Motor activity patterns can distinguish between interepisode bipolar disorder patients and healthy controls

CNS Spectrums ◽  
2020 ◽  
pp. 1-11
Author(s):  
Jakub Schneider ◽  
Eduard Bakštein ◽  
Marian Kolenič ◽  
Pavel Vostatek ◽  
Christoph U. Correll ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Motor Activity ◽  
Employment Status ◽  
Rating Scale ◽  
Activity Patterns ◽  
Healthy Controls ◽  
Respective Group ◽  
Young Mania ◽  
Mean Values ◽  
Time Variations

Abstract Background Bipolar disorder (BD) is linked to circadian rhythm disruptions resulting in aberrant motor activity patterns. We aimed to explore whether motor activity alone, as assessed by longitudinal actigraphy, can be used to classify accurately BD patients and healthy controls (HCs) into their respective groups. Methods Ninety-day actigraphy records from 25 interepisode BD patients (ie, Montgomery–Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) < 15) and 25 sex- and age-matched HCs were used in order to identify latent actigraphic biomarkers capable of discriminating between BD patients and HCs. Mean values and time variations of a set of standard actigraphy features were analyzed and further validated using the random forest classifier. Results Using all actigraphy features, this method correctly assigned 88% (sensitivity = 85%, specificity = 91%) of BD patients and HCs to their respective group. The classification success may be confounded by differences in employment between BD patients and HCs. When motor activity features resistant to the employment status were used (the strongest feature being time variation of intradaily variability, Cohen’s d = 1.33), 79% of the subjects (sensitivity = 76%, specificity = 81%) were correctly classified. Conclusion A machine-learning actigraphy-based model was capable of distinguishing between interepisode BD patients and HCs solely on the basis of motor activity. The classification remained valid even when features influenced by employment status were omitted. The findings suggest that temporal variability of actigraphic parameters may provide discriminative power for differentiating between BD patients and HCs while being less affected by employment status.

scholarly journals Mobile App–Based Self-Report Questionnaires for the Assessment and Monitoring of Bipolar Disorder: Systematic Review

10.2196/13770 ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. e13770
Author(s):  
Eric C Chan ◽  
Yuting Sun ◽  
Katherine J Aitchison ◽  
Sudhakar Sivapalan
Keyword(s):  
Systematic Review ◽  
Bipolar Disorder ◽  
Rating Scale ◽  
Mobile App ◽  
Self Report ◽  
Healthy Controls ◽  
Young Mania ◽  
Good Adherence ◽  
Wide Range ◽  
Meta Analyses

Background Bipolar disorder is a chronic, progressive illness characterized by recurrent episodes of mania and depression. Self-report scales have historically played a significant role in the monitoring of bipolar symptoms. However, these tools rely on episodic memory, which can be unreliable and do not allow the clinician to monitor brief episodic symptoms or the course of symptoms over shorter periods of time. Mobile app–based questionnaires have been suggested as a tool to improve monitoring of patients with bipolar disorder. Objective This paper aims to determine the feasibility and validity of mobile app–based self-report questionnaires. Methods We performed a systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, PsycInfo, Web of Science, Ovid MEDLINE, and EMBASE databases were searched for papers published in English that assessed adherence to and the validity of mobile app–based self-report questionnaires. Relevant studies published from database creation to May 22, 2020, were identified, and results examining the validity of and rates of adherence to app-based self-report questionnaires are reported. Results A total of 13 records were identified for inclusion in this review. Of these studies, 4 assessed the concurrent validity of mobile app–based self-report tools, with the majority of findings indicating significant associations between data collected using these tools and the Young Mania Rating Scale, Hamilton Depression Rating Scale-17, or Montgomery-Åsberg Depression Rating Scale (P<.001 to P=.24). Three studies comparing the variability or range of symptoms between patients with bipolar disorder and healthy controls suggested that these data are capable of differentiating between known groups. Two studies demonstrated statistically significant associations between data collected via mobile app–based self-report tools and instruments assessing other clinically important factors. Adherence rates varied across the studies examined. However, good adherence rates (>70%) were observed in all but 1 study using a once-daily assessment. There was a wide range of adherence rates observed in studies using twice-daily assessments (42%-95%). Conclusions These findings suggest that mobile app–based self-report tools are valid in the assessment of symptoms of mania and depression in euthymic patients with bipolar disorder. Data collected using these tools appear to differ between patients with bipolar disorder and healthy controls and are significantly associated with other clinically important measures. It is unclear at this time whether these tools can be used to detect acute episodes of mania or depression in patients with bipolar disorder. Adherence data indicate that patients with bipolar disorder show good adherence to self-report assessments administered daily for the duration of the study periods evaluated.

