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Tonon AC, Nexha A, Mendonça da Silva M, Gomes FA, Hidalgo MP, Frey BN. Sleep and circadian disruption in bipolar disorders: From psychopathology to digital phenotyping in clinical practice. Psychiatry Clin Neurosci 2024. [PMID: 39210713 DOI: 10.1111/pcn.13729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/11/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024]
Abstract
Sleep and biological rhythms are integral to mood regulation across the lifespan, particularly in bipolar disorder (BD), where alterations in sleep phase, structure, and duration occur in all mood states. These disruptions are linked to poorer quality of life, heightened suicide risk, impaired cognitive function, and increased relapse rates. This review highlights the pathophysiology of sleep disturbances in BD and aims to consolidate understanding and clinical applications of these phenomena. It also summarizes the evolution of sleep and biological rhythms assessment methods, including ecological momentary assessment (EMA) and digital phenotyping. It underscores the importance of recognizing circadian rhythm involvement in mood regulation, suggesting potential therapeutic targets. Future research directions include elucidating circadian clock gene mechanisms, understanding environmental impacts on circadian rhythms, and investigating the bidirectional relationship between sleep disturbances and mood regulation in BD. Standardizing assessment methods and addressing privacy concerns related to EMA technology and digital phenotyping are essential for advancing research. Collaborative efforts are crucial for enhancing clinical applicability and understanding the broader implications of biological rhythms in BD diagnosis and treatment. Overall, recognizing the significance of sleep and biological rhythms in BD offers promise for improved outcomes through targeted interventions and a deeper understanding of the disorder's underlying mechanisms.
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Affiliation(s)
- André C Tonon
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Adile Nexha
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Mariana Mendonça da Silva
- Laboratório de Cronobiologia e Sono, Porto Alegre Clinicas Hospital, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Fabiano A Gomes
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Maria Paz Hidalgo
- Laboratório de Cronobiologia e Sono, Porto Alegre Clinicas Hospital, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Benicio N Frey
- Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Kessing LV, Tønning ML, Busk J, Rohani D, Frost M, Bardram JE, Faurholt-Jepsen M. Mood instability in patients with unipolar depression measured using smartphones and the association with measures of wellbeing, recovery and functioning. Nord J Psychiatry 2024; 78:518-524. [PMID: 38905155 DOI: 10.1080/08039488.2024.2369179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/27/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE While mood instability is strongly linked to depression, its ramifications remain unexplored. In patients diagnosed with unipolar depression (UD), our objective was to investigate the association between mood instability, calculated based on daily smartphone-based patient-reported data on mood, and functioning, quality of life, perceived stress, empowerment, rumination, recovery, worrying and wellbeing. METHODS Patients with UD completed daily smartphone-based self-assessments of mood for 6 months, making it possible to calculate mood instability using the Root Mean Squared Successive Difference (rMSSD) method. A total of 59 patients with UD were included. Data were analyzed using mixed effects regression models. RESULTS There was a statistically significant association between increased mood instability and increased perceived stress (adjusted model: B: 0.010, 95% CI: 0.00027; 0.021, p = 0.044), and worrying (adjusted model: B: 0.0060, 95% CI: 0.000016; 0.012, p = 0.049), and decreased quality of life (adjusted model: B: -0.0056, 95% CI: -0.011; -0.00028, p = 0.039), recovery (adjusted model: B: -0.032, 95% CI: -0.0059; -0.00053, p = 0.019) and wellbeing. There were no statistically significant associations between mood instability and functioning, empowerment, and rumination (p's >0.09). CONCLUSION These findings underscore the significant influence of mood instability on patients' daily lives. Identification of mood fluctuations offer potential insights into the trajectory of the illness in these individuals.
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Affiliation(s)
- Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Lindberg Tønning
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg, Denmark
| | - Jonas Busk
- Department of Energy Conversion and Storage, Technical University of Denmark, Lyngby, Denmark
| | | | | | - Jakob Eyvind Bardram
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Stokholm JR, Vinberg M, Faurholt-Jepsen M, Kessing LV. Study protocol: group-based psychoeducation for relatives of patients with bipolar disorder-a large scale real-world randomized controlled parallel group trial, the R-bipolar RCT. Trials 2024; 25:342. [PMID: 38783322 PMCID: PMC11119791 DOI: 10.1186/s13063-024-08172-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Relatives of patients with bipolar disorder (BD) often experience emotional burden with stress and depressive symptoms that again increase the likelihood of destabilization and relapses in the patient. The effects of group-based psychoeducation have not been investigated in large-scale real-world settings. We are currently conducting a large-scale real-world randomized controlled parallel group trial (RCT) to test whether group-based psychoeducation for 200 relatives to patients with BD improves mood instability and other critical outcomes in relatives and the corresponding patients with BD. METHODS The trial is designed as a two-arm, parallel-group randomized trial with a balanced randomization 1:1 to either group-based psychoeducation or a waiting list for approximately 4 months and subsequent group-based psychoeducation. The primary outcome measure is mood instability calculated based on daily smartphone-based mood self-assessments. Other relevant outcomes are measured, including patients' reported outcomes, assessing self-assessed burden, self-efficacy, and knowledge about BD. DISCUSSION This protocol describes our currently ongoing randomized controlled trial (RCT) that aims at investigating group-based psychoeducation as an intervention for relatives of individuals diagnosed with bipolar disorder (BD). The study is the first large-scale real-world RCT to focus on a relatively short intervention of psychoeducation (6 sessions of 2 h each) in a large group of relatives (approximately 30 participants per group). With this focus, we wish to test an intervention that is feasible to implement in real-life psychiatric settings with limited budgets and time. It is also the first study to use mood instability in relatives as the primary outcome measure and to investigate whether mood instability and other affective symptoms in patients and relatives covary. It could be considered as limitations, that the trial is not blinded and does not include long-term follow-up. TRIAL REGISTRATION ClinicalTrials.gov NCT06176001. Registered on 2023-12-19. The study is approved by the data agency (P-2021-809). The project was allowed to be initiated without permission from the Scientific Ethical Committees for the Capital Region, because it according to section 1, paragraph 4 of the Committee Act was not defined as a health scientific intervention study (case number 21063013).
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Affiliation(s)
- Julie Ravneberg Stokholm
- Psychiatric Center Copenhagen, The Copenhagen Affective Disorder Research Center (CADIC), Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Maj Vinberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre Northern Zealand, Hillerød, Denmark
| | - Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, The Copenhagen Affective Disorder Research Center (CADIC), Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, The Copenhagen Affective Disorder Research Center (CADIC), Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Rowe AL, Perich T, Meade T. Childhood cumulative trauma, social support and stress as predictors of illness outcomes and quality of life in bipolar disorder. Aust N Z J Psychiatry 2024; 58:334-344. [PMID: 37941361 PMCID: PMC10960312 DOI: 10.1177/00048674231209225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE Trauma, social support and stress have been identified as factors which may be associated with the bipolar disorder illness course. However, these are yet to be examined in prospective studies as predictors of illness outcomes and overall quality of life in bipolar disorder. METHOD One hundred and fourteen participants (N = 97; 85.1% female) living with bipolar disorder I (41.2%) or II (58.8%) completed a semi-structured interview and a range of self-report measures assessing trauma history, social support, perceived stress, depression, anxiety, mania, suicidality, number of mood episodes and quality of life, at baseline and 6-month follow-up. RESULTS Childhood cumulative trauma, social support and perceived stress accounted for a substantial and significant portion of the variance in quality of life (62%; 23.6%), anxiety severity (34.6%; 24.5%) and depression severity (49.6%; 26.7%), at both baseline and 6-month follow-up. Perceived stress made significant unique contributions to the prediction of all outcomes, and social support made significant unique contributions to depression and quality of life in bipolar disorder. CONCLUSION Stress and social support play an important role in bipolar disorder and in quality of life for people living with this condition. Given that stress and social support are modifiable risk factors, this provides a promising direction for future intervention-based research.
