ChatGPT may be better than doctors at evidence-based management of clinical depression

by British Medical Journal

Credit: Unsplash/CC0 Public Domain

ChatGPT, the AI language model capable of mirroring human conversation, may be better than a doctor at following recognized treatment standards for clinical depression, and without any of the gender or social class biases sometimes seen in the primary care doctor-patient relationship, finds research published in the open access journal Family Medicine and Community Health.

13 nov 2023--However, further research is needed into how well this technology might manage severe cases as well as potential risks and ethical issues arising from its use, say the researchers.

Depression is very common, and many of those affected turn first to their family (primary care) doctors for help. The recommended course of treatment should largely be guided by evidence-based clinical guidelines, which usually suggest a tiered approach to care, in line with the severity of the depression.

ChatGPT has the potential to offer fast, objective, data-derived insights that can supplement traditional diagnostic methods as well as providing confidentiality and anonymity, say the researchers. They therefore wanted to find out how the technology evaluated the recommended therapeutic approach for mild and severe major depression and whether this was influenced by gender or social class biases, when compared with 1,249 French primary care doctors (73% women).

The researchers drew on carefully designed and previously validated vignettes, centering around patients with symptoms of sadness, sleep problems, and loss of appetite during the preceding three weeks and a diagnosis of mild to moderate depression.

Eight versions of these vignettes were developed with different variations of patient characteristics, such as gender, social class, and depression severity. Each vignette was repeated 10 times for ChatGPT versions 3.5 and 4.

For each of the eight vignettes, ChatGPT was asked, "What do you think a primary care physician should suggest in this situation?" The possible responses were watchful waiting; referral for psychotherapy; prescribed drugs (for depression/anxiety/sleep problems); referral for psychotherapy plus prescribed drugs; none of these.

Only just over 4% of family doctors exclusively recommended referral for psychotherapy for mild cases in line with clinical guidance, compared with ChatGPT-3.5 and ChatGPT-4, which selected this option in 95% and 97.5% of cases, respectively.

Most of the medical practitioners proposed either drug treatment exclusively (48%) or psychotherapy plus prescribed drugs (32.5%).

In severe cases, most of the doctors recommended psychotherapy plus prescribed drugs (44.5%). ChatGPT proposed this more frequently than the doctors (72%, ChatGPT 3.5; 100%, ChatGPT 4 in line with clinical guidelines). Four out of 10 of the doctors proposed prescribed drugs exclusively, which neither ChatGPT version recommended.

When medication was recommended, the AI and human participants were asked to specify which types of drugs they would prescribe.

The doctors recommended a combination of antidepressants and anti-anxiety drugs and sleeping pills in 67.5% of cases, exclusive use of antidepressants in 18%, and exclusive use of anti-anxiety and sleeping pills in 14%.

ChatGPT was more likely than the doctors to recommend antidepressants exclusively: 74%, version 3.5; and 68%, version 4. ChatGPT-3.5 (26%) and ChatGPT-4 (32%) also suggested using a combination of antidepressants and anti-anxiety drugs and sleeping pills more frequently than did the doctors.

But unlike the findings of previously published research, ChatGPT didn't exhibit any gender or social class biases in its recommended treatment.

The researchers acknowledge that the study was limited to iterations of ChatGPT-3 and ChatGPT-4 at specific points in time and that the ChatGPT data were compared with data from a representative sample of primary care doctors from France, so might not be more widely applicable.

Lastly, the cases described in the vignettes were for an initial visit due to a complaint of depression, so didn't represent ongoing treatment of the disease or other variables that the doctor would know about the patient.

"ChatGPT-4 demonstrated greater precision in adjusting treatment to comply with clinical guidelines. Furthermore, no discernible biases related to gender and [socioeconomic status] were detected in the ChatGPT systems," highlight the researchers.

But there are ethical issues to consider, particularly around ensuring data privacy and security which are supremely important, considering the sensitive nature of mental health data, they point out, adding that AI shouldn't ever be a substitute for human clinical judgment in the diagnosis or treatment of depression.

Nevertheless, they conclude, "The study suggests that ChatGPT…. has the potential to enhance decision making in primary health care. However, it underlines the need for ongoing research to verify the dependability of its suggestions. Implementing such AI systems could bolster the quality and impartiality of mental health services."

More information: Identifying depression and its determinants upon initiating treatment: ChatGPT versus primary care physicians, Family Medicine and Community Health (2023). DOI: 10.1136/fmch-2023-002391

 

Fluctuating blood pressure: A warning sign for dementia and heart disease

by University of South Australia

Credit: Pixabay/CC0 Public Domain

A new study by Australian researchers has shown that fluctuating blood pressure can increase the risk of dementia and vascular problems in older people.

13 nov 2023--Short blood pressure (BP) fluctuations within 24 hours as well as over several days or weeks are linked with impaired cognition, say University of South Australia (UniSA) researchers who led the study.

Higher systolic BP variations (the top number that measures the pressure in arteries when a heart beats) are also linked with stiffening of the arteries, associated with heart disease.

The findings have been published in the journal Cerebral Circulation—Cognition and Behaviour.

Lead author Daria Gutteridge, a Ph.D. candidate based in UniSA's Cognitive Aging and Impairment Neuroscience Laboratory (CAIN), says it's well known that high blood pressure is a risk factor for dementia, but little attention is paid to fluctuating blood pressure.

"Clinical treatments focus on hypertension, while ignoring the variability of blood pressure," Gutteridge says.

"Blood pressure can fluctuate across different time frames—short and long—and this appears to heighten the risk of dementia and blood vessel health."

To help explore the mechanisms that link BP fluctuations with dementia, UniSA researchers recruited 70 healthy older adults aged 60–80 years, with no signs of dementia or cognitive impairment.

Their blood pressure was monitored, they completed a cognitive test, and their arterial stiffness in the brain and arteries was measured using transcranial doppler sonography and pulse wave analysis.

"We found that higher blood pressure variability within a day, as well as across days, was linked with reduced cognitive performance. We also found that higher blood pressure variations within the systolic BP were linked with higher blood vessel stiffness in the arteries.

"These results indicate that the different types of BP variability likely reflect different underlying biological mechanisms, and that systolic and diastolic blood pressure variation are both important for cognitive functioning in older adults."

The links were present in older adults without any clinically relevant cognitive impairment, meaning that BP variability could potentially serve as an early clinical marker or treatment target for cognitive impairment, the researchers say.

More information: D.S. Gutteridge et al, Cross-sectional associations between short and mid-term blood pressure variability, cognition, and vascular stiffness in older adults, Cerebral Circulation—Cognition and Behavior (2023). DOI: 10.1016/j.cccb.2023.100181

 

Tai chi may curb Parkinson's disease symptoms and complications for several years

by British Medical Journal

Credit: Pixabay/CC0 Public Domain

Tai chi, the Chinese martial art that involves sequences of very slow controlled movements, may curb the symptoms and complications of Parkinson's disease for several years, reveals research published online in the Journal of Neurology Neurosurgery & Psychiatry.

13 nov 2023--Its practice was associated with slower disease progression and lower doses of required drugs over time, the findings show.

Parkinson's disease is a debilitating and progressive neurodegenerative disorder, characterized by slowness of movement, resting tremor, and stiff and inflexible muscles. It is the fastest growing neurological condition in the world, with the numbers of those affected projected to reach nearly 5 million by 2030 in China alone. In the UK, two people are diagnosed with the disease every hour according to the charity Parkinson's UK.

As yet, there is no cure for Parkinson's, and while drugs can improve clinical symptoms, they don't treat all the manifestations of the disease. There's no evidence that they slow progression either, explain the researchers. Previously published research suggests that tai chi eases Parkinson's symptoms in the short term, but whether this improvement can be sustained over the long term isn't known.

In a bid to find out, the researchers monitored two groups of patients with Parkinson's disease for more than five years from January 2016 to June 2021.

One group of 147 patients practiced tai chi twice a week for an hour, aided by the provision of classes to improve their technique. The other group of 187 patients continued with their standard care, but didn't practice tai chi.

