Case Report: Endocrine, immune and disease dynamics in a patient with rheumatoid arthritis during flare and medication change

ObjectiveRheumatoid arthritis (RA) is a chronic autoimmune disease of mostly unknown etiology and pathophysiology. In this integrative single-case study on a patient with RA, we had the unique opportunity to closely monitor the individual dynamics of endocrine, immune and disease variables during a naturally occurring flare-up and subsequent medication change.MethodsThe 59-year-old female RA patient collected her entire urine over 30 days in 12-h intervals (60 consecutive measurements in total). Subsequently, cortisol, interleukin-6 (IL-6), orosomucoid-2 (ORM-2), neopterin and creatinine levels were determined in the urine samples. Further, each morning and evening, the patient completed the DIARI, a set of questionnaires on variables such as perceived pain, perceived RA disease activity and emotional states. Once a week, the patient was interviewed online and had an appointment with her rheumatologist, in which several indices of RA disease activity were determined: SDAI, CDAI and DAS28. From these data various time series were constructed for statistical analysis.ResultsRA disease state increased from low to high activity during the first 12 study days. Thereupon, the medication was changed, which proved effective in reducing RA disease activity. However, the levels of urinary neopterin, urinary IL-6 and urinary ORM-2 did not show any response, neither to the increasing disease activity nor the medication change. The patient’s daily reports on pain, RA disease activity, emotional states and body temperature, however, mirrored the course of the rheumatologic indices.ConclusionThis integrative single-case study clearly demonstrated the importance of process analysis for the evaluation of therapeutic measures in RA. In the studied patient, urinary levels of neopterin, IL-6 and ORM-2 were not found to be appropriate biomarkers of short-term fluctuations in RA disease activity. Instead, the results reported by the patient proved to be a useful tool for ambulatory and longitudinal monitoring of RA

Multidisciplinary perspectives on personalised prevention in youth mental health

The pervasive impact of mental illnesses extends beyond individual suffering, affecting families, communities, and societies at large. Prevention efforts are imperative to mitigate this burden, promoting well-being and resilience across diverse populations. A particularly vulnerable period is adolescence, which is associated with numerous mental health issues that are exacerbated by declining healthy behaviours as well as socioeconomic inequalities. But adolescence also presents an opportune moment for early intervention. However, recognising warning signs and providing timely support involves considerable hurdles, so innovative prevention measures are needed. Advancements in AI, particularly in emotion recognition, offer promise for early mental health intervention. Yet, current AI achievements fall short in addressing the mental healthcare gap. This vision paper seeks to outline future directions and recommendations for effective preventive approaches by integrating experts of the necessary multidisciplinary field to develop, evaluate and implement novel and promising prevention approaches. Therefore, representatives based in Europe from diverse fields such as clinical psychology, computer science, physical activity, nutrition, economics, entrepreneurship, politics, and digital innovation propose potential avenues to integrate efficient treatment, AI methodology, and comprehensive implementation strategies that align with user needs. Based on a literature review and expert consensus, key ingredients suggested for effective preventive measures for mental health include holistic, individualised, AI-based mHealth interventions, leveraging smart and passive data from digital biomarkers for monitoring and feedback, evaluating cost-effectiveness, conducting participatory research to ensure user acceptance, and identifying barriers and facilitators for integration into regular healthcare systems. By utilising AI-driven interventions for adolescents, we can address the urgent need for preventive mental healthcare, ultimately enhancing the well-being of future generations

Lessons learned from a multimodal sensor-based eHealth approach for treating pediatric obsessive-compulsive disorder

IntroductionThe present study investigates the feasibility and usability of a sensor-based eHealth treatment in psychotherapy for pediatric obsessive-compulsive disorder (OCD), and explores the promises and pitfalls of this novel approach. With eHealth interventions, therapy can be delivered in a patient's home environment, leading to a more ecologically valid symptom assessment and access to experts even in rural areas. Furthermore, sensors can help indicate a patient's emotional and physical state during treatment. Finally, using sensors during exposure with response prevention (E/RP) can help individualize therapy and prevent avoidance behavior.MethodsIn this study, we developed and subsequently evaluated a multimodal sensor-based eHealth intervention during 14 video sessions of cognitive-behavioral therapy (CBT) in 20 patients with OCD aged 12-18. During E/RP, we recorded eye movements and gaze direction via eye trackers, and an ECG chest strap captured heart rate (HR) to identify stress responses. Additionally, motion sensors detected approach and avoidance behavior.ResultsThe results indicate a promising application of sensor-supported therapy for pediatric OCD, such that the technology was well-accepted by the participants, and the therapeutic relationship was successfully established in the context of internet-based treatment. Patients, their parents, and the therapists all showed high levels of satisfaction with this form of therapy and rated the wearable approach in the home environment as helpful, with fewer OCD symptoms perceived at the end of the treatment.DiscussionThe goal of this study was to gain a better understanding of the psychological and physiological processes that occur in pediatric patients during exposure-based online treatment. In addition, 10 key considerations in preparing and conducting sensor-supported CBT for children and adolescents with OCD are explored at the end of the article. This approach has the potential to overcome limitations in eHealth interventions by allowing the real-time transmission of objective data to therapists, once challenges regarding technical support and hardware and software usability are addressed. Clinical Trial Registrationwww.ClinicalTrials.gov, identifier (NCT05291611)

