Smartphone Applications Youth With Early Psychosis in Community Outpatient Settings

Although remission of psychotic symptoms following a patient's first episode of psychosis is achievable through pharmacological and psychosocial treatment, 50% of patients relapse within two years; 80% relapse within five. Relapse, defined as a recurrence of positive psychotic symptoms, is associated with cumulative increases in levels of psychotic symptoms following recovery, decreased social and community functioning, decreased quality of life, and increased hospitalizations. Given the negative impact on patients and their families, and the increasing cost of services as a function of relapse, development of effective relapse prevention strategies is imperative. Predictors of relapse amenable to treatment include: 1) clinical factors such as an exacerbation of clinical symptoms indicative of impending relapse; 2) treatment engagement factors such as medication adherence and therapeutic alliance; and 3) functioning factors such social impairments. Using mobile health technology in a community based outpatient clinic, we propose to specifically address these three types of relapse predictor variables. The mobile health application tested in this study provides a user interface and a provider interface. The user interface is the mobile application (i.e. the "app") that patients interact with via their smartphone. This is designed to be simple and easily accessible. The app gathers "active" data, i.e. self-report surveys, which the user is alerted to via notifications on their device. Active data are analyzed and summarized for each patient on the "Dashboard", a provider-facing web portal for accessing concise and relevant information about a patient. The Dashboard provides up-to-date information regarding a patient's survey responses. Providers then use this information to better inform treatment decisions. Specific aims and associated hypotheses are as follows: Aim 1: Determine the feasibility and acceptability of the mhealth app in a community based outpatient early psychosis population. Hypothesis a: EPs will show high utilization of the mhealth app and low dropout, as well as high satisfaction and endorsement of continued use of the app. Hypothesis b: Clinicians will report high satisfaction and endorsement of continued use of the app. Aim 2: Identify mhealth data related to key patient outcomes to inform calibration of patient status alerts. Hypothesis: Reductions in phone calls/text messages and/or increases in self-reported ratings of basic symptoms will predict psychotic symptom flares, increased clinic utilization, psychiatric ER visits and hospitalizations. Aim 3: Evaluate the effect of the mhealth app on medication adherence, therapeutic alliance, and insight. Hypothesis a: After five months of app use, patients will report improved medication adherence, therapeutic alliance with their clinicians, and insight into their illness. Hypothesis b: After five months of use, clinicians will report improved therapeutic alliance with their patients.