Disease severity was formally assessed in all the participants at the start of the monitoring period, and disease progression, including increases in the need for medication, were subsequently monitored in November 2019, October 2020, and June 2021.

The extent of movement and other symptoms, such as autonomic nervous system function (to include bowel movements, urinary and cardiovascular issues); mood, sleep quality, and cognition; and the prevalence of complications, such as dyskinesia (involuntary movement); dystonia (abnormal muscle tone); decline in responsiveness to drug treatment over time; mild cognitive impairment; hallucinations; restless leg syndrome were also tracked, using validated scales.

Disease severity, medication use, sex, age, and education level, were similar in both groups.

Disease progression was slower at all monitoring points in the tai chi group, as assessed by three validated scales to assess overall symptoms, movement, and balance.

The number of patients who needed to increase their medication in the comparison group was also significantly higher than it was in the tai chi group: 83.5% in 2019 and just over 96% in 2020 compared with 71% and 87.5%, respectively.

Cognitive function deteriorated more slowly in the tai chi group as did other non-movement symptoms, while sleep and quality of life continuously improved.

And the prevalence of complications was significantly lower in the tai chi group than in the comparison group: dyskinesia 1.4% vs. 7.5%; dystonia 0% vs. 1.6%; hallucinations 0% vs. just over 2%; mild cognitive impairment 3% vs. 10%; restless leg syndrome 7% vs. 15.5%.

Falls, dizziness, and back pain were the three side effects reported by study participants, but these were all significantly lower in the tai chi group. While 23 people sustained a fracture, these all occurred during routine daily life and were fewer in the tai chi group: 6 vs. 17.

This is an observational study, and as such, can't establish cause and effect. The researchers also acknowledge that the number of study participants was relatively small and they weren't randomly assigned to their group.

But they conclude, "Our study has shown that tai chi retains the long-term beneficial effect on [Parkinson's disease], indicating the potential disease-modifying effects on both motor and non-motor symptoms, especially gait, balance, autonomic symptoms and cognition."

They add, "[Parkinson's disease] can worsen motor function and non-motor symptoms progressively with time, resulting in disability and influencing the quality of life. The long-term beneficial effect on [the disease] could prolong the time without disability, leading to a higher quality of life, a lower burden for caregivers, and less drug usage."

More information: Effect of long-term Tai Chi training on Parkinson's disease: a 3.5-year follow-up cohort study, Journal of Neurology Neurosurgery & Psychiatry (2023). DOI: 10.1136/jnnp-2022-330967

 

Mediterranean diet plus exercise burns fat, adds muscle

by Denise Mann

Rich in colorful fruits and vegetables, healthy fats and lean proteins, a Mediterranean style of eating consistently earns accolades for its long list of health benefits, including the prevention of heart disease and diabetes.

13 nov 2023--Now, new research from Spain shows this way of eating, when combined with regular exercise and fewer calories, can slash dangerous belly fat in older folks while helping to preserve their muscle mass.

Fat that accumulates around the midsection is known to cause inflammation and has been linked to heart disease, stroke, diabetes and some forms of cancer. Muscle mass is known to decline with advancing age, and this can lead to weakness, less mobility and a greater chance of falls.

The study, led by researcher Dora Romaguera, from the Health Research Institute of the Balearic Islands, included just over 1,500 middle-aged and older people who were overweight or obese and had metabolic syndrome, a cluster of disorders that signal a person's increased risk of diabetes, heart disease and stroke.

One group of people followed a Mediterranean diet while cutting their calories by 30% and increasing their physical activity. They were also told to limit their consumption of processed foods, meats, butter, added sugar and to eat more whole grains. But the advice did not stop with food: They were also encouraged to increase their physical activity progressively, with a goal of walking 45 minutes per day or more on six days per week, along with exercises to improve strength.

A second group of people followed a Mediterranean diet without calorie restrictions or changes in physical activity.

Folks who reduced their calories and got regular exercise while adhering to a Mediterranean diet showed decreases in the belly and total fat, and they kept much of it off for three years.

