Predicting Recurrences in Bipolar Illness (Prompt-BD)

预测双相情感障碍的复发 (Prompt-BD)

• 批准号: 10275582
• 负责人: BORIS BIRMAHER
• 金额: $ 76.34万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10275582
• 关键词: Accelerometer; Address; Adolescent; Adult; Age; Behavior; Biological; Bipolar Disorder; Cellular Phone; Clinical; Clinical Research; Clinical assessments; Communication; Conflict (Psychology); Counseling; Data; Detection; Development; Discrimination; Disease remission; Distal; Early Diagnosis; Evaluation; Family; Family history of; Future; Gold; Grain; Individual; Intake; Intervention; Manic; Maps; Mathematics; Measures; Medicine; Mental Depression; Methods; Modeling; Monitor; Moods; Outcome; Participant; Patient Participation; Patient Self-Report; Patients; Persons; Pharmaceutical Preparations; Problem behavior; Prognosis; Questionnaires; Recurrence; Recurrence Score; Research; Risk; Risk Factors; Sampling; Sleep; Sleep disturbances; Social Interaction; Substance abuse problem; Suicide; Telephone; Testing; Text Messaging; Time; Youth; actigraphy; aged; base; behavior change; clinical practice; clinical predictors; digital; early adolescence; emerging adult; follow-up; improved; improved functioning; individualized medicine; instrument; interest; mood symptom; prevent; psychosocial; recruit; risk prediction; sex; smartphone Application; suicidal risk; time use; tool; young adult

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.

随着每次复发，双相情感障碍（BD）的预后恶化和自杀和底物的风险 滥用增加，表明需要识别和管理与复发风险相关的因素。因素 但是，已经确定了与整个小组复发风险相关的风险 预测BD个人的复发风险仍未得到解答。由于BD的过程是异质的， 在人级别预测复发风险的能力将允许对特定的治疗量身定制 个人。与其他医学领域一样，我们开发了一个风险计算器（RC），该计算器大约预测 80％歧视任何情绪复发的1 - 5年风险和年轻人复发的极性 BD成年人。鉴于RC必须在临床实践中可靠地使用之前对其进行外部验证， BD患者的情绪复发（及时BD）研究建议在外部验证该提案 BD青年/年轻人的RC。现有的RC（称为“远端” RC）是有价值的，但仅预测长期（1-5） 年）复发风险，而不是近端风险（即1-4周）。预测近端风险可以提示 在发现“警告”标志的情况下进行干预，可能会改善BD的过程。为此，因素 与BD中即将来临的回报有关，例如睡眠节奏，流动性和数字社交 相互作用将使用智能手机被动传感进行实时测量，然后 结合远端RC的临床预测因子，以进一步增强预测。与自我报告相反， 被动灵敏度可以评估长时间的行为的持续变化，而无需参与者 输入。虽然行动摄影是评估睡眠节奏节奏的“黄金标准”，但它不可行 参与者在风险预测情绪所需的持续时间内佩戴研究级活动监视器 复发。这，我们将研究如何基于被动灵敏度的睡眠数据映射评估 通过收集五个为期2周的随访（摄入量和每次随访）进行五个为期2周的行为数据进行行动摄影。 我们还将探讨发展和性别是否影响被动敏感性感兴趣的措施。执行此操作 提案，将招募120名BDI/II个人（14-25岁）。临床 评估将以摄入量和6,12,18和24个月的速度进行。睡眠活动节奏（例如电话 用法，加速度计），移动性（例如GPS）和数字社交互动（例如电话通信日志）将 通过智能手机被动传感不断评估，每次参与的数据超过300天 （整个样品中> 30,000天）。最后，更精确地确定复发的时机和 参与者将暂时主持回顾性情绪评估，将完成一份简短的每周问卷 通过短信提示心情。迅速的BD调查结果将在咨询患者及其咨询方面发挥作用 关于复发和长期预后近端风险的家庭，并有很大的希望通知 个性疗法以及临床和生物学研究的未来发展。