OPAL 2 Exploratory Project 3

Mobil Health-aided Measurement-based Care for Schizophrenia

Psychotropic medications are a core, evidence-based component of the treatment of schizophrenia (SZ). As early experiences with medications may have an enduring effect on attitudes toward medications adherence, first-episode psychosis (FEP) is a critical time to optimize prescribing. Yet, evidence suggests that a significant gap exists been the optimal use of medications and how they are used in real-world practice, resulting in persistent symptoms and side effects, as well as poor treatment engagement and satisfaction. One widely promoted approach to improve treatment outcomes is measurement-based care (MBC), defined as the systematic evaluation of patient conditions before or during an encounter to inform treatment. Typical MBC relies on patients’ recalling their clinical status over several days or weeks. However, such retrospective assessments are problematic as they are vulnerable to the influence of memory difficulties, cognitive biases, and reframing. These issues are particularly salient in SZ given the substantial episodic memory deficits in this population. As a result, patients may receive suboptimal treatment, with many receiving higher than recommended dosages of antipsychotic medications leading to troubling side effects. Advances in smart-phone-based mHealth technologies that allow for collection of “in-vivo, in-situ” high time-resolution clinical information may help to overcome many of the limitations of retrospective assessments. By using momentary, brief, self-report assessments that are more frequent, richer in detail, and that capture variation within and across time and social contexts, mHealth technologies may provide a more granular, accurate, timely, and complete picture of patients’ clinical status and functioning. Building on our feasibility study, this project will examine the efficacy of our mHealth intervention to enhance patient satisfaction with treatment, as well as reduce symptom severity and side effects. We will also examine the mechanisms underlying change, including patient and prescriber clinical information availability and shared decision making. Additionally, as high poverty rates and digital illiteracy may make smartphones inaccessible to many individuals with SZ, we will address “digital divide” disparities by exploring whether providing smartphones and data plans to participants who need them, along with digital technology training for individuals who have little experience with smartphone technologies, would improve treatment outcomes. Employing a single-blind, randomized clinical trial design, 80 individuals with FEP from four Coordinated Specialty Care (CSC) sites will be randomized to receive 26 weeks of mHealth MBC or treatment-as-usual (TAU), with research assessment conducted at baseline, 13- and 26-weeks. This project will use mHealth technology innovatively to deliver timely and accurate MBC to prescribers, to promote collaborative decisions, and to improve clinical outcomes in FEP patients.

Investigators: