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Psychiatry Newsletter - Mood Indigo Online
Hopkins Brain Wise Summer 2010
Mood Indigo Online
Date: July 10, 2010
“Our decisions are only as good as the information we have,” says Adam Kaplin.
A group of residents surrounded psychiatrist Adam Kaplin as he quizzed them on the best next step for a patient with bipolar disorder, a woman who’d been on lithium therapy less than a month. She’d emailed Kaplin: My mood is just the same as when I started and I’m feeling a little foggy. What should I do?
Half the residents said not to change a thing. The others voted to decrease the lithium dosage and schedule an office visit. But when Kaplin produced a graph (right) of the young woman’s mood over the past three weeks, it took only 30 seconds for them to agree: Stay on the dose.
Clearly, the patient’s present mood was stable and positive. She’d just forgotten how low she’d been a week earlier and how that felt. But the improvement was in black and white.
The episode typifies what Kaplin sees with Mood 24/7, a cellphone-based system for monitoring patients that’s been in place half a year. “Patients take their own blood pressure; those with diabetes can check their own glucose,” he says.
The value of regular monitoring isn’t in question. Asking patients to assess mood daily and bring the chart to the next session is commonplace. Research confirms that the collected data can write a powerful signature of a patient’s overall mental health. “The problem, however,” says Kaplin, “is that compliance is terrible.” Some studies rate it as low as 11 percent. “We’ve all seen patients sitting in the waiting room trying to backfill two weeks of data points.
“In mood disorders, concentration and memory are frequently impaired, yet, as clinicians, we still often rely on patients’ retrospective recall to make decisions. I find that worrisome.”
So Kaplin turned to texting. His Mood 24/7 system, created in conjunction with an established, online medical data-gathering service, offers daily mood-tracking through text messaging. It’s the only cell-phone based service to monitor moods for medical purposes.
At an agreed-upon time, patients are texted, What is your mood, on a scale of one (lowest) to 10? The number typed-in becomes a data point on an online chart reached via a private ID and password. Patients may also authorize access for psychiatrists or therapists.
Benefits are the same as traditional assessments though they may come faster. Clinicians may be alerted sooner to a precipitous decline in mood that signals a patient’s deepening depression. They may catch an upturn in suicide risk. And, as in the young woman on lithium, Mood 24/7 can already signal that medications look useful or may no longer be needed.
Is there a down side? Could the focus on mood itself alter how patients feel? Not to any extent that would outweigh benefits, Kaplin says. That’s especially true since, early on, he and colleagues switched from using a depression scale to the more global mood score.
Kaplin’s favorite testimonial comes from colleague Patricia Roy. “I’d been working with a chronically ill patient and hadn’t made much headway in her treatment. She wouldn’t keep a mood chart. Within a couple weeks of using [Mood 24/7] she had these lightbulb moments where she got what was going on with her mood disorder for the first time. I’d say she went from being a little bobblehead in a sea of emotions to being able to brace herself against the tide.”
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