Author: pricilagran

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Venue magazine, Greater Cincinnati’s Lifestyle publication and LEAD magazine, the publication for business executives, selected Paul Crosby, MD, as a recipient of their 2018 Healthcare Leadership Awards.

Crosby, a UC Health physician based at the Lindner Center of HOPE, was honored at a recognition ceremony Tuesday, July 17, 2018. During the ceremony, Crosby was spotlighted for being one of our region’s leading healthcare professionals for improving the lives of patients, colleagues and members of our community.

Healthcare Leadership Award winners are selected based on their contributions to their organization and to our region, as well as their personal leadership characteristics that “cultivate a thriving and progressive community.”

Susan Duncan, heart transplant coordinator at UC Medical Center, was also honored.

About Our Honoree

Paul Crosby, MD
Crosby, chief medical officer at Lindner Center of HOPE, and associate professor of psychiatry and behavioral neuroscience and pediatrics at UC’s College of Medicine, was recognized for:

  • Advancing medicine and improving the health of our communities.
    Crosby has made significant achievements at the Lindner Center of HOPE since its opening in 2008 and at the Center for Attentional Disorders, which he founded in 2010. Crosby’s main objective in establishing the Center for Attentional Disorders focused on consolidating and coordinating efforts to provide the best possible assessment and treatment for attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD), as well as associated conditions related to anxiety, mood, learning abilities and substance use.
  • Notable achievements.
    Crosby always puts patients and families first. He is constantly working to raise awareness about attentional disorders and how they affect many facets of life, including learning, work, relationships and health. Crosby also serves on the professional advisory board for the Suburban Cincinnati Children and Adults with Attention Deficit/Hyperactivity Disorder Chapter (CHADD). He presents often to professionals and members of the community on topics related to ADHD and provides consultation to other clinical providers regarding attention difficulties and aspects of performance. In addition to his administrative duties, Crosby provides psychiatric consultation to children, adolescents and young adults and their families. He spends part of his clinical time treating patients referred from all over the world who often require comprehensive diagnostic assessments and treatment of extremely complex conditions.

 

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Lindner Center of HOPE is pleased to announce that the following have joined the Leadership Team:

Michael J. Glen, PE, CPSM, has joined Lindner Center of HOPE in a new role, Vice President, Business Development and Innovation with a primary goal of promoting mental health awareness and education to businesses, schools and government officials. He is also part of the executive leadership team. Mr. Glen’s previous position was as an engineering and marketing professional with extensive experience in project engineering, project management, business development, business planning and implementation.

 

 

Anne VanderPutten MBS, MSN, RN, has joined Lindner Center of HOPE, as Program Director, Residential Services. Her role incorporates both the adult residential unit (Sibcy House) and the adolescent residential unit (Williams House). Prior to joining Lindner Center of HOPE, she managed Psychiatric Emergency Services for six years collaborating with community resources through advisory councils, the Heroin Coalition, the Department of Health, and law enforcement agencies.

 

 

Sharon Simmons, MSW, LCSW, has joined, Lindner Center of HOPE, as Clinical Manager, Residential Services. Her role incorporates both the adult residential unit (Sibcy House) and the adolescent residential unit (Williams House). Prior to joining Lindner Center of HOPE, she worked as a program director for an intensive outpatient program (IOP). She continues to teach as an adjunct professor for Brescia University where she teaches a variety of social work courses, including research, practice and ethics.

 

Lindner Center of HOPE in Mason is a comprehensive mental health center providing excellent, patient-centered, scientifically-advanced care for individuals suffering with mental illness. A state-of-the-science, mental health center and charter member of the National Network of Depression Centers, the Center provides psychiatric hospitalization and partial hospitalization for individuals age 12-years-old and older, outpatient services for all ages, diagnostic and short-term residential services for adults and adolescents, outpatient services for substance abuse through HOPE Center North location and co-occurring disorders for adults and research. The Center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The Center is also affiliated with the University of Cincinnati (UC) College of Medicine.

