One of the major challenges in managing bipolar disorder is its variability over time. The diagnosis of bipolar disorder is often made by following the long-term course of the illness. It is generally difficult to make the diagnosis for the first episode since the majority of the first episodes of bipolar disorder are depressive and often mistaken for major depressive disorder. About 60% of bipolar order patients experience symptoms at ages earlier than 18.
The time course of bipolar disorder is characterized by cycling between manic and depressive episodes. The rates of cycling from mania to depression reported in various clinical trials vary between 17% (Tohen et al, 1990), 21% (Angst et al) and 30% (Keller et al). A patient with bipolar disorder also tends to relapse. The first-year relapse rate reported by Prien et al is 67% and Bowden et al is 38%. It is important to develop tools to predict relapse of episodes so preventive measures can be used to reduce the severity of an episode and to speed up recovery.
Collecting data on patients with bipolar disorder is expensive and involved large uncertainties. To address this issue, a group of researchers at UCLA has developed ChronoRecord, a software that patients can install on a home computer. The software allows patients to track mood changes, medications, sleep, life events, weight and menstrual data. The data will help researchers to characterize the disorder according to:
• Onset of the disorder(type of onset, age of onset)
• Episodes (i.e., type of episode, number, frequency, length)
• Cycles (i.e., number, length, frequency, intervals, persisting symptoms, stability of syndrome shift)
• Activity of the episodes (i.e., re-manifestation during a defined period of time)
• Outcome (the end-point of follow-up in a defined period of time)
ChronoRecord has also been validated against less-automated monitoring methods. ChronoRecord also increases compliance of patients to self-reporting. Bauer et al (2008) demonstrated that 83% of patients comply with this system of self-report and enter daily recordings for a period of 100 days.
In summary, ChronoRecord proves to be a useful technology for monitoring patients with bipolar disorder.
Self-reporting software for bipolar disorder: Validation of ChronoRecord by patients with mania. Michael Bauer, Tina Wilson, Kathrin Neuhaus, Johanna Sasse, Andrea Pfennig, Ute Lewitzka, Paul Grof, Tasha Glenn, Natalie Rasgon, Tom Bschor, Peter C Whybrow , Psychiatry Res. 2008 Apr 17; : 18423616
Hirschfeld RM, Williams JB, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry. 2000;157:1873-1875.
Screening for Bipolar Disorder in a Primary Care Practice, Amar K. Das, et al JAMA. 2005;293:956-963.