GREETINGS... to all of you my beloved and brave participants of the eMonitoring project. I should have put a newsletter together a long time ago, but it is only now that I am getting busy with writing up. The study for now is completed and I ought to say that we did an impressive amount of work together. It has been a long but a challenging and interesting journey in more ways than you can imagine. Most of you had predicted I would have an interesting time ahead dealing with the masses of data we collected. As usual you were right. I am spending days and nights still putting all the databases together. WHAT WE DID... For starters we did a study together that most people had predicted would not be possible to do. We completed one of the most comprehensive symptom monitoring programs possible ever done with people who have a bipolar disorder. Full-stop!!! All in all, out of the 45 people recruited, 37 of you successfully completed most of the study. Yes, you remember correctly, we did 3 months of daily and weekly symptom monitoring! But read on to learn more... So what else lies ahead? Well there are 4 interesting studies that need to be written as a result of our efforts. The first study will look at the entire symptomatology of the group. It will give us an idea of what sort of symptoms are more prevalent when people are relatively well - we call these “sub-syndromal symptoms”. It will also look at how much time people spend experiencing these symptoms. Preliminary analyses indicate that at least half of the group (even though as a group it looks almost symptom free) spends a considerable amount of time with sub-syndromal depressive symptoms. This has been shown before but at least we know we are on the same track. In contrast to previous studies, we can look at these symptoms in greater detail and can determine far more accurately Looking at the future... GEORGE SALAMINIOS started as a junior psychology intern from Brunel university and was instrumental in helping throughout the project. Having achieved a 1st class honours degree, he is now completing an MSc at UCL and is getting ready for his Greek military service. PROJECT NEWSLETTER - ISSUE NO. 1, JULY 2009 P025, DEPARTMENT OF HEALTH SERVICE AND POPULATION RESEARCH,INSTITUTE OF PSYCHIATRY, KING’S COLLEGE LONDON, DE CRESPIGNY PARK ROAD, SE5 8AF, LONDON www.BipolarLab.com 1 CHEWY CHAN (aka GBOT) was our second junior psychology intern from Brunel university. Despite her worries she also achieved a 1st class honours degree. She is currently looking for jobs in human resources. Chewy (rightly) thinks I am a Greek “Ogre” but at least she loves travelling to Greece. AGAZI FESSEHAIE was our third and final student intern from Brunel university. Some of you remember his “reminder” emails. He also completed successfully his psychology degree and is currently thinking of going into counselling psychology.
Transcript
GREETINGS... to all of you my beloved and brave participants of the eMonitoring p r o j e c t . I s h o u l d h av e p u t a newsletter together a long time ago, but it is only now that I am getting busy with writing up.
The study for now is completed and I o u g h t t o s ay t h a t w e d i d a n impressive amount of work together. It has been a long but a challenging and interesting journey in more ways than you can imagine.
Most of you had predicted I would have an interesting time ahead dealing with the masses of data we collected. As usual you were right. I am spending days and nights still putting all the databases together.
WHAT WE DID...For starters we did a study together that most people had predicted would not be possible to do. We completed one of the most comprehensive symptom monitoring programs possible ever done with people who have a bipolar disorder. Full-stop!!!
All in all, out of the 45 people recruited, 37 of you successfully completed most of the study. Yes, you remember correctly, we did 3 months of dai ly and weekly symptom monitoring! But read on to learn more...
So what else lies ahead? Well there are 4 interesting studies that need to be written as a result of our efforts. The first
study will look at the entire symptomatology of the group. It will give us an idea of what sort of symptoms are more prevalent when people are relatively well - we call these “sub-syndromal symptoms”. It will also look at how much time people spend experiencing these symptoms.
Preliminary analyses indicate that at least half of the group (even though as a group it looks almost symptom free) spends a considerable amount of time with sub-syndromal depressive symptoms. This has been shown before but at least we know we are on the same track. In contrast to previous studies, we can look at these symptoms in greater detail and can determine f a r m o r e a c c u r a t e l y
Looking at the future...
GEORGE SALAMINIOS started as a junior psychology intern from Brunel university and was instrumental in helping throughout the project. Having achieved a 1st class honours degree, he is now completing an MSc at UCL and is getting ready for his Greek military service.
PROJECT NEWSLETTER - ISSUE NO. 1, JULY 2009
P025, DEPARTMENT OF HEALTH SERVICE AND POPULATION RESEARCH,INSTITUTE OF PSYCHIATRY, KING’S COLLEGE LONDON, DE CRESPIGNY PARK ROAD, SE5 8AF, LONDON
www.BipolarLab.com
1
CHEWY CHAN (aka GBOT) was our second junior psychology intern from Brunel university. Despite her worries she also achieved a 1st class honours degree. She is currently looking for jobs in human resources. Chewy (rightly) thinks I am a Greek “Ogre” but at least she loves travelling to Greece.
AGAZI FESSEHAIE was our third and final student intern from Brunel university. Some of you remember his “reminder” emails. He also completed successfully his psychology degree and is currently thinking of going into counselling psychology.
important clinical variables such as symptom peaks, mood switches, and overall symptom variability. These a r e l i ke ly t o b e c o m e f u t u r e treatment targets, especially if we find that they influence the clinical course of Bipolar disorder.
The second study will look at our l i t t l e b a b y e l e c t r o n i c d i a r y iMonitor (http://myiMonitor.com). This was something that we developed especially for the needs of the current project. It is important for other researchers and clinicians to know how this software was developed and how it performs as a s y mp t o m m o n i t o r i n g t o o l i n comparison with other established methods.
Preliminary analyses indicate that most of the items included in iMonitor appear to measure what they are meant to measure. I would h a v e l i k e d t o s e e b e t t e r “correlations” with the clinical measures (our interviews) but iMonitor is just as “bad” as other daily symptom monitoring tools that rely on self-report. More analyses are really needed to determine its “psychometric value” and, most importantly, to see whether what was measured in there can give us an idea in predicting people’s clinical course. This is what we cal l “predictive validity”, which will be the most significant test of iMonitor.
The third study will look at your much hated actiwatch and also at your much beloved pedometer. Approximately half of you used an actiwatch in order to monitor your sleep and activity levels. The other half used a pedometer which c o n t a i n e d a r a t h e r s i m i l a r accelerometer sensor but costed much less. We need to figure out how g o o d t h e s e g a d g e t s a r e f o r monitoring people’s symptoms and mood states, more or less like we are doing with iMonitor. We have enough
data I believe to get an idea. These activity sensors should be able to pick up the more severe symptom peaks or changes. The application of these sensors in monitoring bipolar disorder is really our first step towards moving away from self-report methods. Really who wants to keep a mood diary all the time? I don’t.
The final and fourth study will investigate the different predictors of the course. It will be important to
OUR MECHANICS
Andreas Soupianas is the man behind iMonitor. A childhood friend and top programmer from Athens. He did all his work for free in order to help his friend complete his project. We owe him a big manic thank you!
Dr Kristof Van Laerhoven and his students are working behind the scenes to develop the uber-actiwatch from their evil research lab in Germany. It will not only monitor your activity, but it will also know what you do! They sure aim high! Yes, it is them!
Professor Dinesh Bhugra has made the completion of the second part of the study possible. His moral and financial support are helping to see this study through. He is currently acting President of the Royal College of Psychiatry, along with being a Professor of Mental Health & Cultural Psychiatry at the Institute.
Professor Tom Craig acts as a secondary supervisor. He has been instrumental in helping me to clarify my research questions and finalise the outline of my thesis. Professor Craig has an interest in psychosocial predictors of mood disorders.
Both of them have conducted some of the most important studies in the area.
Hence, the attachment project (www.bipolarlab.com/attachment) and the childhood experiences interview most of you participated in at a later stage of the project.
This study is almost over too.
