1
|
Levrat V, Favre S, Richard-Lepouriel H. Current practices of psychoeducation interventions with persons with bipolar disorders: a literature review. Front Psychiatry 2024; 14:1320654. [PMID: 38250257 PMCID: PMC10797008 DOI: 10.3389/fpsyt.2023.1320654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024] Open
Abstract
This review sought to summarize the literature on current practices and forms of psychoeducation in the management of patients with bipolar disorder (BD), including only randomized controlled trials to ensure the best level of evidence. An extensive review of the available literature was conducted using PubMed/MEDLINE, Embase, and PsychInfo databases from inception to April 28th, 2022. The search yielded 381 studies. Seventy articles were included after removing duplicates and applying the inclusion/exclusion criteria. A best-evidence synthesis was used to identify the key results of each study and summarize the outcomes. Eleven descriptive categories were made. They encompass different forms of psychoeducation compared or combined with other psychosocial interventions, varying in setting (individual or group), with or without family members, structured or unstructured, mediated or not by digital tools (smartphone, internet). Globally, these studies show that psychoeducation is important in the treatment of BD, as it leads to a decrease in relapses, mood episodes, hospitalizations, and improved functioning or quality of life. Some studies also showed the benefits of psychoeducation on the patient's level of knowledge of pharmacological treatment and the disorder or compliance with medication, as well as reduced self-stigma. The limitations of this review are linked to the selection of only RCTs and the reliance on their post-hoc analyses. This review confirms the benefit of psychoeducation and psychosocial interventions on the evolution of BD (in different outcomes, including quality of life, relapse, and rehospitalization rates, for example). More recent interventions, such as mindfulness or online psychoeducation, represent an interesting option but more evidence is needed.
Collapse
Affiliation(s)
- Vanessa Levrat
- Mood Disorder and Anxiety Unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland
| | - Sophie Favre
- Mood Disorder and Anxiety Unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland
| | - Hélène Richard-Lepouriel
- Mood Disorder and Anxiety Unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| |
Collapse
|
2
|
Ortiz A, Park Y, Gonzalez-Torres C, Alda M, Blumberger DM, Burnett R, Husain MI, Sanches M, Mulsant BH. Predictors of adherence to electronic self-monitoring in patients with bipolar disorder: a contactless study using Growth Mixture Models. Int J Bipolar Disord 2023; 11:18. [PMID: 37195477 PMCID: PMC10192477 DOI: 10.1186/s40345-023-00297-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/14/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Several studies have reported on the feasibility of electronic (e-)monitoring using computers or smartphones in patients with mental disorders, including bipolar disorder (BD). While studies on e-monitoring have examined the role of demographic factors, such as age, gender, or socioeconomic status and use of health apps, to our knowledge, no study has examined clinical characteristics that might impact adherence with e-monitoring in patients with BD. We analyzed adherence to e-monitoring in patients with BD who participated in an ongoing e-monitoring study and evaluated whether demographic and clinical factors would predict adherence. METHODS Eighty-seven participants with BD in different phases of the illness were included. Patterns of adherence for wearable use, daily and weekly self-rating scales over 15 months were analyzed to identify adherence trajectories using growth mixture models (GMM). Multinomial logistic regression models were fitted to compute the effects of predictors on GMM classes. RESULTS Overall adherence rates were 79.5% for the wearable; 78.5% for weekly self-ratings; and 74.6% for daily self-ratings. GMM identified three latent class subgroups: participants with (i) perfect; (ii) good; and (iii) poor adherence. On average, 34.4% of participants showed "perfect" adherence; 37.1% showed "good" adherence; and 28.2% showed poor adherence to all three measures. Women, participants with a history of suicide attempt, and those with a history of inpatient admission were more likely to belong to the group with perfect adherence. CONCLUSIONS Participants with higher illness burden (e.g., history of admission to hospital, history of suicide attempts) have higher adherence rates to e-monitoring. They might see e-monitoring as a tool for better documenting symptom change and better managing their illness, thus motivating their engagement.