scholarly journals Mobile App–Based Self-Report Questionnaires for the Assessment and Monitoring of Bipolar Disorder: Systematic Review (Preprint)

2019 ◽  
Author(s):  
Eric C Chan ◽  
Yuting Sun ◽  
Katherine J Aitchison ◽  
Sudhakar Sivapalan
Keyword(s):  
Systematic Review ◽  
Bipolar Disorder ◽  
Rating Scale ◽  
Mobile App ◽  
Self Report ◽  
Healthy Controls ◽  
Young Mania ◽  
Good Adherence ◽  
Wide Range ◽  
Meta Analyses

BACKGROUND Bipolar disorder is a chronic, progressive illness characterized by recurrent episodes of mania and depression. Self-report scales have historically played a significant role in the monitoring of bipolar symptoms. However, these tools rely on episodic memory, which can be unreliable and do not allow the clinician to monitor brief episodic symptoms or the course of symptoms over shorter periods of time. Mobile app–based questionnaires have been suggested as a tool to improve monitoring of patients with bipolar disorder. OBJECTIVE This paper aims to determine the feasibility and validity of mobile app–based self-report questionnaires. METHODS We performed a systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, PsycInfo, Web of Science, Ovid MEDLINE, and EMBASE databases were searched for papers published in English that assessed adherence to and the validity of mobile app–based self-report questionnaires. Relevant studies published from database creation to May 22, 2020, were identified, and results examining the validity of and rates of adherence to app-based self-report questionnaires are reported. RESULTS A total of 13 records were identified for inclusion in this review. Of these studies, 4 assessed the concurrent validity of mobile app–based self-report tools, with the majority of findings indicating significant associations between data collected using these tools and the Young Mania Rating Scale, Hamilton Depression Rating Scale-17, or Montgomery-Åsberg Depression Rating Scale (<i>P</i>&lt;.001 to <i>P</i>=.24). Three studies comparing the variability or range of symptoms between patients with bipolar disorder and healthy controls suggested that these data are capable of differentiating between known groups. Two studies demonstrated statistically significant associations between data collected via mobile app–based self-report tools and instruments assessing other clinically important factors. Adherence rates varied across the studies examined. However, good adherence rates (&gt;70%) were observed in all but 1 study using a once-daily assessment. There was a wide range of adherence rates observed in studies using twice-daily assessments (42%-95%). CONCLUSIONS These findings suggest that mobile app–based self-report tools are valid in the assessment of symptoms of mania and depression in euthymic patients with bipolar disorder. Data collected using these tools appear to differ between patients with bipolar disorder and healthy controls and are significantly associated with other clinically important measures. It is unclear at this time whether these tools can be used to detect acute episodes of mania or depression in patients with bipolar disorder. Adherence data indicate that patients with bipolar disorder show good adherence to self-report assessments administered daily for the duration of the study periods evaluated.

