Mobile Apps for Bipolar Disorder: A Systematic Review of Features and Content Quality

August 22, 2015 by  
Filed under Research

Mobile apps abound, but are they any good?

This is one of the few studies I’ve seen to actually look at the quality of apps for a specific diagnosis. Here’s the abstract of the study:

With continued increases in smartphone ownership, researchers and clinicians are investigating the use of this technology to enhance the management of chronic illnesses such as bipolar disorder (BD). Smartphones can be used to deliver interventions and psychoeducation, supplement treatment, and enhance therapeutic reach in BD, as apps are cost-effective, accessible, anonymous, and convenient. While the evidence-based development of BD apps is in its infancy, there has been an explosion of publicly available apps. However, the opportunity for mHealth to assist in the self-management of BD is only feasible if apps are of appropriate quality.

Our aim was to identify the types of apps currently available for BD in the Google Play and iOS stores and to assess their features and the quality of their content.

A systematic review framework was applied to the search, screening, and assessment of apps. We searched the Australian Google Play and iOS stores for English-language apps developed for people with BD. The comprehensiveness and quality of information was assessed against core psychoeducation principles and current BD treatment guidelines. Management tools were evaluated with reference to the best-practice resources for the specific area. General app features, and privacy and security were also assessed.

Of the 571 apps identified, 82 were included in the review. Of these, 32 apps provided information and the remaining 50 were management tools including screening and assessment (n=10), symptom monitoring (n=35), community support (n=4), and treatment (n=1). Not even a quarter of apps (18/82, 22%) addressed privacy and security by providing a privacy policy. Overall, apps providing information covered a third (4/11, 36%) of the core psychoeducation principles and even fewer (2/13, 15%) best-practice guidelines. Only a third (10/32, 31%) cited their information source. Neither comprehensiveness of psychoeducation information (r=-.11, P=.80) nor adherence to best-practice guidelines (r=-.02, P=.96) were significantly correlated with average user ratings. Symptom monitoring apps generally failed to monitor critical information such as medication (20/35, 57%) and sleep (18/35, 51%), and the majority of self-assessment apps did not use validated screening measures (6/10, 60%).

In general, the content of currently available apps for BD is not in line with practice guidelines or established self-management principles. Apps also fail to provide important information to help users assess their quality, with most lacking source citation and a privacy policy. Therefore, both consumers and clinicians should exercise caution with app selection. While mHealth offers great opportunities for the development of quality evidence-based mobile interventions, new frameworks for mobile mental health research are needed to ensure the timely availability of evidence-based apps to the public.

Nicholas J, Larsen ME, Proudfoot J, Christensen H. Mobile Apps for Bipolar Disorder: A Systematic Review of Features and Content Quality. J Med Internet Res. 2015 Aug 17;17(8):e198. doi: 10.2196/jmir.4581.

Is Bipolar Disorder linked to higher intellect and creativity?

August 22, 2015 by  
Filed under Research

Childhood IQ and risk of bipolar disorder in adulthood: prospective birth cohort study
Daniel J. Smith, Jana Anderson, Stanley Zammit, Thomas D. Meyer, Jill P. Pell and Daniel Mackay
British Journal of Psychiatry Open, 2015, 1, 74–80.


Intellectual ability may be an endophenotypic marker for bipolar disorder.

Within a large birth cohort, we aimed to assess whether childhood IQ (including both verbal IQ (VIQ) and performance IQ (PIQ) subscales) was predictive of lifetime features of bipolar disorder assessed in young adulthood.

We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a large UK birth cohort, to test for an association between measures of childhood IQ at age 8 years and lifetime manic features assessed at age 22–23 years using the Hypomania Checklist-32 (HCL-32; n=1881 individuals). An ordinary least squares linear regression model was used, with normal childhood IQ (range 90–109) as the referent group. We adjusted analyses for confounding factors, including gender, ethnicity, handedness, maternal social class at recruitment, maternal age, maternal history of depression and maternal education.

There was a positive association between IQ at age 8 years and lifetime manic features at age 22–23 years (Pearson’s correlation coefficient 0.159 (95% CI 0.120–0.198), P>0.001). Individuals in the lowest decile of manic features had a mean full-scale IQ (FSIQ) which was almost 10 points lower than those in the highest decile of manic features: mean FSIQ 100.71 (95% CI 98.74–102.6) v. 110.14 (95% CI 107.79–112.50), P>0.001. The association between IQ and manic features was present for FSIQ, VIQ and for PIQ but was strongest for VIQ.

A higher childhood IQ score, and high VIQ in particular, may represent a marker of risk for the later development of bipolar disorder. This finding has implications for understanding of how liability to bipolar disorder may have been selected through generations. It will also inform future genetic studies at the interface of intelligence, creativity and bipolar disorder and is relevant to the developmental trajectory of bipolar disorder. It may also improve approaches to earlier detection and treatment of bipolar disorder in adolescents and young adults.

You can access the full-text article here (pdf).

Omega-3 Fatty Acids and Vitamin D May Control Brain Serotonin, Affecting Behavior and Psychiatric Disorders

March 2, 2015 by  
Filed under Research

Although essential marine omega-3 fatty acids and vitamin D have been shown to improve cognitive function and behavior in the context of certain brain disorders, the underlying mechanism has been unclear. In a new paper published in FASEB Journal* by Rhonda Patrick, PhD and Bruce Ames, PhD of Children’s Hospital Oakland Research Institute (CHORI), serotonin is explained as the possible missing link tying together why vitamin D and marine omega-3 fatty acids might ameliorate the symptoms associated with a broad array of brain disorders.

