NEW YORK – A smartphone app designed to provide automated, real-time support for patients with symptoms of schizophrenia demonstrated promising results in a feasibility study, according to data presented at the American Psychiatric Association’s Institute on Psychiatric Services.
The app, called FOCUS, employs an algorithm to provide “semi-tailored care” based on patient responses to specific prompts, explained Dror Ben-Zeev, Ph.D., of the Dartmouth Psychiatric Research Center, Lebanon, N.H., and the Geisel School of Medicine at Dartmouth, Hanover, N.H. The goal is to use automation that allows patients with serious mental illness to get control of bothersome symptoms, regulate mood, enhance social functioning, improve sleep, and improve medication adherence.
©Hocus Focus Studio/iStockphoto.com
In a feasibility study, 33 patients with schizophrenia or schizoaffective disorder were evaluated over 30 days while carrying a smartphone equipped with the FOCUS app. Once downloaded, the app does not require a connection to the Internet. It also was said to be easy to operate without particular technological expertise, although technical support was available.
“The most common technical problem was people forgetting to charge their phone,” reported Dr. Ben-Zeev, who noted that the app was designed for individuals with psychotic symptoms, cognitive impairment, and a relatively low reading level. According to Dr. Ben-Zeev, the 33 participants in the feasibility study were reasonably representative of patients with psychotic disease and “not necessarily technologically savvy.”
Three times per day, the timing of which can be programmed for the individual patient, the app engages the patient with the prompt, “Can you check in with FOCUS right now?” When the patient employs the app, which he or she can also access at any time, not just at the scheduled prompts, it initiates a series of questions leading to algorithm-driven guidance to problem solving.
For example, a patient who is being managed for psychotic symptoms might be asked by the app whether he or she is being bothered by voices and, if so, to rate the severity. If voices are posing difficulty for the patient, the app is designed to deliver cognitive-behavioral therapy for controlling this symptom by walking the patient through cognitive exercises. Other algorithms are used for support for other clinical issues, such as mood regulation.
In the feasibility study, the app was used on average 6.4 times per day during the first week by participating patients. In the 4th week of the study, patients used the app on average 4.9 times per day, meaning that the device was used on average more than the three times that the prompt automatically asked for patient engagement. Acceptance was high. Approximately 90% found the device usable, and 88% reported that they would recommend it to others.
The value of the device also was supported by change in symptoms. Although no change was found from baseline in negative symptoms, the reduction in the end-of-study positive scores was significant (P less than .001).
This app is not yet available, but commercial development is being considered. Dr. Ben-Zeev said this is one of several apps for smartphones that might appear in the near future. This includes passive systems that use sensors in the phone to monitor movement or voice stress as potential signals for an impending relapse. This approach makes sense, as recent data suggest that most outpatients with schizophrenia have smartphones.
“Worldwide, more people have access to cell phones than toilets or toothbrushes,” Dr. Ben-Zeev observed. He estimated that more than 80% of patients with schizophrenia in the United States carry a smartphone capable of running the FOCUS app. He expects mobile interventions in psychiatric disease to proliferate over the coming years.
Dr. Ben-Zeev reported no relevant financial relationships.