Voice analysis as an objective state marker in bipolar disorder A Pilot Study of Mood Ratings Captured by Mobile Phone Versus Paper-and-Pencil Mood Charts in Bipolar Disorder Reproductive cycle-associated mood symptoms in women with major depression and bipolar disorder. Baseline mood-state measures as predictors of antidepressant response to scopolamine Clinical significance of lifetime panic spectrum symptoms in the treatment of patients with bipolar I disorder. Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Breaking Open the Black Box: Isolating the Most Potent Features of a Web and Mobile Phone-Based Intervention for Depression, Anxiety, and Stress Lithium treatment of acute mania in adolescents: a large open trial.
Changes in speech have been suggested as sensitive and valid measures of depression and mania in bipolar disorder . The present study aim ed at investigating ( 1 ) voice features collected during phone calls as objective markers of affective states in bipolar disorder and ( 2 ) if combining voice features with automatically generated objective smartphone data on behavioral activities ( for example , number of text messages and phone calls per day ) and  electronic self-monitored data ( mood ) on illness activity would increase the accuracy as a marker of affective states . Using smartphones , voice features , automatically generated objective smartphone data on behavioral activities  and  electronic self-monitored data  were collected from 28 out patients with bipolar disorder in naturalistic setting s on a daily basis during a period of 12 weeks . Depressive and manic symptoms were assessed using the Hamilton Depression Rating Scale 17-item and the Young Mania Rating Scale , respectively , by a research er blinded to smartphone data . Data were analyzed using r and om forest algorithms . Affective states were classified using voice features extracted during everyday life phone calls . Voice features were found to be more accurate , sensitive and specific in the classification of manic or mixed states with an area under the curve (AUC)=0.89 compared with an AUC=0.78 for the classification of depressive states . Combining voice features with automatically generated objective smartphone data on behavioral activities  and electronic self-monitored data  increased the accuracy , sensitivity and specificity of classification of affective states slightly . Voice features collected in naturalistic setting s using smartphones may be used as objective state markers in patients with bipolar disorder Objective : Patient-reported mood charts are frequently used in management of bipolar disorder . Although mood charts have recently been programmed in electronic devices such as mobile phones , little is known about the impact of the method of data capture on the psychometric properties and validity of these data . Methods : In an ongoing pilot study , a sample of out patients with bipolar disorder were r and omized to complete mood charts either on a mobile phone or with st and ard paper and pencil as part of a 12-week intervention ( primary outcomes for the trial await study completion ) . We compared these conditions across a single item rating of mood state , and we hypothesized that mobile phone-based data capture would produce greater compliance to mood ratings , variability between and within participants , and concurrent validity with blinded clinician-rated affective symptom severity . Results : A total of 56 participants were r and omized and 40 participants were included in the analyses . There were no significant differences between conditions on demographic or clinical variables . The rate of compliance was significantly higher in paper- and -pencil versus mobile phone ratings . Ratings demonstrated significantly more variability within individuals in the mobile phone condition . Mobile phone mood ratings were significantly correlated with clinician-rated depressive symptom severity across the study and with manic symptom severity at the week-6 assessment , whereas paper- and -pencil ratings were not significantly associated with clinician-rated depression or mania . Conclusions : Although preliminary , our results suggest a lower rate of compliance with mobile phones compared to paper- and -pencil daily mood rating in bipolar disorder , yet a greater ability to capture variability and concurrent validity in quantifying affective symptoms . This clinical trial is registered at www . clinical trials.gov as NCT01670123 BACKGROUND We sought to determine the prevalence of , and association between , reproductive cycle-associated mood symptoms in women with affective disorders . We hypothesized that symptoms would correlate with each other across a woman 's reproductive life span in both major depression ( MDD ) and bipolar I disorder ( BP ) . METHODS 2412 women with , MDD or BP were asked st and ardized questions about mood symptoms prior to menstruation , within a month of childbirth and during perimenopause .  Lifetime rates for each of these symptom types were determined and an odds ratio was calculated correlating each of the types with the others . RESULTS Of 2524 women with mood disorders , 67.7 % reported premenstrual symptoms . Of those at risk , 20.9 % reported postpartum symptoms and 26.4 % reported perimenopausal symptoms . The rates did not differ between women with MDD and BP but were significantly different from women who were never ill . The symptoms were significantly correlated in women with MDD with odds ratios from 1.66 to 1.82 , but were not in women with BP . LIMITATIONS This is a secondary analysis of a sample that was collected for other purpose s and is based upon retrospective reporting . CONCLUSIONS Reproductive cycle-associated mood symptoms were commonly reported in women with mood disorders and did not differ based on diagnosis . In MDD , but not BP , the occurrence of these symptoms was trait-like as the presence of one predicted the occurrence of the others . Further prospect i ve study is required to clarify the determinants of this trait Identifying predictors of antidepressant response will facilitate the successful treatment of patients suffering from depression .  