Days monitored 2681Weeks targeted 766Weeks assessed 519Weeks missed 247
# of Symptom peaks 126# of depressive peaks 24# of manic peaks 3# of subsyndromal peaks 101# of episodes ???
see and establish whether the presence and variability of such sub-syndromal symptoms can predict who becomes unwell and who stays well. We have already gathered some of our so called “relapse data” and that’s why we had the follow ups. But ideally we need to have one more
and final follow up. Usually to answer such questions, the longer the follow-up time, the better one can determine such things. Ideally, I would have liked you all to have stayed well, and to have had no relapses. But we know that Bipolar disorder is a recurring condition and relapses are there. However, whether you had them or not, it will still be important to know. You will all get a final invitation letter/email/call with the dates of your last follow up. If you can gather your diaries and other notes to help us best determine what has happened since then, you will make our lives a lot easier.
More studies to come...in reality with all the data that we have gathered there will be many more studies to come. Most of the other s t u d i e s w i l l t e s t d i f f e r e n t v u l n e r a b i l i t y f a c t o r s f r o m
psychological models that make predictions about Bipolar disorder and its course. These are going to be a valuable set of preliminary studies to develop the models further and improve the psychological therapies that use these models to prevent relapses in Bipolar disorder. We have 3 MSc students who are working on these studies as part of their theses. Angeline, Kemi and Rachel will be writing more about their projects in a forthcoming newsletter.
Dr Emil Kraepelin (pictured left), the German father of our modern western psychiatry, who also made t h e d i s t i n c t i o n b e t w e e n schizophrenia and manic depressive illness, was a great advocate of d a i l y s y m p t o m m o n i t o r i n g methods and the prospective investigation of Bipolar disorder. He did it all by himself. He did not bother with coaching his patients really or had to rely on self-report, but that was a different era and many of his pat ients were chronically unwell and were inpatients. Nowadays and thanks to our modern treatments things have changed. We can do studies like the one we did all together, going through our ups and downs but at the same time holding still and going through all the assessments. I am sure he would have been proud of us all.
See Dr Lieberman’s free web reincarnation of Dr Kraepelin’s Life-Chart:
www.moodchart.org
The Final Follow-up?CHRONORECORD STUDY
Some of you used ChronoRecord, our desktop pc based electronic diary. Your efforts are already bearing fruits as we have the first publication out by Dr Bauer (German Psychiatrist), Tasha Glenn (ChronoRecord developer) and other important researchers in the field (yes, they kindly included me too).
The study combined data from ChronoRecord centers across the world and looked at the influence of climate on mood.
Contrary to popular beliefs, at least in this study and our bipolar sample, climate does not seem to af fect your mood! See the
attached article-http://is.gd/BFOF
IN THIS FIRST NEWSLETTER,...I hope you all learned something new about what we did and what we are doing with the research you participated. Your contribution has been invaluable. I will do my best to keep you informed with more papers and newsletters. We are also looking forward to seeing you for one more time to conclude all the follow-ups for my PhD thesis. There will be lunch, and greek treats as usual! As they say, “beware of the Greeks bearing gifts”! But we all like them!
DR MIKE HADJULIS, a friendly shrink, was there for me during the study helping in the background to keep my head together as well as to make sure we get all our diagnoses right. He is assisting with the more analytical matters of the study and the clinical value of our results.
HELLENIC BIPOLAR ORGANISATION
Last but not least, along with a group of colleagues over the last year and a half, I founded the first MDF-Like organisation for Bipolar patients, their relatives, friends, and professionals in Greece. I founded this in my father’s memory who had the illness and suffered much from it. We hope it grows and one day becomes as big and helpful to Bipolar people as the UK group. If you can read Greek, it’s all here: www.bipolar.gr
JON’S MOODSCOPE PROJECT
Also remember to check Jon’s MoodScope project. Jon participated like you in the eMonitoring project and he is public about his experience with Bipolar disorder. Not only did he do an excellent job at it, but was also further inspired to develop his own mood monitoring system. It is best for mild mood disorders and “normal” mood fluctuations.