In contrast, people in the other group did not see any changes in belly fat.

Both groups did gain some lean muscle mass, but the folks in the exercise plus calorie restriction arm lost more fat than muscle.

The study, published Oct. 23 in the journal JAMA Network Open, presents the three-year results of an ongoing eight-year study designed to see if this style of eating can slash the risk for heart attack and stroke.

Two experts were not surprised the combination did the trick.

"This is an ambitious and elegant study," said Cewin Chao, director of clinical nutrition services at Montefiore Health System in New York City. "If you eat a high-quality diet, exercise and reduce calories, you will lose more body fat, especially the more dangerous deeper fat around the belly area surrounding your organs, and preserve more muscle. These investments do look like they will pay off at the three-year mark."

"If you reduce your calorie intake and increase your physical activity, you will lose weight. This works every time," said Marion Nestle, a retired professor of nutrition, food studies and public health at New York University in New York City.

"People following a Mediterranean diet… are able to maintain a reduced calorie intake and better calorie balance for the three years of the study," said Nestle. "This kind of diet is associated with all kinds of good health and is highly recommended."

More information: Jadwiga Konieczna et al, An Energy-Reduced Mediterranean Diet, Physical Activity, and Body Composition, JAMA Network Open (2023). DOI: 10.1001/jamanetworkopen.2023.37994

 

Intermittent fasting is safe, effective for those with type 2 diabetes, suggests new study

by Emily Stone, University of Illinois at Chicago

Credit: CC0 Public Domain

Time-restricted eating, also known as intermittent fasting, can help people with type 2 diabetes lose weight and control their blood sugar levels, according to a new study published in JAMA Network Open from researchers at the University of Illinois Chicago.

13 nov 2023--Participants who ate only during an eight-hour window between noon and 8 p.m. each day actually lost more weight over six months than participants who were instructed to reduce their calorie intake by 25%. Both groups had similar reductions in long-term blood sugar levels, as measured by a test of hemoglobin A1C, which shows blood sugar levels over the past three months.

The study was conducted at UIC and enrolled 75 participants into three groups: those who followed the time-restricted eating rules, those who reduced calories and a control group. Participants' weight, waist circumference, blood sugar levels and other health indicators were measured over the course of six months.

Senior author Krista Varady said that participants in the time-restricted eating group had an easier time following the regime than those in the calorie-reducing group. The researchers believe this is partly because patients with diabetes are generally told to cut back on calories by their doctors as a first line of defense, so many of these participants likely had already tried—and struggled with—that form of dieting. And while the participants in the time-restricted eating group were not instructed to reduce their calorie intake, they ended up doing so by eating within a fixed window.

"Our study shows that time-restricted eating might be an effective alternative to traditional dieting for people who can't do the traditional diet or are burned out on it," said Varady, a professor of kinesiology and nutrition. "For many people trying to lose weight, counting time is easier than counting calories."

There were no serious adverse events reported during the six-month study. Occurrences of hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) did not differ between the diet groups and control groups.

Today, one in 10 U.S. residents has diabetes, and that number is expected to rise to one in three by 2050 if current trends continue, the researchers explain. Finding more options for controlling weight and blood sugar levels for these patients, therefore, is crucial.

Just over half the participants in the study were Black and another 40% were Hispanic. This is notable as diabetes is particularly prevalent among those groups, so having studies that document the success of time-restricted eating for them is particularly useful, the researchers said.

The study was small and should be followed up by larger ones, said Varady, who is also a member of the University of Illinois Cancer Center. While it acts as a proof of concept to show that time-restricted eating is safe for those with type 2 diabetes, Varady said people with diabetes should consult their doctors before starting this sort of diet.

