Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
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Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Reviews
Year : 2021 | Month : August | Volume : 15 | Issue : 8 | Page : VE01 - VE04 Full Version

A Systematic Review of Studies Comparing Actigraphy Indices in Patients with Depression and Schizophrenia


Published: August 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/48760.15293
Ramdas Ransing, Pradeep Patil, Anurag Khapri, Aditya Mahindru

1. Senior Resident, Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, Maharashtra, India. 2. Professor and Head, Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, Maharashtra, India. 3. Junior Resident, Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, Maharashtra, India. 4. Junior Resident, Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Science, Wardha, Maharashtra, India.

Correspondence Address :
Dr. Ramdas Ransing,
Senior Resident, Department of Psychiatry, Datta Meghe Institute of Medical Sciences,
Sawangi (Meghe), Wardha-442004, Maharashtra, India.
E-mail: ramdas_ransing123@yahoo.co.in

Abstract

Introduction: Abnormalities in sleep-wake activities are frequently observed among patients with depression and schizophrenia. These abnormalities are variable and may have discriminative, clinical, diagnostic, and therapeutic significance if measured objectively with actigraphy.

Aim: To systematically review the published literature on actigraphy in depression and schizophrenia, particularly to identify areas of research that need to be addressed before their clinical application in practice.

Materials and Methods: The electronic databases (PubMed and Google Scholar) were searched for studies using the the key terms ‘actigraphy’ OR ‘actigraphic recording’ OR ‘wrist actigraphy’ OR ‘actometer’ OR ‘actimeter’ OR ‘actical’ OR ‘actiwatch’ OR ‘sleep-watch’ AND ‘schizoaffective’ OR ‘schizophr*’ OR ‘psychosis’ AND ‘depression’ OR ‘depressive’ in title and abstract. The literature search was limited to articles published in English and until 31st December, 2020. Data were abstracted by two reviewers and presented as a narrative summary of the findings. A qualitative synthesis of the study designs, populations, and outcomes was conducted. The quantitative synthesis of the results was not possible to conduct due to the heterogeneity and scarcity of the included studies.

Results: Out of 33 searched articles, a total of four studies (three observational and one case report) were included for the review. The included studies were heterogeneous, small in sample size, divergent in methods, inclusive of clinical population, having more than two groups (depression, schizophrenia, mania, or bipolar disorders), and with a low degree of evidence. Overall, the patients with schizophrenia have more structured and less complex activity pattern than those with depression. Furthermore, the patients with schizophrenia showed more irregular patterns in the morning period and increased fluctuations inactivity in the evening period than depression patients.

Conclusion: Currently, available information is insufficient to draw firm conclusions on use of actigraphy indices (e.g., duration of active periods, a pattern of activity, and sleep) for diagnosis and discrimination among the patients with schizophrenia and depression. Large, prospective, and comparative studies are required to identify role of actigraphy among these patients.

Keywords

Accelerometry, Mental health, Psychosis, Sleep

The altered sleep-activity levels (i.e., psychomotor retardation or agitation) is one the recognised feature of both depression and schizophrenia (1),(2),(3),(4). Nonetheless, these symptoms are frequently reported in patients with depression and are one of the diagnostic criteria for Major Depressive Disorder (MDD) (4). These symptoms are indicative of a complex underlying neurobiological mechanism such as diurnal variation in cortisol or depression, neurotransmitters, illness process, and effects of medications (e.g., extrapyramidal effects of antipsychotics) (5),(6).

Sleep and psychomotor activity are also a predictor of clinical response and remission in symptoms of schizophrenia and depression (7). These two disorders differ from normal, other psychiatric conditions, and from each other in terms of gross motor activity, body movement, reaction time, and speech (8). However, the clinical evaluation and monitoring of these symptoms are challenging due to subjective scales and measures (9),(10).

On other hand, body worn accelerometers (actigraphy) can be used to monitor the sleep-activity. Monitoring of these sleep-activity patterns using actigraphy has been found useful in patients with schizophrenia, depression, and psychosis (11),(12),(13). The actigraphic motor activity pattern differs among the patients with schizophrenia and depression (14). The actigraphy can be used as an objective clinical measure of psychomotor activities and to track the progression of mood disorders (15),(16). Thus, actigraphy could be a promising discriminative marker in clinical practice for these two groups of patients. Furthermore, the putative value of actigraphy may lie in the ability to identify subgroups (e.g., low/high sleep-activity), monitor dimensions (e.g., negative symptoms or motor behaviour), and outcome marker of symptoms (e.g., avolition, quality of life) (17),(18),(19).

However, there was no systematic review that attempted to compare actigraphy indices in patients with depression and schizophrenia. This systematic review was conducted to examine published studies in which actigraphy was used to compare the sleep-activity pattern between these two groups in order to identify areas of research that need to be addressed before their clinical application in practice.

Material and Methods

In December 2020-January 2021, this systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (20).