Comparisons of Narrative Psychotherapy to Conventional CBT for the Psychotherapy of Psychosis and Bipolar Disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. s779-s779
Author(s):  
L. Mehl-Madrona ◽  
B. Mainguy
Keyword(s):  
Bipolar Disorder ◽  
Narrative Therapy ◽  
Rating Scales ◽  
Psychotic Disorders ◽  
Rating Scale ◽  
Therapy Group ◽  
Well Being ◽  
Outcome Data ◽  
Symptom Scale ◽  
Young Mania

IntroductionThere is ongoing debate about about both the value of psychotherapy in psychotic disorders and the best type of psychotherapy to use if necessary.MethodsWe conducted narrative psychotherapy with 18 adults, all diagnosed as having bipolar disorder with psychotic features and/or schizo-affective disorder. Outcome data consisted of the Positive and Negative Symptom Scale, the Clinical Global Impressions Scale, the Young Mania Rating Scale, the Hamilton Anxiety and Depression Scales, the My Medical Outcome Profile, Version 2(MYMOP2), and the Outcome Rating Scales of Duncan and Miller. We compare the outcomes of our patients to those of a matched comparison group receiving conventional psycho-education and cognitive behavioural therapy. Patients were seen for a minimum of 16 weeks over an average of 22 weeks. Average age was 31.5 years with a standard deviation of 8.1 years.ResultsThe narrative therapy group showed statistically significant reductions in all outcome measures compared to the conventional treatment group. They continued treatment significantly longer and had fewer re-hospitalizations. They were less distressed by voices.ConclusionsA narrative psychotherapy approach using dialogical theory and therapy ideas is a reasonable approach for the psychotherapy of psychosis. Review of psychotherapy notes showed that narrative approaches allowed the therapist to align with the patient as collaborator in considering the story presented and was therefore less productive of defensiveness and self-criticism than conventional approaches. The therapy included techniques for negotiating changes in illness narratives, identity narratives, and treatment narratives that were more conducive of well-being and recovery.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Recovery and its correlates among patients with bipolar disorder: A study from a tertiary care centre in North India

2016 ◽  
Vol 62 (8) ◽  
pp. 726-736 ◽  
Author(s):  
Sandeep Grover ◽  
Nandita Hazari ◽  
Jitender Aneja ◽  
Subho Chakrabarti ◽  
Sunil Sharma ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Mental Illness ◽  
Depressive Symptoms ◽  
Rating Scale ◽  
Tertiary Care ◽  
North India ◽  
Personal Recovery ◽  
Tertiary Care Centre ◽  
Young Mania ◽  
Level Of Functioning

Background and Aim: The goal of treatment in mental illness has evolved from a symptom-based approach to a personal recovery–based approach. The aim of this study was to evaluate the predictors of personal recovery among patients with bipolar disorder. Methodology: A total of 185 patients with bipolar disorder, currently in remission, were evaluated on Recovery Assessment Scale (RAS), Internalized Stigma of Mental Illness Scale (ISMIS), Brief Religious coping scale (RCOPE), Duke University Religiosity Index (DUREL), Religiousness Measures Scale, Hamilton depression rating scale (HDRS), Young Mania rating scale (YMRS) and Global Assessment of Functioning (GAF) scale. Results: The mean age of the sample was 40.5 (standard deviation (SD), 11.26) years. Majority of the participants were male, married, working, Hindu by religion and belonged to extended/joint families of urban background. In the regression analysis, RAS scores were predicted significantly by discrimination experience, stereotype endorsement and alienation domains of ISMIS, level of functioning as assessed by GAF, residual depressive symptoms as assessed by HDRS and occupational status. The level of variance explained for total RAS score and various RAS domains ranged from 36.2% to 46.9%. Conclusion: This study suggests that personal recovery among patients with bipolar disorder is affected by stigma, level of functioning, residual depressive symptoms and employment status of patients with bipolar disorder.

scholarly journals Mothers with and without bipolar disorder and their infants: group differences in mother-infant interaction patterns at three months postpartum

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Teija M. S. Anke ◽  
Kari Slinning ◽  
Vibeke Moe ◽  
Cathrine Brunborg ◽  
Torill S. Siqveland ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Rating Scale ◽  
Depressive Symptomatology ◽  
Group Differences ◽  
Maternal Behaviour ◽  
Interaction Patterns ◽  
Young Mania ◽  
Significant Group ◽  
Interaction Quality ◽  
Affective Symptoms

Abstract Background Women with bipolar disorder (BD) have a high risk of illness relapse postpartum. The risk coincides with the period when mother-infant interactions are evolving. We compared mother-infant interactions in dyads where the mothers have BD with dyads where the mothers have no mental disorder. The association between concurrent affective symptoms of BD mothers and interaction quality was investigated. Methods Twenty-six women with BD and 30 comparison women with infants were included. The Parent-Child Early Relational Assessment (PCERA) was used to assess maternal behaviour, infant behaviour and dyadic coordination in interactions at 3 months postpartum. The Inventory of Depressive Symptomatology and Young Mania Rating Scale were used to assess affective symptoms of BD mothers at the time of interaction. Results There were significant group differences with medium to large effect sizes (0.73–1.32) on five of six subscales within the three interactional domains. Most interactional concerns were identified in dyadic coordination. No significant associations were found between maternal symptom load and interaction quality within the BD sample. Forty-six percent of the BD mothers experienced a mood episode within 0–3 months postpartum. Conclusions The present study identified challenges for mothers with BD and their infants in “finding” each other in interaction at 3 months postpartum. If sustained, this interaction pattern may have a long-term impact on children’s development. We suggest interventions specifically focusing on sensitising and supporting mothers to read infants’ cues on a micro-level. This may help them to respond contingently and improve dyadic coordination and synchronicity.

Therapeutic effect and tolerability of quetiapine XR in patients with manic episode, bipolar disorder I

2011 ◽  
Vol 26 (S2) ◽  
pp. 220-220
Author(s):  
M. Ladea ◽  
L.S. Grosu ◽  
M.C. Sinca ◽  
M.C. Sarpe
Keyword(s):  
Bipolar Disorder ◽  
Aggressive Behavior ◽  
Rating Scale ◽  
Involuntary Movement ◽  
Good Control ◽  
Manic Episode ◽  
Extrapyramidal Symptoms ◽  
Young Mania ◽  
Acute Relapse ◽  
Quetiapine Xr

IntroductionAgitation and aggressive behavior are common symptoms in patients with an acute relapse of bipolar mania.ObjectivesQuetiapine XR is an effective treatment in agitated patients with an acute relapse of bipolar disorder.AimsThe aim of this study was to assess the efficacy and tolerability of Quetiapine XR in patients with manic episode.MethodsThis naturalistic, observational study evaluated 45 patients diagnosed with manic episode, bipolar disorder I (DSM IV-TR) for a period of 4 weeks, during which the patients received Quetiapine XR, in doses between 800 mg and 1000 mg per day, using a rapid titration scheme.Efficacy of the treatment was measured using Young Mania Rating Scale (YMRS) and Clinical Global Impression Scale (CGI), performed at baseline, and then weekly. The Overt Aggression Scale-Modified (OAS-M) was used daily until day 4 and then once per week. Extrapyramidal symptoms were assessed with Barnes Akathisia Rating Scale and Abnormal Involuntary Movement Scale.ResultsImportant improvement of OAS-M total score was observed from the second day of treatment. After 4 weeks, more than a half of the patients presented a decrease of YMRS score with more than 50%. The CGI score also significantly improved. The treatment was well tolerated, mild to moderated adverse reactions being registered, without extrapyramidal symptoms.ConclusionsThese results confirm that Quetiapine XR is an effective and safe treatment for patients with an acute relapse of bipolar disorder I, the rapid titration scheme of the doses leading to a good control of aggressive behavior.

scholarly journals Does the efficacy of asenapine in bipolar disorder increase in the presence of comorbidity with a substance use disorder? A naturalistic study

2016 ◽  
Vol 7 (2) ◽  
pp. 67-77 ◽  
Author(s):  
Sergio De Filippis ◽  
Ilaria Cuomo ◽  
Georgios D. Kotzalidis ◽  
Daniela Pucci ◽  
Pietro Zingaretti ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Substance Use ◽  
Substance Use Disorder ◽  
Repeated Measures ◽  
Rating Scale ◽  
Type I ◽  
Open Label ◽  
Young Mania ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

