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Daily electronic self-monitoring in bipolar disorder using smartphones – the MONARCA I trial: a randomized, placebo-controlled, single-blind, parallel group trial

Published online by Cambridge University Press:  29 July 2015

M. Faurholt-Jepsen ,
M. Frost ,
C. Ritz ,
E. M. Christensen ,
A. S. Jacoby ,
R. L. Mikkelsen ,
U. Knorr ,
J. E. Bardram ,
M. Vinberg  and
L. V. Kessing
M. Faurholt-Jepsen*
Affiliation:
The Copenhagen Clinic for Affective Disorder, Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen, Denmark
M. Frost
Affiliation:
The Pervasive Interaction Laboratory (PIT Lab), IT University of Copenhagen, Copenhagen, Denmark
C. Ritz
Affiliation:
Department of Basic Sciences and Environment, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark
E. M. Christensen
Affiliation:
The Copenhagen Clinic for Affective Disorder, Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen, Denmark
A. S. Jacoby
Affiliation:
The Copenhagen Clinic for Affective Disorder, Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen, Denmark
R. L. Mikkelsen
Affiliation:
The Copenhagen Clinic for Affective Disorder, Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen, Denmark
U. Knorr
Affiliation:
The Copenhagen Clinic for Affective Disorder, Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen, Denmark
J. E. Bardram
Affiliation:
The Pervasive Interaction Laboratory (PIT Lab), IT University of Copenhagen, Copenhagen, Denmark
M. Vinberg
Affiliation:
The Copenhagen Clinic for Affective Disorder, Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen, Denmark
L. V. Kessing
Affiliation:
The Copenhagen Clinic for Affective Disorder, Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen, Denmark
*
* Address for correspondence: Dr M. Faurholt-Jepsen, The Copenhagen Clinic for Affective Disorder, Psychiatric Centre Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. (Email: maria@faurholt-jepsen.dk)
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Abstract

Background

The number of studies on electronic self-monitoring in affective disorder and other psychiatric disorders is increasing and indicates high patient acceptance and adherence. Nevertheless, the effect of electronic self-monitoring in patients with bipolar disorder has never been investigated in a randomized controlled trial (RCT). The objective of this trial was to investigate in a RCT whether the use of daily electronic self-monitoring using smartphones reduces depressive and manic symptoms in patients with bipolar disorder.

Method

A total of 78 patients with bipolar disorder according to ICD-10 criteria, aged 18–60 years, and with 17-item Hamilton Depression Rating Scale (HAMD-17) and Young Mania Rating Scale (YMRS) scores ≤17 were randomized to the use of a smartphone for daily self-monitoring including a clinical feedback loop (the intervention group) or to the use of a smartphone for normal communicative purposes (the control group) for 6 months. The primary outcomes were differences in depressive and manic symptoms measured using HAMD-17 and YMRS, respectively, between the intervention and control groups.

Results

Intention-to-treat analyses using linear mixed models showed no significant effects of daily self-monitoring using smartphones on depressive as well as manic symptoms. There was a tendency towards more sustained depressive symptoms in the intervention group (B = 2.02, 95% confidence interval −0.13 to 4.17, p = 0.066). Sub-group analysis among patients without mixed symptoms and patients with presence of depressive and manic symptoms showed significantly more depressive symptoms and fewer manic symptoms during the trial period in the intervention group.

Conclusions

These results highlight that electronic self-monitoring, although intuitive and appealing, needs critical consideration and further clarification before it is implemented as a clinical tool.

Keywords

Bipolar disorderelectronic self-monitoringfeedback looprandomized controlled trialsmartphonethe MONARCA I trial
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 13 , October 2015 , pp. 2691 - 2704
Copyright
Copyright © Cambridge University Press 2015 

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