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Affiliation(s)
- Amy-Leigh Rowe
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Tania Perich
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Tanya Meade
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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Sperry S, Yocum A, McInnis M. Beyond traditional metrics: A novel method for measuring mood instability in bipolar disorder. RESEARCH SQUARE 2024:rs.3.rs-3880090. [PMID: 38343860 PMCID: PMC10854331 DOI: 10.21203/rs.3.rs-3880090/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Background Clinical care for bipolar disorder (BD) has a narrow focus on prevention and remission of episodes with pre/post treatment reductions in symptom severity as the 'gold standard' for outcomes in clinical trials and measurement-based care strategies. The study aim was to provide a novel method for measuring outcomes in BD that has clinical utility and can stratify individuals with BD based on mood instability. Methods Participants were 603 with a BD (n=385), other or non-affective disorder (n=71), or no psychiatric history (n=147) enrolled in an intensive longitudinal cohort for at least 10 years that collects patient reported outcomes measures (PROMs) assessing depression, (hypo)mania, anxiety, and functioning every two months. Mood instability was calculated as the within-person variance of PROMs and stratified into low, moderate, and high thresholds, respectively. Outcomes Individuals with BD had significantly higher mood instability index's for depression, (hypo)mania, and anxiety compared to psychiatric comparisons (moderate effects, p's<.001) and healthy controls (large effects, p's<.001). A significantly greater proportion of individuals with BD fell into the moderate (depression: 52·8%; anxiety: 51·4%; (hypo)mania: 48·3%) and high instability thresholds (depression: 11·5%; anxiety: 9·1%; (hypo)mania: 10·8%) compared to psychiatric comparisons (moderate: 25·5 - 26·6%; high: 0% - 4·7%) and healthy controls (moderate: 2·9% - 17·1%; high: 0% - 1·4%). Being in the high or moderate instability threshold predicted worse health functioning (p's < .00, small to large effects). Interpretation Mood instability, as measured in commonly used PROMs, characterized the course of illness over time, correlated with functional outcomes, and significantly differentiated those with BD from healthy controls and psychiatric comparisons. Results suggest a paradigm shift in monitoring outcomes in BD, by measuring mood instability as a primary outcome index.
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Faurholt-Jepsen M, Kyster NB, Dyreholt MS, Christensen EM, Bondo-Kozuch P, Lerche AS, Smidt B, Knorr U, Brøndmark K, Cardoso AMB, Mathiesen A, Sjælland R, Nørbak-Emig H, Sponsor LL, Mardosas D, Sarauw-Nielsen IP, Bukh JD, Heller TV, Frost M, Iversen N, Bardram JE, Busk J, Vinberg M, Kessing LV. The effect of smartphone-based monitoring and treatment including clinical feedback versus smartphone-based monitoring without clinical feedback in bipolar disorder: the SmartBipolar trial-a study protocol for a randomized controlled parallel-group trial. Trials 2023; 24:583. [PMID: 37700334 PMCID: PMC10496351 DOI: 10.1186/s13063-023-07625-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION A substantial proportion of patients with bipolar disorder experience daily subsyndromal mood swings, and the term "mood instability" reflecting the variability in mood seems associated with poor prognostic factors, including impaired functioning, and increased risk of hospitalization and relapse. During the last decade, we have developed and tested a smartphone-based system for monitoring bipolar disorder. The present SmartBipolar randomized controlled trial (RCT) aims to investigate whether (1) daily smartphone-based outpatient monitoring and treatment including clinical feedback versus (2) daily smartphone-based monitoring without clinical feedback or (3) daily smartphone-based mood monitoring only improves mood instability and other clinically relevant patient-related outcomes in patients with bipolar disorder. METHODS AND ANALYSIS The SmartBipolar trial is a pragmatic randomized controlled parallel-group trial. Patients with bipolar disorder are invited to participate as part of their specialized outpatient treatment for patients with bipolar disorder in Mental Health Services in the Capital Region of Denmark. The included patients will be randomized to (1) daily smartphone-based monitoring and treatment including a clinical feedback loop (intervention group) or (2) daily smartphone-based monitoring without a clinical feedback loop (control group) or (3) daily smartphone-based mood monitoring only (control group). All patients receive specialized outpatient treatment for bipolar disorder in the Mental Health Services in the Capital Region of Denmark. The trial started in March 2021 and has currently included 150 patients. The outcomes are (1) mood instability (primary), (2) quality of life, self-rated depressive symptoms, self-rated manic symptoms, perceived stress, satisfaction with care, cumulated number and duration of psychiatric hospitalizations, and medication (secondary), and (3) smartphone-based measures per month of stress, anxiety, irritability, activity, and sleep as well as the percentage of days with presence of mixed mood, days with adherence to medication and adherence to smartphone-based self-monitoring. A total of 201 patients with bipolar disorder will be included in the SmartBipolar trial. ETHICS AND DISSEMINATION The SmartBipolar trial is funded by the Capital Region of Denmark and the Independent Research Fund Denmark. Ethical approval has been obtained from the Regional Ethical Committee in The Capital Region of Denmark (H-19067248) as well as data permission (journal number: P-2019-809). The results will be published in peer-reviewed academic journals, presented at scientific meetings, and disseminated to patients' organizations and media outlets. TRIAL REGISTRATION Trial registration number: NCT04230421. Date March 1, 2021. Version 1.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Natacha Blauenfeldt Kyster
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
| | - Malene Schwarz Dyreholt
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
| | - Ellen Margrethe Christensen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
| | - Pernille Bondo-Kozuch
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
| | - Anna Skovgaard Lerche
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
| | - Birte Smidt
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
| | - Ulla Knorr
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Brøndmark
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
| | - Anne-Marie Bangsgaard Cardoso
- The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Anja Mathiesen
- The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | | - Jakob Eyvind Bardram
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Jonas Busk
- Department of Energy Conversion and Storage, Technical University of Denmark, Lyngby, Denmark
| | - Maj Vinberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Hovedvejen 17, 1. Floor, 2000, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Faurholt-Jepsen M, Busk J, Bardram JE, Stanislaus S, Frost M, Christensen EM, Vinberg M, Kessing LV. Mood instability and activity/energy instability in patients with bipolar disorder according to day-to-day smartphone-based data - An exploratory post hoc study. J Affect Disord 2023; 334:83-91. [PMID: 37149047 DOI: 10.1016/j.jad.2023.04.139] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/21/2023] [Accepted: 04/29/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Alterations and instability in mood and activity/energy has been associated with impaired functioning and risk of relapse in bipolar disorder. The present study aimed to investigate whether mood instability and activity/energy instability are associated, and whether these instability measures are associated with stress, quality of life and functioning in patients with bipolar disorder. METHODS Data from two studies were combined for exploratory post hoc analyses. Patients with bipolar disorder provided smartphone-based evaluations of mood and activity/energy levels from day-to-day. In addition, information on functioning, perceived stress and quality of life was collected. A total of 316 patients with bipolar disorder were included. RESULTS A total of 55,968 observations of patient-reported smartphone-based data collected from day-to-day were available. Regardless of the affective state, there was a statistically significant positive association between mood instability and activity/energy instability in all models (all p-values < 0.0001). There was a statistically significant association between mood and activity/energy instability with patient-reported stress and quality of life (e.g., mood instability and stress: B: 0.098, 95 % CI: 0.085; 0.11, p < 0.0001), and between mood instability and functioning (B: 0.045, 95 % CI: 0.0011; 0.0080, p = 0.010). LIMITATIONS Findings should be interpreted with caution since the analyses were exploratory and post hoc by nature. CONCLUSION Mood instability and activity/energy instability is suggested to play important roles in the symptomatology of bipolar disorder. This highlight that monitoring and identifying subsyndromal inter-episodic fluctuations in symptoms is clinically recommended. Future studies investigating the effect of treatment on these measures would be interesting.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Jonas Busk
- Department of Energy Conversion and Storage, Technical University of Denmark, Lyngby, Denmark
| | - Jakob Eyvind Bardram
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Sharleny Stanislaus
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | | | - Ellen Margrethe Christensen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Maj Vinberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Faurholt-Jepsen M, Kessing LV. Monitoring and treatment in patients with bipolar disorder using smartphones-New perspectives for improved quality in patient care. Psychiatry Res 2022; 317:114844. [PMID: 36115167 DOI: 10.1016/j.psychres.2022.114844] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/29/2022] [Accepted: 09/10/2022] [Indexed: 01/04/2023]
Abstract
The rapid international growth in access to and capabilities of mobile and wireless technologies (mHealth) presents a feasible route towards augmenting traditional mental health care. The interest in mHealth science in psychiatry has been further heightened by the acknowledged potential for these tools to improve individual risk prediction and diagnostic precision, as well as improved treatment options. We have conducted research within smartphone-based monitoring and treatment in patients with bipolar disorder through the last decade. We conclude that the technological capabilities of smartphones are already changing mental health care and is accompanied by an early but promising evidence base. However, further efforts towards strengthening the evidence and implementation must be addressed for digital mental health technologies to truly improve mental health research and treatment in the future.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Copenhagen Affective disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Lars Vedel Kessing
- Copenhagen Affective disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Mood Instability in Youth at High Risk for Bipolar Disorder. J Am Acad Child Adolesc Psychiatry 2022; 61:1285-1295. [PMID: 35307538 PMCID: PMC9728243 DOI: 10.1016/j.jaac.2022.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/26/2021] [Accepted: 03/10/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Mood instability is associated with the onset of bipolar disorder (BD) in youth with a family history of the illness. In a clinical trial with youth at high risk for BD, we examined the association between mood instability and symptomatic, psychosocial, and familial functioning over an average of 2 years. METHOD Youth (aged 9-17 years) with major depressive disorder or other specified BD, current mood symptoms, and a family history of BD were rated by parents on a mood instability scale. Participants were randomly assigned to 4 months of family-focused therapy or enhanced care psychoeducation, both with medication management as needed. Independent evaluators rated youth every 4-6 months for up to 4 years on symptom severity and psychosocial functioning, whereas parents rated mood instability of the youth and levels of family conflict. RESULTS High-risk youth (N = 114; mean age 13.3 ± 2.6 years; 72 female) were followed for an average of 104.3 ± 65.8 weeks (range, 0-255 weeks) after randomization. Youth with other specified BD (vs major depressive disorder), younger age, earlier symptom onset, more severe mood symptoms, lower psychosocial functioning, and more familial conflict over time had higher mood instability ratings throughout the study period. Mood instability mediated the association between baseline diagnosis and mother/offspring conflict at follow-up (Z = 2.88, p = .004, αβ = 0.19, 95% CI = 0.06-0.32). Psychosocial interventions did not moderate these associations. CONCLUSION A questionnaire measure of mood instability tracked closely with symptomatic, psychosocial, and family functioning in youth at high risk for BD. Interventions that are successful in reducing mood instability may enhance long-term outcomes among high-risk youth. CLINICAL TRIAL REGISTRATION INFORMATION Early Intervention for Youth at Risk for Bipolar Disorder; https://clinicaltrials.gov/; NCT01483391.
