Psychiatric disorder therapy control

• US 9,333,350 B2
• Filed: 04/17/2009
• Issued: 05/10/2016
• Est. Priority Date: 04/18/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Rise, Mark T., Giftakis, Jonathon E., Stypulkowski, Paul H., Denison, Timothy J., Torgerson, Nathan A.
• Primary Examiner(s): LEVICKY, WILLIAM J
• Application Number:
  US12/425,903
• Publication Number:
  US 20090264956A1
• Time in Patent Office: 2,580 Days
• Field of Search: 607/45, 607/2
• US Class Current: 1/1
• CPC Class Codes: A61B 5/01 Measuring temperature of body parts ; Diagnostic temperature sensing, e.g. for malignant or inflamed tissue clinical contact thermometers G01K13/20
• CPC Class Codes: A61B 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61B 5/165 Evaluating the state of mind, e.g. depression, anxiety
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/441 Skin evaluation, e.g. for skin disorder diagnosis
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61B 5/7275 Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: A61N 1/36082 Cognitive or psychiatric applications, e.g. dementia or Alzheimer's disease
• CPC Class Codes: G16H 20/70 relating to mental therapies, e.g. psychological therapy or autogenous training
• CPC Class Codes: G16H 40/63 for local operation

Abstract

A therapy system for managing a psychiatric disorder of the patient may be controlled based on a patient mood state. Therapy may be delivered to a patient according to a therapy program, and a physiological parameter of the patient may be monitored during or after therapy delivery. The patient mood state may be determined based on the monitored physiological parameter, and the therapy delivery may be controlled based on the determined mood state. In some embodiments, the therapy delivery is stopped prior to determining the patient mood state and the therapy delivery is restarted upon detecting a negative mood state. In other embodiments, therapy delivery is delivered until a positive mood state is detected, at which point the therapy delivery may be stopped.

Claims

1. A method comprising:

delivering psychiatric disorder therapy to a patient via a medical device according to a therapy program;

monitoring a physiological parameter of the patient in response to the psychiatric disorder therapy, wherein the physiological parameter comprises at least one of a respiratory rate, electrodermal activity, thermal activity or muscle activity;

determining a patient mood state based on the physiological parameter; and

controlling the delivery of the psychiatric disorder therapy based on the determined patient mood state, wherein controlling the delivery of the psychiatric disorder therapy comprises stopping the delivery of therapy by the medical device based on the determined patient mood state.

2. The method of claim 1, wherein delivering psychiatric disorder therapy to the patient comprises delivering electrical stimulation to a brain of the patient.

3. The method of claim 1, wherein delivering psychiatric disorder therapy to the patient comprises delivering the psychiatric disorder therapy to the patient during a period of time and determining the patient mood state comprises determining the patient mood state after the period of time.

4. The method of claim 3, wherein controlling the delivery of the psychiatric disorder therapy further comprises initiating the delivery of the psychiatric disorder therapy after the period of time.

5. The method of claim 4, further comprising modifying a value of at least one therapy parameter defined by the therapy program based on the patient mood state, wherein initiating the delivery of the psychiatric disorder therapy comprises initiating the delivery of the psychiatric disorder therapy according to the modified value of the at least one therapy parameter.

6. The method of claim 1, wherein monitoring the physiological parameter of the patient comprises monitoring the physiological parameter of the patient while the psychiatric disorder therapy is delivered to the patient.

7. The method of claim 1, further comprising modifying a value of at least one therapy parameter defined by the therapy program based on the patient mood state.

8. The method of claim 1, further comprising receiving patient feedback to the delivery of the psychiatric disorder therapy according to the therapy program, wherein determining the patient mood state comprises determining the patient mood state based on the physiological parameter and the patient feedback.

9. The method of claim 1, further comprising:

receiving patient feedback to the delivery of the psychiatric disorder therapy according to the therapy program;

determining whether the patient feedback is consistent with the mood state determined based on the monitored physiological parameter; and

generating an indication if the patient feedback is not consistent with the mood state determined based on the monitored physiological parameter.

10. The method of claim 1, wherein determining the patient mood state comprises:

receiving a signal from a sensor, wherein the signal is indicative of the physiological parameter;

at least one of comparing a peak amplitude of the signal to a threshold amplitude, comparing an average amplitude of the signal to the threshold amplitude, comparing a median amplitude of the signal to the threshold amplitude, comparing a trend in a waveform of the signal over time to a template, comparing a power level within one or more frequency bands of the signal to a threshold power level, or comparing a ratio of power levels in two or more frequency bands of the signal to a threshold power level ratio; and

determining the patient mood state based on the comparison.

