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Anticipating Depressive and Manic Episodes in Bipolar Disorders Using Vocal Biomarkers (SPEECHBIPO)

C

Centre Hospitalier St Anne

Status

Not yet enrolling

Conditions

Bipolar Disorder (BD)

Treatments

Other: Voice interviews and questionnaires carried out via the CALLYOPE application
Device: Smartwatch for measuring activity, sleep, and skin temperature
Device: Sleep measurements using an under-mattress sensor

Study type

Interventional

Funder types

Other

Identifiers

NCT07298278
D24-P020

Details and patient eligibility

About

Bipolar disorder (BD) is a chronic, cyclical mental illness affecting over 1% of the global population. It is characterized by alternating episodes of elevated mood and energy (mania or hypomania) and episodes of decreased mood and energy (depression).

Manic episodes involve hyperactivity, decreased need for sleep, grandiosity, accelerated speech, and sometimes psychotic symptoms such as hallucinations or delusions. Depressive episodes, in contrast, are characterized by sadness, low energy, social withdrawal, sleep and appetite disturbances, and low self-esteem. Bipolar patients are at very high risk of suicide, with rates up to 20 times higher than in the general population; nearly half will attempt suicide during their lifetime, and 15-20% of these attempts are fatal.

BD is associated with a substantial decrease in quality of life, often greater than that seen in other mood or anxiety disorders. This reduction is primarily driven by depressive symptoms, including residual ones that may persist during remission periods. The frequent comorbidity with anxiety disorders further exacerbates the burden of the illness.

Recently, research has turned toward the concept of the digital phenotype to identify early markers of relapse using passive and continuous monitoring. Among potential digital biomarkers, voice has shown particular promise. Automated speech analysis, combined with machine learning algorithms, has demonstrated effectiveness in detecting psychiatric symptoms and differentiating mood states. In BD, vocal and linguistic patterns vary with mood fluctuations, suggesting that voice could serve as a sensitive indicator of relapse risk.

The main hypothesis of the present study is that automated analysis of speech and lifestyle data can help develop a predictive model capable of identifying early signs of relapse, whether manic, depressive, or mixed, or transitions to high-risk states in individuals with bipolar disorder.

Full description

Bipolar disorder (BD) is a chronic and cyclical illness that affects a significant portion of the population, representing more than 1% worldwide. It is characterized by alternating episodes of elevated mood and energy (mania or hypomania) and episodes of decreased mood and energy (depression). These mood episodes manifest as substantial variations in energy levels and behavior, which recur over time and have a major social and occupational impact. According to the World Health Organization, BD rank as the fourth leading cause of morbidity and mortality.

Manic episodes are marked by hyperactivity, exalted mood, insomnia, inflated self-esteem, expansive speech and behavior, and sometimes psychotic symptoms (such as delusions of persecution or hallucinations). In contrast, depressive episodes are characterized by low energy, sadness, social withdrawal, hypersomnia or insomnia, and low self-esteem, often accompanied by weight loss or gain and decreased or increased appetite. The risks associated with manic, depressive, or mixed episodes are numerous; notably, individuals with BD have a suicide rate up to 20 times higher than that of the general population. Nearly half of patients with BD will attempt suicide at least once in their lifetime, and 15-20% of these attempts are fatal.

BD are associated with a marked reduction in quality of life, often greater than that observed in other mood or anxiety disorders. This decrease in quality of life is more strongly correlated with depressive symptoms than with manic or hypomanic symptoms. Furthermore, poor quality of life is related to residual depressive symptoms that may persist during remission periods, as well as to the high comorbidity of bipolar disorder with anxiety disorders.

The annual relapse rate ranges between 40% and 61% during the first two years following the initiation of treatment. This high incidence of relapse makes stabilization particularly difficult for patients with BD, with a period of significant vulnerability following each episode. The average duration of hospitalization is 58 days, at an approximate cost of €850 per day, resulting in direct hospitalization costs related to mood disorder relapses of about €3 billion per year. According to the French Court of Auditors, for every euro of direct cost, there are two euros of indirect costs related to social benefits and the negative impact on employment. Extrapolating these figures, the cost of hospitalizations due to relapses in BD is estimated at €45 billion across Europe.

Moreover, each relapse or rehospitalization irreversibly affects the individual's cognitive functioning and contributes to social and occupational disintegration. Staging models of the illness based on neuroprogression have been developed, taking into account the number of relapses and the degree of functional impairment. However, these models are not yet implemented in clinical practice.

Preventing (hypo)manic and depressive episodes through early intervention is therefore a key priority both at the individual level and as a major public health issue.

A new line of research has emerged in mood disorders, focusing on the digital phenotype. Among new digital biomarkers of relapse, voice appears to be a promising parameter. Several studies have demonstrated the efficacy of automated speech analysis, using machine learning models, to aid in the diagnosis of psychiatric disorders. In bipolar disorder, the illness has been shown to influence patients' vocal and linguistic features.

Thus, the main hypothesis of the study is that automated speech analysis and lifestyle data can be used to develop a model capable of predicting either relapse (manic, depressive, or mixed episode) or the transition to a high-risk state in patients with bipolar disorder.

Enrollment

170 estimated patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • Adult patient
  • Patient capable of providing informed consent
  • Patient suffering from bipolar disorder according to DSM-5-TR (2022) criteria
  • Patient recently discharged from hospitalization or in remission after a mood episode within the last 12 months, with a MADRS score ≤10 and a YMRS score ≤8, or based on the psychiatrist's subjective evaluation
  • Patient treated with lithium/antipsychotics/benzodiazepines (monotherapy or combination therapy)
  • Patient capable of performing speech assessments and responding to questionnaires on a smartphone
  • Patient able to speak, read, and understand French
  • Patient enrolled in a social security system

Exclusion criteria

  • Patient with a cognitive disorder
  • Patient suffering from a known demential disorder
  • Patient receiving treatment for a known addictive disorder
  • Patient with a condition affecting speech production
  • Patient with a neurological disorder (stroke or neurodegenerative diseases)
  • Patient under legal protection, guardianship, or curatorship
  • Subjects deprived of liberty by judicial or administrative decision
  • Pregnant or breastfeeding women

Trial design

Primary purpose

Basic Science

Allocation

N/A

Interventional model

Single Group Assignment

Masking

None (Open label)

170 participants in 1 patient group

Patients with Bipolar Disorder (6-month observational follow-up)
Experimental group
Description:
Performing voice and language tests on the Callyope application: testing the voice and language analysis algorithm. Daily recording (6 months) of all passive data via the connected watch and the under-mattress sensor and the number of steps via the Callyope application (remotely)
Treatment:
Device: Sleep measurements using an under-mattress sensor
Device: Smartwatch for measuring activity, sleep, and skin temperature
Other: Voice interviews and questionnaires carried out via the CALLYOPE application

Trial contacts and locations

0

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Central trial contact

Pierre-Alexis Geoffroy, Pr

Data sourced from clinicaltrials.gov

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