Mood instability in bipolar disorder type I versus type II-continuous daily electronic self-monitoring of illness activity using smartphones

Maria Faurholt-Jepsen, Christian Ritz, Mads Frost, Rie Lambæk Mikkelsen, Ellen Margrethe Christensen, Jakob Bardram, Maj Vinberg, Lars Vedel Kessing

    Research output: Journal Article or Conference Article in JournalJournal articleResearchpeer-review

    Abstract

    Background

    A substantial proportion of patients with bipolar disorder remain symptomatic during inter-episode periods, and mood instability is associated with high risk of relapse and hospitalization. Few studies have investigated long-term daily illness activity and none has compared bipolar type I and II using daily data. The objectives were to investigate differences in daily illness activity between bipolar disorder type I and II.

    Methods

    A smartphone-based system for self-monitoring was developed. A total of 33 patients treated in a mood clinic used the system for daily self-monitoring during a median period of 310 days [IQR 189; 437]. Data presented summarize over 8500 observations.

    Results

    Patients with bipolar disorder type II (n=20), compared to patients with bipolar disorder type I (n=13), experienced a significant lower mean level of mood on a scale from −3; +3 (−0.54 (95% CI: −0.74; −0.35) versus −0.19 (95% CI: −0.35; −0.02), p=0.02), less time euthymic (51.0% (95% CI: 36.4; 65.7) versus 74.5% (95% CI: 62.4; 86.7), p=0.03) and a higher proportion of time with depressive symptoms (45.1% (95% CI: 30.6; 59.5) versus 18.8% (95% CI: 6.9; 30.7), p=0.01). The proportion of time spent with (hypo)manic symptoms did not differ (2.7% (95% CI: 0.1; 5.5) versus 5.5% (95% CI: 3.1; 7.8), p=0.17).
    Limitations

    Patients received different types, doses and combinations of psychopharmacological treatment.

    Conclusion

    Euthymia was obtained for a substantial proportion of time in patients with bipolar disorder type I, but despite on-going treatment only for half of the time for patients with bipolar disorder type II. This emphasizes the need for improving treatment strategies for bipolar disorder type II.

    Keywords
    Bipolar disorderMood instabilitySummary indexes on illness activityDaily electronic self-monitoringSmartphone
    Original languageEnglish
    JournalJournal of Affective Disorders
    Volume186
    Pages (from-to)342-349
    Number of pages8
    ISSN0165-0327
    DOIs
    Publication statusPublished - 2015

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