Effectiveness of smartphone-based ambulatory assessment (SBAA-BD) including a predicting system for upcoming episodes in the long-term treatment of patients with bipolar disorders: study protocol for a randomized controlled single-blind trial

• Published in: BMC psychiatry 2018-10, Vol.18 (1), p.349-349, Article 349
• Main Authors: Mühlbauer, Esther, Bauer, Michael, Ebner-Priemer, Ulrich, Ritter, Philipp, Hill, Holger, Beier, Fabrice, Kleindienst, Nikolaus, Severus, Emanuel
• Format: Article
• Language: English
• Subjects: Affective disorders; Ambulatory assessment; Ambulatory care; Automation; Bipolar disorder; Care and treatment; Clinical medicine; Clinical trials; Costs; Data processing; Diagnosis; Early warning signs; Evidence-based medicine; Feedback; Health aspects; Intervention; Mental depression; Methods; Mood; Mood disorders; Motivation; Patients; Prevention; Psychiatry; Smart phones; Smartphones; Software; Study Protocol; Technology application; Telemedicine
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/s12888-018-1929-y

The detection of early warning signs is essential in the long-term treatment of bipolar disorders. However, in bipolar patients' daily life and outpatient treatment the assessment of upcoming state changes faces several difficulties. In this trial, we examine the effectiveness of a smartphone based automated feedback about ambulatory assessed early warning signs in prolonging states of euthymia and therefore preventing hospitalization. This study aims to assess, whether patients experience longer episodes of euthymia, when their treating psychiatrists receive automated feedback about changes in communication and activity. With this additional information an intervention at an earlier stage in the development of mania or depression could be facilitated. We expect that the amount of time will be longer between affective episodes in the intervention group. The current study is designed as a randomized, multi-center, observer-blind, active-control, parallel group trial within a nationwide research project on the topic of innovative methods for diagnostics, prevention and interventions of bipolar disorders. One hundred and twenty patients with bipolar disorder will be randomly assigned to (1) the experimental group with included automated feedback or (2) the control group without feedback. During the intervention phase, the psychopathologic state of all participants is assessed every four weeks over 18 months. Kaplan-Meier estimators will be used for estimating the survival functions, a Log-Rank test will be used to formally compare time to a new episode across treatment groups. An intention-to-treat analysis will include data from all randomized patients. This article describes the design of a clinical trial investigating the effectiveness of a smartphone-based feedback loop. This feedback loop is meant to elicit early interventions at the detection of warning signs for the prevention of affective episodes in bipolar patients. This approach will hopefully improve the chances of a timely intervention helping patients to keep a balanced mood for longer periods of time. In detail, if our hypothesis can be confirmed, clinical practice treating psychiatrists will be enabled to react quickly when changes are automatically detected. Therefore, outpatients would receive an even more individually tailored treatment concerning time and frequency of doctor's appointments. ClinicalTrials.gov : NCT02782910 : Title: "Smartphone-based Ambulatory Assessment of Early Warning S