Scopolamine produces robust antidepressant responses in unipolar and bipolar depression . Here we evaluate the potential for baseline self-ratings to predict treatment response to scopolamine .  Fifty-one unipolar and bipolar patients participated in a double-blind , placebo-controlled crossover trial . Following a single-blind placebo session , participants r and omly received P/S or S/P ( P=3 placebo ; S=3 scopolamine ( 4μg/kg ) sessions ) . Mood-state self-ratings ( Profile of Mood State ( POMS ) and Visual Analog Scales ( VAS ) ) and depression severity ( Montgomery-Åsberg Depression Rating Scale ( MADRS ) ) were obtained before each infusion . Day 1 ( baseline/placebo ) self-ratings were used in a discriminant function analysis to identify linear combinations of individual items that predict response . The discriminant analysis significantly separated responders from non-responders in both the unipolar and bipolar diagnostic subgroups . The discriminant functions accurately classified over 85 % of patients as responders/non-responders . The POMS depression subscale significantly correlated with clinical response , as did the VAS restlessness , sad , and irritated scales . These results indicate that self-report mood-ratings obtained before treatment can predict response outcome to scopolamine , and suggest that a constellation of mood-state features may be related to clinical response BACKGROUND Given the observed association between panic disorder and bipolar disorder and the potential negative influence of panic symptoms on the course of bipolar illness , we were interested in the effects of what we have defined as " panic spectrum " conditions on the clinical course and treatment outcome in patients with bipolar I ( BPI ) disorder . We hypothesized that lifetime panic spectrum features would be associated with higher levels of suicidal ideation and a poorer response to acute treatment of the index mood episode in this patient population . METHODS A sample of 66 patients with BPI disorder completed a self-report measure of lifetime panic-agoraphobic spectrum symptoms .  Patients falling above and below a predefined clinical threshold for panic spectrum were compared for clinical characteristics , the presence of suicidal ideation during acute treatment , and acute treatment response . RESULTS Half of this outpatient sample reported panic spectrum features above the predefined threshold . These lifetime features were associated with more prior depressive episodes , higher levels of depressive symptoms , and greater suicidal ideation during the acute-treatment phase . Patients with BPI disorder who reported high lifetime panic-agoraphobic spectrum symptom scores took 27 weeks longer than those who reported low scores to remit with acute treatment ( 44 vs 17 weeks , respectively ) . CONCLUSIONS The presence of lifetime panic spectrum symptoms in this sample of patients with BPI disorder was associated with greater levels of depression , more suicidal ideation , and a marked ( 6-month ) delay in time to remission with acute treatment . Alternate treatment strategies are needed for patients with BPI disorder who endorse lifetime panic spectrum features OBJECTIVE Little is known about clinical features associated with the risk of recurrence in patients with bipolar disorder receiving treatment according to contemporary practice guidelines . The authors looked for the features associated with risk of recurrence . METHOD The authors examined prospect i ve data from a cohort of patients with bipolar disorder participating in the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder ( STEP-BD ) study for up to 24 months . For those who were symptomatic at study entry but subsequently achieved recovery , time to recurrence of mania , hypomania , mixed state , or a depressive episode was examined with Cox regression . RESULTS Of 1,469 participants symptomatic at study entry , 858 ( 58.4 % ) subsequently achieved recovery . During up to 2 years of follow-up , 416 ( 48.5 % ) of these individuals experienced recurrences , with more than twice as many developing depressive episodes ( 298 , 34.7 % ) as those who developed manic , hypomanic , or mixed episodes ( 118 , 13.8 % ) . The time until 25 % of the individuals experienced a depressive episode was 21.4 weeks and until 25 % experienced a manic/hypomanic/mixed episode was 85.0 weeks . Residual depressive or manic symptoms at recovery and proportion of days depressed or anxious in the preceding year were significantly associated with shorter time to depressive recurrence . Residual manic symptoms at recovery and proportion of days of elevated mood in the preceding year were significantly associated with shorter time to manic , hypomanic , or mixed episode recurrence . CONCLUSIONS Recurrence was frequent and associated with the presence of residual mood symptoms at initial recovery . Targeting residual symptoms in maintenance treatment may represent an opportunity to reduce risk of recurrence Background Internet-delivered mental health ( eMental Health ) interventions produce treatment effects similar to those observed in face-to-face treatment . However , there is a large degree of variation in treatment effects observed from program to program , and eMental Health interventions