In a previous paper published last year, authors Patrick and Ames discussed the implications of their finding that vitamin D regulates the conversion of the essential amino acid tryptophan into serotonin, and how this may influence the development of autism, particularly in developing children with poor vitamin D status.

Here they discuss the relevance of these micronutrients for neuropsychiatric illness. Serotonin affects a wide-range of cognitive functions and behaviors including mood, decision-making, social behavior, impulsive behavior, and even plays a role in social decision-making by keeping in check aggressive social responses or impulsive behavior.

Many clinical disorders, such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), bipolar disorder, schizophrenia, and depression share as a unifying attribute low brain serotonin. “In this paper we explain how serotonin is a critical modulator of executive function, impulse control, sensory gating, and pro-social behavior,” says Dr. Patrick. “We link serotonin production and function to vitamin D and omega-3 fatty acids, suggesting one way these important micronutrients help the brain function and affect the way we behave.”

Eicosapentaenoic acid (EPA) increases serotonin release from presynaptic neurons by reducing inflammatory signaling molecules in the brain known as E2 series prostaglandins, which inhibit serotonin release and suggests how inflammation may negatively impact serotonin in the brain. EPA, however, is not the only omega-3 that plays a role in the serotonin pathway. Docosahexaenoic acid (DHA) also influences the action of various serotonin receptors by making them more accessible to serotonin by increasing cell membrane fluidity in postsynaptic neurons.

Their paper illuminates the mechanistic links that explain why low vitamin D, which is mostly produced by the skin when exposed to sun, and marine omega-3 deficiencies interacts with genetic pathways, such as the serotonin pathway, that are important for brain development, social cognition, and decision-making, and how these gene-micronutrient interactions may influence neuropsychiatric outcomes. “Vitamin D, which is converted to a steroid hormone that controls about 1,000 genes, many in the brain, is a major deficiency in the US and omega-3 fatty acid deficiencies are very common because people don’t eat enough fish,” said Dr. Ames.

This publication suggests that optimizing intakes of vitamin D, EPA, and DHA would optimize brain serotonin concentrations and function, possibly preventing and ameliorating some of the symptoms associated with these disorders without side effects.

*Vitamin D and the Omega-3 Fatty Acids Control Serotonin Synthesis and Action Part 2: Relevance for ADHD, Bipolar, Schizophrenia, and Impulsive Behavior. FASEB Journal

SOURCE: Children’s Hospital Oakland Research Institute (CHORI)

Bipolar Disorder Genes Uncovered

September 1, 2014 by  
Filed under Research

Jane Collingwood reports on a new study:

… Professor Markus Nothen of the University of Bonn, Germany, explains, “There is no one gene that has a significant effect on the development of bipolar disorder. Many different genes are evidently involved and these genes work together with environmental factors in a complex way.”

His international team analyzed genetic information from 2,266 patients with bipolar disorder and 5,028 comparable people without bipolar disorder. They merged these individuals’ information with that of thousands of others held in previous databases. Altogether, this included the genetic material of 9,747 patients and 14,278 non-patients. The researchers analyzed about 2.3 million different regions of DNA.

This highlighted five areas that appeared to be connected to bipolar disorder. Two of these were new gene regions containing “candidate genes” connected to bipolar disorder, specifically the gene “ADCY2″ on chromosome five and the so-called “MIR2113-POU3F2″ region on chromosome six.

Read more on PsychCentral.

Can antidepressants over-activate or “trip” children and teens into mania?

July 4, 2014 by  
Filed under Research

Can antidepressant medications used in treating depression and anxiety disorders  “trip” kids or teens into mania or hypomania? A study reported by Offidani et al. in Psychotherapy and Psychosomatics in March 2013 investigated that question.

The investigators compared reports of antidepressant trials (n = 6,767 subjects) in juvenile depressive (n = 17) and anxiety disorders (n = 25) for indications of excessive mood elevation or behavioral activation. They found that excessive arousal-activation was higher in juveniles treated with antidepressants than it was for children treated with placebos.  The rates of excessive mood or behavioral activation was similar across the anxiety and depressive samples. 

So what does that mean, you ask? It means you need to monitor carefully if a child is being prescribed an antidepressant for an anxiety disorder or depression. If you see signs of excessive mood elevation or behavioral (over)activation, contact the doctor.  

While interpreting the findings from this study is difficult and more research is needed, the investigators note:

Notably, we recommend special caution and close monitoring in the use of ADs to treat depression or anxiety in juvenile patients in whom the risk of excessive mood elevation or the presence of undiagnosed BPD [Bipolar Disorder] is likely to be underestimated. Those who experience pathological mood elevation or activation during AD [antidepressant] treatment need especially close monitoring for similar future responses and for development of BPD. We also encourage avoidance of unnecessary and potentially burdensome or risky, indefinite, long-term use of mood-stabilizing treatments following single mood-elevating responses to AD treatment  and consideration of effective and safe nonpharmacological interventions, such as psychotherapy, for anxiety disorders.

You can access the full article online, here

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