Retinal vascular fractal dimension in bipolar disorder and schizophrenia

Appaji, Abhishek; Nagendra, Bhargavi; Chako, Dona Maria; Padmanabha, Ananth; Hiremath, Chaitra; Jacob, Arpitha; Varambally, Shivarama; Muralidharan, Kesavan; Venkatasubramanian, Ganesan; Rao, Shyam Vasudeva; Webers, Carroll A.B.; Berendschot, Tos T. J. M.; Rao, Naren P.

doi:10.1016/j.jad.2019.08.061

Cited by 28 publications

(20 citation statements)

References 58 publications

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“…Individuals with these affective disorders have symptoms across the attention and behavior spectrum that are often accompanied by vascular co-morbidities. The results suggest that some of these effects can be captured by retinal vessel complexity metrics (38). In contrast, a sparser retinal microvascular network was associated with poorer cognitive performance in older populations (15,39).…”

Section: Discussionmentioning

confidence: 86%

Denser Retinal Microvascular Network Is Inversely Associated With Behavioral Outcomes and Sustained Attention in Children

et al. 2021

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Changes in geometry of the retinal microvascular network, including vessel width, vessel density, and tortuosity, have been associated with neurological disorders in adults. We investigated metrics of the retinal microvasculature in association with behavior and cognition in 8- to 12-year-old children. Digital fundus images of 190 children (48.2% girls, mean age 9.9 years) were used to calculate retinal vessel diameters, fractal dimension, lacunarity, and tortuosity. Parents filled out a Strengths and Difficulties Questionnaire (SDQ) for behavioral screening. Cognitive performance testing included a computerized version of the Stroop test (selective attention), the Continuous Performance (sustained attention), the Digit-Symbol (visual scanning and information-processing speed) and the Pattern Comparison (visuospatial analytic ability) tests from the Neurobehavioral Evaluation System (NES3) battery. Retinal vessel geometry was significantly associated with the SDQ problem score, which increased with 1.1 points (95% CI: 0.3 to 1.9 points) per interquartile (IQR) increment in retinal fractal dimension, and decreased 1.4 points (95% CI: −2.4 to −0.4 points) or decreased 1.0 points (95% CI: −2.1 to 0.1 points) per IQR increment in retinal vascular lacunarity or tortuosity, respectively. Sensitivity analyses showed that results were driven by the hyperactivity/inattention and conduct problem scales of the SDQ. Correspondingly, mean reaction time on the Continuous Performance test increased by 11 ms (95% CI: 4.4 to 17.6 ms) with an IQR increase in fractal dimension. The results indicate that a denser retinal microvascular network, exemplified by a higher fractal dimension and lower lacunarity, are inversely associated with behavioral outcomes and sustained attention in children.

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Section: Discussionmentioning

confidence: 86%

Denser Retinal Microvascular Network Is Inversely Associated With Behavioral Outcomes and Sustained Attention in Children

et al. 2021

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“…Studies show that telepsychiatry and AI can be effectively deployed for automated evaluation, namely imaging and behavior analysis, 47 evaluating biosignals, 48 assessing language use in mental disorders, 49 acoustic analysis, 50 knowledge-based methods, 51 and retinal examination. 52 – 56 Other potential uses include online information exchange and support services using social media and networking, 57 psychiatric consultation in primary care and emergency rooms, 58 and asynchronous psychotherapy. 59 Home care and related interventions for the geriatric population are also possible using technology.…”

Section: Discussionmentioning

confidence: 99%

“…Technological features include videoconference, telephone, and messaging systems, 61,62 web-based interactions, 63,64 mobile phone technologies, 65 networking via social media and group discussions, 66 simulated people and places, 67 and internet games. 68 The technology aspect of telepsychiatry has been experimented on a small scale in different cultural set- Retinal examination [52][53][54][55][56] Online information exchange and support services 57 Psychiatric consultation in primary care and emergency rooms 58 Asynchronous psychotherapy 59 Home care and related interventions 60 for ways to accommodate this online health-seeking behavior of their patients in their regular practice, beginning from the current pandemic, into the future.…”