Background: Asenapine is a second-generation antipsychotic approved in Europe for treating moderate-to-severe manic episodes in adults affected by type I bipolar disorder (BD-I). We aimed to compare its efficacy in psychiatric inpatients with BD-I, with or without substance use disorder (SUD). Methods: We administered flexible asenapine doses ranging from 5–20 mg/day to 119 voluntarily hospitalized patients with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) BD-I diagnosis, with or without SUD. Patients were assessed with clinician-rated questionnaires [i.e. Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and Global Assessment of Functioning (GAF)]. Assessments were carried out at baseline (T0, prior to treatment), and 3 (T1), 7 (T2), 15 (T3), and 30 days (T4) after starting treatment for all clinical scales and at T0 and T4 for the GAF. Results: Patients improved on all scales ( p < 0.001) across all timepoints, as shown both by paired-sample comparisons and by applying a repeated-measures, generalized linear model (GLM). Patients without comorbid SUD showed greater reductions in BPRS scores at T2 and T3, greater reduction in YMRS scores at T3, and lower HARS scores at all timepoints. HDRS scores did not differ between the two groups at any timepoint. However, the reduction in HARS scores in the comorbid group was stronger than in the BD-I only group, albeit not significantly. Side effects were few and mild-to-moderate. Conclusions: The open-label design and the relatively short observation period may expose to both type I and type II statistical errors (false positive and false negatives). Asenapine showed effectiveness and safety in hospitalized BD-I patients. Its effect was stronger in patients without comorbid SUD.

An Open-Label Trial of Aripiprazole Monotherapy in Children and Adolescents with Bipolar Disorder

CNS Spectrums ◽  
2007 ◽  
Vol 12 (9) ◽  
pp. 683-689 ◽  
Author(s):  
Joseph Biederman ◽  
Eric Mick ◽  
Thomas Spencer ◽  
Robert Doyle ◽  
Gagan Joshi ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Rating Scale ◽  
Vital Signs ◽  
Pediatric Bipolar Disorder ◽  
Open Label ◽  
Young Mania ◽  
Double Blind ◽  
Scale Scores ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

ABSTRACTIntroduction: Aripiprazole is a novel second-generation antipsychotic approved for the treatment of bipolar disorder in adults but there is no systematic data available in pediatric bipolar disorder.Methods: This was an 8-week, open-label, prospective study of aripiprazole 9.4±4.2 mg/day monotherapy to assess the efficacy and tolerability of this compound in treating pediatric bipolar disorder. Assessments included the Young Mania Rating Scale, Clinical Global Impressions-Improvement scale, and Brief Psychiatric Rating Scale. Adverse events were assessed through spontaneous self-reports, vital signs weight monitoring, and laboratory analysis.Results: Fifteen of the 19 bipolar youth (79%) completed the study. Aripiprazole treatment was associated with clinically and statistically significant improvement in mean Young Mania Rating Scale scores (−18.0±6.9, P<.0001). With the important exception of two cases of extrapyramidal symptoms that precipitated dropout, aripiprazole was well tolerated with no statistically significant increase in body weight (1.8±1.7 kg, P=.2).Conclusion: Open-label aripiprazole treatment was beneficial in the treatment of mania in youth with bipolar disorder. Future placebo-controlled, double blind studies are warranted.

scholarly journals Role of Age at Onset in the Clinical Presentation of Bipolar Disorder

2021 ◽  
Author(s):  
Ajitabh Soni ◽  
Paramjeet Singh ◽  
Raghav Shah ◽  
Sunil Kumar ◽  
Lalit Batra
Keyword(s):  
Bipolar Disorder ◽  
Family History ◽  
Rating Scale ◽  
Clinical Presentation ◽  
Late Onset ◽  
Age At Onset ◽  
P Value ◽  
Young Mania ◽  
Thought Disorders ◽  
History Of

