who daily acceded to internet was 63.9% while 21.6% weekly acceded. 90.7% of participants owned a mobile phone and 68% had a social media account. Related to feelings about internet, 60.8% of patients felt socially linked due to internet usage and 78.4% felt informed. However, 22.7% felt frustrated and 19.6% felt suspicious. Internet was considered as a benefit for mental health for 46.4% of patients, while 38.1% have had unpleasant experiences related to its usage, 24.7% have had internet-related relapses and 26.8% expended excessive time online. Significant association was found between feeling informed and frequency of access to internet (χ2= 6.17 p=0.05), however any other significant association was found between feelings about internet and clinical or demographic characteristics or patterns of use of technology. According to experiences, significant associations were found between internet-related relapses and length of illness (χ2= 4.74 p=0.03), frequency of internet access (χ2= 9.76 p<0.01) and social media ownership (χ2= 5.55 p=0.02). Expending excessive time on internet was found significant associated to age of the sample (χ2= 6.57 p=0.04), employment status (χ2= 10.73 p=0.03), frequency of access to internet (χ2= 10.15 p<0.01) and social media ownership (χ2= 9.62 p<0.01). Association between stop taking medication because of information read on the internet and level of education was also found (χ2= 9.03 p=0.01). Despite the general positive feelings about internet usage, percentages between 38-19% of patients had a negative vision of internet. Furthermore, frequency of access to internet and social media ownership have been found associated to internet-related relapses and potential pathological use of internet (excessive time on it). Younger patients, recent diagnosis of psychosis and being in a non-active employment situation seem to be related to these pathological results too. To our knowledge, this is the first study to describe the potential risks about internet usage in patients diagnosed with psychotic disorders, however further studies are needed. Reference: 1. Bonet L, et al Use of mobile technologies in patients with psychosis: A systematic review. Rev Psiquiatr Salud Ment. 2017; 10 (3): 168–178
In spite of promising results of mobile Health (mHealth) interventions for patients with psychosis, integration of these appliances into clinical practice remains a significant challenge (Bonet et al. 2017). Moreover, some studies have pointed out that percentages between 19–38% of patients have had negative experiences related to internet or cell phone usage, which may increase the risk of psychotic relapses (Bonet et al. 2018). In order to address these issues, we have developed an app called “ReMindCare” whose main objective is being simple, useful and automatically integrated into clinical practice. ReMindCare is an app that collects the following information: a) Three daily questions regarding anxiety, sadness and irritability b) 18 weekly questions about: 1. level of adherence to medication, 2. presence of medication side-effects, 3. prodromal psychotic symptoms and 4. attitude towards medication. Answers to these questions are displayed following a Likert scale (1 to 5). In addition, patients are able to contact clinicians by clicking an “urgent consultation” tab. All this information is summarized in a clinical report which is given to patients and uploaded at their electronic medical record at the hospital database, being accessible for consultation for any clinician involved in treatment of the patient. Exclusion criteria are: presence of severe mental disability, language barriers and not to sign the informant consent. All patients from the First Episode of Psychosis Unit are being offered the use of ReMindCare as a part of their usual treatment. 56 patients have been offered the app (from 26 September to 26 November). Mean age 32.96 (SD=8.82), 78.6% are male, 87,5% Caucasian, 80.4% single, 80% have medium education level (until 16 years old) or more and 98.2% are taking antipsychotic medication. From this sample, 38 patients (67.9%) accepted using the app. Significant differences were found between users and no-users regarding: previous suicidal attempts (None of no-users have had previous suicidal attempts while 37.8% of users have) (χ2= 8.23 p=.004), years of illness (65.8% of users have less than 3 years of illness compared to 38.9% of no-users) (χ2= 3.61 p=.005) and in GAF punctuations (50% of users have punctuations between 100–60 in GAF compared to 33.3% of no users, and 13.2% have punctuations lower than 50 compared 50% of no-users) (χ2=9.03 p=.01). No differences were found in other clinical and demographic factors. To our knowledge, this is the first attempt to integrate the use of mHealth technologies into daily practice and electronic clinical records. Rate of acceptance is high, however some clinical differences regarding years of illness and GAF punctuations, may indicate that chronic patients are less willing to use ReMindCare. On the contrary, patients who have had previous suicide attempts are very interested in using the app. This can be due to the “urgent consultation” function which would allow them to contact clinicians in case of mood aggravation. ReMindCare is being especially useful in order to detect deception into medication intake in some patients. Encouraging feedback is being received for patients and clinicians, especially in regards of improvement of quality of interview and clinical alliance. References: Bonet L, Izquierdo C, Escartí MJ, Sancho JV, Arce D, Blanquer I et al. Utilización de tecnologías móviles en pacientes con psicosis: una revisión sistemática. Rev Psiquiatr Salud Ment 2017 Jul-Sept; 10(3): 168–78. Bonet L, Llácer B, Hernandez-Viadel M, Arce D, Blanquer I, Cañete C et al. Differences in the Use and Opinions About New eHealth Technologies Among Patients with Psychosis: Structured Questionnaire. JMIR Ment Health. 2018 Jul;5(3):e51.
Patients with chronic hepatitis C and stage 3 fibrosis are thought to remain at risk of hepatocellular carcinoma after sustained virological response. We investigated this risk in a large cohort of patients with well-defined stage 3 fibrosis.We performed a multicentre, ambispective, observational study of chronic hepatitis C patients with sustained virological response after treatment with direct-acting antivirals started between January and December 2015. Baseline stage 3 was defined in a two-step procedure: we selected patients with transient elastography values of 9.5-14.5 kPa and subsequently excluded those with nodular liver surface, splenomegaly, ascites or collaterals on imaging, thrombopenia or esophago-gastric varices. Patients were screened twice-yearly using ultrasound.The final sample comprised 506 patients (median age, 57.4 years; males, 59.9%; diabetes, 17.2%; overweight, 44.1%; genotype 3, 8.9%; HIV coinfection, 18.4%; altered liver values, 15.2%). Median follow-up was 33.7 (22.1-39.1) months. Five hepatocellular carcinomas and 1 cholangiocarcinoma were detected after a median of 29.4 months (95% CI: 26.8-39.3), with an incidence of 0.47/100 patients/year (95% CI: 0.17-1.01). In the multivariate analysis, only males older than 55 years had a significant higher risk (hazard ratio 7.2 [95% CI: 1.2-41.7; P = .029]) with an incidence of 1.1/100 patients/year (95% CI: 0.3-2.8).In a large, well-defined cohort of patients with baseline hepatitis C stage-3 fibrosis, the incidence of primary liver tumours was low after sustained virological response and far from the threshold for cost-effectiveness of screening, except in males older than 55 years.