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Anmella G, Faurholt‐Jepsen M, Hidalgo‐Mazzei D, Radua J, Passos IC, Kapczinski F, Minuzzi L, Alda M, Meier S, Hajek T, Ballester P, Birmaher B, Hafeman D, Goldstein T, Brietzke E, Duffy A, Haarman B, López‐Jaramillo C, Yatham LN, Lam RW, Isometsa E, Mansur R, McIntyre RS, Mwangi B, Vieta E, Kessing LV. Smartphone-based interventions in bipolar disorder: Systematic review and meta-analyses of efficacy. A position paper from the International Society for Bipolar Disorders (ISBD) Big Data Task Force. Bipolar Disord 2022; 24:580-614. [PMID: 35839276 PMCID: PMC9804696 DOI: 10.1111/bdi.13243] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The clinical effects of smartphone-based interventions for bipolar disorder (BD) have yet to be established. OBJECTIVES To examine the efficacy of smartphone-based interventions in BD and how the included studies reported user-engagement indicators. METHODS We conducted a systematic search on January 24, 2022, in PubMed, Scopus, Embase, APA PsycINFO, and Web of Science. We used random-effects meta-analysis to calculate the standardized difference (Hedges' g) in pre-post change scores between smartphone intervention and control conditions. The study was pre-registered with PROSPERO (CRD42021226668). RESULTS The literature search identified 6034 studies. Thirteen articles fulfilled the selection criteria. We included seven RCTs and performed meta-analyses comparing the pre-post change in depressive and (hypo)manic symptom severity, functioning, quality of life, and perceived stress between smartphone interventions and control conditions. There was significant heterogeneity among studies and no meta-analysis reached statistical significance. Results were also inconclusive regarding affective relapses and psychiatric readmissions. All studies reported positive user-engagement indicators. CONCLUSION We did not find evidence to support that smartphone interventions may reduce the severity of depressive or manic symptoms in BD. The high heterogeneity of studies supports the need for expert consensus to establish ideally how studies should be designed and the use of more sensitive outcomes, such as affective relapses and psychiatric hospitalizations, as well as the quantification of mood instability. The ISBD Big Data Task Force provides preliminary recommendations to reduce the heterogeneity and achieve more valid evidence in the field.
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Affiliation(s)
- Gerard Anmella
- Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institute of NeuroscienceHospital Clinic, University of Barcelona, IDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Maria Faurholt‐Jepsen
- Copenhagen Affective Disorder research Center (CADIC)Psychiatric Center CopenhagenCopenhagenDenmark
| | - Diego Hidalgo‐Mazzei
- Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institute of NeuroscienceHospital Clinic, University of Barcelona, IDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Joaquim Radua
- Imaging of Mood‐ and Anxiety‐Related Disorders (IMARD) groupIDIBAPS, CIBERSAMBarcelonaSpain,Early Psychosis: Interventions and Clinical‐detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Centre for Psychiatric Research and Education, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Ives C. Passos
- Laboratory of Molecular Psychiatry and Bipolar Disorder Program, Programa de Pós‐Graduação em Psiquiatria e Ciências do Comportamento, Centro de Pesquisa Experimental do Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Luciano Minuzzi
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Sandra Meier
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Tomas Hajek
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada,National Institute of Mental HealthKlecanyCzech Republic
| | - Pedro Ballester
- Neuroscience Graduate ProgramMcMaster UniversityHamiltonCanada
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and ClinicUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Danella Hafeman
- Department of Psychiatry, Western Psychiatric Institute and ClinicUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Tina Goldstein
- Department of Psychiatry, Western Psychiatric Institute and ClinicUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Elisa Brietzke
- Department of PsychiatryQueen's UniversityKingstonONCanada
| | - Anne Duffy
- Department of PsychiatryQueen's UniversityKingstonONCanada
| | - Benno Haarman
- Department of PsychiatryUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Carlos López‐Jaramillo
- Research Group in Psychiatry, Department of Psychiatry, Faculty of MedicineUniversity of AntioquiaMedellínColombia,Mood Disorders ProgramHospital Universitario San Vicente FundaciónMedellínColombia
| | - Lakshmi N. Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Raymond W. Lam
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Erkki Isometsa
- Department of PsychiatryUniversity of Helsinki and Helsinki University Central HospitalHelsinkiFinland
| | - Rodrigo Mansur
- Mood Disorders Psychopharmacology Unit (MDPU)University Health Network, University of TorontoTorontoONCanada
| | | | - Benson Mwangi
- Department of Psychiatry and Behavioral Sciences, UT Center of Excellence on Mood Disorders, McGovern Medical SchoolThe University of Texas Health Science Center at HoustonHoustonTXUSA
| | - Eduard Vieta
- Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institute of NeuroscienceHospital Clinic, University of Barcelona, IDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder research Center (CADIC)Psychiatric Center CopenhagenCopenhagenDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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A systematic review of engagement reporting in remote measurement studies for health symptom tracking. NPJ Digit Med 2022; 5:82. [PMID: 35768544 PMCID: PMC9242990 DOI: 10.1038/s41746-022-00624-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/01/2022] [Indexed: 01/25/2023] Open
Abstract
Remote Measurement Technologies (RMTs) could revolutionise management of chronic health conditions by providing real-time symptom tracking. However, the promise of RMTs relies on user engagement, which at present is variably reported in the field. This review aimed to synthesise the RMT literature to identify how and to what extent engagement is defined, measured, and reported, and to present recommendations for the standardisation of future work. Seven databases (Embase, MEDLINE and PsycINFO (via Ovid), PubMed, IEEE Xplore, Web of Science, and Cochrane Central Register of Controlled Trials) were searched in July 2020 for papers using RMT apps for symptom monitoring in adults with a health condition, prompting users to track at least three times during the study period. Data were synthesised using critical interpretive synthesis. A total of 76 papers met the inclusion criteria. Sixty five percent of papers did not include a definition of engagement. Thirty five percent included both a definition and measurement of engagement. Four synthetic constructs were developed for measuring engagement: (i) engagement with the research protocol, (ii) objective RMT engagement, (iii) subjective RMT engagement, and (iv) interactions between objective and subjective RMT engagement. The field is currently impeded by incoherent measures and a lack of consideration for engagement definitions. A process for implementing the reporting of engagement in study design is presented, alongside a framework for definition and measurement options available. Future work should consider engagement with RMTs as distinct from the wider eHealth literature, and measure objective versus subjective RMT engagement.Registration: This review has been registered on PROSPERO [CRD42020192652].