Introduction: There is considerable evidence to suggest that the clinical expression of Bipolar Disorder (BD) differs according to Age at Onset (AAO) that has therefore been identified as a potential specifier of interest. Aim: To compare the clinical presentation of BD and also to compare the presence of family history of illness in three subgroups made on the basis of AAO. Materials and Methods: A cross-sectional hospital based observational study was carried out on 162 patients having a diagnosis of BD current episode manic. Three subgroups were made according to AAO viz., Early Onset Bipolar Disorder (EOBD; AAO ≤21 years; 67 patients), Intermediate Onset Bipolar Disorder (IOBD; AAO=22-34 years; 59 patients) and Late Onset Bipolar Disorder (LOBD; AAO ≥35 years; 36 patients). The subgroups were compared on clinical variables, items of the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D) and Scale for Assessment of Positive Symptoms (SAPS) scales and family history of illness. Results: The EOBD subgroup had significantly more episodes per year (p-value <0.001 and partial eta squared value=0.17) than IOBD and LOBD subgroups (mean episodes per year, respectively in EOBD, IOBD and LOBD were 1.8, 0.8 and 0.6). The prevalence of family history of mood disorder was also significantly higher in the EOBD (present in 35 out of 67; χ2 value=22.8 and p-value <0.001) than both the other subgroups (present in 10 out of 59 in IOBD and 6 out of 36 in LOBD). Significant differences were found on different items of YMRS, HAM-D and SAPS scales among the subgroups EOBD subgroup had higher rating on irritability, motor activity energy, sexual interest, depressed mood, delusions, thought disorders, while LOBD subgroup had higher rating on elevated mood. Conclusion: EOBD subgroup can be considered as a specific phenotype of BD patients, which is more homogenous, severe and heritable form of illness.

scholarly journals Evidence for the continuous latent structure of mania and depression in out-patients with bipolar disorder: results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)

2015 ◽  
Vol 45 (12) ◽  
pp. 2595-2603 ◽  
Author(s):  
J. J. Prisciandaro ◽  
B. K. Tolliver
Keyword(s):  
Bipolar Disorder ◽  
Structural Equation ◽  
Rating Scale ◽  
Latent Structure ◽  
Diagnostic Systems ◽  
Young Mania ◽  
Systematic Treatment ◽  
Mood Symptoms ◽  
Mood Episode ◽  
General Functioning

BackgroundEvidence supporting the continuous latent structure of mood phenomena has not been incorporated into psychiatric diagnostic systems, in part because the evidence has been incomplete. For example, no studies have investigated the boundary between ‘sick’ and ‘well’ periods in individuals with bipolar disorder, despite agreement that characterization of mood disorders as having a discrete episodic course is inaccurate. The present study examined the validity of mood episode symptom thresholds in out-patients with bipolar disorder using multiple methodologies: taxometrics and information-theoretic latent distribution modeling (ITLDM), to evaluate the continuity/discontinuity of mood symptoms; and structural equation mixture modeling (SEMM), to evaluate the continuity/discontinuity of associations between mood symptoms and general functioning.MethodA total of 3721 out-patients with bipolar disorder from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were available for analysis. Data were collected at participants’ baseline STEP-BD visit. Taxometric [maximum covariance/means above minus below a cut (MAXCOV/MAMBAC) with simulated comparison data], ITLDM and SEMM methods were applied twice, once to the Montgomery–Åsberg Depression Rating Scale and again to the Young Mania Rating Scale.ResultsTaxometric results unequivocally supported a continuous interpretation of the data. ITLDM results favored many valued ‘discrete metrical’ models, suggesting that mood symptoms have continuous, but potentially non-normally distributed, latent structures in out-patients with bipolar disorder. Finally, SEMM results demonstrated that latent associations between mood symptoms and general functioning were linear.ConclusionsResults from the present study argue against the validity of DSM mood episode thresholds and argue for a graded continuum of care of bipolar symptom management.

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