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Amanda Porter, MSN, APRN, PMHNP-BC

Psychiatric Nurse Practitioner, Lindner Center of HOPE Board-Certified in Internal Medicine, Psychiatry/Mental Health, and Addictions

 

The question of “What causes mental health disorders?” is the eternal question on the field of psychiatry. The most widely accepted theory as to the cause of depression thus far has been the neurotransmitter theory; however even with correct diagnosis and appropriate treatment “between 40% and 70% do no respond to treatment, or only partially, while roughly half of patients who do achieve full remission following txt for severe depressed mood relapse within 2 years even when continuing on antidepressants.” (Greenblatt & Brogan, 2016; Keitner & Mansfield, 2012). Even when we place patients on medications meant to boost their neurotransmitters, often remission of mood disorder symptoms is elusive. Therefore, it behooves us as clinicians to seek out complementary and integrative methods (CIM) for treating for mood disorders that can augment or sometimes replace traditional medical treatments.

One method of CIM includes Mindfulness and Meditation. Broadly, this is described as cultivation of awareness, relaxation, focused attention and stillness. This is a methodology pioneered by Jon Kabat-Zinn. Release of serotonin, GABA, dopamine and melatonin occurs during meditation (Newberg, 2010). Since 2009, roughly 10 studies have examined the efficacy of mindfulness practices with patients who were unresponsive to antidepressant therapy. Three-quarters of these studies showed statistically significant reduction in Ham-D scores (Jain, 2015). Mindfulness has been suggested to have the ability modulate the immune system itself as demonstrated in HIV-infected adults who show increased in circulation of CD4+ T lymphocyte counts (Cresswell, 2009).

Another method of CIM includes Spirituality/Prayer. Many of my patients experience depression surrounding some pretty heady questions such as “What is my purpose in life? What was I created for? What happens after I die?” Becoming involved in a faith community, and engaging in spiritual practices associated with that community increase a sense of belonging and self-worth in a person, which leads to overall improved mental health. “In a systematic review of 850 studies of religion and mental health, religion was associated with greater overall well-being in 79% of these studies, lower suicidality in 84%, lower depression 66% and lower anxiety in 51%.” (Koenig, 2001).  Also, it’s postulated that while a sense of well-being and purpose provides greater benefit in preventing depression, a positive relationship with God provides greater benefit after onset of depression.

Another method of CIM includes Yoga and Movement therapies. Yoga and other movement therapies such as Tai Chi or Qi Gong have been found to be helpful for depression, ADHD, anxiety and chronic pain and are especially helpful in vulnerable populations such as pregnancy, adolescents or the elderly. When combined with meditation, this is an incredibly effective therapy, and the beauty of Yoga practice is that even 15 minutes a day can be helpful, so it’s not time-consuming. Yoga practitioners downregulate their HPA axis and modulate their cortisol levels (Sieverdes, et al 2014). Yoga and Tai Chi also have excellent indication for sleep duration with less arousal time. The mechanisms that are involved in the effects of yoga on stress response include the following: positive affect, self-compassion, and inhibition of the posterior hypothalamus and salivary cortisol (Riley, 2015).

Another method of CIM includes Exercise. With depression, often the patient becomes isolated, withdrawn, with poor motivation. This leads to increase in sedentary behaviors. Therefore, it’s important to increase activity in the form of exercise. The higher the dose, the lower the risk of relapse rates in patients with MDD, with 10 days being sufficient to begin seeing an improvement in mood (Knubben, et al, 2007). Exercise increases rate of neurogenesis, production of BDNF, increases serotonin by increasing tryptophan, increases norepinephrine, increases phenylethylamine, decreased cortisol, increase endorphins, and increases dopamine (Greenblatt & Brogan, 2016). It’s hypothesized that exercise helps the brain deal more efficiently with stress by enhancing the body’s ability to respond to stress, and coordinating the sympathetic nervous system response (McWilliams, 2001).

