Ratheesh Aswin, Gates Jesse, Hammond Dylan, Shelton Clare, Macneil Craig, Hasty M Melissa, Dhar Arup, D'Alfonso Simon, Schmaal Lianne, Kessing Lars V, Gleeson John F, Davey Chris, Chanen Andrew, Murray Greg, Cotton Sue M, McGorry Patrick D, Berk Michael, Alvarez-Jimenez Mario
Orygen, Parkville, Australia.
Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.
Early Interv Psychiatry. 2025 Jun;19(6):e70060. doi: 10.1111/eip.70060.
Despite evidence for early interventions for bipolar disorder (BD), there are relatively few accessible treatment models. We developed a digitally augmented model of care termed BLEND (BipoLar early interventions using New Digital technologies) which aims to improve mood symptoms in BD. BLEND includes: (a) guideline-concordant pharmacotherapy; (b) in-person psychological therapies blended with digital therapeutic content and (c) digital relapse monitoring. The aim of this study was twofold: (i) describe the acceptability, safety and feasibility of delivering BLEND and (ii) examine the feasibility of an efficacy trial of BLEND compared with enhanced standard care (ESC).
We conducted a parallel-group, open-label, 2:1 randomised pilot trial within a youth mental-health outpatient service in Melbourne, Australia. We included youth aged 15-25 years with BD I or II, who had not previously accessed multidisciplinary care. All participants received similar background care. BLEND differed from ESC in having manualised blended digital and in-person psychological therapies and digital relapse monitoring.
We randomised 21 young people over a 12-month recruitment period, predominantly female participants (71.4%) with BD Type II (85.7%). Both treatment models were acceptable and safe, but the BLEND group had greater reductions in suicidal ideation. Among components of BLEND, in-person psychological therapy and psychopharmacological interventions could be delivered with fidelity. Digital therapy engagement was high, but participants used digital relapse monitoring variably.
The BLEND model was safe and acceptable and may lead to improvements in suicidality compared with ESC. Concordant with the aims of a pilot study, there is scope for the content to be rationalised based on feedback to improve feasibility of the digital therapy. Relapse monitoring may usefully be extended to depressive symptoms. The next step is to confirm the efficacy of BLEND compared with standard care.
尽管有证据表明双相情感障碍（BD）需要早期干预，但可获得的治疗模式相对较少。我们开发了一种名为BLEND（使用新数字技术的双相情感障碍早期干预）的数字增强护理模式，旨在改善双相情感障碍的情绪症状。BLEND包括：（a）符合指南的药物治疗；（b）与数字治疗内容相结合的面对面心理治疗，以及（c）数字复发监测。本研究的目的有两个：（i）描述提供BLEND的可接受性、安全性和可行性，以及（ii）检验与强化标准护理（ESC）相比，BLEND疗效试验的可行性。
我们在澳大利亚墨尔本的一家青少年心理健康门诊服务机构进行了一项平行组、开放标签、2:1随机试点试验。我们纳入了年龄在15 - 25岁之间、患有I型或II型双相情感障碍且此前未接受过多学科护理的青少年。所有参与者都接受了类似的背景护理。BLEND与ESC的不同之处在于，它有标准化的数字与面对面心理治疗相结合的方法以及数字复发监测。
在为期12个月的招募期内，我们随机分配了21名年轻人，主要是女性参与者（71.4%），患有II型双相情感障碍（85.7%）。两种治疗模式都是可接受且安全的，但BLEND组在自杀意念方面有更大程度的减轻。在BLEND的各个组成部分中，面对面心理治疗和心理药物干预能够忠实地实施。数字治疗的参与度很高，但参与者对数字复发监测的使用情况各不相同。
与ESC相比，BLEND模式是安全且可接受的，可能会改善自杀倾向。与试点研究的目标一致，有必要根据反馈对内容进行合理化调整，以提高数字治疗的可行性。复发监测可能有益地扩展到抑郁症状。下一步是确认BLEND与标准护理相比的疗效。