11. The method of claim 1, wherein delivering psychiatric disorder therapy to a patient comprises delivering the psychiatric disorder therapy to at least one of a dorsal ventral striatum, anterior cingulate, an anterior limb of an internal capsule, a pre-frontal cortex, an orbitofrontal cortex, a nucleus accumbens, a thalamus, an intralaminar thalamic nuclei, an amygdala, a hippocampus, a lateral hypothalamus, a Locus ceruleus, a dorsal raphe nucleus, a ventral tegmentum or a substantia nigra of a brain of the patient.

12. The method of claim 1, wherein the physiological parameter comprises the at least one of the respiratory rate, electrodermal activity, thermal activity or muscle activity, and a brain signal of the patient.

13. The method of claim 1, wherein the physiological parameter comprises at least one of electrodermal activity or thermal activity.

14. The method of claim 1, wherein determining the patient mood state comprises determining the patient mood state from among a plurality of stored patient mood states.

15. A system comprising:

a medical device configured to deliver psychiatric disorder therapy to a patient according to a therapy program;

a sensing module configured to generate a signal indicative of a physiological parameter of the patient, wherein the physiological parameter comprises at least one of a respiratory rate, electrodermal activity, thermal activity or muscle activity; and

a processor configured to receive the signal from the sensing module, determine a patient mood state based on the signal, and control the delivery of the psychiatric disorder therapy by the medical device based on the determined patient mood state by at least controlling the medical device to stop the delivery of therapy based on the determined patient mood state.

16. The system of claim 15, further comprising a programming device including a user input mechanism configured to receive input from the patient, wherein the processor is configured to determine the patient mood state based on the signal and the patient input.

17. The system of claim 15, wherein the processor is configured to determine the patient mood state by at least one of comparing a peak amplitude of the signal to a threshold amplitude, comparing an average amplitude of the signal to the threshold amplitude, comparing a median amplitude of the signal to the threshold amplitude, comparing a trend in a waveform of the signal over time to a template, comparing a power level within one or more frequency bands of the signal to a threshold power level or comparing a ratio of power levels in two or more frequency bands of the signal to a threshold power level ratio, and determining the patient mood state based on the comparison.

18. The system of claim 17, wherein the processor is configured to determine at least one of the threshold amplitude, the template, the threshold power level or the threshold power level ratio by at least:

controlling the medical device to deliver electrical stimulation therapy to the patient during a trial stimulation period,

monitoring the physiological parameter of the patient during a post-stimulation period following the trial stimulation period, and

determining a characteristic of a washout period based on the monitored physiological parameter during the post-stimulation period, wherein the washout period occurs during the post-stimulation period, and

wherein the characteristic of the washout period comprises the at least one of the threshold amplitude, the template, the threshold power level or the threshold power level ratio.

19. The system of claim 15, further comprising a memory that associates a plurality of patient mood states with a plurality of signal characteristics, wherein the processor is configured to determine the patient mood state by selecting the patient mood state from among the plurality of stored patient mood states.

20. The system of claim 15, wherein the medical device is configured to deliver the psychiatric disorder therapy to the patient according to the therapy program during a period of time, and the processor is configured to determine a patient mood state based on the signal after the period of time, and control the delivery of the psychiatric disorder therapy based on the patient mood state after the period of time.

21. The system of claim 15, wherein the processor is configured to modify a value of at least one therapy parameter defined by the therapy program based on the patient mood state.

22. The system of claim 15, further comprising a programming device including a user input mechanism configured to receive input from the patient indicating a mood state, wherein the processor is configured to determine whether the patient indicated mood state is consistent with the mood state determined based on the monitored physiological parameter and generate an indication if the patient indicated mood state is not consistent with the mood state determined based on the monitored physiological parameter.

23. A system comprising:

means for delivering psychiatric disorder therapy to a patient according to a therapy program;

means for monitoring a physiological parameter of the patient in response to the psychiatric disorder therapy, wherein the physiological parameter comprises at least one of a respiratory rate, electrodermal activity or muscle activity;

means for determining a patient mood state based on the physiological parameter; and

means for controlling the means for delivering psychiatric disorder therapy based on the determined patient mood state, wherein the means for controlling the means for delivering psychiatric disorder therapy is configured to control the means for delivering psychiatric disorder therapy to stop the delivery of therapy based on the determined patient mood state.

24. The system of claim 23, wherein the means for delivering psychiatric disorder therapy to the patient is configured to deliver the psychiatric disorder therapy to the patient during a period of time, the means for determining the patient mood state is configured to determine the patient mood state after the period of time, and the means for controlling the delivery of therapy is configured to initiate the delivery of the psychiatric disorder therapy after the period of time.