The association between mixed symptoms, irritability and functioning measured using smartphones in bipolar disorder

Abstract

LV. The association between mixed symptoms, irritability and functioning measured using smartphones in bipolar disorder Objective: To (i) validate patient-evaluated mixed symptoms and irritability measured using smartphones against clinical evaluations; (ii) investigate associations between mixed symptoms and irritability with stress, quality of life and functioning, respectively, in patients with bipolar disorder. Methods: A total of 84 patients with bipolar disorder used a smartphone-based system for daily evaluation of mixed symptoms and irritability for nine months. Clinically evaluated symptoms, stress, quality of life and clinically rated functioning were collected multiple times during follow-up. Results: Patients presented mild affective symptoms. Patient-reported mixed symptoms and irritability correlated with clinical evaluations. In analyses including confounding factors there was a statistically significant association between both mixed symptoms and irritability and stress (P < 0.0001) and between irritability and both quality of life and functioning (P < 0.0001) respectively. There was no association between mixed mood and both quality of life and functioning. Conclusion: Mixed symptoms and irritability can be validly selfreported using smartphones in patients with bipolar disorder. Mixed symptoms and irritability are associated with increased stress even during full or partial remission. Irritability is associated with decreased quality of life and functioning. The findings emphasize the clinical importance of identifying inter-episodic symptoms including irritability pointing towards smartphones as a valid tool. Significant outcomes• Daily evaluated mixed symptoms and irritability were validly self-reported using smartphones compared with clinically evaluated symptoms in patients with bipolar disorder.• Mixed symptoms and irritability were associated with increased perceived stress even during full or partial remission, and irritability was associated with decreased quality of life and functioning. Limitations• Data on perceived stress and quality of life were collected using questionnaires answered by patients who, due to the nature of the smartphone-based monitoring system, were not blinded to the monitoring tool.• The patients received different types of psychopharmacologic treatment during the study; thus, medication class were included as a covariate in the statistical analyses.• The findings were based on analyses of associations between variables, and the included covariates did not alter the estimates. It may be that other possible confounding factors could have affected the associations and thus interpretation should be taken with caution.

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

“…Aim 1: In accordance with our hypotheses, we found a statistically significant association between smartphone-based self-monitored mood and scores on the mood item 1 and the total HAMD. This finding is in line with findings from similar studies on adults with BD [ 15 , 21 , 36 , 37 ], and indicates that smartphone-based self-monitoring can identify depressive symptoms and thus function as a fine-grained monitoring tool for young patients with BD, and as a potential diagnostic tool for patients where BD or unipolar disorder is suspected. There was no significant association between self-monitored mood and scores on the YMRS.…”

“…Smartphone-based self-monitored data have shown to validly reflect illness activity in patients with BD [15,21,[36][37][38]. Thus, smartphone-based self-monitoring may improve the timeliness in monitoring symptoms, functioning, and fluctuations in symptoms, and might, therefore, be a promising supportive diagnostic tool in individuals where BD is suspected.…”

Beyond the Therapist’s Office: Merging Measurement-Based Care and Digital Medicine in the Real World

“…Assessment data obtained through self-reported and objective means may sometimes diverge, as symptom ratings may not correlate with quality of life or daily functioning [ 32 ]. This should not be viewed as a disadvantage but as a strength.…”

Digital navigators to implement smartphone and digital tools in care

“…The potential of digital psychiatry, especially using smartphone apps to help patients with mental illnesses both remotely monitor symptoms and access interventions on demand, continues to expand . Yet, impressive pilot results of many app studies have not translated into clinical practice .…”