Section: Technological Attributes Of Telepsychiatry and Aimentioning

confidence: 99%

Telepsychiatry and the Role of Artificial Intelligence in Mental Health in Post-COVID-19 India: A Scoping Review on Opportunities

Thenral

Annamalai

2020

Indian Journal of Psychological Medicine

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Background: COVID-19 has a profound impact on people with existing mental disorders, augmenting the prevailing inequalities in mental health. Methods: In order to understand the status of telepsychiatry in India and the role of artificial intelligence (AI) in mental health and its potential applications, a scoping review was done between March 2020 and May 2020. The literature review revealed 253 papers, which were used to derive the primary framework for analysis. The information was then reviewed for ideas and concepts, which were integrated with evidence from gray literature and categorized under broader themes based on the insights derived. Finally, a thematic framework was developed for discussion to tailor scientific information for decision-makers’ needs. Results: Review findings are summarized under the following headings: changing patterns of health-seeking behavior, origin and evolution of telepsychiatry, possible applications of telepsychiatry and AI, technological features, and AI models in mental health. Conclusions: Though there are several potential opportunities, the time is not yet ripe for telepsychiatry and AI to be adopted fully in the field of mental health care. But it is time that we develop indigenous proprietary technology and test and validate it. With many solutions offered by telepsychiatry and AI, psychiatrists must choose an appropriate tool based on their requirements, availability of resources, and feasibility of deployment. Harmony between conventional care and technology-based care must be reached gradually.

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“…After an initial study regarding retinal vascular photography in adolescents with bipolar disorder, 215 there have since been several studies on this topic in adults 216‐219 . One study found that both adults with bipolar disorder and those with schizophrenia had narrower arterioles and wider venules as compared to healthy volunteers, and adults with bipolar disorder had narrower arterioles and wider venues even as compared to adults with schizophrenia, 216 a pattern generally considered indicative of increased cardiovascular risk 220 …”

Section: Vascular Imaging and Functionmentioning

confidence: 99%

Call to action regarding the vascular‐bipolar link: A report from the Vascular Task Force of the International Society for Bipolar Disorders

et al. 2020

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Objectives The association of bipolar disorder with early and excessive cardiovascular disease was identified over a century ago. Nonetheless, the vascular‐bipolar link remains underrecognized, particularly with regard to how this link can contribute to our understanding of pathogenesis and treatment. Methods An international group of experts completed a selective review of the literature, distilling core themes, identifying limitations and gaps in the literature, and highlighting future directions to bridge these gaps. Results The association between bipolar disorder and vascular disease is large in magnitude, consistent across studies, and independent of confounding variables where assessed. The vascular‐bipolar link is multifactorial and is difficult to study given the latency between the onset of bipolar disorder, often in adolescence or early adulthood, and subsequent vascular disease, which usually occurs decades later. As a result, studies have often focused on risk factors for vascular disease or intermediate phenotypes, such as structural and functional vascular imaging measures. There is interest in identifying the most relevant mediators of this relationship, including lifestyle (eg, smoking, diet, exercise), medications, and systemic biological mediators (eg, inflammation). Nonetheless, there is a paucity of treatment studies that deliberately engage these mediators, and thus far no treatment studies have focused on engaging vascular imaging targets. Conclusions Further research focused on the vascular‐bipolar link holds promise for gleaning insights regarding the underlying causes of bipolar disorder, identifying novel treatment approaches, and mitigating disparities in cardiovascular outcomes for people with bipolar disorder.

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Retinal vascular fractal dimension in bipolar disorder and schizophrenia

Cited by 28 publications

References 58 publications

Denser Retinal Microvascular Network Is Inversely Associated With Behavioral Outcomes and Sustained Attention in Children

Denser Retinal Microvascular Network Is Inversely Associated With Behavioral Outcomes and Sustained Attention in Children

Telepsychiatry and the Role of Artificial Intelligence in Mental Health in Post-COVID-19 India: A Scoping Review on Opportunities

Call to action regarding the vascular‐bipolar link: A report from the Vascular Task Force of the International Society for Bipolar Disorders

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