Inclusion criteria: Studies fulfilling the following criteria were considered eligible for inclusion in the study:

1. Population: Patients with schizophrenia and depression regardless of any subtype of illness, age, gender, medications status (naïve, on treatment), treatment setting (inpatients or outpatients), or other clinical characteristics.
2. Investigation: Actigraphy measurement.
3. Comparison: Studies having at least these two groups (patients with schizophrenia compared with patients with depression).
4. Outcomes: Actigraphy-related outcomes (actigraphy), remission in clinical symptoms.
5. Study design: Descriptive (case report or case series) and analytical studies (cross-sectional, case-control, or cohort).

Exclusion criteria: Studies assessing other conditions (e.g., obesity, sleep disorders, cancer, diabetes, or parkinsons disease), lacking the comparison between depression and schizophrenia, and studies that include reviews, protocol, or correspondences, and published in a language other than English were excluded.

Search strategy: PubMed and Google Scholar databases were searched till 31st December, 2020. The literature search was carried out using the three groups of terms ‘actigraphy’ OR ‘actigraphic recording’ OR ‘wrist actigraphy’ OR ‘actometer’ OR ‘actimeter’ OR ‘actical’ OR ‘actiwatch’ OR ‘sleep-watch’ AND ‘schizoaffective’ OR ‘schizophr*’ OR ‘psychosis’ AND ‘depression’ OR ‘depressive’ and was limited to title and abstract. The filters were restricted to studies available in the English language. The reference lists of the final included studies were also hand-searched and Google Scholar was used to find articles that cited these studies.

Selection Process

Zotero® software was used to import all studies obtained from the literature search. After the removal of duplicates, the two authors (RR and AK) reviewed the title and abstract independently and then jointly to identify the potentially eligible studies based on inclusion and exclusion criteria. At the screening stage, any disagreement was resolved by including the article in the full text. Then the full text screenings of articles were done by two authors (RR and AM). The disagreement if any was resolved by consensus and a discussion with the fourth author (PP).

Data Abstraction and Risk of Bias Assessment

Two authors (RR and AM) independently extracted the data of interest from the full texts of the eligible studies. The data comprised the following information: study design, year of the study, sample characteristics, actigraphic parameters (e.g., duration of monitoring, duration of activities), relevant outcomes, potential confounders, and conflict of interest. Any discrepancies were corrected by referring to original studies and resolved by consensus. Two reviewers (RR and AM) independently assessed the risk of bias based on GRADE 4 guidelines in each eligible study (21). The disagreement if any was resolved by consensus and a discussion with the fourth author (PP).

Statistical Analysis

A qualitative synthesis of the study designs, populations, and outcomes was conducted. The quantitative synthesis of the results was not possible to conduct due to the heterogeneity and scarcity of the included studies.

Results

A total of 30 potentially eligible studies were obtained after the electronic search of the two databases. Additionally, three records were found in the reference list of identified studies. After the removal of duplicates, a total of 19 records were processed via title and abstract screening. Among the 13 studies, which were full text screened, another nine studies were excluded. Finally, four articles were selected for qualitative analysis (Table/Fig 1).

Study characteristics and risk of bias: Of the included studies, three were observational longitudinal studies (14),(22),(23), while one was a case report (Table/Fig 2) (24). These studies were carried out on the clinical population receiving in-patient treatment. Interventional studies were not found in a literature review. The studies were conducted in Norway (n=3) and Switzerland (n=1). Based on GRADE 4 guidelines, there was a considerable bias of moderate risk in the methodological quality of these non randomised observational studies (21).

Synthesis of results: More than two groups (schizophrenia, mania, depression, and healthy controls) were compared for actigraphy recordings for the duration of 12 days to 14 days (14),(22),(23). In observational studies, the participants receiving medications such as antipsychotics or other drugs were included. However, these participants were not matched for age, gender, and socio-demographic factors.

Study tools/scales: Berle JO et al., and Fasmer OB et al., used the semi-structured interview SCID-I along with Montgomery-Asberg Depression Rating Scale (MADRS) and Brief Psychiatric Rating Scale (BPRS) to rate the symptoms of depression and schizophrenia in their study (14),(23). On other hand, Krane-Gartiser K et al., used ICD-10 research diagnostic criteria without any additional rating scales for the diagnostic evaluation (22). In a case study, Haug HJ et al., did not employ a scale or mention diagnostic criteria for evaluating patients (24).

Concurrent medications: The effects of these medications on actigraphy parameters were not studied in other reported studies except Berle JO et al., and Krane-Gartiser K et al., (14),(22). Berle JO et al., compared the patients with schizophrenia who were treated with clozapine with those treated with other antipsychotics (14). In Krane-Gartiser K et al., study the patients with schizophrenia were treated most commonly by antipsychotics with or without hypnotics or sedatives or mood stabilisers, while those with depression were treated by using antidepressants with or without hypnotics or mood stabilisers (22) (Table/Fig 1).

Actigraphy indices: The actigraphy was placed on the non dominant hand (24), while in some studies it was placed on hand as per patient convenience (14),(23). Variable actigraphy devices and measurement protocols were used by authors. Berle JO et al., used actigraphy indices such as gross motor activity, interdaily stability, intradaily variability, and relative amplitude (14). Fasmer OB et al., has evaluated the mean activity scores, active and inactive period (23).