Collapse
Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
| | - Yunkyung Park
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Christina Gonzalez-Torres
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Daniel M Blumberger
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Rachael Burnett
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Marcos Sanches
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| |
Collapse
|
3
|
McIntyre RS, Alda M, Baldessarini RJ, Bauer M, Berk M, Correll CU, Fagiolini A, Fountoulakis K, Frye MA, Grunze H, Kessing LV, Miklowitz DJ, Parker G, Post RM, Swann AC, Suppes T, Vieta E, Young A, Maj M. The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management. World Psychiatry 2022; 21:364-387. [PMID: 36073706 PMCID: PMC9453915 DOI: 10.1002/wps.20997] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Bipolar disorder is heterogeneous in phenomenology, illness trajectory, and response to treatment. Despite evidence for the efficacy of multimodal-ity interventions, the majority of persons affected by this disorder do not achieve and sustain full syndromal recovery. It is eagerly anticipated that combining datasets across various information sources (e.g., hierarchical "multi-omic" measures, electronic health records), analyzed using advanced computational methods (e.g., machine learning), will inform future diagnosis and treatment selection. In the interim, identifying clinically meaningful subgroups of persons with the disorder having differential response to specific treatments at point-of-care is an empirical priority. This paper endeavours to synthesize salient domains in the clinical characterization of the adult patient with bipolar disorder, with the overarching aim to improve health outcomes by informing patient management and treatment considerations. Extant data indicate that characterizing select domains in bipolar disorder provides actionable information and guides shared decision making. For example, it is robustly established that the presence of mixed features - especially during depressive episodes - and of physical and psychiatric comorbidities informs illness trajectory, response to treatment, and suicide risk. In addition, early environmental exposures (e.g., sexual and physical abuse, emotional neglect) are highly associated with more complicated illness presentations, inviting the need for developmentally-oriented and integrated treatment approaches. There have been significant advances in validating subtypes of bipolar disorder (e.g., bipolar I vs. II disorder), particularly in regard to pharmacological interventions. As with other severe mental disorders, social functioning, interpersonal/family relationships and internalized stigma are domains highly relevant to relapse risk, health outcomes, and quality of life. The elevated standardized mortality ratio for completed suicide and suicidal behaviour in bipolar disorder invites the need for characterization of this domain in all patients. The framework of this paper is to describe all the above salient domains, providing a synthesis of extant literature and recommendations for decision support tools and clinical metrics that can be implemented at point-of-care.
Collapse
Affiliation(s)
- Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Ross J Baldessarini
- Harvard Medical School, Boston, MA, USA
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA
- Mailman Research Center, McLean Hospital, Belmont, MA, USA
| | - Michael Bauer
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
- Orygen, National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Kostas Fountoulakis
- 3rd Department of Psychiatry, Division of Neurosciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Heinz Grunze
- Allgemeinpsychiatrie Ost, Klinikum am Weissenhof, Weinsberg, Germany
- Paracelsus Medical Private University Nuremberg, Nuremberg, Germany
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Center, Psychiatric Center Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David J Miklowitz
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles (UCLA) Semel Institute, Los Angeles, CA, USA
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Robert M Post
- School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
- Bipolar Collaborative Network, Bethesda, MD, USA
| | - Alan C Swann
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Trisha Suppes
- Department of Psychiatry and Behavioural Sciences, Stanford School of Medicine and VA Palo Alto Health Care -System, Palo Alto, CA, USA
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Allan Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| |
Collapse
|
4
|
A randomized controlled trial of customized adherence enhancement (CAE-E): study protocol for a hybrid effectiveness-implementation project. Trials 2022; 23:634. [PMID: 35927740 PMCID: PMC9351150 DOI: 10.1186/s13063-022-06517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Mood-stabilizing medications are a cornerstone of treatment for people with bipolar disorder, though approximately half of these individuals are poorly adherent with their medication, leading to negative and even severe health consequences. While a variety of approaches can lead to some improvement in medication adherence, there is no single approach that has superior adherence enhancement and limited data on how these approaches can be implemented in clinical settings. Existing data have shown an increasing need for virtual delivery of care and interactive telemedicine interventions may be effective in improving adherence to long-term medication. METHODS Customized adherence enhancement (CAE) is a brief, practical bipolar-specific approach that identifies and targets individual patient adherence barriers for intervention using a flexibly administered modular format that can be delivered via telehealth communications. CAE is comprised of up to four standard treatment modules including Psychoeducation, Communication with Providers, Medication Routines, and Modified Motivational Interviewing. Participants will attend assigned module sessions with an interventionist based on their reasons for non-adherence and will be assessed for adherence, functioning, bipolar symptoms, and health resource use across a 12-month period. Qualitative and quantitative data will also be collected to assess barriers and facilitators to CAE implementation and reach and adoption of CAE among clinicians in the community. DISCUSSION The proposed study addresses the need for practical adherence interventions that are effective, flexible, and designed to adapt to different settings and patients. By focusing on a high-risk, vulnerable group of people with bipolar disorder, and refining an evidence-based approach that will integrate into workflow of public-sector care and community mental health clinics, there is substantial potential for improving bipolar medication adherence and overall health outcomes on a broad level. TRIAL REGISTRATION The study was registered on ClinicalTrials.gov NCT04622150 on November 9, 2020.
