Publications by authors named "Fernando Goes"

In this case series, we present several examples from participants (2 patients and 1 healthy control) of a 12-week pilot feasibility study to create a digital phenotype of depression (unipolar or bipolar) through active and passive data collection from a smartphone and a wearable device combined with routine clinical care for mood disorders. The selected cases represent real clinical examples that highlight the intrinsic challenges that should be expected when conducting similar studies, including appropriate health data privacy protection, clinical standardization, and interindividual differences in levels of engagement and acceptability of active and passive data collection (ie, self-reported, behavioral, cognitive, and physiological data), particularly with patient-generated data in mobile apps, digital proficiency habituation, and consistent use of wearable devices. In the context of the rapidly growing use of digital technologies in psychiatry, anticipating challenges for the integration of personal mobile devices and smartphone mental health apps as aides to track specific aspects of depressive disorders is critical for a clinically meaningful digital transformation of mood disorders care.

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  • Major depressive disorder (MDD) includes a challenging subset known as treatment-resistant depression (TRD), which can be effectively targeted using rapid-acting antidepressants such as ketamine and esketamine, though individual responses vary.
  • Research is focusing on identifying clinical predictors for better treatment outcomes with ketamine/esketamine, including factors like family history of alcohol use and history of childhood trauma, as well as potential brain-based biomarkers detected through EEG.
  • Most response predictors show modest effects, thus future studies should employ multivariate models and standardize biomarker collection methods to improve the robustness and comparability of findings across trials.
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  • Diagnostic delays in Bipolar Disorder (BD) are common and the study aimed to understand conversion rates from other disorders like Major Depressive Disorder (MDD), anxiety, and ADHD using a large dataset from Johns Hopkins Medicine.
  • Of the 21,341 patients studied, 1,232 transitioned to BD, with one-year conversion rates of 4.2% for MDD, 3.4% for anxiety, and 4.0% for ADHD, highlighting certain risk factors like age, treatment setting, and medication.
  • The findings suggest that patients with MDD face the highest risk of developing BD, while anxiety disorders and ADHD are also significant precursors, especially in adults.
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  • The ELEKT-D trial explored whether intravenous ketamine is as effective as ECT for patients with treatment-resistant depression (TRD), finding that ketamine is noninferior to ECT in this group.
  • This secondary analysis aimed to identify which clinical features might predict better outcomes with either ketamine or ECT in treating TRD.
  • The study involved 365 participants from five U.S. medical centers, comparing treatment responses based on various baseline factors, such as depression severity and cognitive function, using advanced statistical methods.
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  • Obsessive-compulsive disorder (OCD) affects about 1% of people and has a strong genetic component, but previous studies have not fully explained its genetic causes or biological mechanisms.
  • A large genome-wide association study (GWAS) analyzed data from over 53,000 OCD cases and over 2 million control participants, identifying 30 significant genetic markers related to OCD and suggesting a 6.7% heritability from SNPs.
  • The research also found 249 candidate risk genes linked to OCD, particularly in specific brain regions, and showed genetic correlations with various psychiatric disorders, laying the groundwork for further studies and potential treatments.
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This nonrandomized, multicenter, open-label clinical trial explored the impact of intravenous (IV) ketamine on cognitive function in adults (n = 74) with treatment-resistant depression (TRD). Patients received three IV ketamine infusions during the acute phase and, if remitted, four additional infusions in the continuation phase (Mayo site). Cognitive assessments using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) were conducted at baseline, end of the acute phase, and end of the continuation phase (Mayo site).

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  • Accurately diagnosing bipolar disorder (BD) can take around 7 years due to its overlap with unipolar major depressive disorder (MDD), especially since the first manic episode often follows a depressive one.
  • This study uses genome-wide association analyses (GWAS) and polygenic risk scores (PRS) from a large cohort to identify genetic factors that could help differentiate between BD and MDD early on.
  • The results show that while BD and MDD are genetically distinct and share a continuum of genetic risk, larger future studies are needed to enhance the accuracy of these genetic predictors for early diagnosis.
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  • Lithium is the primary treatment for bipolar disorder (BD), but how it works and predicts outcomes is not fully understood.
  • A previous study identified key cellular pathways linked to lithium response, including focal adhesion and PI3K-Akt signaling.
  • In this new study, researchers confirmed these pathways in a larger group of 2039 patients but found no connection with the extracellular matrix, suggesting that issues with neuronal growth signaling may impact lithium effectiveness.
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Background: In the burgeoning area of clinical digital phenotyping research, there is a dearth of literature that details methodology, including the key challenges and dilemmas in developing and implementing a successful architecture for technological infrastructure, patient engagement, longitudinal study participation, and successful reporting and analysis of diverse passive and active digital data streams.

Objective: This article provides a narrative rationale for our study design in the context of the current evidence base and best practices, with an emphasis on our initial lessons learned from the implementation challenges and successes of this digital phenotyping study.

Methods: We describe the design and implementation approach for a digital phenotyping pilot feasibility study with attention to synthesizing key literature and the reasoning for pragmatic adaptations in implementing a multisite study encompassing distinct geographic and population settings.