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12
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Patapoff M, Ramsey M, Titone M, Kaufmann CN, Malhotra A, Ancoli-Israel S, Wing D, Lee E, Eyler LT. Temporal relationships of ecological momentary mood and actigraphy-based sleep measures in bipolar disorder. J Psychiatr Res 2022; 150:257-263. [PMID: 35405410 PMCID: PMC9107496 DOI: 10.1016/j.jpsychires.2022.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 03/16/2022] [Accepted: 03/31/2022] [Indexed: 02/01/2023]
Abstract
Sleep disturbances are a key feature of bipolar disorder (BD), and poor sleep has been linked to mood symptoms. Recent use of ecological momentary assessment (EMA) has allowed for nuanced exploration of the sleep-mood link; though, the scale and directionality of this relationship is still unclear. Using EMA, actigraphy, and self-reported sleep measures, this study examines the concurrent and predictive relationships between sleep and mood. Participants with BD (n = 56) wore actigraphy devices for up to 14 days and completed validated scales and daily EMA surveys about mood and sleep quality. Linear mixed models were used to examine overall and time-lagged relationships between sleep and mood variables. EMA mood ratings were correlated with validated rating scales for depression, mania, anxiety, and impulsivity. Poor self-reported sleep quality was associated with worse overall ratings of sadness and anger. Worse self-reported sleep quality was associated with greater sadness the following day. Higher daytime impulsivity was associated with worse sleep quality the following night. Exploratory analyses found relationships between worse and more variable mood (sadness, anger, and impulsivity) with worse and more variable sleep that evening (efficiency, WASO, and sleep onset time). The sample size was modest, fairly homogenous, and included mainly euthymic persons with BD. EMA-based assessments of mood and sleep are correlated with validated scale scores and provide novel insight into intra-individual variability. Further work on the complex two-way interactions between sleep and mood is needed to better understand how to improve outcomes in BD.
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Affiliation(s)
- Molly Patapoff
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 92093, USA
| | - Marina Ramsey
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 92093, USA
| | - Madison Titone
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 92093, USA; Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - Christopher N Kaufmann
- Division of Geriatrics and Gerontology, Department of Medicine, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 92093, USA
| | - Atul Malhotra
- Department of Medicine, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 92093, USA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 92093, USA
| | - David Wing
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 92093, USA
| | - Ellen Lee
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 92093, USA; Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - Lisa T Eyler
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, 9500 Gilman Dr. La Jolla, CA, 92093, USA; Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA.
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13
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Fletcher K, Lindblom K, Seabrook E, Foley F, Murray G. Pilot Testing in the Wild: Feasibility, Acceptability, Usage Patterns, and Efficacy of an Integrated Web and Smartphone Platform for Bipolar II Disorder. JMIR Form Res 2022; 6:e32740. [PMID: 35639462 PMCID: PMC9198820 DOI: 10.2196/32740] [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: 08/09/2021] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Bipolar II disorder (BD-II) is associated with significant burden, disability, and mortality; however, there continues to be a dearth of evidence-based psychological interventions for this condition. Technology-mediated interventions incorporating self-management have untapped potential to help meet this need as an adjunct to usual clinical care. OBJECTIVE The objective of this pilot study is to assess the feasibility, acceptability, and clinical utility of a novel intervention for BD-II (Tailored Recovery-oriented Intervention for Bipolar II Experiences; TRIBE), in which mindfulness-based psychological content is delivered via an integrated web and smartphone platform. The focus of the study is evaluation of the dynamic use patterns emerging from ecological momentary assessment and intervention to assist the real-world application of mindfulness skills learned from web-delivered modules. METHODS An open trial design using pretest and posttest assessments with nested qualitative evaluation was used. Individuals (aged 18-65 years) with a diagnosis of BD-II were recruited worldwide and invited to use a prototype of the TRIBE intervention over a 3-week period. Data were collected via web-based questionnaires and phone interviews at baseline and 3-week follow-up. RESULTS A total of 25 participants completed baseline and follow-up assessments. Adherence rates (daily app use) were 65.6% across the 3-week study, with up to 88% (22/25) of participants using the app synergistically alongside the web-based program. Despite technical challenges with the prototype intervention (from user, hardware, and software standpoints), acceptability was adequate, and most participants rated the intervention positively in terms of concept (companion app with website: 19/25, 76%), content (19/25, 76%), and credibility and utility in supporting their management of bipolar disorder (17/25, 68%). Evaluation using behavioral archetypes identified important use pathways and a provisional model to inform platform refinement. As hypothesized, depression scores significantly decreased after the intervention (Montgomery-Asberg Depression Rating Scale baseline mean 8.60, SD 6.86, vs follow-up mean 6.16, SD 5.11; t24=2.63; P=.01; Cohen d=0.53, 95% CI 0.52-4.36). CONCLUSIONS Our findings suggest that TRIBE is feasible and represents an appropriate and acceptable self-management program for patients with BD-II. Preliminary efficacy results are promising and support full development of TRIBE informed by the present behavioral archetype analysis. Modifications suggested by the pilot study include increasing the duration of the intervention and increasing technical support.
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Affiliation(s)
- Kathryn Fletcher
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Katrina Lindblom
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Elizabeth Seabrook
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Fiona Foley
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
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14
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Kessing LV, Faurholt-Jepsen M. Mood instability - A new outcome measure in randomised trials of bipolar disorder? Eur Neuropsychopharmacol 2022; 58:39-41. [PMID: 35219178 DOI: 10.1016/j.euroneuro.2022.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 12/20/2022]
Affiliation(s)
- Lars Vedel Kessing
- Copenhagen Affective disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Maria Faurholt-Jepsen
- Copenhagen Affective disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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15
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Saccaro LF, Amatori G, Cappelli A, Mazziotti R, Dell'Osso L, Rutigliano G. Portable technologies for digital phenotyping of bipolar disorder: A systematic review. J Affect Disord 2021; 295:323-338. [PMID: 34488086 DOI: 10.1016/j.jad.2021.08.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/30/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bias-prone psychiatric interviews remain the mainstay of bipolar disorder (BD) assessment. The development of digital phenotyping promises to improve BD management. We present a systematic review of the evidence about the use of portable digital devices for the identification of BD, BD types and BD mood states and for symptom assessment. METHODS We searched Web of KnowledgeSM, Scopus ®, IEEE Xplore, and ACM Digital Library databases (until 5/1/2021) for articles evaluating the use of portable/wearable digital devices, such as smartphone apps, wearable sensors, audio and/or visual recordings, and multimodal tools. The protocol is registered in PROSPERO (CRD42020200086). RESULTS We included 62 studies (2325 BD; 724 healthy controls, HC): 27 using smartphone apps, either for recording self-assessments (n = 10) or for passively gathering metadata (n = 7) or both (n = 10); 15 using wearable sensors for physiological parameters; 17 analysing audio and/or video recordings; 3 using multiple technologies. Two thirds of the included studies applied artificial intelligence (AI)-based approaches. They achieved fair to excellent classification performances. LIMITATIONS The included studies had small sample sizes and marked heterogeneity. Evidence of overfitting emerged, limiting generalizability. The absence of clear guidelines about reporting classification performances, with no shared standard metrics, makes results hardly interpretable and comparable. CONCLUSIONS New technologies offer a noteworthy opportunity to BD digital phenotyping with objectivity and high granularity. AI-based models could deliver important support in clinical decision-making. Further research and cooperation between different stakeholders are needed for addressing methodological, ethical and socio-economic considerations.
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Affiliation(s)
- Luigi F Saccaro
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy; Department of Clinical Neurosciences, Geneva University Hospital (HUG), Geneva, Switzerland
| | - Giulia Amatori
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Raffaele Mazziotti
- Institute of Neuroscience of the Italian National Research Council (CNR), Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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16
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Knorr U, Blom RA, Simonsen AH, Poulsen HE, Akhøj M, Forman J, Hasselbalch SG, Kessing LV. Associations between oxidative stress and perceived stress in patients with bipolar disorder and healthy control individuals. Nord J Psychiatry 2021; 75:532-537. [PMID: 33781161 DOI: 10.1080/08039488.2021.1901987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Patients with neurodegenerative disorders, schizophrenia, and bipolar disorder present with increased oxidative stress markers. Not only is oxidative stress associated with development of disease, but also with increased disease progression and mortality. Oxidative stress reflects an increase in pro-oxidants, which subsequently leads to oxidative modifications of cellular components, such as RNA and DNA. Urinary excretion of 8-oxo-7,8-dihydroguanosine (8-oxoGuo) and 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) is the valid marker of whole-body RNA and DNA damage, respectively. Recently, cerebrospinal fluid (CSF) oxidative stress markers of RNA damage (8-oxoGuo) have showed both state and trait dependence in patients with bipolar disorder. However, the relation to subjective measures of stress and quality of life (QoL) is unknown. MATERIALS AND METHODS This prospective, longitudinal 1-year follow-up case-control study investigated the association between the oxidative stress markers, 8-oxoGuo and 8-oxodG and, perceived stress and QoL in patients with bipolar disorder (n = 86, 51% female) and gender-and-age-matched healthy control (HC) individuals (n = 44, 44% female). Oxidative stress markers obtained in CSF and urine were analysed using ultra-performance liquid chromatography-tandem mass spectrometry. The subjective perception of stress was assessed using the Perceived Stress Scale. Subjective evaluation of QoL was assessed using the World Health Organization Quality of Life questionnaire. RESULTS AND CONCLUSION We found that markers of oxidative stress in CSF and urine were not associated with perceived stress and QoL quality in patients with bipolar disorder. However, a putative association between urinary 8-oxoGuo oxidative stress marker for RNA damage and perceived stress in HC encourages further investigations.