Collapse
|
5
|
Ortiz A, Maslej MM, Husain MI, Daskalakis ZJ, Mulsant BH. Apps and gaps in bipolar disorder: A systematic review on electronic monitoring for episode prediction. J Affect Disord 2021; 295:1190-1200. [PMID: 34706433 DOI: 10.1016/j.jad.2021.08.140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/18/2021] [Accepted: 08/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term clinical monitoring in bipolar disorder (BD) is an important therapeutic tool. The availability of smartphones and wearables has sparked the development of automated applications to remotely monitor patients. This systematic review focus on the current state of electronic (e-) monitoring for episode prediction in BD. METHODS We systematically reviewed the literature on e-monitoring for episode prediction in adult BD patients. The systematic review was done according to the guidelines for reporting of systematic reviews and meta-analyses (PRISMA) and was registered in PROSPERO on April 29, 2020 (CRD42020155795). We conducted a search of Web of Science, MEDLINE, EMBASE, and PsycINFO (all 2000-2020) databases. We identified and extracted data from 17 published reports on 15 relevant studies. RESULTS Studies were heterogeneous and most had substantial methodological and technical limitations. Models varied widely in their performance. Published metrics were too heterogeneous to lend themselves to a meta-analysis. Four studies reported sensitivity (range: 0.21 - 0.95); and two reported specificity for prediction of mood episodes (range: 0.36 - 0.99). Two studies reported accuracy (range: 0.64 - 0.88) and four reported area under the curve (AUC; range: 0.52-0.95). Overall, models were better in predicting manic or hypomanic episodes, but their performance depended on feature type. LIMITATIONS Our conclusions are tempered by the lack of appropriate information impeding our ability to synthesize the available evidence. CONCLUSIONS Given the clinical variability in BD, predicting mood episodes remains a challenging task. Emerging e-monitoring technology for episode prediction in BD requires more development before it can be adopted clinically.
Collapse
Affiliation(s)
- Abigail Ortiz
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Marta M Maslej
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of California San Diego, United States
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada
| |
Collapse
|
6
|
A Real-World Study of the Association between a Brief Group Psychoeducation and the Course of Bipolar Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18095019. [PMID: 34068535 PMCID: PMC8126006 DOI: 10.3390/ijerph18095019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 11/27/2022]
Abstract
Although pharmacotherapy is considered the first-line treatment for bipolar disorders (BD), adjunctive psychoeducation has proven its effectiveness in improving self-management of the disease and reducing relapse rates. Few studies have evaluated the effect of brief group psychoeducation on pragmatic variables, such as the number of hospitalizations. The aim of the present study was to assess the mid-term effect of a four-session group psychoeducation on course-related variables in BD. Thirty-two individuals with BD were included in the study. Sixteen were exposed to psychoeducation and were matched to sixteen nonexposed individuals who received their usual treatment. Both groups were compared on insight, treatment adherence, change in the number of hospitalizations and visits to the emergency services, occurrence rate after intervention, and time to the first psychiatric hospitalization and the first urgent attendance. There was a significant reduction in the mean number of hospitalizations and urgent attendances in the exposed group in comparison to the nonexposed group. The first urgent attendance was significantly sooner in the nonexposed cohort. There were no differences between groups in any of the other variables. This intervention has shown benefits for pragmatic variables of the disease course and may be a feasible and cost-effective intervention to routinely implement in the management of BD.
Collapse
|
7
|
Nielsen AS, Kidholm K, Kayser L. Patients' reasons for non-use of digital patient-reported outcome concepts: A scoping review. Health Informatics J 2020; 26:2811-2833. [PMID: 32731773 DOI: 10.1177/1460458220942649] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Data from digitally administered patient reported outcomes (PROs) is used more and more in routine healthcare for long-term conditions as a part of daily clinical practice. This literature study reviews empirical studies of digital PRO to examine patients' reasons for non-use of digitally administered PRO data in routine care. This scoping review searched through PubMed, Embase, Web of Science and PsycINFO databases, reporting on study population, intervention, duration of intervention and motivational factors alongside stated reasons for nonparticipation or dropout for each study. The patients' reasons for not participating, either from study start or by dropout, were analysed through a thematic approach.Fifty-one studies were included, published from 2010 to 2019, mostly from Europe and the Unites States covering different long-term conditions. The reasons for non-use are manifold and cover the themes of ability to use PRO, engagement, emotional distress and technical barriers.Several reasons are given explaining why patients with long-term conditions are not using digitally administered PRO as intended. This should be taken into account in the design phase of digital PRO interventions and considered in conversations with patients during the intervention.
