Predicting Recurrences in Bipolar Illness (Prompt-BD)

每一次复发，双相情感障碍(BD)的预后都会恶化，并有自杀和吸毒的风险 滥用增加，表明需要确定和管理与复发风险相关的因素。因素 与整个群体的复发风险相关的问题已经确定，然而，如何 BD患者的复发风险预测仍未得到回答。由于BD的过程是异质性的， 在个人层面预测复发风险的能力将使治疗能够针对特定的患者量身定做 个人的。就像在医学的其他领域一样，我们开发了一个风险计算器(RC)，它可以用大约 80%的歧视1-5年内任何情绪复发的风险以及复发的两极 患有BD的成年人。鉴于RC必须在外部验证后才能可靠地用于临床实践， BD患者情绪复发的预测(PROMPT-BD)研究建议外部验证 BD青少年/青壮年的RC。现有的RC(称为“远端”RC)是有价值的，但只能预测长期(1-5 年)复发风险，而不是近期风险(即1-4周)。预测近期风险可以迅速 一旦检测到“警告”征兆就进行干预，有可能改善BD的病程。要做到这一点，因素 与即将复发的BD有关，如睡眠活动节律、活动能力和数字社交 互动将使用智能手机被动感知连续实时测量，并随后 结合远端RC的临床预测指标，进一步加强预测。与自我报告不同， 被动感知可以在不需要参与者参与的情况下评估较长时间内行为的持续变化 输入。虽然动作记录仪是评估睡眠活动节律的“黄金标准”，但它不适用于 参与者佩戴研究级活动监测器，持续时间用于情绪风险预测 反复发作。因此，我们将研究基于被动感知的睡眠活动数据评估如何映射到 通过收集五个为期两周的随访期间(摄入量和每次随访)的肌动图数据进行肌动学检查。 我们还将探索发展和性别是否会影响感兴趣的被动感知措施。要实现这一点 根据这项提议，将招募120名目前处于缓解期的BDI/II个人(14-25岁)。临床 评估将在入学时、6个月、12个月、18个月和24个月进行。睡眠活动节律(例如，电话 使用、加速计)、移动性(例如GPS)和数字社交交互(例如电话通信日志)将 通过智能手机被动感知进行持续评估，为每位参与者提供超过300天的数据 (样本中的30,000天合计)。最后，为了更准确地确定复发的时间和 在时间上，参与者将完成一份简短的每周问卷，以进行情绪回顾评估 通过短信提示心情。Prompt-BD的发现将有助于咨询患者和他们的 家庭的近期复发风险和长期预后，并有很大希望告知 个体化治疗以及临床和生物学研究的未来发展。

With each recurrence, the prognosis for Bipolar Disorder (BD) worsens and the risk for suicidality and substance abuse increases, indicating the need to identify and manage the factors associated with recurrence risk. Factors associated with recurrence risk for the group as a whole have been identified, however, the question of how to predict recurrence risk for an individual with BD remains unanswered. Since the course of BD is heterogenous, the ability to predict recurrence risk at the person level would allow treatment to be tailored to the specific individual. As in other fields of medicine, we developed a risk calculator (RC) that predicts with approximately 80% discrimination the 1-5 year risk of any mood recurrence and the polarity of the recurrence in youths/young adults with BD. Given that the RC must be externally validated before it can reliably be used in clinical practice, the Predicting Recurrence of Mood in Patients with BD (PROMPT-BD) study proposes to externally validate the RC in BD youth/young adults. The existing RC (termed “distal” RC) is valuable, but only predicts long-term (1-5 year) recurrence risk and not proximal risk (i.e.1-4 weeks). Predicting proximal risk could enable prompt intervention upon detection of “warning” signs, potentially improving the course of BD. To do this, factors associated with impending recurrences in BD such as sleep-activity rhythms, mobility, and digital social interactions will be measured continuously in real-time using smartphone passive sensing and subsequently combined with clinical predictors from the distal RC to further enhance prediction. In contrast to self-reports, passive sensing can assess continuous changes in behavior over extended periods without requiring participant input. While actigraphy is the “gold standard” for assessment of sleep-activity rhythms, it is not feasible for participants to wear a research-grade activity monitor for the duration necessary for risk prediction of mood recurrences. Thus, we will examine how passive sensing-based assessments of sleep-activity data map onto actigraphy by collecting actigraphy data for five 2-week periods over follow-up (intake and at each follow-up). We will also explore if development and sex influence passive sensing measures of interest. To carry out this proposal, 120 BDI/II individuals (14-25 years old) who are currently in remission will be recruited. Clinical assessments will be administered at intake and 6,12,18, and 24-months. Sleep-activity rhythms (e.g. phone usage, accelerometer), mobility (e.g., GPS), and digital social interaction (e.g. phone communication log), will be continuously evaluated via smartphone passive sensing, yielding over 300 days of data per participant (>30,000 days combined across the sample). Finally, to more precisely identify the timing of recurrence and to temporally anchor retrospective mood assessments, participants will complete a brief weekly questionnaire for mood prompted via text message. PROMPT-BD findings will be instrumental in counseling patients and their families regarding proximal risk for recurrence and long-term prognosis and have great promise for informing the future development of individualized treatments and both clinical and biological studies.