Tuesday, March 27, 2018

Patients With Early Psychosis May Benefit From App on How to Cope With Symptoms

Actissist—a smartphone app that prompts patients with early psychosis to share information about psychotic symptoms and responds with tips on how best to manage these symptoms—may offer an advantage over apps that capture data about symptoms alone, according to a report published in Schizophrenia Bulletin.

Sandra Bucci, D.Clin.Psy., of the University of Manchester and colleagues randomly assigned 36 patients with early psychosis to use either Actissist or ClinTouch (a symptom monitoring app) and receive treatment as usual (regular clinician meetings, medication, risk monitoring, and psychosocial interventions) for 12 weeks.

Patients assigned to the Actissist and ClinTouch groups received regular daily notifications from the smartphone apps, prompting them to answer questions about symptoms, but the steps that followed once a patient submitted a response to the notification differed.

“If [an Actissist] user accepts a notification or initiates use, they are invited to select an intervention domain(s) [for instance, “suspicious thoughts”] and then complete a series of self-assessment questions structured as question-answer exchanges that focus on cognitive appraisals, belief conviction, emotions, and associated behaviors,” Bucci and colleagues wrote. “Depending on the appraisal selected, the exchange is followed by … cognitive or behavioral strategies aimed at suggesting ways of coping with distressing experiences.”

In contrast, ClinTouch invited participants to use a touchscreen slider to rate the severity of 12 symptoms on a scale of 1 to 7, and the data were uploaded to a secure server.

Researchers blind to treatment assignment completed assessments of patients at baseline, 12 weeks, and 22 weeks. The primary outcome of the study was feasibility, which was assessed in terms of uptake (the proportion of eligible participants consenting to the study), attrition, the proportion of participants completing user and alert-initiated data entries across participants (>33% data points), and the proportion continuing for 12 weeks. During the assessments, the researchers asked participants about the frequency, intensity, and distress of psychotic symptoms; health status and health-related quality of life; and more.

Overall, the study showed that Actissist was “feasible” (75% participants used Actissist at least once/day, “acceptable” (97% participants remained in the trial), and “safe” (0 serious adverse events), with high levels of user satisfaction and indications of a beneficial effect that surpassed that of the control group. Additional analysis suggested that there were improvements in key outcome measures, including PANSS negative score and general and total scores, in the Actissist group relative to the control group after treatment ended. While effects were not fully sustained at 22-week follow-up, the patients did not decline on any of the clinical outcomes measured.

“Smartphone-extended care could drive improvements in quality, efficiency, cost, and access to treatment, while enhancing patient experience,” the authors wrote. “Our findings suggest that the Actissist system may confer additional benefits over routine mobile symptom monitoring in the short term. Participants were engaged, active, and adherent with the system.”

For related information on digital interventions, see the Psychiatric Services articles “Using Digital Media Advertising in Early Psychosis Intervention” and “A Hierarchical Framework for Evaluation and Informed Decision Making Regarding Smartphone Apps for Clinical Care.”

(Image: Kostenko Maxim/Shutterstock)


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