Symptom Monitoring, Psycho-education and Relapse Prevention for People with Bipolar disorder and Recurrent depression
1. What is the clinical monitoring service?
The clinical monitoring service is an informational intervention for people with bipolar disorder and/or recurrent depression. The purpose of this service is to provide the best possible symptom monitoring before, during and after therapy, to educate about symptom monitoring methods and the patient's disorder, and finally to provide information that may help to prevent future relapses or to track progress during treatment. The programme was developed at the University of London, Institute of Psychiatry, King’s College London by Dr. Yanni Malliaris and his colleagues.
2. What does it offer?
- Continuous monitoring of the symptoms of a bipolar or recurrent depressive disorder by expert mood monitoring facilitators using gold-standard assessments.
- Training in symptom monitoring methods and self-assessment techniques.
- Psychoeducation about manic and depressive symptoms and the course of these disorders.
- User-friendly systematic feedback about the symptomatic status and response to treatments that may help to identify triggers and prevent future relapses.
- Confirmation of a Bipolar or depressive disorder and clarification of the type of the mood disorder through the systematic and continuous monitoring.
- Assessment of early signs of relapse and continuous monitoring of these signs using new technologies (iMonitor).
- Use of advanced technologies for monitoring activity and sleep in a continuous and objective manner without burdening the patient.
- The results of the program can be also useful to other health professionals with whom the patients works with and of course, for patient’s relatives who many times wish for a more thorough and comprehensive update. The use of the results, as well as their dissimination to third parties (relatives, professionals) is always a private matter and choice of the patient.
3. What it cannot do?
The clinical monitoring service cannot replace drug treatments. Also, it works better when the patient is not in a crisis/episode but can continue during times that the patient is unwell. It cannot work without the explicit consent and collaboration of the patient.
4. Rationale and history of the clinical monitoring service
If you have a bipolar disorder or a recurrent depressive disorder you realise how important it is to keep constant track of your mood in order to identify your triggers and prevent future episodes. You also realise how important it is to keep track of your symptoms every time you change treatments. You may have been advised to keep a mood diary by your doctor or even better you may be trying to keep one already. You may have even been told that mood monitoring is even good therapy for you.
We realise that mood monitoring is vital for the majority of patients and their relatives but it is not always easy to do on your own. You may have mood assessments by your treatment providers but again their job is to treat you rather than keep a constant track of your mood. Nevertheless, in order to provide the best possible care they really need to know how you have been between appointments and during periods you have been away from treatment.
Over the last 5 years, and through Dr Malliaris thesis, we have turned mood monitoring into the science and service it deserves to be. The project started with important scientific aims namely identifying clinical and psychological factors that can predict who will become unwell and for how long in the future. Nevertheless, through the efforts of 43 Bipolar patients it soon became obvious that an important service had been developed. The majority of our participants really valued having an independent symptom monitoring service in their lives. We soon had realised that what we had developed was the best available "thermometer" for Bipolar disorder. This service goes far and beyond DIY mood diaries as it relies on expert human assessments (once upon a time Yanni and now BipolarLab's expert Mood Monitoring Facilitators).
The service involves a significant psycho-education component, as you will learn in the best possible manner how to monitor your moods and other symptoms. Ideally, before you start you should have completed the first diagnostic service that will give us important background information about your clinical history, diagnosis and symptom presentation.
Some times people with bipolar disorder become overly occupied with monitoring their moods and every single fluctuation is feared to be a sign of an impending episode. With the correct training in symptom monitoring and always with a human mood monitoring expert by your side such fears will quickly go away. Your own mood monitoring efforts will be greatly supported and enhanced, and most importantly you will realise that good monitoring only takes a little time from your life. Once mood monitoring becomes a habit, it will be like having learned to brush your teeth and cycle a bicycle when and as needed.
These 3 analogues really summarise the jist of our symptom monitoring service:
1. A thermometer for your moods.
2. A touth brush for your day.
3. A bicycle for your life.
5. How it works?
There are 3 phases to this service. The baseline phase, where we check your diagnosis and current symptom levels. Then, the symptom-monitoring phase, where you learn how to keep track of your mood and other symptoms in a systematic and structured manner. And finally, the follow-up phase, where we have regular monthly or quarterly or annual checks of your symptoms and episodes.
1. Baseline Phase: 1 session (Spartan plan) to 10 sessions (Persian plan)
2. Symptom Monitoring Phase: 12 weeks (minimum) to life
3. Follow-up phase: monthly, quarterly, annually for life
We have 3 symptom monitoring packages that differ on the amount of human contact you get and subsequently their cost.
The Spartan plan is our most basic symptom monitoring package. It involves a brief assessment of your history and current state, and then symptom monitoring takes places using self-report questionnaires and basic human contact. Spartans were very self-sufficient and were famous for their laconic (little talk) interactions and lack of money.
The Athenian plan is our regular symptom monitoring package. It involves an assessment of your history and current state using both questionnaires and a human expert. The symptom monitoring phase also involves expert human based assessments. Athenians liked to philosophise a bit more and thrived on intelligent human contact. They were a bit more well off than Spartans, and appreciated good human services in their life.
The Persian plan is our premium symptom monitoring package. It involves the most thorough baseline assessments and the most thorough possible symptom monitoring and follow-up assessements. Persians used to live in luxury and to have everything they wanted in their lives. They had lots of slaves who also lived in luxury but served all their needs. There are no limits to what we can do with this plan. You may even live in Los Angeles and have one of our mood monitoring facilitators come to your house or spent the entire baseline and symptom monitoring phase in an exotic villa on a beautiful greek island (we will even help you to pick your island and villa house).
The use of Technology in assisting your symptom monitoring
In order to use the service you will only need to have access to a telephone line and to a computer connected to the internet.
Additionally, we use a number of important technologies that greatly enhance your mood monitoring efforts and also the quality of the data we collect from you.