Collapse
Affiliation(s)
| | - Kristian Kidholm
- Kristian Kidholm Odense University Hospital, University of Southern Denmark, Denmark
| | | |
Collapse
|
8
|
Faurholt-Jepsen M, Frost M, Christensen EM, Bardram JE, Vinberg M, Kessing LV. The effect of smartphone-based monitoring on illness activity in bipolar disorder: the MONARCA II randomized controlled single-blinded trial. Psychol Med 2020; 50:838-848. [PMID: 30944054 DOI: 10.1017/s0033291719000710] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recently, the MONARCA I randomized controlled trial (RCT) was the first to investigate the effect of smartphone-based monitoring in bipolar disorder (BD). Findings suggested that smartphone-based monitoring sustained depressive but reduced manic symptoms. The present RCT investigated the effect of a new smartphone-based system on the severity of depressive and manic symptoms in BD. METHODS Randomized controlled single-blind parallel-group trial. Patients with BD, previously treated at The Copenhagen Clinic for Affective Disorder, Denmark and currently treated at community psychiatric centres, private psychiatrists or GPs were randomized to the use of a smartphone-based system or to standard treatment for 9 months. Primary outcomes: differences in depressive and manic symptoms between the groups. RESULTS A total of 129 patients with BD (ICD-10) were included. Intention-to-treat analyses showed no statistically significant effect of smartphone-based monitoring on depressive (B = 0.61, 95% CI -0.77 to 2.00, p = 0.38) and manic (B = -0.25, 95% CI -1.1 to 0.59, p = 0.56) symptoms. The intervention group reported higher quality of life and lower perceived stress compared with the control group. In sub-analyses, the intervention group had higher risk of depressive episodes, but lower risk of manic episodes compared with the control group. CONCLUSIONS There was no effect of smartphone-based monitoring. In patient-reported outcomes, patients in the intervention group reported improved quality of life and reduced perceived stress. Patients in the intervention group had higher risk of depressive episodes and reduced risk of manic episodes. Despite the widespread use and excitement of electronic monitoring, few studies have investigated possible effects. Further studies are needed.
Collapse
Affiliation(s)
- Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Mads Frost
- IT University of Copenhagen, Rued Langgaards Vej 7, 2300 Copenhagen, Denmark
| | - Ellen Margrethe Christensen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jakob E Bardram
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
9
|
Goodday SM, Atkinson L, Goodwin G, Saunders K, South M, Mackay C, Denis M, Hinds C, Attenburrow MJ, Davies J, Welch J, Stevens W, Mansfield K, Suvilehto J, Geddes J. The True Colours Remote Symptom Monitoring System: A Decade of Evolution. J Med Internet Res 2020; 22:e15188. [PMID: 31939746 PMCID: PMC6996723 DOI: 10.2196/15188] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/25/2019] [Accepted: 10/22/2019] [Indexed: 01/04/2023] Open
Abstract
The True Colours remote mood monitoring system was developed over a decade ago by researchers, psychiatrists, and software engineers at the University of Oxford to allow patients to report on a range of symptoms via text messages, Web interfaces, or mobile phone apps. The system has evolved to encompass a wide range of measures, including psychiatric symptoms, quality of life, and medication. Patients are prompted to provide data according to an agreed personal schedule: weekly, daily, or at specific times during the day. The system has been applied across a number of different populations, for the reporting of mood, anxiety, substance use, eating and personality disorders, psychosis, self-harm, and inflammatory bowel disease, and it has shown good compliance. Over the past decade, there have been over 36,000 registered True Colours patients and participants in the United Kingdom, with more than 20 deployments of the system supporting clinical service and research delivery. The system has been adopted for routine clinical care in mental health services, supporting more than 3000 adult patients in secondary care, and 27,263 adolescent patients are currently registered within Oxfordshire and Buckinghamshire. The system has also proven to be an invaluable scientific resource as a platform for research into mood instability and as an electronic outcome measure in randomized controlled trials. This paper aimed to report on the existing applications of the system, setting out lessons learned, and to discuss the implications for tailored symptom monitoring, as well as the barriers to implementation at a larger scale.
