title: Applications of time-series analysis to mood fluctuations in bipolar disorder to promote treatment innovation: a case series.
abstract: Treatment innovation for bipolar disorder has been hampered by a lack of techniques to capture a hallmark symptom: ongoing mood instability. Mood swings persist during remission from acute mood episodes and impair daily functioning. The last significant treatment advance remains Lithium (in the 1970s), which aids only the minority of patients. There is no accepted way to establish proof of concept for a new mood-stabilizing treatment. We suggest that combining insights from mood measurement with applied mathematics may provide a step change: repeated daily mood measurement (depression) over a short time frame (1 month) can create individual bipolar mood instability profiles. A time-series approach allows comparison of mood instability pre- and post-treatment. We test a new imagery-focused cognitive therapy treatment approach (MAPP; Mood Action Psychology Programme) targeting a driver of mood instability, and apply these measurement methods in a non-concurrent multiple baseline design case series of 14 patients with bipolar disorder. Weekly mood monitoring and treatment target data improved for the whole sample combined. Time-series analyses of daily mood data, sampled remotely (mobile phone/Internet) for 28 days pre- and post-treatment, demonstrated improvements in individuals' mood stability for 11 of 14 patients. Thus the findings offer preliminary support for a new imagery-focused treatment approach. They also indicate a step in treatment innovation without the requirement for trials in illness episodes or relapse prevention. Importantly, daily measurement offers a description of mood instability at the individual patient level in a clinically meaningful time frame. This costly, chronic and disabling mental illness demands innovation in both treatment approaches (whether pharmacological or psychological) and measurement tool: this work indicates that daily measurements can be used to detect improvement in individual mood stability for treatment innovation (MAPP).
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.|Department for Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.|University Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
authors.forename: E A
authors.initials: EA
authors.lastname: Holmes
authors.affiliation: Mathematical Ecology Research Group, Department of Zoology, University of Oxford, Oxford, UK.|St Peter's College, University of Oxford, Oxford, UK.
authors.forename: M B
authors.initials: MB
authors.lastname: Bonsall
authors.affiliation: University Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Hales
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
authors.forename: H
authors.initials: H
authors.lastname: Mitchell
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
authors.forename: F
authors.initials: F
authors.lastname: Renner
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
authors.forename: S E
authors.initials: SE
authors.lastname: Blackwell
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
authors.forename: P
authors.initials: P
authors.lastname: Watson
authors.affiliation: University Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
authors.forename: G M
authors.initials: GM
authors.lastname: Goodwin
authors.affiliation: Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK.
authors.forename: M
authors.initials: M
authors.lastname: Di Simplicio
mesh_terms: D000328:Adult; D000339:Affect / Q000502:physiology*; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy / Q000379:methods*; D008297:Male; D012720:Severity of Illness Index; D016896:Treatment Outcome
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