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Objective: We conducted an open-label clinical trial ("Bio-K") using IV ketamine for treatment-resistant depression to identify biomarkers linked to remission. Here, we report the clinical efficacy and side effect outcomes of Bio-K.

Methods: Across 4 US sites, 75 patients ages 18-65 with treatment-refractory unipolar or bipolar depression received 3 IV ketamine infusions over an 11-day period.

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Differentiating between bipolar disorder and major depressive disorder can be challenging for clinicians. The diagnostic process might benefit from new ways of monitoring the phenotypes of these disorders. Smartphone data might offer insight in this regard.

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The Human Phenotype Ontology (HPO) is a widely used resource that comprehensively organizes and defines the phenotypic features of human disease, enabling computational inference and supporting genomic and phenotypic analyses through semantic similarity and machine learning algorithms. The HPO has widespread applications in clinical diagnostics and translational research, including genomic diagnostics, gene-disease discovery, and cohort analytics. In recent years, groups around the world have developed translations of the HPO from English to other languages, and the HPO browser has been internationalized, allowing users to view HPO term labels and in many cases synonyms and definitions in ten languages in addition to English.

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Lithium is the gold standard treatment for bipolar disorder (BD). However, its mechanism of action is incompletely understood, and prediction of treatment outcomes is limited. In our previous multi-omics study of the Pharmacogenomics of Bipolar Disorder (PGBD) sample combining transcriptomic and genomic data, we found that focal adhesion, the extracellular matrix (ECM), and PI3K-Akt signaling networks were associated with response to lithium.

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Ketamine is an effective antidepressant, but there is substantial variability in patient response and the precise mechanism of action is unclear. Neuroimaging can provide predictive and mechanistic insights, but findings are limited by small sample sizes. This systematic review covers neuroimaging studies investigating baseline (pre-treatment) and longitudinal (post-treatment) biomarkers of responses to ketamine.

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Line work is a core element for the stylization of computer animations used by recent shows. However, existing stylization techniques are limited to edge treatments based on brush strokes or textures applied solely on top of curves. In this work, we propose new stylization effects by offering artists direct control over the inside and outside of surface contours.

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  • The study examined the completion rates of telepsychiatry versus in-person psychiatric appointments for patients with depression over five years in an academic health system.
  • Results indicated that telepsychiatry became the primary method for psychiatric care during the COVID-19 pandemic, with completion rates for telepsychiatry appointments being significantly higher than for in-person visits.
  • The authors concluded that maintaining telepsychiatry services post-pandemic could enhance efficiency and patient care outcomes in the psychiatric field.
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  • * Researchers examined 4,925 immune-related genes and their association with lithium treatment response and clinical features in a large bipolar patient sample.
  • * Findings indicate a few genetic associations with treatment response and clinical characteristics, revealing potential biomarkers, but overall support a weak connection between immune factors and bipolar disorder at a genetic level.
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Lithium is regarded as the first-line treatment for bipolar disorder (BD), a severe and disabling mental health disorder that affects about 1% of the population worldwide. Nevertheless, lithium is not consistently effective, with only 30% of patients showing a favorable response to treatment. To provide personalized treatment options for bipolar patients, it is essential to identify prediction biomarkers such as polygenic scores.

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Background: Electroconvulsive therapy (ECT) and subanesthetic intravenous ketamine are both currently used for treatment-resistant major depression, but the comparative effectiveness of the two treatments remains uncertain.

Methods: We conducted an open-label, randomized, noninferiority trial involving patients referred to ECT clinics for treatment-resistant major depression. Patients with treatment-resistant major depression without psychosis were recruited and assigned in a 1:1 ratio to receive ketamine or ECT.

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Background: Across clinical settings, black individuals are disproportionately less likely to be diagnosed with bipolar disorder compared to schizophrenia, a traditionally more severe and chronic disorder with lower expectations for remission. The causes of this disparity are likely multifactorial, ranging from the effects of implicit bias, to developmental and lifelong effects of structural racism, to differing cultural manifestations of psychiatric symptoms and distress. While prior studies examining differences have found a greater preponderance of specific psychotic symptoms (such as persecutory delusions and hallucinations) and a more dysphoric/mixed mania presentation in Black individuals, these studies have been limited by a lack of systematic phenotypic assessment and small sample sizes.

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Bipolar disorders (BDs) are recurrent and sometimes chronic disorders of mood that affect around 2% of the world's population and encompass a spectrum between severe elevated and excitable mood states (mania) to the dysphoria, low energy, and despondency of depressive episodes. The illness commonly starts in young adults and is a leading cause of disability and premature mortality. The clinical manifestations of bipolar disorder can be markedly varied between and within individuals across their lifespan.

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  • Lithium is recognized as a leading treatment for bipolar disorder, but predicting who will respond to it remains a challenge, leading researchers to investigate the genetic and functional differences between lithium responders and non-responders.
  • A study analyzing iPSC-derived neurons found 41 genes significantly expressed differently between these groups, and further gene prioritization identified over a thousand candidate genes related to lithium response.
  • The research highlighted the role of focal adhesion and the extracellular matrix in response mechanisms, indicating that differences in these areas may have a more significant impact on lithium treatment efficacy than the drug itself.
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