Introduction
Patient non-compliance is a common obstacle to the achievement of therapeutic results. Compliance rates in affective disorders have been reported between 50%-75% on average. The rates commonly drop below the 50% rate, the longer the treatment takes1. The consequences of non-compliance can include increased morbidity and mortality, in addition to increased cost of treatment2. One approach to improve compliance is by advancing patients’ levels of information concerning the specifics of their regimens, actively involving patients in their treatment, and emphasizing the importance of the therapeutic plan3.
The Case
A 29-year-old female diagnosed with depression and previous failed medication therapies seeks treatment at a psychiatric practice.
Methods
The treating doctor recommends treatment with deep transcranial magnetic stimulation (dTMS). He schedules the patient for a six-week treatment with 5 dTMS sessions per week distributed across 5 working days. BNA™’s Auditory Oddball ERP task was recorded at baseline (before initiation of the treatment) and one week, three weeks and 5 weeks into treatment.
BNA™ Results & Physician Interpretation
The treating physician interpreted the BNA results as following:
BNA Visit 1: The Baseline shows an increased amplitude in The P200 ERP component as reflected by a Z-score of +1.6. The P200 measurement is thought to be associated with the auditory attention domain and is commonly found to be increased in depressed patients4,5. Furthermore, the response time shows an increased score (Z-score of +1.6), reflecting a slow reaction time at baseline.
BNA Visit 2: One week after treatment initiation, the patient did not feel an improvement in her affective symptoms. Given the required time commitment and financial costs of a dTMS treatment, the patient started to miss scheduled sessions and suggested stopping the therapy plan prematurely. The physician ordered a second BNA test to assess the neurophysiological and behavioral changes that the treatment may have already induced. Indeed, the BNA results showed that the P200 amplitude had decreased to a Z-score of +1.2, indicating a trend towards the healthy control group measures. Also, the behavioral scores improved, as reflected by faster response times, and decreased response variability. Given these positive changes in the BNA results, the physician felt confident in advising the patient to continue her treatment. To support the patient’s compliance with the treatment plan, the clinic utilized the easy-to-understand BNA summary report to discuss the results with the patient at eye level. Convinced by the BNA results, the patient continued fully compliant with the planned therapy regime.
BNA Visit 3: Three weeks into treatment, the patient reported first symptom improvements. In line with this, the P200 amplitude continued to decrease (score of +0.5) and behaviorally the patient became faster and less variable in her responses.
BNA Visit 4: A final BNA test in the last week of the treatment confirmed that the therapy’s effects on the patient’s neurophysiology and behavioral performance remained largely stable. The patient completed the treatment six weeks after initiation with a full remission.
Benefits of BNA™ for Supporting Patient Compliance
BNA™ objectively measures the neurophysiology and behavior, making it an ideal tool for tracking therapy-induced alterations in brain functioning. BNA™’s Summary Report is designed to optimally support the comparison across visits of some of the clinically most relevant ERP and behavioral scores. The Summary Report is automatically created for the Auditory Oddball and the Visual Go No-Go Paradigms and allows a comparison of the last four BNA™ visits. Its simple design and straightforward score presentation facilitate the communication between the physician and the patient, allowing an active involvement of the patient in tracking the success of the treatment. Actively tracking the impact a treatment has on their brain health can motivate patients to stay compliant even in the initial absence of subjective improvements. The use of BNA™ as a treatment tracking tool can thus help to achieve therapeutic results.
References
1. Sabaté E (WHO). Adherence to Long-Term Therapies – Evidence for action. WHO Library Catalogue. 2003;12:2205-2216. doi:10.2147/PPA.S174652
2. Morris LS, Schulz RM, Morris LS. Patient Compliance-an Overview. Vol 17.; 1992. doi:10.1111/j.1365-2710.1992.tb01306.x
3. DiMatte MR, Haskard-Zolnierek KB, Martin LR. Improving patient adherence: A three-factor model to guide practice. Health Psychology Review. 2012;6(1):74-91. doi:10.1080/17437199.2010.537592
4. Kemp AH, Pe Benito L, Quintana DS, et al. Impact of depression heterogeneity on attention: An auditory oddball event related potential study. Journal of Affective Disorders. 2010;123(1-3):202-207. doi:10.1016/j.jad.2009.08.010
5. Kemp AH, Hopkinson PJ, Hermens DF, et al. Fronto-temporal alterations within the first 200 ms during an attentional task distinguish major depression, non-clinical participants with depressed mood and healthy controls: A potential biomarker? Human Brain Mapping. 2009;30(2):602-614. doi:10.1002/hbm.20528
