# Daily electronic self-monitoring of subjective and objective symptoms in bipolar disorder—the MONARCA trial protocol (MONitoring, treAtment and pRediCtion of bipolAr disorder episodes) Maria Faurholt-Jepsen, Maj Vinberg, Ellen Margrethe Christensen, Mads Frost, Jakob Bardram, Lars Vedel Kessing --- [[Bipolar Disorder]] 6 Months study. Give patients with bipolar disorder smartphone for passive tracking, and subjective feedback. (EMA) Hypothesis - Electronic monitoring, including a feedback loop between patient and clinicians reduce severity of depression and manic symptoms and stress and increases social functioning, quality of life, adherence of medication and cognitive functioning ## What EMA do they ask? - Every evening, ask to enter - Mood - -3 to +3 (depressive to manic) - Sleep duration - Medicine - yes or no. - Activity level - -3 to 3 - Irritability Yes or no - Mixed mood Yes or no - Cognitive problems Yes or no - Alcohol consumption (number of units per day) - Stress (0 - 5) - Menstruation (yes or no) - Early relapse sign (yes or no) ^df8954 ## Objective (passive tracking) - Speech duration (mins of calls on phone) - Social activities - incoming/outcoming calls and text - Physical activities - Accelerometer - Physical movement - accelerometer Design - a nurse from the service attached, and call the patients - Control group nurse no access to data Threshold to call patient - -2 or +2 mood change for 2 days - Sleep patter 1hr more or less for 3 days - Medication not taking - Mixed mood registered for >3 days After 4 weeks, they discussed, to adjust the threshold, with patients and caregiver, identify early earning signs etc.. every month, affective symptoms clinical rated using HDRS and YMRS Also collect biological samples