Behavioral and Self-reported Data Collected From Smartphones for the Assessment of Depressive and Manic Symptoms in Patients With Bipolar Disorder: Prospective Observational Study.

BACKGROUND: Smartphones allow for real-time monitoring of patients' behavioral activities in a naturalistic setting. These data are suggested as markers for the mental state of patients with bipolar disorder (BD). OBJECTIVE: We assessed the relations between data collected from smartphones and the clinically rated depressive and manic symptoms together with the corresponding affective states in patients with BD. METHODS: BDmon, a dedicated mobile app, was developed and installed on patients' smartphones to automatically collect the statistics about their phone calls and text messages as well as their self-assessments of sleep and mood. The final sample for the numerical analyses consisted of 51 eligible patients who participated in at least two psychiatric assessments and used the BDmon app (mean participation time, 208 [SD 132] days). In total, 196 psychiatric assessments were performed using the Hamilton Depression Rating Scale and the Young Mania Rating Scale. Generalized linear mixed-effects models were applied to quantify the strength of the relation between the daily statistics on the behavioral data collected automatically from smartphones and the affective symptoms and mood states in patients with BD. RESULTS: Objective behavioral data collected from smartphones were found to be related with the BD states as follows: (1) depressed patients tended to make phone calls less frequently than euthymic patients (ß=-.064, P=.01); (2) the number of incoming answered calls during depression was lower than that during euthymia (ß=-.15, P=.01) and, concurrently, missed incoming calls were more frequent and increased as depressive symptoms intensified (ß=4.431, P<.001; ß=4.861, P<.001, respectively); (3) the fraction of outgoing calls was higher in manic states (ß=2.73, P=.03); (4) the fraction of missed calls was higher in manic/mixed states as compared to that in the euthymic state (ß=3.53, P=.01) and positively correlated to the severity of symptoms (ß=2.991, P=.02); (5) the variability of the duration of the outgoing calls was higher in manic/mixed states (ß=.0012, P=.045) and positively correlated to the severity of symptoms (ß=.0017, P=.02); and (6) the number and length of the sent text messages was higher in manic/mixed states as compared to that in the euthymic state (ß=.031, P=.01; ß=.015, P=.01; respectively) and positively correlated to the severity of manic symptoms (ß=.116, P<.001; ß=.022, P<.001; respectively). We also observed that self-assessment of mood was lower in depressive (ß=-1.452, P<.001) and higher in manic states (ß=.509, P<.001). CONCLUSIONS: Smartphone-based behavioral parameters are valid markers for assessing the severity of affective symptoms and discriminating between mood states in patients with BD. This technology opens a way toward early detection of worsening of the mental state and thereby increases the patient's chance of improving in the course of the illness.

Smartphone as a monitoring tool for bipolar disorder: a systematic review including data analysis, machine learning algorithms and predictive modelling.

BACKGROUND: Bipolar disorder (BD) is a chronic illness with a high recurrence rate. Smartphones can be a useful tool for detecting prodromal symptoms of episode recurrence (through real-time monitoring) and providing options for early intervention between outpatient visits. AIMS: The aim of this systematic review is to overview and discuss the studies on the smartphone-based systems that monitor or detect the phase change in BD. We also discuss the challenges concerning predictive modelling. METHODS: Published studies were identified through searching the electronic databases. Predictive attributes reflecting illness activity were evaluated including data from patients' self-assessment ratings and objectively measured data collected via smartphone. Articles were reviewed according to PRISMA guidelines. RESULTS: Objective data automatically collected using smartphones (voice data from phone calls and smartphone-usage data reflecting social and physical activities) are valid markers of a mood state. The articles surveyed reported accuracies in the range of 67% to 97% in predicting mood status. Various machine learning approaches have been analyzed, however, there is no clear evidence about the superiority of any of the approach. CONCLUSIONS: The management of BD could be significantly improved by monitoring of illness activity via smartphone.

Survival of lymphocytes is not restricted by IDO-expressing fibroblast from rheumatoid arthritis patients.

Objective: Rheumatoid arthritis (RA) is characterized by expansion of fibroblast-like synoviocytes (FLS) in inflamed joints and activation of lymphocytes. Tryptophan (trp) is an essential amino acid indispensable for the biosynthesis of proteins and critical for survival of lymphocytes. Indoleamine 2,3-dioxygenase (IDO) that initiates the degradation of trp and tryptophanyl-tRNA synthetase (TTS) essential for tryptophan synthesis, regulate trp bioavailability. Here, we tested the hypothesis that triggered by cytokines, enhanced IDO activity modulate regulatory function of otherwise non-tolerogenic FLS isolated from RA patients. Materials and methods: IDO and TTS mRNA expression were evaluated by RT-PCR. IDO enzymatic activity was confirmed using HPLC. Resting or PHA-activated PBMC from healthy volunteers and RA patients were co-cultured with IDO expressing untreated (FLSC) or IFNγ-treated (FLSIFNγ) RA FLS. Lymphocyte survival and proliferation were evaluated by flow cytometry analysis and tritiated thymidine incorporation, respectively. Results: RA FLSIFNγ produce functionally active IDO and constitutively express TTS. RA FLSC and FLSIFNγ increased survival of resting lymphocytes in both studied groups, and decreased proliferation of healthy, but not RA, PBMC. Only FLSIFNγ diminished survival of activated CD3+CD4-, but not CD3+CD4+, healthy T cells and similar tendency was observed in rheumatoid cells. Importantly, IDO inhibitor, 1-methyl-DL-tryptophan (1-MT), failed to reverse this effect. PBMC, irrespective of their state (resting versus activated) or origin (healthy or RA), expressed high level of TTS mRNA. Conclusions: We suggest that RA FLS express functionally active IDO but control survival and expansion of healthy cells in IDO-independent mechanism and exert weaker, if any, suppressive effect on rheumatoid cells.

Postnatal verification of prenatal diagnoses established on foetal magnetic resonance imaging.

OBJECTIVES: The role of magnetic resonance imaging, similarly to ultrasound, in the evaluation of foetal anomalies is in-disputable. This gives rise to a question, whether prenatal diagnostics can replace postnatal one. To assess the diagnostic accuracy of foetal MRI in children with congenital anomalies by using postnatal MRI, X-ray/US and surgery (histopathol-ogy/autopsy) results as a reference standard. MATERIAL AND METHODS: 110 children were included in the analysis. All of them underwent foetal MRI, and the diagnoses were verified after birth. All the results were analysed both by: 1. evaluation of correctness of the prenatal diagnosis with the reference standard diagnosis of each patient, and 2. statistical evaluation of prenatal diagnosis using standard measures of binary diagnostic tests' abilities. RESULTS: The accordance of prenatal and final diagnoses was 70%. Only 3.64% of patients were misdiagnosed. Most of the prenatal diagnoses that were incomplete (23.64%), concerned children who underwent surgery, and among them patients with abdominal cystic laesions of undetermined origin on foetal MRI constituted the majority. In 2.73% of cases prenatal diagnoses remained inconclusive. CONCLUSIONS: High correlation of prenatal and postnatal tests' results in the study material confirms the high value of foetal MRI in perinatal diagnostics. Comprehensive assessment of the foetus in prenatal MRI is very effective and facilitates impor-tant therapeutic decisions in the prenatal period (in utero treatment) and in perinatal care (application or withdrawal from the EXIT procedure, surgery or backtracking from neonatal resuscitation if it should bear the hallmarks of persistent therapy).