Actigraphy outcome: Berle JO et al., found that patients with schizophrenia had a more pronounced reduction in night time activity and lower intradaily variability than patients with depression (14). Intradaily stability was a little higher in patients with schizophrenia than in patients with depression. They didn’t found any significant correlation between either MADRS or BPRS with different actigraphy motor parameters.

Fasmer OB et al., found no significant difference between the schizophrenia and depression groups in the mean length of the longest active period (23). The schizophrenia group had a higher mean value for an inactive period duration and a higher percentage of inactive periods (Duration: ≥21 minutes) compared to the depression group. While the depression group has a lower percentage of active periods (Duration: ≥36 min) compared to the schizophrenia group. Krane-Gartiser K et al., demonstrated that the depression group has the lowest mean level of activity than the schizophrenia group. Also, the depression group displayed increased fluctuations from the mean, successive count variability, and more shifts between inactivity and activity (22). The cases with schizophrenia showed more irregular patterns in the morning period and increased fluctuations inactivity in the evening period than depression cases (22). However, no significant difference was observed in mean activity over 24 hours after adjusting the medication treatment (22).

Discussion

Though the published studies attempted to understand the role of sleep-activity pattern, motor activities, none attempted to compare the clinical parameters (e.g., total sleep time, total night-time sleep, total wake time, wake after sleep onset, total awakenings, sleep latency, sleep efficiency). These parameters can have a vital role in the diagnosis and management of these conditions. Also, there was variation in actigraphy placement, previous studies have shown small differences between the right and left wrist (25),(26).

The pattern of motor activity among patients with schizophrenia was less complex than patients with depression (14). Further, the patients treated with clozapine had a more pronounced reduction in night time activity, increased interdaily stability, and reduced intradaily variability than the non-clozapine group (14). The actigraphy parameters such as sleep efficiency, sleep continuity, sleep latency, and variability in sleep hours in patients with schizophrenia could be valuable in measuring the effect of antipsychotic or antidepressant (27). Circadian disruption is associated with a high risk for schizophrenia and depression and associated with increased serum cortisol and inflammatory activity (28),(29). But, the lack of studies about this topic restricts the understanding of the relationship between these indices and complex psychopathology linked with worse prognosis, as the severity, treatment response, and non-remission. In addition, age and gender affect the actigraphy indices; the lack of matched controls in most of the studies affects the clinical utility of these findings (23).

These four studies have used a wide range of assessment protocols (e.g., total motor activity, intradaily activities), and were mainly confined to hospital inpatients. Certain clinical parameters such as Body Mass Index (BMI), socio-demographic characteristics, co-morbidities (e.g., substance use, diabetes) were not compared in these studies. The activity level as measured by actigraphy is often indicative of the severity and course of negative symptoms, as well as lifestyle choices and nosological entities among these patients (18). Therefore, population-based, clinical, interventional, and longitudinal studies are required to predict their role in remission and relapse in subsequent studies.

The poor sleep quality, altered sleep duration, number of awakenings has been associated with residual mood symptoms or psychotic symptoms and as an independent risk factor for these conditions due to the possible involvement of serotonergic pathways (30),(31),(32). This finding enforces the importance of investigating the role of actigraphy indices to elucidate the underlying pathophysiological mechanisms.

This review is the first to provide analyses of published studies that attempted to compare the actigraphy pattern among patients with schizophrenia and depression. The evidence clarifies some issues and gives direction for further research. We have not registered our review protocol with Prospero and this review is part of our ongoing study (33).

Limitation(s)

The limited sample size and small number of studies limit the generalisation of study findings for clinical use. Also, the lack of comparative subjective clinical scales (e.g., Pittsburgh sleep quality index, insomnia severity index), gold standard methods (e.g., polysomnography), and biomarkers (e.g., sleep electroencephalogram, hormones: cortisol, melatonin, or other hormones) in these studies limits the clinical utilisation of actigraphy in clinical practice. The small number of studies, heterogeneity of study designs, study tools/instruments, and study population prevented us from performing meta-analysis. These studies were observational and findings were also confounded by concurrent administration of medications.

Conclusion

In terms of sleep motor activity, actigraphy reveals that people with schizophrenia differ from those with depression. However, clinical and pathophysiological importance of these motor activity complexities in these patients was inconclusive. The study findings though promising require further evaluation with polysomnography, subjective measures of sleep, and biomarkers. Also, studies should focus on the diagnostic, prognostic, and clinical significance of actigraphy in these groups of patients.

References

1.
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DOI and Others

10.7860/JCDR/2021/48760.15293

Date of Submission: Jan 28, 2021
Date of Peer Review: May 21, 2021
Date of Acceptance: Jul 02, 2021
Date of Publishing: Aug 01, 2021

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 29, 2021
• Manual Googling: Jun 25, 2021
• iThenticate Software: Jul 30, 2021 (11%)

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