Another method of CIM includes appropriate Nutrition. There is an ongoing discussion about the gut-brain connection and the impact that our nutritional choices have on our mental health. The typical Western Diet consist of high fructose foods or beverages, transaturated fats, with large amounts of carbohydrates in the form of bread products. Sugar and gluten are both incredibly inflammatory, and alter the microbiome of the gut. Factors like alcohol, antibiotic use, NSAIDS, cytokine production, and psychological stress increase also intestinal permeability (Greenblatt and Brogan, 2016). So our dietary choices do have great impact on our mental health. Gluten attacks an enzyme involved in the production of GABA (Kramer & Bressnan, 2016). Patients with schizophrenia and autism are at higher risk for intolerance to gluten, and respond very positively to gluten-free and casein-free diets. Higher dietary fiber content was associated with lower odds of depression; increased consumption of vegetables and nonjuice fruit was associated with lower odds for depression; added sugars, but not total sugars or total carbohydrates, to be strongly associated with depression incidence (Gangswisch, 2015). It’s important to remember that sugar is not the enemy here, but excess sugar is. As with most things in life, balance is key.

Further methods of CIM used to treat mood disorders include: Creative Arts including painting, drawing, music, dance, and writing/narrative medicine; Nature therapy; Pet therapy; Water therapy/Floating; Life coaching/Financial planning; Massage therapy; Acupuncture; Micronutrient therapy; Essential oils; Light therapy; Media fasts; Psychotherapy; and TMS/ECT.

At Lindner Center of HOPE, an Integrative Mental Health consult service incorporates the above treatment modalities, aimed at addressing mental health disorders as holistically as possible. The goal is to strive for recovery with the whole person in mind.

 

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By Danielle J. Johnson, MD, FAPA
Lindner Center of HOPE, Chief of Adult Psychiatry

May is Maternal Mental Health Awareness Month.  One in five women will develop a maternal mental health disorder.  They are also referred to as perinatal mood and anxiety disorders (PMADs) to emphasize that women experience more than postpartum depression during pregnancy and after birth.  Women who have symptoms of PMADs might not seek help because of guilt, shame, or embarrassment for feeling something different than the expected norms of motherhood.  Awareness and education are important to reduce stigma so mothers and babies get the help they need.

PMADs can occur during pregnancy or up to one year after giving birth. The most common PMAD is the “baby blues”, affecting up to 80% of new mothers.  Symptoms include sudden mood swings, loneliness, sadness, crying spells, loss of appetite, problems sleeping, irritability, restlessness, and anxiety.  These symptoms are a normal adjustment to changes in hormones and resolve without treatment in two to three weeks.

About 10% of women experience depression during pregnancy and about 15% during the first year postpartum.  Feeling sad, hopeless, helpless, or worthless; fatigue, difficulty sleeping or sleeping too much, appetite changes, difficulty concentrating, crying, loss of interest or pleasure; lack of interest in, difficulty bonding with, or excessive anxiety about the baby; feelings of being a bad mother, and fear of harming the baby or self are symptoms of peripartum depression.  Risk factors include poverty, being a teen mother, advanced maternal age; personal or family history of depression, anxiety, or postpartum depression; premenstrual dysphoric disorder, inadequate support, financial stress, relationship stress; complications in pregnancy, birth or breastfeeding; a history of abuse or trauma, a major recent life event, birth of multiples, babies in neonatal intensive care, infertility treatments, thyroid imbalance, and diabetes.

Anxiety can occur alone, or with depression, in 10% of new mothers.  Symptoms include constant worry, racing thoughts, inability to sit still, changes in sleep or appetite, feeling that something bad is going to happen; and physical symptoms like dizziness, hot flashes, and nausea.  Some mothers may also have panic attacks with shortness of breath, chest pain, dizziness, a feeling of losing control, and numbness and tingling.  Risk factors are a personal or family history of anxiety, previous perinatal depression or anxiety, and thyroid imbalance.

Post-traumatic stress disorder (PTSD) can occur in up to 6% of mothers following a traumatic childbirth.  Possible traumas are prolapsed cord, unplanned C-section, use of vacuum extractor or forceps to deliver the baby, baby going to NICU; and feelings of powerlessness, poor communication and/or lack of support and reassurance during the delivery.  Women who have experienced a previous sexual trauma are also at a higher risk for developing postpartum PTSD.  Intrusive re-experiencing of the traumatic event, flashbacks or nightmares; avoidance of stimuli associated with the event; increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response); anxiety and panic attacks, and feeling a sense of unreality and detachment are symptoms of PTSD.