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Affiliation(s)
- Ulla Knorr
- Faculty of Health and Medical Sciences, Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Ahrens Blom
- Faculty of Health and Medical Sciences, Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Anja Hviid Simonsen
- Faculty of Health and Medical Sciences, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Enghusen Poulsen
- Faculty of Health and Medical Sciences, Laboratory of Clinical Pharmacology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Pharmacology, Faculty of Health and Medical Sciences, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Akhøj
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Julie Forman
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Steen Gregers Hasselbalch
- Faculty of Health and Medical Sciences, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Faculty of Health and Medical Sciences, Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
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17
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Dubad M, Elahi F, Marwaha S. The Clinical Impacts of Mobile Mood-Monitoring in Young People With Mental Health Problems: The MeMO Study. Front Psychiatry 2021; 12:687270. [PMID: 34393850 PMCID: PMC8363129 DOI: 10.3389/fpsyt.2021.687270] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/30/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Limited evidence suggests that mobile mood-monitoring can improve mental health outcomes and therapeutic engagement in young people. The aim of this mixed methods study was to explore the clinical impacts of mobile mood-monitoring in youth with mental health problems, using a publicly accessible app. Methods: Twenty-three patients with mental health problems and 24 young people without mental health problems participated in the quantitative study. Participants monitored their mood using a mood-monitoring app twice a day for 3 weeks, which was preceded by a 3-week baseline period. Outcome measures included momentary and retrospective assessments of affect regulation (all participants) and therapeutic engagement (patients only). Following the quantitative study, patients (n = 7) and their clinicians (n = 6) participated in individual interviews. Interview data was analysed using thematic analysis. Results: Use of the mood-monitoring app significantly reduced momentary negative mood (p < 0.001) and retrospectively assessed impulsivity across all 47 participants (p = 0.001). All other outcomes showed no significant difference. Qualitative feedback similarly indicated the potential of apps to improve problems with impulsivity in patients. Furthermore, apps may aid communication, promote empowerment, and ameliorate memory difficulties in clinical appointments. Conclusions: This mixed methods study demonstrated the potential utility of apps for clinical practice. Apps may potentially be an interventional tool, or at a minimum, an adjunct to existing treatments. Data was collected from a small sample size over a short study duration, limiting the generalisability of findings and inferences regarding long-term effects. Potential sources of bias in the qualitative study (e.g., researcher bias) should also be considered.
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Affiliation(s)
- Muna Dubad
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Farah Elahi
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Steven Marwaha
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- Specialist Mood Disorders Clinic, Zinnia Centre, Birmingham, United Kingdom
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18
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Wright K, Dodd AL, Warren FC, Medina-Lara A, Dunn B, Harvey J, Javaid M, Jones SH, Owens C, Taylor RS, Duncan D, Newbold A, Norman S, Warner F, Lynch TR. Psychological therapy for mood instability within bipolar spectrum disorder: a randomised, controlled feasibility trial of a dialectical behaviour therapy-informed approach (the ThrIVe-B programme). Int J Bipolar Disord 2021; 9:20. [PMID: 34195864 PMCID: PMC8245616 DOI: 10.1186/s40345-021-00226-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background A subgroup of those with bipolar spectrum disorders experience ongoing mood fluctuations outside of full episodes. We conducted a randomised, controlled feasibility study of a Dialectical Behavioural Therapy-informed approach for bipolar mood fluctuations (Therapy for Inter-episode mood Variability in Bipolar [ThrIVe-B]). Our study aimed to examine the feasibility and acceptability of a future definitive trial evaluating the clinical and cost effectiveness of the ThrIVe-B programme. Participants were required to meet diagnostic criteria for a bipolar spectrum disorder and report frequent mood swings outside of acute episodes. They were randomised to treatment as usual (control arm) or the ThrIVe-B intervention plus treatment as usual (intervention arm). Follow-up points were at 3, 6, 9 and 15 months after baseline, with 9 months as the primary end point. To evaluate feasibility and acceptability we examined recruitment and retention rates, completion rates for study measures, adverse events and feedback from participants on their experience of study participation and therapy. Results Of the target 48 participants, 43 were recruited (22 in the intervention arm; 21 in the control arm), with a recruitment rate of 3.9 participants per month. At 9 months 74% of participants engaged in research follow-up assessment, exceeding the pre-specified criterion of 60%. There were no serious concerns about the safety of the research procedures or the intervention. On one of the four candidate primary outcome measures, the 95% CI for the between-group mean difference score excluded the null effect and included the minimal clinically important difference, favouring the intervention arm, whilst on no measure was there evidence of deterioration in the intervention arm relative to the control arm. Attendance of the intervention (50% attending at least half of the mandatory sessions) was below the pre-specified continuation criterion of 60%, and qualitative feedback from participants indicated areas that may have hampered or facilitated engagement. Conclusions It is broadly feasible to conduct a trial of this design within the population of people with frequent bipolar mood swings. Changes should be made to the therapy to increase uptake, such as simplifying content and considering individual rather than group delivery. Trial registration ISRCTN: ISRCTN54234300. Registered 14th July 2017, http://www.isrctn.com/ISRCTN54234300 Supplementary Information The online version contains supplementary material available at 10.1186/s40345-021-00226-4.
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Affiliation(s)
- Kim Wright
- Washington Singer Labs., University of Exeter Department of Psychology, Perry Road, Exeter, EX4 4QG, UK.
| | - Alyson L Dodd
- Washington Singer Labs., University of Exeter Department of Psychology, Perry Road, Exeter, EX4 4QG, UK
| | - Fiona C Warren
- Washington Singer Labs., University of Exeter Department of Psychology, Perry Road, Exeter, EX4 4QG, UK
| | - Antonieta Medina-Lara
- Washington Singer Labs., University of Exeter Department of Psychology, Perry Road, Exeter, EX4 4QG, UK
| | - Barnaby Dunn
- Washington Singer Labs., University of Exeter Department of Psychology, Perry Road, Exeter, EX4 4QG, UK
| | - Julie Harvey
- Washington Singer Labs., University of Exeter Department of Psychology, Perry Road, Exeter, EX4 4QG, UK
| | - Mahmood Javaid
- Washington Singer Labs., University of Exeter Department of Psychology, Perry Road, Exeter, EX4 4QG, UK
| | - Steven H Jones
- Washington Singer Labs., University of Exeter Department of Psychology, Perry Road, Exeter, EX4 4QG, UK
| | - Christabel Owens
- Washington Singer Labs., University of Exeter Department of Psychology, Perry Road, Exeter, EX4 4QG, UK
| | - Rod S Taylor
- Washington Singer Labs., University of Exeter Department of Psychology, Perry Road, Exeter, EX4 4QG, UK
| | - Deborah Duncan
- Washington Singer Labs., University of Exeter Department of Psychology, Perry Road, Exeter, EX4 4QG, UK
| | - Alexandra Newbold
- Washington Singer Labs., University of Exeter Department of Psychology, Perry Road, Exeter, EX4 4QG, UK
| | - Shelley Norman
- Washington Singer Labs., University of Exeter Department of Psychology, Perry Road, Exeter, EX4 4QG, UK
| | - Faith Warner
- Washington Singer Labs., University of Exeter Department of Psychology, Perry Road, Exeter, EX4 4QG, UK
| | - Thomas R Lynch
- Washington Singer Labs., University of Exeter Department of Psychology, Perry Road, Exeter, EX4 4QG, UK
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19
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Increased Global-Brain Functional Connectivity Is Associated with Dyslipidemia and Cognitive Impairment in First-Episode, Drug-Naive Patients with Bipolar Disorder. Neural Plast 2021; 2021:5560453. [PMID: 34194487 PMCID: PMC8203345 DOI: 10.1155/2021/5560453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/10/2021] [Accepted: 05/22/2021] [Indexed: 01/01/2023] Open
Abstract
Objectives Previous researches have demonstrated that abnormal functional connectivity (FC) is associated with the pathophysiology of bipolar disorder (BD). However, inconsistent results were obtained due to different selections of regions of interest in previous researches. This study is aimed at examining voxel-wise brain-wide functional connectivity (FC) alterations in the first-episode, drug-naive patient with BD in an unbiased way. Methods A total of 35 patients with BD and 37 age-, sex-, and education-matched healthy controls underwent resting-state functional magnetic resonance imaging (rs-fMRI). Global-brain FC (GFC) was applied to analyze the image data. Support vector machine (SVM) was adopted to probe whether GFC abnormalities could be used to identify the patients from the controls. Results Patients with BD exhibited increased GFC in the left inferior frontal gyrus (LIFG), pars triangularis and left precuneus (PCu)/superior occipital gyrus (SOG). The left PCu belongs to the default mode network (DMN). Furthermore, increased GFC in the LIFG, pars triangularis was positively correlated with the triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) and negatively correlated with the scores of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) coding test and Stroop color. Increased GFC values in the left PCu/SOG can be applied to discriminate patients from controls with preferable sensitivity (80.00%), specificity (75.68%), and accuracy (77.78%). Conclusions This study found increased GFC in the brain regions of DMN; LIFG, pars triangularis; and LSOG, which was associated with dyslipidemia and cognitive impairment in patients with BD. Moreover, increased GFC values in the left PCu/SOG may be utilized as a potential biomarker to differentiate patients with BD from controls.