More information: Krista Varady et al, Effect of Time-Restricted Eating onWeight Loss in Adults With Type 2 Diabetes A Randomized Clinical Trial, JAMA Network Open (2023). DOI: 10.1001/jamanetworkopen.2023.39337

 

Newly published updates on hypertensive heart disease burden in older adults

by Cactus Communications

Joinpoint regression analysis of global prevalence (A), mortality (B), and DALY rate (C) for HHD in individuals aged 60–89 years between 1990 and 2019. * P <0.05. APC: Annual percentage change; DALY: Disability-adjusted life-year; HHD: Hypertensive heart disease. Credit: Chinese Medical Journal (2023). DOI: 10.1097/CM9.0000000000002863

High blood pressure, also called hypertension, has become quite a common health problem among adults worldwide, with over one billion cases reported in 2019. When blood pressure is not properly controlled, the heart undergoes adaptive changes at the macroscopic and microscopic levels, affecting its valves, chambers, and muscles. This condition, known as hypertensive hearth disease (HHD), can cause permanent remodeling of the heart over time, affecting its normal function and ultimately leading to heart failure.

13 nov 2023--Today, over 15 million people worldwide suffer from HDD, which has become the second leading cause of heart failure. Thus, HDD represents a massive challenge in health care that needs to be urgently addressed. Although HDD manifests mainly in older adults, there is limited data on its trends in this population.

To tackle this problem, a research team from the Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China conducted a comprehensive statistical analysis on the impact of HHD among older adults (60–89 years old) at the global, regional, and national levels.

Their study, which was led by Professor Jun Cai, was published in the Chinese Medical Journal.

"HHD remains a major concern in the management of hypertension and an important public health challenge," says Prof. Cai.

The data for this study came from the Global Burden of Disease Study 2019 project. Using its publicly available dataset, the researchers estimated the incidence, prevalence, mortality, and disability-adjusted life years (DALY) associated with HHD of 204 countries by age, sex, location, and year between 1990 and 2019.

The authors noted that there was an overall increase in the global prevalence of HHD between 1990 and 2019, but a decrease in mortality and DALY rates. This pattern was mostly maintained for both sexes across all age groups, as well as for sociodemographic index (SDI), which summarizes health-related social and economic development indicators.

Unfortunately, these results paint a particularly difficult situation for health care systems, as higher prevalence but lower mortality imply that more people will require treatment for HHD. "We observed the largest increasing trend in the prevalence of HHD since 2017 with a slowing of decreasing trends in HHD-related mortality and DALY rate since 2014," says Prof. Cai, "This finding suggests that we are presently facing even more rapid growth of the burden of HHD, which needs urgent attention."

Interestingly, the results for males and females were considerably different in a few regards. While males exhibited a higher prevalence of HHD, females had higher mortality and DALY rates. This suggests that the management of cardiovascular diseases in females is less effective, leading to worse prognosis. Moreover, the increasing trend of HHD prevalence was also higher in females, with a steep increase in 2017. Thus, the gap in prevalence between males and females seems to be narrowing.

"Our findings highlight disparities in the disease burden between the sexes, and the burden of HHD in older females should not be ignored," says Prof. Cai.

Worth noting, there were significant differences in the indicators for HHD between different countries and for different SDI groups. Overall, there were 85 countries with a significant increasing trend in HHD prevalence and 81 with a significant decreasing trend between 1990 and 2019. Notably, high-income Asia-Pacific countries (such as Japan, Singapore, and South Korea) exhibited the largest increase in HHD prevalence, but also the largest decrease in HHD mortality and DALY rate.

Despite the increasingly aging population in these countries contributing to the prevalence of HHD, it appears that they have managed to keep risk factors in check by providing adequate health care and keeping their populations informed.

Taken together, the study sheds light on the burden of HHD at the global, regional, and national level and provides a solid groundwork for the development of strategies to combat this challenging disorder.

"There are gaps in the prevention, management, and treatment of HHD world-wide," concludes Prof. Cai. "Our findings regarding the current situation of HHD and its temporal trends highlight inequities in the burden of HHD among older adults globally as well as a need for public health interventions at the individual and population levels."

More information: Ruixue Yang et al, Global, regional, and national burden of hypertensive heart disease among older adults in 204 countries and territories between 1990 and 2019: a trend analysis, Chinese Medical Journal (2023). DOI: 10.1097/CM9.0000000000002863