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      Smartphone Apps for Schizophrenia: A Systematic Review

      research-article
      , PhD 1 , , MD 2 , 3 ,
      (Reviewer), (Reviewer)
      JMIR mHealth and uHealth
      JMIR Publications Inc.
      eHealth, fitness, mHealth, psychosis, schizophrenia, smartphones, technology, wearables

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          Abstract

          Background

          There is increasing interest in using mobile technologies such as smartphones for improving the care of patients with schizophrenia. However, less is known about the current clinical evidence for the feasibility and effectiveness of smartphone apps in this population.

          Objective

          To review the published literature of smartphone apps applied for the care of patients with schizophrenia and other psychotic disorders.

          Methods

          An electronic database search of Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, Allied and Complementary Medicine, Health and Psychosocial Instruments, PsycINFO, and Embase was conducted on May 24, 2015. All eligible studies were systematically reviewed, and proportional meta-analyses were applied to pooled data on recruitment, retention, and adherence to examine the overall feasibility of smartphone interventions for schizophrenia.

          Results

          Our search produced 226 results from which 7 eligible articles were identified, reporting on 5 studies of smartphone apps for patients with schizophrenia. All examined feasibility, and one assessed the preliminary efficacy of a smartphone intervention for schizophrenia. Study lengths varied between 6 and 130 days. Overall retention was 92% (95% CI 82-98%). Participants consistently used the smartphone apps on more than 85% of days during the study period, averaging 3.95 interactions per person per day. Furthermore, participants responded to 71.9% of automated prompts (95% CI 65.7-77.8%). Participants reported a range of potential benefits from the various interventions, and user experience was largely positive.

          Conclusions

          Although small, the current published literature demonstrates strong evidence for the feasibility of using smartphones to enhance the care of people with schizophrenia. High rates of engagement and satisfaction with a broad range of apps suggest the nascent potential of this mobile technology. However, there remains limited data on the efficacy of such interventions.

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          Most cited references22

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          The digital phenotype.

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            Mobile technologies among people with serious mental illness: opportunities for future services.

            Several national bodies have proposed using mobile technology to improve mental health services. But rates of current use and interest in using technology to enhance services among individuals with serious mental illness are uncertain. The authors surveyed 1,592 individuals with serious mental illness regarding their use of mobile devices and interest in using mobile technologies to enhance mental health services. Seventy-two percent of survey respondents reported currently owning a mobile device, a rate approximately 12 % lower than the general adult population. The most common uses were for talking, followed by texting, and internet activities. Both mobile device users and nonusers expressed interest in future mobile services.
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              The feasibility and validity of ambulatory self-report of psychotic symptoms using a smartphone software application

              Background Semi-structured interview scales for psychosis are the gold standard approach to assessing psychotic and other symptoms. However, such assessments have limitations such as recall bias, averaging, insensitivity to change and variable interrater reliability. Ambulant, real-time self-report assessment devices may hold advantages over interview measures, but it needs to be shown that the data thus collected are valid, and the collection method is acceptable, feasible and safe. We report on a monitoring system for the assessment of psychosis using smartphone technology. The primary aims were to: i) assess validity through correlations of item responses with those on widely accepted interview assessments of psychosis, and ii) examine compliance to the procedure in individuals with psychosis of varying severity. Methods A total of 44 participants (acute or remitted DSM-4 schizophrenia and related disorders, and prodromal) completed 14 branching self-report items concerning key psychotic symptoms on a touch-screen mobile phone when prompted by an alarm at six pseudo-random times, each day, for one week. Face to face PANSS and CDS interviews were conducted before and after the assessment period blind to the ambulant data. Results Compliance as defined by completion of at least 33% of all possible data-points over seven days was 82%. In the 36 compliant participants, 5 items (delusions, hallucinations, suspiciousness, anxiety, hopelessness) showed moderate to strong (rho 0.6-0.8) associations with corresponding items from interview rating scales. Four items showed no significant correlation with rating scales: each was an item based on observable behaviour. Ambulant ratings showed excellent test-retest reliability and sensitivity to change. Conclusions Ambulatory monitoring of symptoms several times daily using smartphone software applications represents a feasible and valid way of assessing psychotic phenomena for research and clinical management purposes. Further evaluation required over longer assessment periods, in clinical trials and service settings.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications Inc. (Toronto, Canada )
                2291-5222
                Oct-Dec 2015
                06 November 2015
                : 3
                : 4
                : e102
                Affiliations
                [1] 1Institute of Brain, Behaviour and Mental Health University of Manchester MachesterUnited Kingdom
                [2] 2Brigham and Women's Hospital Department of Psychiatry Harvard Medical School Boston, MAUnited States
                [3] 3Beth Israel Deaconess Medical Center Department of Psychiatry Harvard Medical School Boston, MAUnited States
                Author notes
                Corresponding Author: John Torous jtorous@ 123456bidmc.harvard.edu
                Author information
                http://orcid.org/0000-0002-0618-2752
                http://orcid.org/0000-0002-5362-7937
                Article
                v3i4e102
                10.2196/mhealth.4930
                4704940
                26546039
                478b4ee1-42d6-4089-9a2a-872d37864275
                ©Joseph Firth, John Torous. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 06.11.2015.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

                History
                : 12 July 2015
                : 2 August 2015
                : 9 August 2015
                : 14 October 2015
                Categories
                Original Paper
                Original Paper

                ehealth,fitness,mhealth,psychosis,schizophrenia,smartphones,technology,wearables

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