In many ways, psychiatry is the laggard that has
fallen far behind other disciplines in medicine. Unlike all other
specialties, most psychiatric diseases have no objective biomarkers to
diagnose or monitor treatment. Distressed that classical psychiatry
research was leading nowhere, Thomas Insel, Director of National
Institute of Mental Health left his 3000 strong team to join a mental
health venture of Google called ‘Verily’ with one staff assistant.
Insel is one of the leaders of the smartphone
psychiatry movement. Though heavy smartphone usage may actually be
contributing to rising psychological problems in teenagers, the answer
may also lie in this technology. The smartphone has the potential to
record huge amount of the user data, including daily activities like
sleep, exercise, location as well as collect subtle data that can
reflect mood and behavior. Changes in typing speed, voice tone, word
choice, videos watched, all can signal potential trouble. There may be
more than 1000 smartphone clues for depression. Now researchers are
racing ahead to develop apps that can use artificial intelligence to
predict depressive episodes and prevent self-harm.
Last year, after a live streamed suicide on Facebook
hit the headlines, remedial measures were instituted. Facebook now uses
its artificial intelligence systems to pick-up words or phrases that
could indicate self-harm. The next step for smartphone psychiatry is to
offer real-time help with automated text messages, links to helplines,
or digital alerts to parents or first responders.
About one in seven of the world’s 7.5 billion people
is estimated to have a psychiatric disorder. In the absence of universal
access to quality psychiatric services, a smartphone may come handy.
(The Hindu 5 January 2019; Int J Bipolar Disord.
2018;6:9)
Infantile Hemangiomas – Guidelines
The American Academy of Pediatrics has published the
first clinical practice guidelines on the management of infantile
hemangiomas. There has been a paradigm shift from the laissez-faire
approach that has been the norm in the past. It is now acknowledged that
some of the infantile hemangiomas may cause permanent scarring or
significant functional impairment. It is now well recognized that
significant growth of the hemangiomas occurs between 1-3 months of age,
and ceases by 5 months. Hence the recommendation is to start treatment
before one month of age in select infantile hemangiomas. Propranalol is
used for treatment at a dose of 2-3 mg/kg/d for atleast 6 months and
preferably 12 months. Topical timolol may be used for thin superficial
lesions. Surgery or laser may be used for residual scarring.
Indications for treatment are life-threatening
complications (e.g., airway and hepatic lesions), functional
impairment, risk of ulceration, or risk of permanent scarring. Airway
hemangiomas may be suspected in infants with beard distribution of the
lesion with biphasic stridor. Screening for hepatic lesions is required
in infants with
5
cutaneous hemangiomas. Functional impairment may occur in infants with
lesions causing mechanical ptosis or oral lesions interfering with
feeding. Scalp and perineal hemangiomas are at risk for ulceration and
bleeding. Infants with segmental hemangiomas measuring >5 cm are at risk
for PHACE syndrome, and need further evaluation with magnetic resonance
imaging. The guidelines are very detailed and thorough, and will be
useful for practitioners.
(Pediatrics. 2019;143:e20183475 )
Obesity as a Risk Factor for Asthma
In adults, the link between asthma and obesity has
been well-studied. A recent article in Pediatrics has tried to quantify
the risk of asthma attributable to obesity in children. The study found
that about 10% of all asthma in children in the US can be prevented by
correcting obesity. This means obesity may become the first modifiable
risk factor, offering an opportunity for primary prevention of asthma.
The study included 507,496 children, half who were
overweight or obese and half who had a healthy weight, from more than
19.5 million doctor visits from the PEDS net clinical data research
network from January 2009 to December 2015. The adjusted risk for
incident asthma was increased among children who were overweight (RR
1.17; 95% CI 1.10-1.25) and obese (RR 1.26; 95% CI 1.18-1.34). An
estimated 23% to 27% of new asthma cases in children with obesity was
directly attributable to obesity.
Other studies have shown that obesity-related asthma
differs from the garden variety of allergen-mediated asthma. Initial
investigations into the mechanisms have identified a role of truncal
adiposity, metabolic abnormalities including insulin resistance and
dyslipidemia, and obesity-mediated systemic inflammation. All these
mechanisms are notable for the lack of a role of allergy. There is
consistent evidence that obesity-related asthma in children is
nonallergic, severe, and poorly responsive to medications in comparison
to asthma in children with normal weight. Unlike allergic asthma, there
are no targeted therapies for nonallergic asthma.
This important study highlights the need for
clinicians to monitor children for obesity with measurements of body
mass index and waist circumference during routine visits.
(Pediatrics 2018;142:pii: e20182119)