Obsessive-compulsive disorder (OCD) can occur in 3% to 5% of new mothers.  Obsessions are persistent, repetitive thoughts or mental images, often related to the baby. Obsessions can be so bizarre or disturbing that they can be mistaken as psychosis.  Compulsions are repetitive acts performed to reduce obsessions.   Mothers are distressed by the obsessions which can lead to a fear of being left alone with the baby or hypervigilance in protecting the baby.  Mothers with postpartum OCD know that their thoughts are out of the ordinary and are unlikely to ever act on them.

Postpartum psychosis is the most severe of the PMADs.  It is often associated with an episode of bipolar disorder. It is rare, occurring in 1 to 2 per 1000 women.  The onset is abrupt, within 48 to 72 hours and up to two weeks after delivery. This is a psychiatric emergency, requiring immediate treatment.  Mothers may experience hallucinations (hearing voices or seeing things) and/or delusions (believing things that aren’t true.)  If psychosis occurs as part of a bipolar manic episode, there might be additional symptoms such as irritability, hyperactivity, decreased need for or inability to sleep, paranoia and suspiciousness, rapid mood swings, difficulty communicating, and confusion or memory loss. Risk factors are a personal or family history of bipolar disorder or a psychotic disorder.  Most women with postpartum psychosis do not have violent delusions but there is an up to 5% rate of infanticide or suicide due to acting on delusions or having irrational judgement.

PMADs are the most common complication of pregnancy and childbirth.  They are treatable with psychotherapy and/or medication and early intervention provides relief for the mother and ensures the baby’s wellbeing.

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We recently participated in Mediaplanet USA’s College Health and Safety campaign where we united with industry leaders for College safety awareness to educate students, parents and teachers on how we can better protect our students from drug abuse, sexual violence, mental health issues and more.This campaign will serve as a much-needed guide to arm them with the latest tools, programs and resources to tackle the most pressing health and safety issues prevalent on campuses across the United States. The campaign was distributed through USA TODAY on March 23rd 2018 and is published online. For the full campaign, visit: http://bit.ly/2pB6acC

 

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Free Community Education Series Offered the Third Wednesday of Every Other Month

The second session of a free education series to help community members increase awareness of mental health, substance use disorders, treatment and strategies for coping is April 18, 2018. Stacey Spencer, EdD, Lindner Center of HOPE staff psychologist, will present ADHD Through the Lifespan.

Lindner Center of HOPE with the support of Manor House in Mason, Ohio is once again offering a Free Community Education Series to increase awareness of mental health issues and substance use. The series offers expert discussion of Mental Health, Substance Use Disorders, Treatment and Strategies for Coping for community members seeking information.

The series is held at Manor House, 7440 Mason-Montgomery Rd., Mason at 6 p.m. the third Wednesday of every other month.

Register by calling Pricila Gran at 513-536-0318. Learn more by visiting lindnercenterofhope.org/education.

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Center’s Fundraising Auxiliary, High Hopes, Inc. to celebrate its 10th Anniversary

Celebrating their 10-year anniversary, High Hopes, (an organization of caring volunteers serving Lindner Center of HOPE) will host “A Day of High Hopes” on Tuesday, April 17 at Kenwood Country Club. The fundraising event will benefit Lindner Center of HOPE. Guest speakers, Cinda and Linea Johnson; co-authors of the book, Perfect Chaos, A Daughter’s Struggle to Survive Bipolar and A Mother’s Journey to Save Her, will serve as the keynote speakers. The mother-daughter duo will share their inspiring story of hope and their will to end the stigma surrounding mental health challenges.

Linea is a recent graduate from Seattle University, with a major in English and Creative Writing. Prior to transferring to SU, she completed three years at Columbia College, Chicago, in a musical performance program. Linea recently worked as an intern at the World Health Organization in the Mental Health department. She is a national speaker and writer, advocating for understanding and support for people with mental illness and the elimination of the stigma surrounding it.

