Self-Monitoring Strategies for Bipolar II Disorder

Patients with bipolar disorder who have lingering levels of symptoms and instable moods between episodes often relapse and require hospitalization.

A recent study used modern technology to identify differences in daily illness activity among the different types of bipolar disorder, and its results draw attention to the need for better self-monitoring strategies, especially for patients with bipolar II disorder.

Ideally, patients with chronic, recalcitrant, and/or severe bipolar disorder should have continuous daily self-monitoring of illness activity, the researchers acknowledged. To help facilitate this, they developed an electronic system in which a smartphone’s alarm prompted patients to complete self-monitoring.

Previous studies using paper- or Web-based self-monitoring tools have been plagued with problems—most notably patients’ propensity to input their entries after the fact, rather than recording throughout the day. Using a smart phone allows real-time reporting that reduces error.

In this study, 33 patients used the smart phone-based system daily for an average of 310 days, logging more than 8500 comments. These participants received different types, doses, and combinations of medications.

The 20 patients with bipolar II disorder reported significantly more unstable mood than the 13 patients with bipolar I. They were also less likely to spend time in euthymia, and more likely to experience periods of depression.

Patients with bipolar I and II spent similar amounts of time experiencing hypomanic symptoms.

These findings confirm that bipolar II is not simply a milder form of bipolar disorder than bipolar I; it’s a serious and different condition, the researchers stressed. In bipolar II patients, depression is more significant, and drugs are less effective.

Self-monitoring and good communication with the treatment team can improve outcomes.