Collapse
Affiliation(s)
- Sarah M Goodday
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- 4YouandMe, Seattle, WA, United States
| | - Lauren Atkinson
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Center for Human Brain Activity, University of Oxford, Oxford, United Kingdom
| | - Guy Goodwin
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Kate Saunders
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Matthew South
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Clare Mackay
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Mike Denis
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Chris Hinds
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Mary-Jane Attenburrow
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Jim Davies
- Big Data Institute, University of Oxford, Oxford, United Kingdom
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - James Welch
- Big Data Institute, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - William Stevens
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Karen Mansfield
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Juulia Suvilehto
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - John Geddes
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| |
Collapse
|
10
|
Novick DM, Swartz HA. Evidence-Based Psychotherapies for Bipolar Disorder. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2019; 17:238-248. [PMID: 32047369 DOI: 10.1176/appi.focus.20190004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Bipolar disorder is a recurrent psychiatric disorder marked by waxing and waning affective symptoms and impairment in functioning. Some of the morbidity and mortality associated with the illness may be reduced with evidence-based psychotherapies (EBPs) along with pharmacotherapy. To enhance clinicians' understanding of which therapy modalities have evidence supporting their use, the authors conducted a systematic literature review to identify randomized controlled trials (RCTs) of psychotherapy for adults with bipolar disorder. A strong evidence base exists for psychoeducation, cognitive-behavioral therapy, family-focused therapy, interpersonal and social rhythm therapy, and peer-support programs. Promising modalities include functional remediation, mindfulness-based cognitive therapy, illness management and recovery, and technology-assisted strategies. RCTs demonstrate a consistent advantage of these psychotherapies plus pharmacotherapy, compared with the use of pharmacotherapy alone. Adjunctive EBPs hasten time to remission, delay time to recurrence, and improve functional outcomes. EBPs play an important role in helping individuals develop skills needed to manage the persistent and lifelong psychosocial, neurocognitive, vocational, and interpersonal consequences of bipolar disorder. Continued efforts to improve the effectiveness of EBPs for adults with bipolar disorder are warranted.
Collapse
Affiliation(s)
- Danielle M Novick
- Outpatient Mood Disorders Clinic and Clinical Training Committee, VA Pittsburgh Healthcare System, Pittsburgh (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz)
| | - Holly A Swartz
- Outpatient Mood Disorders Clinic and Clinical Training Committee, VA Pittsburgh Healthcare System, Pittsburgh (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Swartz)
| |
Collapse
|
11
|
Abstract
Bipolar II disorder causes significant suffering among patients and their families, some of which may be alleviated by psychotherapy alone or as an adjunct to pharmacotherapy. Psychotherapies may be more effective if modified to meet the specific needs of patients with bipolar II disorder.
Collapse
Affiliation(s)
- Danielle M Novick
- Outpatient Mood Disorders Clinic and Clinical Training Committee, VA Pittsburgh Healthcare System (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine (Swartz)
| | - Holly A Swartz
- Outpatient Mood Disorders Clinic and Clinical Training Committee, VA Pittsburgh Healthcare System (Novick); Department of Psychiatry, University of Pittsburgh School of Medicine (Swartz)
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW Disruptions in circadian rhythms are believed to underlie the illness course of bipolar disorder (BD). This review evaluates recent studies on the treatment of circadian dysfunction in BD. RECENT FINDINGS Targeted social rhythm therapy may be useful for bipolar depression though some studies suggest that a non-targeted psychosocial or pharmacological intervention may be just as efficacious. Lithium holds potential for addressing circadian dysfunction in BD. Blue-blocking therapy may be useful for mania and midday bright light therapy may relieve depression. CONCLUSIONS Psychosocial, pharmacological, and light-based approaches are promising avenues for treating circadian dysfunction in BD.
Collapse
Affiliation(s)
- Alexandra K. Gold
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Boston, MA 02215, USA
| | - Gustavo Kinrys
- Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| |
Collapse
|
13
|
Disease management apps and technical assistance systems for bipolar disorder: Investigating the patients´ point of view. J Affect Disord 2018; 229:351-357. [PMID: 29331693 DOI: 10.1016/j.jad.2017.12.059] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/16/2017] [Accepted: 12/30/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Smartphone-based disease management has become increasingly interesting for research in the field of bipolar disorders. This article investigates the attitudes of persons affected by this disorder towards the appropriation of mobile apps or assistance systems for the management of their disease. METHODS We conducted two separate studies. Study 1 was an online survey with 88 participants. In study 2 we consulted 15 participants during a semi-structured interview. All the participants had formerly been diagnosed with bipolar disorder. RESULTS More than half of the participants of study 1 and most participants of study 2 agreed with the use of an app or assistance system for self-ratings, third party ratings and an objective symptom monitoring. Potential interventions that were popular in both groups included a regular feedback, the visualization of monitored data and advice in crises. LIMITATIONS With study 1 we were not able to ensure correct diagnoses or to interact in a flexible way. In Study 2 those issues were resolved, but the small number of participants raises the question of a possible generalisability of the results. Furthermore, for both studies a selection bias could not be excluded. CONCLUSIONS Our results indicate positive attitudes of bipolar patients towards disease management apps and assistance systems. Even new and innovative features such as partner apps or the analysis of facial expressions in video data were appreciated and daily interactions were favoured. However, the variety of answers calls for flexible systems which allow activating or deactivating certain features.