Linea’s mother, Cinda Johnson, Ed.D., is a professor and director of the special education graduate program at Seattle University. She is a national leader in the area of transition from high school to post-high school settings for young people with disabilities. She has written articles and book chapters in the area of secondary special education and transition services, including youth with emotional and behavioral disorders and mental illnesses.

Proceeds from the event will benefit patients at Lindner Center of HOPE. A silent auction and raffle will begin at 11:00 a.m. with lunch and program at 12:30 p.m. The Johnson’s book will also be available for purchase at the event, where Linea and Cinda will be available for signing.

 TO REGISTER for the event go to: www.myhighhopes.com. Tickets are $75 per individual, or $750 for a patron table of 10. Sponsorships are also available by visiting the website.

For more information, please contact Kathy Bechtold at 513-791-8133, or email Kathy at: [email protected]

Lindner Center of HOPE  provides excellent, patient-centered, scientifically-advanced care for individuals suffering with mental illness. A state-of-the-science, mental health center and charter member of the National Network of Depression Centers, the Center provides psychiatric hospitalization and partial hospitalization for individuals age 12-years-old and older, outpatient services for all ages, diagnostic and short-term residential services for adults and adolescents, intensive outpatient program for substance abuse and co-occurring disorders for adults and research. The Center is enhanced by its partnership with UC Health as its clinicians are ranked among the best providers locally, nationally and internationally. Together Lindner Center of HOPE and UC Health offer a true system of mental health care in the Greater Cincinnati area and across the country. The Center is also affiliated with the University of Cincinnati (UC) College of Medicine.

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By Michael O’Hearn, MSW, LISW-S

The drum is one of the oldest musical instruments. An interesting paradox of medical and cognitive neuroscience is how a range of intra- and inter-personal stress mediation, self-regulation, and mind-body continuity interventions are accomplished through ancient
traditions of meditation (mental training) (Davidson & McEwen, 2012; Khalsa, Rudrauf, Davidson, & Tranel, 2015), and drumming (Bittman, Berk, Fleton, Westenguard, Pappas, & Ninehouser, 2001; Bittman, Berk, Shannon, Sharaf, Westenguard, Guegler, & Ruff, 20015; Bittman, Croft, Brinker, van Laar, Vernalis, & Elisworth, 2013).
This paper outlines a drumming technology that naturally integrates with Shamatha (Object) meditation (Ponlop, 2006). Drumming technology is a source of practically limitless transverse, bi-lateral, fine, and gross motor algorithms for individuals, couples, or groups. The targeted and individualized interventions (algorithms) serve as the object of Shamatha meditation. The psychoneuromuscular (PNM) practice not only conditions self-regulation, mind-body continuity, and stress mediation; the acquired abilities are eventually habituated in procedural or working memory (Sacks, 2007; Sapolsky, 2017) in
client systems.
The proposed drumming technology is central to a theoretical paper on music-based learning culture in former totalitarian undergraduate, graduate, and post-graduate education. It is expected to be published by Summer, 2018. Michael Radin, Ph.D., a classically trained pianist and Mathematics Professor at the Rochester Institute of Technology and Riga Technical University, and Liga Engele, Head of the Music Therapy
Center at Leipaja University, Latvia are lead and co-authors.

A Drumming Technology
The following is a description of drumming technology components and processes, some dyadic tables, and a low complexity algorithm. Table 1 and 1a outline phalange/hand, and foot sources for drumming algorithms:

 

 

 

 

 

 

 

Time Signatures. Time signatures are expressed as fractions; Table 2 illustrates a 4/4-time signature. The denominator represents the total number of beats per measure; the numerator represents the number of beats played per measure. Any source combinations can fit with practically any desired time signature.
Additional time signatures are not limited to 3/3, 3/4, 2/4, and 6/8.

Basic Rhythms. The following are basic rhythmic patterns ubiquitous in drumming and dance choreography. Again, any combination of  sources can fit these basic rhythms.