remain somewhat of a black box in terms of the mechanisms by which they exert their therapeutic benefit . Trials of eMental Health interventions typically use large sample sizes and therefore provide an ideal context within which to systematic ally investigate the therapeutic benefit of specific program features . Furthermore , the growth and impact of mobile phone technology within eMental Health interventions provides an opportunity to examine associations between symptom improvement and the use of program features delivered across computer and mobile phone platforms . Objective The objective of this study was to identify the patterns of program usage associated with treatment outcome in a r and omized controlled trial ( RCT ) of a fully automated , mobile phone- and Web-based self-help program , “ myCompass ” , for individuals with mild-to-moderate symptoms of depression , anxiety , and /or stress . The core features of the program include interactive psychotherapy modules , a symptom tracking feature , short motivational messages , symptom tracking reminders , and a diary , with many of these features accessible via both computer and mobile phone . Methods Patterns of program usage were recorded for 231 participants with mild-to-moderate depression , anxiety , and /or stress , and who were r and omly allocated to receive access to myCompass for seven weeks during the RCT .  Depression , anxiety , stress , and functional impairment were examined at baseline and at eight weeks . Results Log data indicated that the most commonly used components were the short motivational messages ( used by 68.4 % , 158/231 of participants ) and the symptom tracking feature ( used by 61.5 % , 142/231 of participants ) . Further , after controlling for baseline symptom severity , increased use of these alert features was associated with significant improvements in anxiety and functional impairment . Associations between use of symptom tracking reminders and improved treatment outcome remained significant after controlling for frequency of symptom tracking . Although correlations were not statistically significant , reminders received via SMS ( ie , text message ) were more strongly associated with symptom reduction than were reminders received via email . Conclusions These findings indicate that alerts may be an especially potent component of eMental Health interventions , both via their association with enhanced program usage , as well as independently . Although there was evidence of a stronger association between symptom improvement and use of alerts via the mobile phone platform , the degree of overlap between use of email and SMS alerts may have precluded identification of alert delivery modalities that were most strongly associated with symptom reduction . Future research using r and om assignment to computer and mobile delivery is needed to fully determine the most ideal platform for delivery of this and other features of online interventions . Trial Registration Australian New Zeal and Clinical Trials Registry ( ACTRN ) : 12610000625077 ; http://www.anzctr.org.au/Trial Search .aspx ? ( Archived by WebCite http://www.webcitation.org/6WPqHK0mQ ) OBJECTIVE To examine initial response to treatment in a large sample of acutely manic bipolar I adolescents and to examine potential predictors of nonresponse , such as the presence of prominent depressive features , psychosis , or psychiatric comorbidity . METHOD Adolescents , 12 to 18 years of age , with an acute manic episode were treated with open lithium . Response was defined as a decline in Young Mania Rating Scale total score of > or=33 % and a rating of " much improved " or " very much improved " on the Clinical Global Impressions Improvement item at week 4 . Remission of mania was defined as a Young Mania Rating Scale score of < or=6 . Axis I diagnoses were assessed using the Lifetime Schedule for Affective Disorders and Schizophrenia for Adolescents . RESULTS Of 100 subjects , 63 met response criteria and 26 achieved remission of manic symptoms at the week 4 assessment . Prominent depressive features , age at first mood episode , severity of mania , and comorbidity with attention-deficit/hyperactivity disorder did not distinguish responders from nonresponders . When treated with adjunctive antipsychotic medication , subjects with psychotic features at baseline responded as well as subjects without psychosis . CONCLUSIONS In this largest systematic treatment trial of acutely manic adolescents to date , lithium appears effective for acute stabilization of symptoms . Controlled treatment studies in adolescents with acute mania are needed
Hence , continuous and everyday monitoring of behavioral aspects in affective disorders could be a promising supplementary objective measure for estimating depressive mood symptoms .
BACKGROUND Several studies have recently reported on the correlation between objective behavioral features collected via mobile and wearable devices and depressive mood symptoms in patients with affective disorders ( unipolar and bipolar disorders ) .
However , individual studies have reported on different and sometimes contradicting results , and no quantitative systematic review of the correlation between objective behavioral features and depressive mood symptoms has been published .
OBJECTIVE The objectives of this systematic review were to ( 1 ) provide an overview of the correlations between objective behavioral features and depressive mood symptoms reported in the literature and ( 2 ) investigate the strength and statistical significance of these correlations across studies .
The answers to these questions could potentially help identify which objective features have shown most promising results across studies .