Collapse
|
14
|
Van der Watt ASJ, Roos T, Beyer C, Seedat S. Participants' perspectives of weekly telephonic mood monitoring in South Africa: a feasibility study. Pilot Feasibility Stud 2018; 4:56. [PMID: 29484200 PMCID: PMC5824463 DOI: 10.1186/s40814-018-0245-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mood and anxiety disorders have a high lifetime prevalence, and their chronicity adds to the management burden of already scarce and strained mental health care resources, particularly in developing countries. Non-professional-assisted interventions and technology (such as weekly telephonic mood monitoring) could assist in the early identification of symptoms of relapse and hospitalization prevention. The present study aimed to determine participants' perspectives and the feasibility of weekly telephonic mood monitoring in order to inform the development of the full study. METHOD Semi-structured telephonic interviews (n = 37; 89.2% female; mean age = 33.1 years) were conducted as part of the full-scale feasibility study (N = 61; named the Bipolar Disorder Mood Monitoring (BDMM) Study). The BDMM Study was conducted to determine the viability of weekly telephonic mood monitoring, spanning 26 weeks and starting 1 week post-discharge. Frequency and descriptive statistical analyses (using SPSS version 24) were undertaken, and qualitative data were analyzed using thematic content analysis. RESULTS This article presents the findings from the semi-structured interview section of the BDMM Study. Participants generally expressed positive experiences and perceptions of weekly telephonic mood monitoring, stating that they would advise others to also take part in weekly telephonic mood monitoring. Nonetheless, some participants did make suggestions for improvement of mood monitoring while others expressed negative experiences of weekly telephonic mood monitoring. CONCLUSION The results of the semi-structured interviews of the BDMM Study indicated that participants perceived weekly telephonic mood monitoring to be helpful in lightening the burden of mood and anxiety disorders (e.g., having someone to talk to, providing insight into their disorders). Not only did it help them, but they also perceived mood monitoring to be potentially helpful to future participants. However, weekly mood monitoring was also burdensome in itself (including being too time consuming and having to answer questions when feeling down). Importantly, the findings highlighted that participants' and researchers' perceptions and experiences may not be congruent (especially in terms of therapeutic misconception). The current findings may inform researchers' future approach to study design and participant relationships.
Collapse
Affiliation(s)
- A. S. J. Van der Watt
- Department of Psychiatry, Stellenbosch University, PO Box 19063, Francie van Zijl Drive, Cape Town, 7505 South Africa
| | - T. Roos
- Department of Psychiatry, University of Cape Town, Anzio Rd, Cape Town, 7925 South Africa
| | - C. Beyer
- Department of Medicine and Allied Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505 South Africa
| | - S. Seedat
- Department of Psychiatry, Stellenbosch University, PO Box 19063, Francie van Zijl Drive, Cape Town, 7505 South Africa
| |
Collapse
|
15
|
Faurholt-Jepsen M, Bauer M, Kessing LV. Smartphone-based objective monitoring in bipolar disorder: status and considerations. Int J Bipolar Disord 2018; 6:6. [PMID: 29359252 PMCID: PMC6161968 DOI: 10.1186/s40345-017-0110-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 12/19/2017] [Indexed: 12/19/2022] Open
Abstract
In 2001, the WHO stated that: "The use of mobile and wireless technologies to support the achievement of health objectives (mHealth) has the potential to transform the face of health service delivery across the globe". Within mental health, interventions and monitoring systems for depression, anxiety, substance abuse, eating disorder, schizophrenia and bipolar disorder have been developed and used. The present paper presents the status and findings from studies using automatically generated objective smartphone data in the monitoring of bipolar disorder, and addresses considerations on the current literature and methodological as well as clinical aspects to consider in the future studies.