The influence of stress and emotions on immune system dynamics: a time series analytic approach

Im theoretischen Teil dieser Arbeit werden die Grundlagen der Psychoneuroimmunologie (PNI) im Hinblick auf den Einfluss von Stress und emotionaler Zustände auf Immunsystemaktivität diskutiert. Dabei werden die bidirektionalen, psychophysiologischen Signalwege zwischen kognitiven und emotionalen Zuständen auf das Immunsystem beleuchtet. Außerdem wird der Nutzen und die Möglichkeiten neuer Forschungsmethoden, wie ambulantem Assessment, intensiver longitudinaler Daten und Zeitreihenanalysen für das Forschungsfeld diskutiert. Im kumulativen Teil der Dissertation werden die Ergebnisse von drei Artikeln vorgestellt, welche im Rahmen dieser Dissertation kumulativ veröffentlicht wurden. In diesen integrativen Einzelfallstudien wurden Probanden über einen Zeitraum von mehreren Wochen begleitet und haben täglich Urinproben gesammelt und psychologische Fragebögen ausgefüllt. Dadurch konnten die dynamischen Abhängigkeiten zwischen den psychologischen Zuständen und Markern der Immunsystemaktivität untersucht werden.In the theoretical part of this paper, the basics of psychoneuroimmunology (PNI) are discussed with regard to the influence of stress and emotional states on immune system activity. The bidirectional, psychophysiological signaling pathways between cognitive and emotional states on the immune system will be highlighted. In addition, the utility and potential of new research methods, such as ambulatory assessment, intensive longitudinal data, and time series analyses for the research field will be discussed. The cumulative section of the dissertation presents the results of three articles that were published cumulatively as part of this dissertation. In these integrative single-case studies, subjects were followed over a period of several weeks and collected urine samples and completed psychological questionnaires on a daily basis. This allowed the dynamic dependencies between psychological states and markers of immune system activity to be investigated.Lennart SeizerDie Artikel sind in englischer SpracheKumulative Dissertation aus drei ArtikelnDissertation Universität Innsbruck 202

The influence of stress and emotions on immune system dynamics: a time series analytic approach

Im theoretischen Teil dieser Arbeit werden die Grundlagen der Psychoneuroimmunologie (PNI) im Hinblick auf den Einfluss von Stress und emotionaler Zust\ue4nde auf Immunsystemaktivit\ue4t diskutiert. Dabei werden die bidirektionalen, psychophysiologischen Signalwege zwischen kognitiven und emotionalen Zust\ue4nden auf das Immunsystem beleuchtet. Au ferdem wird der Nutzen und die M\uf6glichkeiten neuer Forschungsmethoden, wie ambulantem Assessment, intensiver longitudinaler Daten und Zeitreihenanalysen f\ufcr das Forschungsfeld diskutiert. Im kumulativen Teil der Dissertation werden die Ergebnisse von drei Artikeln vorgestellt, welche im Rahmen dieser Dissertation kumulativ ver\uf6ffentlicht wurden. In diesen integrativen Einzelfallstudien wurden Probanden \ufcber einen Zeitraum von mehreren Wochen begleitet und haben t\ue4glich Urinproben gesammelt und psychologische Frageb\uf6gen ausgef\ufcllt. Dadurch konnten die dynamischen Abh\ue4ngigkeiten zwischen den psychologischen Zust\ue4nden und Markern der Immunsystemaktivit\ue4t untersucht werden.In the theoretical part of this paper, the basics of psychoneuroimmunology (PNI) are discussed with regard to the influence of stress and emotional states on immune system activity. The bidirectional, psychophysiological signaling pathways between cognitive and emotional states on the immune system will be highlighted. In addition, the utility and potential of new research methods, such as ambulatory assessment, intensive longitudinal data, and time series analyses for the research field will be discussed. The cumulative section of the dissertation presents the results of three articles that were published cumulatively as part of this dissertation. In these integrative single-case studies, subjects were followed over a period of several weeks and collected urine samples and completed psychological questionnaires on a daily basis. This allowed the dynamic dependencies between psychological states and markers of immune system activity to be investigated.Lennart SeizerDie Artikel sind in englischer SpracheKumulative Dissertation aus drei ArtikelnDissertation Universit\ue4t Innsbruck 202