The MDiary Study is a part of the ENTER project (previously called E-Mental), which is being done in collaboration with The Mental Health Services in the Region of Southern Denmark (MHS), the South Denmark University, Aalborg University, and Context Consulting.
Borderline Personality Disorder (BPD)
Borderline is a serious and debilitating mental disorder characterised by difficulties with regulating emotions, which leads to unstable and self-destructive behaviours and relationships.
The prevalence of BPD is 1%-5%. Borderline increases the risk for suicide by 4-fold, while patients with comorbid Borderline and a tendency to self-harm have a further 2-fold attenuated risk. BDP is difficult to treat, and even more difficult when co-occurring with other disorders.
Dialectical Behaviour Therapy (DBT) is the best validated treatment for Borderline, showing medium to large effect sizes as compared to treatment as usual. Dialectical Behaviour Therapy uses self-monitoring as the mainstay of treatment, which helps patients regulate their emotions by means of emotional regulating skills, and reduce problem behaviour.
Self-monitoring has traditionally been done by means of daily paper diaries. The latest developments in smartphone applications have generated alternatives for ecological momentary assessments of problematic behaviour with the additional functionality of prompting patients to practice skills targeting emotion regulation.
Monsenso’s involvement in the the mDIARY Study for patients with Borderline Personality Disorder
Monsenso is responsible for improving and developing additional modules in the Monsenso mHealth solution. The objective of the study is to prove that the Monsenso DBT (Dialectical Behavioural Therapy) solution is a reliable and clinically valid way to collect patient data, helping individuals with Borderline learn these skills at home, speeding up their recovery.
1. Skills tracking
In the current configuration used for DBT treatment, skill used throughout the day can be selected in the daily self-assessment. This does not take into account if the patients have actually learned the skills, meaning a lot of skills will appear in the list that the patient might not already know. In order to personalise the skills list, and in order to help the clinicians and patients to track progress, the skills should be configurable in the sense that the patient is able to indicate whether they have not learned a skill, are in the process of learning a skill, or know it and can use it meaningfully. This implies, the the patients should be able to, on their phone in the configuration section of the self-assessment, to have a list of skills appear, where they can indicate whether a skill is ’Not known’, ’In the process of learning’, or ’I know it, and can use it meaningfully’.
2. Skills training / Psychoeducation
In DBT treatment, skills are an essential part, and patients often have a paper folder, with descriptions of each skill. In the current version, the “Action Plans”’ in the system have been used for this purpose, but it makes it not very easy to overview and need more ways of presenting content, like videos or sound files. The layout is like a dictionary, where patients can find information regarding their disorder, usual treatment regime, prevalence, but alto typical issues and preventive actions that could be taken.
3. Emotion rating (BEARS)
One parameter in the self-assessment should be named “Emotions” in which joy, anger, attachment, sadness, safety, anxiety, pride and shame can be be rated on a scale of 0-4:
0 – Not at all
1 – A Little
2 – Some
3 – A lot
4 – Extreme
It is important that they are all rated in the same screen, as the patient need to see these together.
4. Therapy progress / Detailed overview
The overview screen will be re-designed and focus around “Therapy progress,” highlighting the progress over time. The key factor for the use of the system should be the patients’ development and progress over an extended period. The scope of the solution is to include graphs of the clinical questionnaires in the overview screen, which includes summary scores of DERS, BSL, and HTQ questionnaires. Likewise the attendance percentage should be shown, together with the Hierarchy level rated by the clinician.
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SmartCare by Smartphones was developed in collaboration with the Unit for Psychiatric Research, a group of young patients and their caregivers from the Infirmary for adolescents with schizophrenia in North Jutland.
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling and include hallucinations (hearing or seeing things that don’t exist), delusions (unusual beliefs not based on reality), muddled thoughts (based on hallucinations or delusions) and changes in behaviour.
Monsenso’s involvement in SmartCare by Smartphones
The SmartCare by Smartphones project developed a mobile health (mHealth) solution called “MindFrame,” which is powered by Monsenso, that supports the treatment of individuals with schizophrenia. It consists of a smartphone application for patients and a web portal for clinicians. MindFrame was developed as a framework that offers a unique impression of the correlation between the illness and daily life. Together, healthcare providers and patients can customise the application’s settings so that it corresponds to the person’s actual challenges and supports his particular needs.
MindFrame also provides individuals with customised action plans within the application ensuring that self-help tools are readily available, even when the person is feeling well. Participants are required to fill out a self-assessment on their smartphone; these assessments will reveal the state of the individual’s mental health. The data collected on the self-assessment will be subsequently displayed on the smartphone app as a graph over the course of 14 days.