Collapse
Affiliation(s)
- Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| |
Collapse
|
16
|
McKnight RF, Bilderbeck AC, Miklowitz DJ, Hinds C, Goodwin GM, Geddes JR. Longitudinal mood monitoring in bipolar disorder: Course of illness as revealed through a short messaging service. J Affect Disord 2017; 223:139-145. [PMID: 28753472 DOI: 10.1016/j.jad.2017.07.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/05/2017] [Accepted: 07/08/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Online self-monitoring of mood can be used to investigate differences in course patterns across patient groups. This study explored the feasibility of remote symptom capture with True Colours, a self-rated online mood monitoring tool completed on a weekly basis. METHODS Participants with bipolar disorder (N = 297) completed weekly depression and mania questionnaires over an average of 27.5 months (range 1 -81 months). Subgroups defined by sex, age, and bipolar I vs. II status were compared on time in various mood states, number of episodes, and week-to-week mood variability. RESULTS Compliance with weekly questionnaires was generally high (median, 92% of weeks). Mood symptoms occurred for an average of 55.4% of weeks across the follow-up period. Females spent more time with hypomanic/manic and depressive symptoms and had more depressive episodes compared to males. Younger participants were found to experience more hypomanic/manic episodes and showed greater variability in mood symptoms than older participants. No significant differences in mood symptoms or variability were observed between bipolar I and II patients. LIMITATIONS This was a naturalistic study with a heterogeneous cohort, and did not include a control group. True Colours does not identify mood fluctuations that may occur in the days between weekly assessments. CONCLUSIONS Monitoring moods through an online tool is both feasible and informative regarding course of illness in patients with bipolar disorder. Interventions aiming to reduce mood variability and manic/hypomanic episodes in the early phases of bipolar disorder may enhance the long-term symptomatic course of the illness.
Collapse
Affiliation(s)
- Rebecca F McKnight
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
| | - Amy C Bilderbeck
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - David J Miklowitz
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK; UCLA Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry & David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Christopher Hinds
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| |
Collapse
|
17
|
Pakpour AH, Modabbernia A, Lin CY, Saffari M, Ahmadzad Asl M, Webb TL. Promoting medication adherence among patients with bipolar disorder: a multicenter randomized controlled trial of a multifaceted intervention. Psychol Med 2017; 47:2528-2539. [PMID: 28446253 DOI: 10.1017/s003329171700109x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The present research aimed to investigate the efficacy of a multifaceted intervention that included motivational interviewing (MI) and psychoeducation in improving medication adherence (MA) among patients with bipolar disorder (BD). METHOD A multicenter, cluster randomized, observer-blind, controlled, parallel-group trial was conducted in ten academic centers in Iran. Patients with BD were randomly assigned to the experimental group (EXP; n = 136) or the usual care group (UC; n = 134). The EXP group received five sessions of MI and psychoeducation together with their family members. The primary outcome measure was changes in scores on the Medication Adherence Rating Scale from baseline to 6 months post-intervention. Other outcome measures included serum levels of mood stabilizers, clinical symptoms, quality of life, as well as measures of intention, beliefs about medicine, perceived behavioral control, automaticity, action and coping planning, and adverse reactions. RESULTS Medication adherence improved over time in both groups, but patients in the EXP group improved more (baseline score: 6.03; score at the sixth month: 9.55) than patients in the UC group (baseline score: 6.17; score at the sixth month: 6.67). In addition, patients in the EXP group showed greater improvement than patients in the UC group in almost all secondary outcomes 6 months following the intervention. CONCLUSIONS Multifaceted interventions that include motivational-interviewing and psychoeducation can significantly improve MA and clinical and functional outcomes in patients with BD. TRIAL REGISTRATION NUMBER The trial was registered with theClinicalTrials.gov database (NCT02241863) https://clinicaltrials.gov/ct2/show/NCT02241863.
