A Mobile Behavioral Monitoring Intervention for Bipolar Disorder

描述（由申请人提供）：这项R34研究将开发和试点双相情感障碍的智能手机干预。背景：双相情感障碍是一种严重的慢性精神疾病，它会增加死亡率并极大地损害功能。社会心理疗法与药物结合可以改善治疗效果，但获得社会心理干预的机会有限，只有一半的双相情感障碍患者接受了这些干预。目前的治疗还存在以下方面的局限性：1)依赖于患者的主观报告，2)难以识别即将发作的警告信号。此外，即使睡眠和活动的改变是双相情感障碍的核心症状，对可观察到的日常行为模式的直接测量也不是常规的。意义：该项目将开发一种智能手机干预双相情感障碍，这将增加获得社会心理干预的机会。使用电话将允许患者和提供者使用常规反馈

DESCRIPTION (provided by applicant): This R34 study will develop and pilot a smartphone intervention for bipolar disorder. Background: Bipolar disorder is a severe and chronic mental illness that increases mortality and greatly impairs functioning. Psychosocial therapies in combination with medication improve treatment outcomes, but access to psychosocial interventions is limited and only half of bipolar patients receive them. Current therapies also have limitations in terms of: 1) reliance on subjective patient report and 2) difficulties in identifying warning signs of impending episodes. Furthermore, direct measurement of observable daily patterns of behavior is not routinely available, even though alterations in sleep and activity are core symptoms of bipolar disorder. Significance: This project will develop a smartphone intervention for bipolar disorder that will increase access to psychosocial interventions. The use of the phone will allow routine feedback to patients and providers utilizing behavioral data collected by the phone. This should enhance patient self-management of their symptoms and improve treatment outcomes. Innovation: 1) Use of a smartphone to make psychosocial interventions readily accessible to patients during their day-to-day life. 2) Use of a wrist-worn actimeter communicating with the phone to provide consistent collection of activity data relevant to symptom status. 3) Use of the phone to collect novel location and social interaction data relevant to symptom status. 4) Utilizing behavioral data feedback to increase patient symptom self-management and to inform providers for improved evaluation and targeting of treatment. Preliminary studies: Members of the research team have developed algorithms for stratifying patients based on actimetry data and have used mobile phones to measure lifespace which might decrease during depression and expand during mania. The rapid successful development of the system will be facilitated by collaborating with the Center for Behavioral Intervention Technologies, which has substantial expertise in developing and delivering effective psychosocial interventions via smartphones. Design: An iterative, user-centered design process will increase acceptance, participation, and long-term system use by patients and providers. A small randomized controlled trial will test the feasibility of the study protocol (system, recruitment, control, assessment) in preparation for a larger randomized controlled trail. Population: Adult bipolar disorder patients in current remission with a history o two acute episodes in the last two years who are in routine treatment. Outcomes: All aspects of the study protocol will be operationalized in preparation for the subsequent randomized controlled trial. Markers of system use, usability, and satisfaction will be assessed. The primary outcome piloted for the larger study will be percent time symptomatic. Secondary outcomes will include time to relapse, symptom severity, and quality of life.