The clinician can also access the patient’s self-assessments through the clinical web portal enabling him to identify any patterns and make possible connections between certain behaviours and the symptoms they may trigger. With the data from the self-assessments, the system can also identify triggers and early warning signs notifying both, the patient, and the clinician.
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The MONARCA II Research Project aims to establish clinical evidence on the use of the Monsenso system. The MONARCA II trial uses a randomised controlled single-blind parallel-group design.
Approximately 25% of all people in Europe and the US experience a mental illness at least once in their lifetime. Currently, the monitoring of mental illness relies on subjective clinical self-reporting rating scales, which were developed more than 50 years ago. The EU-funded MONARCA project established a platform for the daily electronic monitoring of subjective and objective measures of illness activity in bipolar disorder using smartphones. The system supports the treatment of bipolar disorder by collecting (i) self-rated (‘subjective’) data on parameters like mood, stress, and cognitive problems, and (ii) automatically sensor-based (‘objective’) data the patients behaviour in terms of mobility (GPS), physical activity (accelerometer), social activity (telephony and texting), and general phone usage. This data is captured and forwarded to a server, where it can be accessed, visualised, and monitored by the clinical staff and applied for clinical decision support. The MONARCA system is now further developed and supported by Monsenso.
Monsenso’s involvement in the The MONARCA II RESEARCH PROJECT
Patients with bipolar disorder according to ICD-10 who previously have been treated at the Copenhagen Clinic for Affective Disorder, Denmark are included and randomised to either daily use of the Monsenso system including a feedback loop between patients and clinicians (the intervention group) or to the use of a smartphone for normal communicative purposes (the control group) for a 9-month trial period. The trial started in September 2014.
The outcome measures between the intervention group and the control group are:
- Differences in depressive and manic symptoms; rate of depressive and manic episodes (primary);
- Automatically generated objective data on measures of illness activity; number of days hospitalised; psychosocial functioning (secondary);
- Perceived stress; quality of life; self-rated depressive symptoms; self-rated manic symptoms; recovery; empowerment and adherence to medication (tertiary)
- Ethical permission has been obtained. Positive, neutral and negative findings will be published.
If the system is effective in reducing depressive and/or manic symptoms (and other symptoms of bipolar disorder) and the rate of episodes, there will be basis for extending the use to the treatment of bipolar disorder in general and in larger scale.
To read more download the research paper:
The RADMIS Research Project is supported by the Innovation Foundation in Denmark and is done in collaboration with the “MONARCA team” with the department of psychiatry represented (RHP) by professor Lars V. Kessing and DTU represented by professors Jakob E. Bardram and Ole Winther.
Depression and bipolar disorder
According to WHO, depression and bipolar disorder are leading causes of disability worldwide, and they cause a high burden in terms of cost, lost productivity, morbidity, suffering, and mortality. According to the European Commission, depression is one of the most pressing public health concerns today, accounting for more than 12% of all estimated ill health and premature mortality in Europe, only exceeded by heart disease and cancer.
Although during the last few decades, psychiatric treatment has shifted more from inpatient treatment to outpatient treatment, the costs of psychiatric hospitalisations are still significant.
In fact, patients with affective disorders are more frequently hospitalised than any other patient group, counting for approximately 20% of all psychiatric hospitalisations.
Monsenso’s involvement in the RADMIS RESEARCH PROJECT
Monsenso is responsible for improving and developing four modules in the Monsenso mHealth solution.
1. Data-collection framework. This task will research and develop a framework for data collection, clustering, preprocessing, and management based on both patient self-reporting and automatic sensor data collection. This will be done as part of the Monsenso platform with input from DTU research on data preprocessing and pathological insight from RHP.
2. Context-aware CBT module. This task will research and develop a module for context-aware (just-in-time) delivery of a rumination-focused CBT and (b) concreteness training, a facilitated self-help intervention intended to increase specificity of processing in patients with depression. This will be done as part of the Monsenso platform with design and technical input from DTU and psychological insight and input from RHP.
3. CBT content. This task will develop multimedia content for CBT training, such as action and coping plans for patients, cartoon and video instruction material, and medication guidance. This content will be developed by psychologist from RHP and incorporated into the CBT module.
4. Illness-forecasting module. This task will research and develop a module for disease forecasting based on research from DTU on correlations analysis and prediction. This module will be included into the Monsenso platform.
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