Collapse
Affiliation(s)
- A H Pakpour
- Social Determinants of Health Research Center,Qazvin University of Medical Sciences,Qazvin,Iran
| | - A Modabbernia
- Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York, NY,USA
| | - C-Y Lin
- Department of Rehabilitation Sciences, Faculty of Health & Social Sciences,The Hong Kong Polytechnic University,Hung Hom,Hong Kong
| | - M Saffari
- Health Research Center, Baqiyatallah University of Medical Sciences,Tehran,Iran
| | - M Ahmadzad Asl
- Mental Health Research Center,School of Medicine,Department of Psychiatry,Iran University of Medical Sciences,Tehran,IR Iran
| | - T L Webb
- Department of Psychology,The University of Sheffield,Sheffield,UK
| |
Collapse
|
18
|
Freeman D, Sheaves B, Goodwin GM, Yu LM, Nickless A, Harrison PJ, Emsley R, Luik AI, Foster RG, Wadekar V, Hinds C, Gumley A, Jones R, Lightman S, Jones S, Bentall R, Kinderman P, Rowse G, Brugha T, Blagrove M, Gregory AM, Fleming L, Walklet E, Glazebrook C, Davies EB, Hollis C, Haddock G, John B, Coulson M, Fowler D, Pugh K, Cape J, Moseley P, Brown G, Hughes C, Obonsawin M, Coker S, Watkins E, Schwannauer M, MacMahon K, Siriwardena AN, Espie CA. The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis. Lancet Psychiatry 2017; 4:749-758. [PMID: 28888927 PMCID: PMC5614772 DOI: 10.1016/s2215-0366(17)30328-0] [Citation(s) in RCA: 383] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/16/2017] [Accepted: 07/19/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations. METHODS We did this single-blind, randomised controlled trial (OASIS) at 26 UK universities. University students with insomnia were randomly assigned (1:1) with simple randomisation to receive digital cognitive behavioural therapy (CBT) for insomnia or usual care, and the research team were masked to the treatment. Online assessments took place at weeks 0, 3, 10 (end of therapy), and 22. The primary outcome measures were for insomnia, paranoia, and hallucinatory experiences. We did intention-to-treat analyses. The trial is registered with the ISRCTN registry, number ISRCTN61272251. FINDINGS Between March 5, 2015, and Feb 17, 2016, we randomly assigned 3755 participants to receive digital CBT for insomnia (n=1891) or usual practice (n=1864). Compared with usual practice, the sleep intervention at 10 weeks reduced insomnia (adjusted difference 4·78, 95% CI 4·29 to 5·26, Cohen's d=1·11; p<0·0001), paranoia (-2·22, -2·98 to -1·45, Cohen's d=0·19; p<0·0001), and hallucinations (-1·58, -1·98 to -1·18, Cohen's d=0·24; p<0·0001). Insomnia was a mediator of change in paranoia and hallucinations. No adverse events were reported. INTERPRETATION To our knowledge, this is the largest randomised controlled trial of a psychological intervention for a mental health problem. It provides strong evidence that insomnia is a causal factor in the occurrence of psychotic experiences and other mental health problems. Whether the results generalise beyond a student population requires testing. The treatment of disrupted sleep might require a higher priority in mental health provision. FUNDING Wellcome Trust.
Collapse
Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Oxford, UK.
| | - Bryony Sheaves
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Oxford, UK
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Oxford, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alecia Nickless
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Oxford, UK
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, Manchester University, Manchester Academic Health Centre, Manchester, UK
| | - Annemarie I Luik
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK; Big Health Ltd, London, UK
| | - Russell G Foster
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK
| | - Vanashree Wadekar
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Christopher Hinds
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Ray Jones
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Stafford Lightman
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, UK
| | - Steve Jones
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Richard Bentall
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Peter Kinderman
- Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Georgina Rowse
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Traolach Brugha
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, Centre for Medicine, University of Leicester, Leicester, UK
| | - Mark Blagrove
- Department of Psychology, University of Swansea, Swansea, UK
| | - Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Leanne Fleming
- Department of Psychology, University of Strathclyde, Glasgow, UK
| | - Elaine Walklet
- Department of Psychology, Institute of Health and Society, University of Worcester, Worcester, UK
| | - Cris Glazebrook
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Healthcare Research MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - E Bethan Davies
- National Institute for Healthcare Research MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Chris Hollis
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Healthcare Research MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Bev John
- School of Psychology and Therapeutic Studies, University of South Wales, Treforest, UK
| | - Mark Coulson
- Department of Psychology, School of Science and Technology, University of Middlesex, London, UK
| | - David Fowler
- Department of Psychology, University of Sussex, Brighton, UK; Sussex Partnership NHS Foundation Trust, Worthing, UK
| | | | - John Cape
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter Moseley
- School of Psychology, University of Central Lancashire, Preston, UK
| | - Gary Brown
- Psychology Department, Royal Holloway, Egham, UK
| | - Claire Hughes
- University of Cambridge Centre for Family Research, Cambridge, UK
| | - Marc Obonsawin
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow UK
| | - Sian Coker
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Edward Watkins
- SMART Lab, College of Life and Environmental Sciences, Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Matthias Schwannauer
- School of Health in Social Sciences, University of Edinburgh, Medical School, Edinburgh, UK
| | - Kenneth MacMahon
- School of Health in Social Sciences, University of Edinburgh, Medical School, Edinburgh, UK
| | | | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK; Big Health Ltd, London, UK
| |
Collapse
|