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Faurholt-Jepsen M, Frøkjær VG, Nasser A, Jørgensen NR, Kessing LV, Vinberg M. Associations between the cortisol awakening response and patient-evaluated stress and mood instability in patients with bipolar disorder: an exploratory study. Int J Bipolar Disord 2021; 9:8. [PMID: 33644824 PMCID: PMC7917033 DOI: 10.1186/s40345-020-00214-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/17/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The Cortisol Awakening Response (CAR) measured as the transient increase in cortisol levels following morning awakening appears to be a distinct feature of the HPA axis. Patients with bipolar disorder (BD) experience daily stress, mood instability (MI) and studies have shown disrupted HPA-axis dynamics. AIMS to evaluate (1) patient-evaluated stress against the CAR, (2) associations between the CAR and mood symptoms, and (3) the effect of smartphone-based treatment on the CAR. METHODS Patients with BD (n = 67) were randomized to the use of daily smartphone-based monitoring (the intervention group) or to the control group for six months. Clinically rated symptoms according to the Hamilton Depression Rating Scale 17-items (HDRS), the Young Mania Rating Scale (YMRS), patient-evaluated perceived stress using Cohen's Perceived Stress Scale (PSS) and salivary awakening cortisol samples used for measuring the CAR were collected at baseline, after three and six months. In the intervention group, smartphone-based data on stress and MI were rated daily during the entire study period. RESULTS Smartphone-based patient-evaluated stress (B: 134.14, 95% CI: 1.35; 266.92, p = 0.048) and MI (B: 430.23, 95% CI: 52.41; 808.04, p = 0.026) mapped onto increased CAR. No statistically significant associations between the CAR and patient-evaluated PSS or the HDRS and the YMRS, respectively were found. There was no statistically significant effect of smartphone-based treatment on the CAR. CONCLUSION Our data, of preliminary character, found smartphone-based patient-evaluations of stress and mood instability as read outs that reflect CAR dynamics. Smartphone-supported clinical care did not in itself appear to disturb CAR dynamics.
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Affiliation(s)
- Maria Faurholt-Jepsen
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Blegdamsvej 9, Rigshospitalet, 2100, Copenhagen, Denmark. .,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Vibe Gedsø Frøkjær
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Blegdamsvej 9, Rigshospitalet, 2100, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Arafat Nasser
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Niklas Rye Jørgensen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Blegdamsvej 9, Rigshospitalet, 2100, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Blegdamsvej 9, Rigshospitalet, 2100, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Psychiatric Research Unit, Psychiatric Centre North Zealand, Faculty of Health and Medical Sciences, University of Copenhagen, Hillerød, Denmark
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21
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Have I argued with my family this week?": What questions do those with lived experience choose to monitor their bipolar disorder? J Affect Disord 2021; 281:918-925. [PMID: 33234286 DOI: 10.1016/j.jad.2020.11.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/25/2020] [Accepted: 11/07/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Electronic self-report mood monitoring tools for individuals with bipolar disorder (BD) are rapidly emerging and predominately employ predefined symptom-based questions. Allowing individuals to additionally choose what they monitor in relation to their BD offers the unique opportunity to capture and gain a deeper insight into patient priorities in this context. METHODS In addition to monitoring mood symptoms with two standardised self-rated questionnaires, 308 individuals with BD participating in the Bipolar Disorder Research Network True Colours electronic mood-monitoring tool for research chose to create and complete additional personalised questions. A content analysis approach was used to analyse the content of these questions. RESULTS 35 categories were created based on the personalised questions with the most common being physical activity and exercise, anxiety and panic, sleep and coping/stress levels. The categories were grouped into six overarching themes 1) mental health; 2) behaviour and level of functioning; 3) physical wellbeing; 4) health behaviours; 5) active self-management; and, 6) interpersonal. LIMITATIONS The average age of the sample was around 50 years meaning our findings may not be generalisable to younger individuals with BD. CONCLUSIONS Aspects of BD important to patients in relation to longitudinal monitoring extend well beyond mood symptoms, highlighting the limitations of solely relying on standardised questions/mood rating scales based on symptoms primarily used for diagnosis. Additional symptoms and aspects of life not necessarily useful diagnostically for BD may be more important for individuals themselves to monitor and have more meaning in capturing their own experience of changes in BD severity.
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22
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Chan EC, Sun Y, Aitchison KJ, Sivapalan S. Mobile App-Based Self-Report Questionnaires for the Assessment and Monitoring of Bipolar Disorder: Systematic Review. JMIR Form Res 2021; 5:e13770. [PMID: 33416510 PMCID: PMC7822726 DOI: 10.2196/13770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 01/13/2020] [Accepted: 10/02/2020] [Indexed: 01/21/2023] Open
Abstract
Background Bipolar disorder is a chronic, progressive illness characterized by recurrent episodes of mania and depression. Self-report scales have historically played a significant role in the monitoring of bipolar symptoms. However, these tools rely on episodic memory, which can be unreliable and do not allow the clinician to monitor brief episodic symptoms or the course of symptoms over shorter periods of time. Mobile app–based questionnaires have been suggested as a tool to improve monitoring of patients with bipolar disorder. Objective This paper aims to determine the feasibility and validity of mobile app–based self-report questionnaires. Methods We performed a systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, PsycInfo, Web of Science, Ovid MEDLINE, and EMBASE databases were searched for papers published in English that assessed adherence to and the validity of mobile app–based self-report questionnaires. Relevant studies published from database creation to May 22, 2020, were identified, and results examining the validity of and rates of adherence to app-based self-report questionnaires are reported. Results A total of 13 records were identified for inclusion in this review. Of these studies, 4 assessed the concurrent validity of mobile app–based self-report tools, with the majority of findings indicating significant associations between data collected using these tools and the Young Mania Rating Scale, Hamilton Depression Rating Scale-17, or Montgomery-Åsberg Depression Rating Scale (P<.001 to P=.24). Three studies comparing the variability or range of symptoms between patients with bipolar disorder and healthy controls suggested that these data are capable of differentiating between known groups. Two studies demonstrated statistically significant associations between data collected via mobile app–based self-report tools and instruments assessing other clinically important factors. Adherence rates varied across the studies examined. However, good adherence rates (>70%) were observed in all but 1 study using a once-daily assessment. There was a wide range of adherence rates observed in studies using twice-daily assessments (42%-95%). Conclusions These findings suggest that mobile app–based self-report tools are valid in the assessment of symptoms of mania and depression in euthymic patients with bipolar disorder. Data collected using these tools appear to differ between patients with bipolar disorder and healthy controls and are significantly associated with other clinically important measures. It is unclear at this time whether these tools can be used to detect acute episodes of mania or depression in patients with bipolar disorder. Adherence data indicate that patients with bipolar disorder show good adherence to self-report assessments administered daily for the duration of the study periods evaluated.
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Affiliation(s)
- Eric C Chan
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Yuting Sun
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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23
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Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 246] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
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Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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24
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Mood, activity, and sleep measured via daily smartphone-based self-monitoring in young patients with newly diagnosed bipolar disorder, their unaffected relatives and healthy control individuals. Eur Child Adolesc Psychiatry 2021; 30:1209-1221. [PMID: 32743692 PMCID: PMC8310852 DOI: 10.1007/s00787-020-01611-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
Diagnostic evaluations and early interventions of patients with bipolar disorder (BD) rely on clinical evaluations. Smartphones have been proposed to facilitate continuous and fine-grained self-monitoring of symptoms. The present study aimed to (1) validate daily smartphone-based self-monitored mood, activity, and sleep, against validated questionnaires and clinical ratings in young patients with newly diagnosed BD, unaffected relatives (UR), and healthy controls persons (HC); (2) investigate differences in daily smartphone-based self-monitored mood, activity, and sleep in young patients with newly diagnosed BD, UR, and HC; (3) investigate associations between self-monitored mood and self-monitored activity and sleep, respectively, in young patients with newly diagnosed BD. 105 young patients with newly diagnosed BD, 24 UR and 77 HC self-monitored 2 to 1077 days (median [IQR] = 65 [17.5-112.5]). There was a statistically significantly negative association between the mood item on Hamilton Depression Rating Scale (HAMD) and smartphone-based self-monitored mood (B = - 0.76, 95% CI - 0.91; - 0.63, p < 0.001) and between psychomotor item on HAMD and self-monitored activity (B = - 0.44, 95% CI - 0.63; - 0.25, p < 0.001). Smartphone-based self-monitored mood differed between young patients with newly diagnosed BD and HC (p < 0.001), and between UR and HC (p = 0.008) and was positively associated with smartphone-based self-reported activity (p < 0.001) and sleep duration (p < 0.001). The findings support the potential of smartphone-based self-monitoring of mood and activity as part of a biomarker for young patients with BD and UR. Smartphone-based self-monitored mood is better to discriminate between young patients with newly diagnosed BD and HC, and between UR and HC, compared with smartphone-based activity and sleep.Trial registration clinicaltrials.gov NCT0288826.
