Maria Faurholt-Jepsen1,2, Vibe Gedsø Frøkjær3,4,5, Arafat Nasser5, Niklas Rye Jørgensen4,6, Lars Vedel Kessing3,4, Maj Vinberg3,4,7. 1. Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Blegdamsvej 9, Rigshospitalet, 2100, Copenhagen, Denmark. maria@faurholt-jepsen.dk. 2. Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. maria@faurholt-jepsen.dk. 3. Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Blegdamsvej 9, Rigshospitalet, 2100, Copenhagen, Denmark. 4. Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. 5. Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark. 6. Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. 7. Psychiatric Research Unit, Psychiatric Centre North Zealand, Faculty of Health and Medical Sciences, University of Copenhagen, Hillerød, Denmark.
Abstract
OBJECTIVE: The Cortisol Awakening Response (CAR) measured as the transient increase in cortisol levels following morning awakening appears to be a distinct feature of the HPA axis. Patients with bipolar disorder (BD) experience daily stress, mood instability (MI) and studies have shown disrupted HPA-axis dynamics. AIMS: to evaluate (1) patient-evaluated stress against the CAR, (2) associations between the CAR and mood symptoms, and (3) the effect of smartphone-based treatment on the CAR. METHODS:Patients with BD (n = 67) were randomized to the use of daily smartphone-based monitoring (the intervention group) or to the control group for six months. Clinically rated symptoms according to the Hamilton Depression Rating Scale 17-items (HDRS), the Young Mania Rating Scale (YMRS), patient-evaluated perceived stress using Cohen's Perceived Stress Scale (PSS) and salivary awakening cortisol samples used for measuring the CAR were collected at baseline, after three and six months. In the intervention group, smartphone-based data on stress and MI were rated daily during the entire study period. RESULTS: Smartphone-based patient-evaluated stress (B: 134.14, 95% CI: 1.35; 266.92, p = 0.048) and MI (B: 430.23, 95% CI: 52.41; 808.04, p = 0.026) mapped onto increased CAR. No statistically significant associations between the CAR and patient-evaluated PSS or the HDRS and the YMRS, respectively were found. There was no statistically significant effect of smartphone-based treatment on the CAR. CONCLUSION: Our data, of preliminary character, found smartphone-based patient-evaluations of stress and mood instability as read outs that reflect CAR dynamics. Smartphone-supported clinical care did not in itself appear to disturb CAR dynamics.
RCT Entities:
OBJECTIVE: The Cortisol Awakening Response (CAR) measured as the transient increase in cortisol levels following morning awakening appears to be a distinct feature of the HPA axis. Patients with bipolar disorder (BD) experience daily stress, mood instability (MI) and studies have shown disrupted HPA-axis dynamics. AIMS: to evaluate (1) patient-evaluated stress against the CAR, (2) associations between the CAR and mood symptoms, and (3) the effect of smartphone-based treatment on the CAR. METHODS:Patients with BD (n = 67) were randomized to the use of daily smartphone-based monitoring (the intervention group) or to the control group for six months. Clinically rated symptoms according to the Hamilton Depression Rating Scale 17-items (HDRS), the Young Mania Rating Scale (YMRS), patient-evaluated perceived stress using Cohen's Perceived Stress Scale (PSS) and salivary awakening cortisol samples used for measuring the CAR were collected at baseline, after three and six months. In the intervention group, smartphone-based data on stress and MI were rated daily during the entire study period. RESULTS: Smartphone-based patient-evaluated stress (B: 134.14, 95% CI: 1.35; 266.92, p = 0.048) and MI (B: 430.23, 95% CI: 52.41; 808.04, p = 0.026) mapped onto increased CAR. No statistically significant associations between the CAR and patient-evaluated PSS or the HDRS and the YMRS, respectively were found. There was no statistically significant effect of smartphone-based treatment on the CAR. CONCLUSION: Our data, of preliminary character, found smartphone-based patient-evaluations of stress and mood instability as read outs that reflect CAR dynamics. Smartphone-supported clinical care did not in itself appear to disturb CAR dynamics.
Authors: Maria Faurholt-Jepsen; Mads Frost; Ellen Margrethe Christensen; Jakob E Bardram; Maj Vinberg; Lars Vedel Kessing Journal: Psychol Med Date: 2019-04-04 Impact factor: 7.723
Authors: Nienke Jabben; Willem A Nolen; Johannes H Smit; Sophie A Vreeburg; Aartjan T F Beekman; Brenda W J H Penninx Journal: J Psychiatr Res Date: 2011-03-29 Impact factor: 4.791
Authors: Maria Faurholt-Jepsen; Mads Frost; Jonas Busk; Ellen Margrethe Christensen; Jakob Eyvind Bardram; Maj Vinberg; Lars Vedel Kessing Journal: Bipolar Disord Date: 2019-05-27 Impact factor: 6.744
Authors: Lisa A O'Donnell; Alissa J Ellis; Margaret M Van de Loo; Jonathan P Stange; David A Axelson; Robert A Kowatch; Christopher D Schneck; David J Miklowitz Journal: J Affect Disord Date: 2018-04-09 Impact factor: 4.839
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