Taken together , the literature presented in this dissertation illustrates that 1 ) smartphone-based electronic self-monitoring of mood  seems to reflect clinical ly assessed depressive and manic symptoms and enables the long-term characterization of mood instability in bipolar disorder ; 2 ) preliminary results suggest that smartphone-based automatically generated data ( e.g. the number of text messages sent/day ; the number of incoming and outgoing calls/day ; the number of changes in cell tower IDs/day ; and voice features ) seem to reflect clinical ly assessed depressive and manic symptoms in bipolar disorder ; 3 ) smartphone-based electronic self-monitoring had no effects on the severity of depressive and manic symptoms in bipolar disorder , according to a r and omized controlled trial ; and 4 ) electronic  monitoring of psychomotor activity and heart rate variability seems to reflect illness activity in bipolar disorder and differentiate between patients with bipolar disorder and healthy control individuals .
These findings point toward the usefulness of  electronic monitoring  as a marker of illness in bipolar disorder .
Major reasons for the insufficient effects of current treatment options in bipolar disorder include delayed intervention for prodromal depressive and manic symptoms and decreased adherence to psychopharmacological treatment .
The reliance on subjective information and clinical evaluations when diagnosing and assessing the severity of depressive and manic symptoms calls for less biased and more objective markers .
By using electronic devices , fine-grained data on complex psychopathological aspects of bipolar disorder can be evaluated unobtrusively over the long term .
Using electronic monitoring as a treatment intervention could provide innovative and novel interventions on-dem and with a potential global reach , filling the gap between availability and the need for treatment .
Efficacy of a text messaging (SMS) based intervention for adults with hypertension: protocol for the StAR (SMS Text-message Adherence suppoRt trial) randomised controlled trial
Background Interventions to support people with hypertension in attending clinics and taking their medication have potential to improve outcomes , but delivery on a wide scale and at low cost is challenging . Some trials evaluating clinical interventions using short message service ( SMS ) text-messaging systems have shown important outcomes , although evidence is limited . We have developed a novel SMS system integrated with clinical care for use by people with hypertension in a low-re source setting . We aim to test the efficacy of the system in improving blood pressure control and treatment adherence compared to usual care . Methods / design The SMS Text-message Adherence suppoRt trial ( StAR ) is a pragmatic individually r and omised three-arm parallel group trial in adults treated for hypertension at a single primary care centre in Cape Town , South Africa . The intervention is a structured programme of clinic appointment , medication pick-up reminders , medication adherence support and hypertension-related education delivered remotely using an automated system with either informational or interactive SMS text-messages . Usual care is supplemented by infrequent non-hypertension related SMS text-messages . Participants are 1:1:1 individually r and omised , to usual care or to one of the two active interventions using minimisation to dynamically adjust for gender , age , baseline systolic blood pressure , years with hypertension , and previous clinic attendance . The primary outcome is the change in mean systolic blood pressure at 12-month follow-up from baseline measured with research staff blinded to trial allocation . Secondary outcomes include the proportion of patients with 80 % or more of days medication available , proportion of participants achieving a systolic blood pressure less than 140 mmHg and a diastolic blood pressure less than 90 mmHg , hospital admissions , health status , retention in clinical care , satisfaction with treatment and care , and patient related quality of life . Anonymised demographic data are collected on non- participants . Discussion The StAR trial uses a novel , low cost system based on widely available mobile phone technology to deliver the SMS-based intervention , manage communication with patients , and measure clinical ly relevant outcomes . The results will inform implementation and wider use of mobile phone based interventions for health care delivery in a low-re source setting .Trial registration
Taken together , the literature presented in this dissertation illustrates that 1 ) smartphone-based electronic self-monitoring of mood  seems to reflect clinical ly assessed depressive and manic symptoms and enables the long-term characterization of mood instability in bipolar disorder ; 2 ) preliminary results suggest that smartphone-based automatically generated data ( e.g. the number of text messages sent/day ; the number of incoming and outgoing calls/day ; the number of changes in cell tower IDs/day ; and voice features ) seem to reflect clinical ly assessed depressive and manic symptoms in bipolar disorder ; 3 ) smartphone-based electronic self-monitoring had no effects on the severity of depressive and manic symptoms in bipolar disorder , according to a r and omized controlled trial ; and 4 ) electronic  monitoring of psychomotor activity and heart rate variability seems to reflect illness activity in bipolar disorder and differentiate between patients with bipolar disorder and healthy control individuals .
These findings point toward the usefulness of  electronic monitoring  as a marker of illness in bipolar disorder .
Major reasons for the insufficient effects of current treatment options in bipolar disorder include delayed intervention for prodromal depressive and manic symptoms and decreased adherence to psychopharmacological treatment .
The reliance on subjective information and clinical evaluations when diagnosing and assessing the severity of depressive and manic symptoms calls for less biased and more objective markers .
By using electronic devices , fine-grained data on complex psychopathological aspects of bipolar disorder can be evaluated unobtrusively over the long term .
Using electronic monitoring as a treatment intervention could provide innovative and novel interventions on-dem and with a potential global reach , filling the gap between availability and the need for treatment .