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25
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Wang K, Ding L, Yang C, Hao X, Wang C. Exploring the Relationship Between Psychiatric Traits and the Risk of Mouth Ulcers Using Bi-Directional Mendelian Randomization. Front Genet 2020; 11:608630. [PMID: 33424931 PMCID: PMC7793678 DOI: 10.3389/fgene.2020.608630] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/09/2020] [Indexed: 12/26/2022] Open
Abstract
Background Although the association between mouth ulcers and psychiatric traits has been reported by observational studies, their causal relationship remains unclear. Mendelian randomization (MR), powered by large-scale genome-wide association studies (GWAS), provides an opportunity to clarify the causality between mouth ulcers and psychiatric traits. Methods We collected summary statistics of mouth ulcers (sample size n = 461,106) and 10 psychiatric traits from the largest publicly available GWAS on Europeans, including anxiety disorder (n = 83,566), attention deficit/hyperactivity disorder (n = 53,293), autism spectrum disorder (n = 46,350), bipolar disorder (n = 51,710), insomnia (n = 1,331,010), major depressive disorder (n = 480,359), mood instability (n = 363,705), neuroticism (n = 168,105), schizophrenia (n = 105,318), and subjective wellbeing (n = 388,538). We applied three two-sample bi-directional MR analysis methods, namely the Inverse Variance Weighted (IVW) method, the MR pleiotropy residual sum and outlier (MR-PRESSO) method, and the weighted median method, to assess the causal relationship between each psychiatric trait and mouth ulcers. Results We found significant effects of autism spectrum disorder, insomnia, major depressive disorder, and subjective wellbeing on mouth ulcers, with the corresponding odds ratio (OR) from the IVW method being 1.160 [95% confidence interval (CI): 1.066–1.261, P = 5.39 × 10–4], 1.092 (1.062–1.122, P = 3.37 × 10–10), 1.234 (1.134–1.342, P = 1.03 × 10–6), and 0.703 (0.571–0.865, P = 8.97 × 10–4), respectively. We also observed suggestive evidence for mood instability to cause mouth ulcers [IVW, OR = 1.662 (1.059–2.609), P = 0.027]. These results were robust to weak instrument bias and heterogeneity. We found no evidence on causal effects between other psychiatric traits and mouth ulcers, in either direction. Conclusion Our findings suggest a protective effect of subjective wellbeing and risk effects of autism spectrum disorder, insomnia, major depressive disorder, and mood instability on mouth ulcers. These results clarify the causal relationship between psychiatric traits and the development of mouth ulcers.
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Affiliation(s)
- Kai Wang
- Key Laboratory for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Ding
- Key Laboratory for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Can Yang
- Department of Mathematics, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Xingjie Hao
- Key Laboratory for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaolong Wang
- Key Laboratory for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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26
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McIntyre RS, Berk M, Brietzke E, Goldstein BI, López-Jaramillo C, Kessing LV, Malhi GS, Nierenberg AA, Rosenblat JD, Majeed A, Vieta E, Vinberg M, Young AH, Mansur RB. Bipolar disorders. Lancet 2020; 396:1841-1856. [PMID: 33278937 DOI: 10.1016/s0140-6736(20)31544-0] [Citation(s) in RCA: 416] [Impact Index Per Article: 104.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 06/11/2020] [Accepted: 07/07/2020] [Indexed: 12/17/2022]
Abstract
Bipolar disorders are a complex group of severe and chronic disorders that includes bipolar I disorder, defined by the presence of a syndromal, manic episode, and bipolar II disorder, defined by the presence of a syndromal, hypomanic episode and a major depressive episode. Bipolar disorders substantially reduce psychosocial functioning and are associated with a loss of approximately 10-20 potential years of life. The mortality gap between populations with bipolar disorders and the general population is principally a result of excess deaths from cardiovascular disease and suicide. Bipolar disorder has a high heritability (approximately 70%). Bipolar disorders share genetic risk alleles with other mental and medical disorders. Bipolar I has a closer genetic association with schizophrenia relative to bipolar II, which has a closer genetic association with major depressive disorder. Although the pathogenesis of bipolar disorders is unknown, implicated processes include disturbances in neuronal-glial plasticity, monoaminergic signalling, inflammatory homoeostasis, cellular metabolic pathways, and mitochondrial function. The high prevalence of childhood maltreatment in people with bipolar disorders and the association between childhood maltreatment and a more complex presentation of bipolar disorder (eg, one including suicidality) highlight the role of adverse environmental exposures on the presentation of bipolar disorders. Although mania defines bipolar I disorder, depressive episodes and symptoms dominate the longitudinal course of, and disproportionately account for morbidity and mortality in, bipolar disorders. Lithium is the gold standard mood-stabilising agent for the treatment of people with bipolar disorders, and has antimanic, antidepressant, and anti-suicide effects. Although antipsychotics are effective in treating mania, few antipsychotics have proven to be effective in bipolar depression. Divalproex and carbamazepine are effective in the treatment of acute mania and lamotrigine is effective at treating and preventing bipolar depression. Antidepressants are widely prescribed for bipolar disorders despite a paucity of compelling evidence for their short-term or long-term efficacy. Moreover, antidepressant prescription in bipolar disorder is associated, in many cases, with mood destabilisation, especially during maintenance treatment. Unfortunately, effective pharmacological treatments for bipolar disorders are not universally available, particularly in low-income and middle-income countries. Targeting medical and psychiatric comorbidity, integrating adjunctive psychosocial treatments, and involving caregivers have been shown to improve health outcomes for people with bipolar disorders. The aim of this Seminar, which is intended mainly for primary care physicians, is to provide an overview of diagnostic, pathogenetic, and treatment considerations in bipolar disorders. Towards the foregoing aim, we review and synthesise evidence on the epidemiology, mechanisms, screening, and treatment of bipolar disorders.
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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; Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation Strategic Research Centre, School of Medicine, Deakin University, Melbourne, VIC, Australia; Mental Health Drug and Alcohol Services, Barwon Health, Geelong, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia; Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health, Melbourne, VIC, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Elisa Brietzke
- Department of Psychiatry, Adult Division, Kingston General Hospital, Kingston, ON, Canada; Department of Psychiatry, Queen's University School of Medicine, Queen's University, Kingston, ON, Canada; Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Benjamin I Goldstein
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Carlos López-Jaramillo
- Department of Psychiatry, Faculty of Medicine, University of Antioquia, Medellín, Colombia; Mood Disorders Program, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Lars Vedel Kessing
- Copenhagen Affective Disorders Research Centre, Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark; Department of Psychiatry, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gin S Malhi
- Discipline of Psychiatry, Northern Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Academic Psychiatry, Northern Sydney Local Health District, Sydney, Australia
| | | | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amna Majeed
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Maj Vinberg
- Department of Psychiatry, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød, Denmark
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley National Health Service Foundation Trust, Bethlem Royal Hospital, London, UK
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Dargél AA, Mosconi E, Masson M, Plaze M, Taieb F, Von Platen C, Buivan TP, Pouleriguen G, Sanchez M, Fournier S, Lledo PM, Henry C. Toi Même, a Mobile Health Platform for Measuring Bipolar Illness Activity: Protocol for a Feasibility Study. JMIR Res Protoc 2020; 9:e18818. [PMID: 32638703 PMCID: PMC7463390 DOI: 10.2196/18818] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The diagnosis and management of bipolar disorder are limited by the absence of available biomarkers. Patients with bipolar disorder frequently present with mood instability even during remission, which is likely associated with the risk of relapse, impaired functioning, and suicidal behavior, indicating that the illness is active. OBJECTIVE This research protocol aimed to investigate the correlations between clinically rated mood symptoms and mood/behavioral data automatically collected using the Toi Même app in patients with bipolar disorder presenting with different mood episodes. This study also aimed to assess the feasibility of this app for self-monitoring subjective and objective mood/behavior parameters in those patients. METHODS This open-label, nonrandomized trial will enroll 93 (31 depressive, 31 euthymic, and 31 hypomanic) adults diagnosed with bipolar disorder type I/II (Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria) and owning an iPhone. Clinical evaluations will be performed by psychiatrists at the baseline and after 2 weeks, 1 month, 2 months, and 3 months during the follow-up. Rather than only accessing the daily mood symptoms, the Toi Même app also integrates ecological momentary assessments through 2 gamified tests to assess cognition speed (QUiCKBRAIN) and affective responses (PLAYiMOTIONS) in real-life contexts, continuously measures daily motor activities (eg, number of steps, distance) using the smartphone's motion sensors, and performs a comprehensive weekly assessment. RESULTS Recruitment began in April 2018 and the completion of the study is estimated to be in December 2021. As of April 2019, 25 participants were enrolled in the study. The first results are expected to be submitted for publication in 2020. This project has been funded by the Perception and Memory Unit of the Pasteur Institute (Paris) and it has received the final ethical/research approvals in April 2018 (ID-RCB: 2017-A02450-53). CONCLUSIONS Our results will add to the evidence of exploring other alternatives toward a more integrated approach in the management of bipolar disorder, including digital phenotyping, to develop an ethical and clinically meaningful framework for investigating, diagnosing, and treating individuals at risk of developing bipolar disorder or currently experiencing bipolar disorder. Further prospective studies on the validity of automatically generated smartphone data are needed for better understanding the longitudinal pattern of mood instability in bipolar disorder as well as to establish the reliability, efficacy, and cost-effectiveness of such an app intervention for patients with bipolar disorder. TRIAL REGISTRATION ClinicalTrials.gov NCT03508427; https://clinicaltrials.gov/ct2/show/NCT03508427. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18818.
