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Frequently Asked Questions 1. What is the ChronoRecord Chart? 2. Who should use ChronoRecord? 4. Is a single mood point each day sufficient to chart mood disorders? 8. How should the extreme anchor point for mania be defined for a person with unipolar depression? 9. Must patients be very knowledgeable about computers to use ChronoRecord? 11. Can anybody read the data on a patient’s home computer? 12. Is home computer ownership common? 13. How are patients trained remotely? 14. Can anybody read the mood charts that are sent by e-mail? 1. What is the ChronoRecord Chart? The ChronoRecord Chart is a longitudinal display of data entered by a patient using ChronoRecord software on a home computer or on the web - mood, sleep, life events, medications, weight and menstrual data if female. The data is displayed in three graphs: Mood Versus Time, Sleep Versus Time and Medications Versus Time. The display extends for a period of 30, 60, 90, 120 or 180 days and any date may be selected as the starting date. Statistical charts are also available. The ChronoRecord Charts are easy to understand and provide a graphical display of the patient’s progress. 2. Who should use ChronoRecord? ChronoRecord is designed for tracking patients who were diagnosed with a mood disorder, are suspected of having a mood disorder or are having mood changes in association with other psychiatric disorders or medical illnesses. 3. Can ChronoRecord be used to track the mood of patients with other psychiatric disorders or medical illnesses? Yes. ChronoRecord may be used to track parameters that frequently vary in patients with other psychiatric disorders or medical illnesses such as such as mood, sleep and body weight. In addition, ChronoRecord will provide an accurate longitudinal record of drug therapies. This is valuable for following the depression that may commonly accompany psychiatric disorders such as schizophrenia or anxiety disorders, or medical illnesses such as heart disease, Parkinson’s disease, cancer, multiple sclerosis, diabetes and hypothyroidism. Where mania is triggered by medications such as corticosteroids, antidepressants and stimulants, ChronoRecord can provide an effective means to track recovery. 4. Is a single mood point each day sufficient to chart mood disorders? Yes. Using ChronoRecord, every day the patient enters a single point that best describes the overall mood for the previous 24 hours. Validation studies have shown that entering a single point correlates with a clinician’s objective rating of mood and adequately describes an individual’s mood in the previous 24 hours. Over time, longitudinal analysis of these data points will display the pattern of the patient’s mood disorder. All variants of mood disorders, including rapid cycling, can be tracked. Mood is a very complex phenomenon. Mood is continuously modulated by a myriad of interlaced internal brain systems and external stimuli. Additionally mood, like sleep, follows a Circadian rhythm. In all humans there is a predictable diurnal rhythm in mood and energy as we cycle from high activity while awake to rest and recovery during nighttime sleep. If multiple points for mood were collected within each 24-hour period, these circadian variations would cloud an objective understanding of the patient’s mood disorder. By obtaining the single point that best aggregates an individual's subjective mood for the previous 24 hours, a clear pattern of the patient’s mood disorder is obtained. 5. What about patients who suffer episodes of mixed mania? Is a single mood point each day sufficient to chart these patients? Yes. When enrolled in the system, the 0 and 100 anchor points are calibrated to each patient's most extreme total manic and depressed experience. These descriptions, including dysphoria and irritability in mania, are recorded in the system. It is our experience that patients who experience a mixed mood of irritable mania and depression will generally enter a data point for mood in the manic range along with decreased hours of sleep. When such states occur we encourage the individual to also describe the mixed state in the notes available. A disruption of Circadian rhythms (sleep deprivation) in patients with mood disorders may lead to irritability, anxiety, depression, difficulty concentrating and fatigue. In some patients with bipolar disorder, sleep deprivation precipitates mania. In an episode of mixed mania, the patient may experience the low mood and irritability associated with sleep deprivation in conjunction with the increased energy, activity and drive associated with the start of a new Circadian cycle. 6. What if a patient includes depressive symptoms in the description of their anchor point for mania (most extreme manic state)? Patients often describe a mixed episode as their most extreme manic state and thus include depressive symptoms such as suicidal thoughts. The patient identifies the hyperactivity, increased drive, racing thoughts as mania even when accompanied by depressed or irritable mood. Patients who have experienced both a manic and a mixed episode will invariably describe the mixed episode, typified by agitation, insomnia, and suicidal thinking, as the extreme anchor point for mania. Patients who experience a mixed mood of irritable mania and depression will generally enter a data point for mood in the manic range along with decreased hours of sleep. 7. What instructions are given to patients on how to enter the daily mood rating using ChronoRecord software? ChronoRecord uses a Visual Analog Scale between 0 and 100 for mood entry. The anchor points (0 and 100) on the scale are set during enrollment when the patient describes the most depressed and most manic states ever experienced. This description includes mood, irritability, energy level and overall functioning. The patients are given the following guidelines for daily entry of the single point that best describes overall mood for the past 24 hours:
8. How should the extreme anchor point for mania be defined for a person with unipolar depression? To define the extreme anchor point for mania for a patient with unipolar depression, the patient is asked to describe the best they ever felt in life. If they consider this to be normal, a point halfway on the Visual Analog Scale between the midpoint (50) and mania (100), or about 75, should represent their anchor point. 9. Must patients be very knowledgeable about computers to use ChronoRecord? No. ChronoRecord is as simple to use as an ATM at a bank. Only basic familiarity with a personal computer is required. ChronoRecord is easy to use and fast to complete. Only a few minutes a day must be spent a day to enter ChronoRecord data; speed of use was of primary importance during product design. Product support will show the administrative staff how to train patients to install the software on a home computer and enter all data. Documentation containing step-by-step instructions for all ChronoRecord functions is provided for both patients and administrative staff. 10. Will most patients complete ChronoRecord daily? Does a patient’s mood interfere with using ChronoRecord? Yes, patients will complete ChronoRecord daily. In our 3-month validation study, 80 out of 96 patients (83%) with bipolar disorder from 3 locations showed high acceptance of the computerized approach*. They returned 8662 days of data (mean 114.7, SD 32.3) by e-mail or diskette in over 240 transfers without incident. The mean percentage of missing days of data was 6.1 with a SD of 9.3 percent. This is equlivant to missing 7.3 days in the 114.7 day study. There was no relationship between mood or demographic characteristics and using ChronoRecord. 11. Can anybody read the data on a patient’s home computer? No. The ChronoRecord data file on the patient’s home computer, on the diskettes given to the patient, and in the E-mail sent from the patient to the physician are all encrypted using the patient’s password. Without knowing the patient’s password, the content of the data files cannot be read. 12. Is home computer ownership common? Yes, the PC has become a standard household applicance in most industrialized countries. In 2005, two-thirds of all households in Australia, Austria, Canada, Denmark, Finland, Germany, Iceland, Japan, Korea, Luxembourg, Netherlands, Norway, Sweden, UK and the US had at least one PC (Organization for Economic Cooperation and Development OECD Factbook 2007). About half the households in Frace, Ireland, Italy and the Slovak Republic had a PC. Between 20% to 40% of the households in Czech Republic, Greece, Hungary, Poland, Portugal and Mexico had a PC. By the end of 2004, there were 616 million PCs in the 15 countries with the most computer according to the Computer Industry Almanac, Inc. 13. How are patients trained remotely? We schedule two phone calls with the patient. The first call lasts less than 10 minutes and is used to register the patient. After the patient is registered, a ChronoRecord software package is mailed to them. During the second phone call, we install the software, enter a day of data and review all aspects of using ChronoRecord. The second phone call takes about 30 minutes. 14. Can anybody read the mood charts that are sent by e-mail? No. All medical data that you send to the ChronoRecord Association and any charts you or your physician receive from the ChronoRecord Association are protected by password encryption. You choose your password when you register to use ChronoRecord and use it to access the program every day. When you prepare data to be sent to the Association, ChronoRecord automatically encrypts your data with your personal password. When you receive charts from the Association using e-mail, you must use the ChronoRecord Secure program to decrypt the data with your personal password before you can view it. Without your personal password, your medical data cannot be read. 15. What if a patient includes symptoms of mania in their description of their anchor point for depression (most depressed state)? Some patients describe manic symptoms such as agitation, racing thoughts or lack of sleep during their most extreme depressed state. The patient identifies this severe agitation as depression. This may be recorded as the most depressed state for the patient. * Bauer M, Grof P, Gyulai L, Rasgon N, Glenn T, Whybrow PC. Using Technology To Improve Longitudinal Studies: Self-Reporting In Bipolar Disorder. Bipol Disord 2004;6:67-74
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