By: Steven Chan

While much trumpeting has been done about the smartphone, physical medicine encompasses much more than science.

The art — the psychosocial aspects — of medicine can also be improved by mobile technologies.

In fact, mental health applications comprised a significant portion of the Health 2.0 2012 conference’s showcase of next-generation products. Depression, anxiety, and other psychiatric diagnoses are the next set of large problems that mobile health can tackle as they affect patients’ day-to-day lives. For instance, [f] the United States government is already attempting to do this with applications like T2 Mood Tracker and the VA’s PTSD Coach.

Mood Tracker is an application designed by a bipolar patient. It was recently released onto the Google Play Store and Apple’s App Store. For those in primary care, pain management, and psychiatry who manage their patients’ psychiatric medications, this $0.99 interactive diary may be useful to get a gestalt of their symptoms.

However, this app not only lacks polish but, due to its poor design, will likely confuse patients.[g]

Tracking day-to-day activities is cumbersome and confusing

The symptoms themselves aren’t fully customizable. Users are assigned a fixed number of categories that are redundant (e.g. anxiety and calm) but whose qualitative scales can’t be customized.

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As a clinician, the app fails to capture symptoms I’d be interested in for my patients. For starters, the “quality of sleep” is too general.

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As can be seen from above, maybe there are nightmares. If so, how many are there? Is the patient having problems with sleep-onset insomnia or sleep-maintenance insomnia? Perhaps they are depressed and have early morning awakenings. It’s hard to tell from this measure.

The application is filled with numerous user interface glitches. Besides making it cumbersome to switch dates, it will refuse to let you go back to add or modify the prior day’s entries (should you forget a day). Plus, the Instruction screen uses a large, obnoxious typeface.

Are you a night owl? You are out of luck.[h] The alarm and data intervals are set at fixed times, only letting you record your symptoms and thoughts for 8am, noon, 6pm, and 10pm.

Tracking medications could use more detail

The application allows you to do this, but there doesn’t seem to be a way to track different dosages, frequencies, and formulations of medications on the input screen.

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Trending the symptoms, along with dosage changes, would be useful for clinicians who are still adjusting a patient’s medications.

Creating reports for the clinician

One strength of the application is the Report view. You can view a beautiful chart on your screen, or e-mail it through a plain text file or a PDF file. Interestingly, you can share the file created, which makes this useful for saving it to cloud services like Evernote or Dropbox, or even uploading it to your clinician’s secure website.

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The user interface for viewing the reports is a little odd: users can’t zoom in or zoom out to see general high-level trends, nor can they highlight a particular area of the graph to view more details. To view these in conjunction with the medication entries, users have to view the PDF files.

Another problem with exporting: its human-readable plain text isn’t immediately usable or importable into spreadsheet or data-crunching programs as it doesn’t bother using CSV or tab-separated values.

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Little evidence exists supporting the use of the app

The developers’ website does not cite any literature or clinical studies demonstrating the effectiveness of this application, especially with such intense daily solicitation of symptoms. In fact, a quick search of “diary” in the existing literature on American Psychiatric Publishing’s website shows a handful of instances in which diaries may be useful:

  • under intense monitoring for eating disorders, in the “form of a weekly diary recording all foods eaten, symptoms and symptom urges, strategies utilized, and feelings. The self-monitoring diaries are intended to increase patients’ awareness of their eating behavior, symptom triggers, and coping strategies.” (Gabbard)
  • monitoring panic symptoms to “aid in identification of triggers for panic symptoms, which may become a focus of subsequent intervention.” (Practice Guideline for the Treatment of Patients With Panic Disorder, Second Edition)
  • for tracking (Odgers CL et al)

These citations monitor symptoms with less frequency than this app’s four-times-a-day alarms. After digging through the developer’s website, I finally found their explanation of how this came to be developed at the indiegogo website.

In an inpatient psychiatric facility such a product like this might be useful. Patients with primary mood disorders in an outpatient setting, however, likely won’t experience such extreme hour-to-hour variability in symptoms — unless they are developing full-blown mania. Anxiety disorders and personality disorders, perhaps, would experience great amounts of such fluctuations.

But even so, this application only pidgeonholes symptoms into fixed morning, noon, and evening categories. The app doesn’t take into account shift workers or night owls’ schedules, nor triggers (e.g. in the case of panic disorder or PTSD).

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Price

  • $0.99

Likes

  • Tracks medications, symptoms, and thoughts for each day
  • Exporting of reports to both PDF and plain text useful for clinicians
  • Quick to load, using native Android user interface widgets

Dislikes

  • Half-polished Android user interface with numerous glitches
  • Can’t track triggers (for things like eating disorders and other anxiety disorders)
  • Could be more useful for clinicians if it incorporated medication dosage trends and more refined symptom customization
  • Egregiously large at 7.3 MB, which seems unusual for an application that does not much more than track and graph

Healthcare providers that would benefit from the app

  • primary care MD’s, DO’s, and NP’s
  • psychiatry MD’s, DO’s, and NP’s, and other mental health clinicians

Patients that may benefit from app

  • those suffering from mental health disorders

Conclusion

  • While this is a great start for a mood-tracking application, it does not cover the complexity and variability of mood disorders.
  • A customized spreadsheet, OfficeSuite, and the Android alarm clock app may be more useful for clinicians to provide to patients at this point. For a similar (and less expensive) tool, check out T2 Mood Tracker, which has similar functionality but also falls somewhat short in areas like sleep symptom tracking.

iMedicalApps recommended?

  • No

iTunes Link
Google Play Link

Rating: (1 to 5 stars)
Overall: 3.5 stars
1. User Interface – 2 stars
2. Multimedia usage – 3 stars
3. Price – 4 stars
4. Real world applicability – 5 stars

Type of Device used to review app: Samsung Galaxy Note GT-N7000
Version of App: version as of March 31st, 2013

References

  • [F] Gabbard’s Treatment of Psychiatric Disorders, 4th Edition, Chapter 46: Intensive Treatments
  • [G] Practice Guideline for the Treatment of Patients With Panic Disorder, Second Edition
  • [H] Odgers CL et al, “Capturing the Ebb and Flow of Psychiatric Symptoms With Dynamical Systems Models”, The American Journal of Psychiatry, May 1 2009, http://ajp.psychiatryonline.org/article.aspx?articleID=100801

Disclaimer:
This post does not establish, nor is it intended to establish, a patient physician relationship with anyone. It does not substitute for professional advice, and does not substitute for an in-person evaluation with your health care provider. It does not provide the definitive statement on the subject addressed. Before using these apps please consult with your own physician or health care provider as to the apps validity and accuracy as this post is not intended to affirm the validity or accuracy of the apps in question. The app(s) mentioned in this post should not be used without discussing the app first with your health care provider.