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Affiliation(s)
- Aroldo A Dargél
- Perception and Memory Unit, Neuroscience Department, Pasteur Institute, Paris, France.,Unité Mixte de Recherche 3571, Centre National de la Recherche Scientifique (CNRS), Paris, France.,Centre Thérapeutique de Jour (CTPJ) Troubles Bipolaires, Clinique Bellevue, Meudon, France
| | - Elise Mosconi
- Centre Thérapeutique de Jour (CTPJ) Troubles Bipolaires, Clinique Bellevue, Meudon, France
| | - Marc Masson
- Clinique du Château de Garches, Garches, France
| | - Marion Plaze
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neuroscience, Paris, France
| | - Fabien Taieb
- Centre of Translational Research, Institut Pasteur, Paris, France
| | | | - Tan Phuc Buivan
- Centre of Translational Research, Institut Pasteur, Paris, France
| | | | - Marie Sanchez
- Department of Information Systems, Institut Pasteur, Paris, France
| | | | - Pierre-Marie Lledo
- Perception and Memory Unit, Neuroscience Department, Pasteur Institute, Paris, France.,Unité Mixte de Recherche 3571, Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Chantal Henry
- Perception and Memory Unit, Neuroscience Department, Pasteur Institute, Paris, France.,Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neuroscience, Paris, France
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28
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Manchia M, Vieta E, Smeland OB, Altimus C, Bechdolf A, Bellivier F, Bergink V, Fagiolini A, Geddes JR, Hajek T, Henry C, Kupka R, Lagerberg TV, Licht RW, Martinez-Cengotitabengoa M, Morken G, Nielsen RE, Pinto AG, Reif A, Rietschel M, Ritter P, Schulze TG, Scott J, Severus E, Yildiz A, Kessing LV, Bauer M, Goodwin GM, Andreassen OA. Translating big data to better treatment in bipolar disorder - a manifesto for coordinated action. Eur Neuropsychopharmacol 2020; 36:121-136. [PMID: 32536571 DOI: 10.1016/j.euroneuro.2020.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/15/2020] [Accepted: 05/24/2020] [Indexed: 12/15/2022]
Abstract
Bipolar disorder (BD) is a major healthcare and socio-economic challenge. Despite its substantial burden on society, the research activity in BD is much smaller than its economic impact appears to demand. There is a consensus that the accurate identification of the underlying pathophysiology for BD is fundamental to realize major health benefits through better treatment and preventive regimens. However, to achieve these goals requires coordinated action and innovative approaches to boost the discovery of the neurobiological underpinnings of BD, and rapid translation of research findings into development and testing of better and more specific treatments. To this end, we here propose that only a large-scale coordinated action can be successful in integrating international big-data approaches with real-world clinical interventions. This could be achieved through the creation of a Global Bipolar Disorder Foundation, which could bring government, industry and philanthropy together in common cause. A global initiative for BD research would come at a highly opportune time given the seminal advances promised for our understanding of the genetic and brain basis of the disease and the obvious areas of unmet clinical need. Such an endeavour would embrace the principles of open science and see the strong involvement of user groups and integration of dissemination and public involvement with the research programs. We believe the time is right for a step change in our approach to understanding, treating and even preventing BD effectively.
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Affiliation(s)
- Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eduard Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Olav B Smeland
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Andreas Bechdolf
- Vivantes Klinikum im Friedrichshain, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Charité-Universitätsmedizin, Berlin, Germany; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; ORYGEN, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Frank Bellivier
- Université de Paris and INSERM UMRS 1144, Paris, France; AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Hopital Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France
| | - Veerle Bergink
- Department of Psychiatry - Erasmus Medical Center, Rotterdam, the Netherlands; Department of Psychiatry, Department of Obstetrics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - John R Geddes
- Department of Psychiatry and Oxford Health NHS Foundation Trust, University of Oxford, Oxford, United Kingdom
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; National Institute of Mental Health, Klecany, Czech Republic
| | - Chantal Henry
- Department of Psychiatry, Service Hospitalo-Universitaire, GHU Paris Psychiatrie & Neurosciences, F-75014 Paris, France
| | - Ralph Kupka
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam, Netherlands
| | - Trine V Lagerberg
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Rasmus W Licht
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Psychiatry - Aalborg University Hospital, Aalborg, Denmark
| | | | - Gunnar Morken
- Østmarka Department of Psychiatry, St Olav University Hospital, Trondheim, Norway; Department of Mental Health, Faculty of Medicine and Healthsciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - René E Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Psychiatry - Aalborg University Hospital, Aalborg, Denmark
| | - Ana Gonzalez Pinto
- Hospital Universitario de Alava. BIOARABA, UPV/EHU. CIBERSAM. Vitoria, Spain
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany and German Society for Bipolar Disorders (DGBS), Frankfurt am Main, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Phillip Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig-Maximilian University of Munich, Munich, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University of Munich, Munich, Germany; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA; Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jan Scott
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Hopital Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Department of Mental Health, Faculty of Medicine and Healthsciences, Norwegian University of Science and Technology, Trondheim, Norway; Academic Psychiatry, Institute of Neuroscience, Newcastle University, UK
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Aysegul Yildiz
- Dokuz Eylül University Department of Psychiatry, Izmir, Turkey
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen and University of Copenhagen, Faculty of Health and Medical Sciences, Denmark
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Guy M Goodwin
- Department of Psychiatry and Oxford Health NHS Foundation Trust, University of Oxford, Oxford, United Kingdom
| | - Ole A Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
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Mood instability in patients with newly diagnosed bipolar disorder, unaffected relatives, and healthy control individuals measured daily using smartphones. J Affect Disord 2020; 271:336-344. [PMID: 32479333 DOI: 10.1016/j.jad.2020.03.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/14/2019] [Accepted: 03/20/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate whether mood instability (MI) qualify as a trait marker for bipolar disorder (BD) we investigated: 1) differences in smartphone-based self-reported MI between three groups: patients with newly diagnosed BD, unaffected first-degree relatives (UR), and healthy control individuals (HC); 2) the correlation between MI and functioning, stress, and duration of illness, respectively; and 3) the validity of smartphone-based self-evaluated mood ratings as compared to observer-based ratings of depressed and manic mood. METHODS 203 patients with newly diagnosed BD, 54 UR and 109 HC were included as part of the longitudinal Bipolar Illness Onset study. Participants completed daily smartphone-based mood ratings for a period of up to two years and were clinically assessed with ratings of depression, mania and functioning. RESULTS Mood instability scores were statistically significantly higher in patients with BD compared with HC (mean=1.18, 95%CI: 1.12;1.24 vs 1.05, 95%CI: 0.98;1.13, p = 0.007) and did not differ between patients with BD and UR (mean=1.17, 95%CI: 1.07;1.28, p = 0.91). For patients, increased MI scores correlated positively with impaired functioning (p<0.001), increased stress level (p<0.001) and increasing number of prior mood episodes (p<0.001). Smartphone-based mood ratings correlated with ratings of mood according to sub-item 1 on the Hamilton Depression Rating Scale 17-items and the Young Mania Rating Scale, respectively (p´s<0.001). LIMITATION The study had a smaller number of UR than planned. CONCLUSION Mood instability is increased in patients with newly diagnosed BD and unaffected relatives and associated with decreased functioning. The findings highlight MI as a potential trait marker for BD.
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