Mobile-assisted therapy for schizophrenia
Community programmes for schizophrenia are mainly focused on patients with a first episode or with negative symptoms. Patients with persistent positive symptoms usually do not participate and require extensive periods of hospital care, inducing excessive suffering and a greater risk of mortality and multi-morbidity. To make matters worse, these measures are not enough to achieve remission in patients with treatment-resistant schizophrenia. To address this issue, the EU-funded m-RESIST project proposed to develop mobile health applications that can help monitor and treat patients with schizophrenia. The m-RESIST consortium integrated technological and clinical expertise to overcome the major challenge of translating complex clinical interventions into specific system functionalities and ICT tools. Benefits of mobile health applications Overall, mobile health interventions promote engagement and empowerment of patients as well as participation in the therapeutic process. “Evidence from studies shows that patients’ involvement in their own treatment helps improve adherence and reduce relapse,″ explains project coordinator Mr Jesús Berdún Peñato. Moreover, a mobile health solution facilitates the monitoring of patients by integrating assistance from different healthcare professionals including psychiatrists and psychologists. The m-RESIST solution includes a mobile application, a wearable smartwatch that collects data from patients and sends it wirelessly to the smartphone, and a web-based platform used by healthcare providers to monitor the patient’s state. The application tracks patients’ early warning signs, symptoms and biological variables such as the level of activity, heart rate, sleeping pattern and number of steps. The intervention focuses on key problems and links the patient’s early warning signs with personalised cognitive behaviour therapy strategies. Also caregivers can exchange messages with the patient’s healthcare providers. The m-RESIST approach is tailored to the patient’s condition. It has been designed to deliver a basic set of questions through the application, to measure patients’ clinical status, and depending on the patients’ answers to follow up with appropriate questions or recommendations. Importantly, the m-RESIST intervention is capable of detecting patient clinical worsening. This is achieved by comparing clinical and sensor variables with a baseline profile created by capturing multidimensional data during a specific period of time. Using predefined algorithms, the system can detect significant changes and trigger tailored recommendations, notifications, or in extreme cases, suggest to patients and caregivers emergency assistance. The importance of patient involvement When testing an innovative solution for disease management and therapeutic intervention, it is important that patients, caregivers and professionals all actively participate in its testing. As Mr. Berdún explains, “patient’s receptiveness was one of the major concerns of the project; we used different methods (focus groups, workshops, pilots) to make patients part of the team.″ Central to the success of patient participation was the explanation by clinicians of the benefits of the approach. A video was also generated explaining the scope of the project. Overall, the m-RESIST solution was successfully tested in real patients and helped improve care. According to the literature and professional organisations, patients with schizophrenia need – in addition to decreasing psychotic symptoms – information concerning their condition, treatment, and strategies to cope with it. Mr. Berdún is confident that “by promoting the involvement of patients in the therapeutic process and personalising their treatment, the m-RESIST solution will impact on patient’s worsening and quality of care.″
Keywords
m-RESIST, schizophrenia, mobile application