 

 

 

Accents. Downbeat and syncopation are two examples of various  accents to basic rhythms. Table 2 also illustrates the downbeat accent in 4/4 time.

 

 

Syncopated rhythms have accents that are not necessarily patterned or predictable; the accent often “anticipates,” or is played on the half-beat in Latin rhythms, Jazz, and progressive rock music. As syncopated  rhythms require additional effort and resources to capture and integrate, they are indicated to enhance integration in trauma recovery (van der Kolk, 2009; 2014) patients.

Medium. Drum kit, hand drum, finger drum, homemade drum, lap,  belly, table, or other are examples of medium – the instrument selected for a drumming algorithm.

Tuplet. Tuplet is the number of strokes attributed to each beat (the numerator) in any time signature; typically, single, double, or triple.

Tempo. A metronome is a meter that measures tempo in beats per minute/second (bpm/s), and provides an auditory “click track.” The  practitioner plays at a precise tempo, in sync or “on meter” with the  metronome. There are advantages to fast and slow tempo. Drumming  algorithms can emphasize one, the other, or include both.

Duration. Duration is the length of time of practice session, or the number of repetitions a drumming algorithm is played.

Examples of Dyadic Tables and a Drumming Algorithm.
The following are samples of fine and gross motor, transverse and bi-lateral dyadic tables for drumming algorithms. It is followed by an  illustration of a low complexity drummingalgorithm.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUMMARY
Meditative drumming is a psychoneuromuscular (PNM) intervention for individuals, couples, and groups that facilitates self-regulation, mind-body continuity, and stress reduction.
Individualized drumming algorithms are designed to engage one or a combination of: autonomic/vagal, cognitive, emotional, language,  visual-spatial, fine/gross motor, and memory along transverse and/or  bi-lateral pathways. Acquired abilities from meditative drumming algorithms are eventually habituated in procedural or working memory (Sacks, 2007; Sapolsky, 2017).

Its value for generating nonlinear efficacy in all settings (including all levels of care continuums), is matched only by its portability and cost efficiency.

REFERENCES
Davidson, R. & McEwen, B. (2012). Social influences on neural plasticity: Stress and interventions to promote well-being.
Nature Neuroscience, 689-695.
Khalsa, Rudrauf, Davidson, & Tranel. (2015). The effect of meditation on regulation of internal body states. Frontiers in Psychology, 1-15.
Bittman, B., Berk, L., Felten, D., Westenguard, J., Pappas, J., Ninehouser, M. (2001). Composite effects of group drumming music therapy on modulation of neuroendocrine-immune parameters in normal subjects, Alternative Therapies In Health and Medicine, Jan: 7(1), 38-47.
Bittman, B., Berk, L., Shannon, M., Sharaf, M., Westenguard, J.,
Guegler, K., Ruff, D. (2005). Recreational music-making
modulates the human stress response: a preliminary
individualized gene expression strategy, Medical Science
Monitor, 11, BR31-40.
Bittman, B., Croft, D., Brinker, J., van Laar, R., Vernalis, M., & Elisworth,
D. (2013 Recreational music-making alters gene expression pathways in patients with coronary artery disease, Medical Science Monitor,19, 139-147.
Ponlop, D. (2006). Mind beyond death. Ithaca, NY: Snowlion.
Sacks, O. (2007). Musicophilia. NY: Vintage.
Sapolsky, R. (2017). Behave: The biology of humans at our best and worst. NY: Penguin.
van der Kolk, B. (2009). Presentation of Trauma and Recovery, to the Milton H. Erikson Foundation Evolution of Psychotherapy Conference, Sacramento, CA.
van der Kolk, B. (2014). Trauma Recovery presentation to the 2014 International Trauma Conference, Boston, MA.

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Mike Glen, Lindner Center of HOPE Board Member and Cincinnati area business professional, gave the keynote presentation at the February 15, 2018 Business Courier Healthcare Heroes event. We are humbled by his willingness to share his story to help drive increased awareness of the impact of mental illness.

Please click to view the presentation.

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By Nicole Mori, RN, MSN, APRN-BC, Research Advanced Practice Nurse

Medical mobile phone apps are changing the doctor-patient relationship by promising patients greater control over their care, lower costs, improved safety and convenience.  Patient demand for apps is increasing with an estimated 50% of smartphone users having a medical app by the end of 2017.  Acceptance among clinicians is increasing, with as many as 1/3 of doctors recommending health and wellness apps to their patients.  In mental health, mobile apps have great potential as platforms for psychoeducation, self-management and enhanced patient-provider communication, in addition to increasing access and improving care for patients in rural and underserved areas.

Even though mental health apps could be useful, the market is still dominated by low-quality products that may not follow best clinical practice guidelines.   There is little published research and reliable information to guide patients and clinicians while app store and user-generated ratings do not correlate with quality of content.  This is a rapidly-evolving market, with new products and updates arriving on a weekly basis, therefore, clinicians need a framework to evaluate products, weigh risks versus benefits and offer guidance.

A review of recent literature, including 2016 published review of commercially-available mental health apps reveals significant concerns1:

Quality, functionality and reliability:  Mobile health apps are often developed without the input of clinicians and without validation by research or reference to best practice guidelines.  Information is often generic, incomplete and in some cases, inaccurate.  Few apps cited their sources of information.  Less than 50% of mental health apps used validated symptom scales, and when these were used, developers failed to properly credit the sources.

Patient Safety:  Symptom-monitoring apps may not issue safety alerts instructing patients with high illness severity scores (such as severe suicidal ideation) to seek prompt medical evaluation.  Few apps are designed to respond to indicators of deteriorating condition.

Burden on clinicians:  Apps may generate large amounts of data that may not be clinically-relevant or useful.  There is no framework for reimbursing patients for the costs of downloads or physicians for the time spent reviewing the data.

Absent regulatory oversight:  Laws and regulations have failed to address privacy and cybersecurity risks associated with health apps.  The majority of apps marketed to patients are exempt from regulations, with only a small number subject to FDA oversight.  Security and disclosure standards are left to the discretion of developers who often lack the expertise and resources to manage protected health information.

Privacy and confidentiality:  Health app developers are generally exempt from HIPAA regulations.  Products storing sensitive patient information pose significant privacy and security risks but many still lack mechanisms to safeguard patient information such as passwords and encryption.  There are no laws against the sale of patient information to data aggregators, who may in turn sell it to third parties such as credit card and insurance companies. Few products have comprehensive privacy policies, disclosing how personal information would be stored, used and protected.   Patients assume that information entered into mobile apps is private, when this is often not the case3.

In view of these quality concerns, more research and development of evidence-based mobile apps driven by clinicians is needed in addition to legal protections to safeguard the privacy and security of patient data.  At the present time, clinicians should be aware of the uneven level of quality in the app market and be familiar with a few reliable websites patients can visit for health education and be able to offer some guidance to patients using apps that store personal health information.

Discussion should address potential security risks and unauthorized disclosure of personal data, whether the product is evidence-based and in agreement with best practice guidelines and consider risks and potential benefits.

Note:  The American Psychiatric Association has developed an App Evaluation Model to help clinicians evaluate health apps.  The guidelines provide a list of issues that must be considered in order to make an informed decision about an app 2.

Sources
1         Nicholas, J., Larsen, M. E., Proudfoot, J., & Christensen, H. (2015). Mobile Apps for Bipolar Disorder: A Systematic Review of Features and Content Quality. Journal of Medical Internet Research, 17(8), e198. http://doi.org/10.2196/jmir.4581
2         APA (Ed.). (n.d.). App Evaluation Model. Retrieved November 16, 2017, from https://www.psychiatry.org/psychiatrists/practice/mental-health-apps/app-evaluation-model
3         Sarah R. Blenner, Melanie Köllmer, Adam J. Rouse, Nadia Daneshvar, Curry Williams, Lori B. Andrews. Privacy Policies of Android Diabetes Apps and Sharing of Health Information. JAMA. 2016;315(10):1051–1052. doi:10.1001/jama.2015.19426