Abstract
BackgroundIn the European Union approximately 5 million people suffer from psychotic disorders. Patients with schizophrenia make up the largest subgroup of these, and between 30–50% of them are considered resistant to treatment. Despite the proven potential of m-health solutions, there remains a lack of technological solutions in the treatment of patients with this disease. To improve the quality of care of these outpatients, an m-health solution termed Mobile Therapeutic Attention for Patients with Treatment Resistant Schizophrenia (m-RESIST) has been created in European Union and implemented in three countries (Spain, Hungary and Israel). m-RESIST is an innovative project aimed to empower patients with Treatment Resistant Schizophrenia, which integrates pharmacological and psychosocial approaches, develops knowledge of the illness using predictive models, and includes the following m-Health tools: a Dashboard, a Smartwatch and a Smartphone. Prior to the implementation in the healthcare reality, the solution has been tested in pilot groups to assess the acceptability, usability and satisfaction of all m-RESIST components in each country. In addition to online and onsite visits, this phase has included an anonymous online questionnaire, with the aim of capturing more consistently the opinion of participants in their experience with m-RESIST. We summarize their opinions about services and devices included in the solution, as well as the improvement proposals of each group.MethodsDuring three months (from August to October), a case manager from Spain sent out an interval question to the Spanish participants via m-RESIST Dashboard, in order to collect information about the users experience with the system. It was administered weekly on different days and at different times, being anonymous for both parts. We have obtained qualitative information from nine patients, one caregiver and two clinicians.ResultsPatients consider m-RESIST a useful tool, in terms of immediacy of contact with clinicians, improvement of disease awareness, better follow-up of their disease, less-worries from caregivers and feeling protected by having a team with whom they can share their concerns. As cons, patients have a strong feeling of being observed and with too much repetitive questionnaires to answer. They consider a bit difficult to use the devices, with several errors in its operation. They do not like to carrying the smartwatch and to check the battery of the devices. Also, the program is not available on weekends, which leads to a feeling of being somehow disregarded. For patients, this solution should also include the possibility of changing programmed location when on vacations and it should not be a substitute for traditional treatment. Regarding caregivers, m-RESIST is considered as a good tool to have in their daily lives, because it helps in terms of disease improvement, to have a better follow-up about pharmacological issues and symptoms, and to feel secure knowing there is a support for both patient and caregiver. No cons were reported. For clinicians, m-RESIST is a system with high potential, being easy, intuitive and useful, specially to share psychoeducational content with patients and to improve communication with them. However, several technological problems must be solved in the future, there still provide a poor patient monitoring and much more time is needed than regarding the traditional treatment.DiscussionThe three user groups consider m-RESIST as a useful tool, with pros and cons being described regarding their specific needs and provided proposals for improvement.
Highlights
Information and interventions for mental illness are increasingly being provided on-line
People with schizophrenia are often excluded from social engagement, have cognitive impairment and have very limited income; all of which may reduce their use of technology
Technology literacy and internet access were limited in this population. This needs to be addressed before the on-line delivery of educational information, service information and e-health interventions can be widely utilised in people with schizophrenia
Summary
Psychosocial functioning has received a lot of attention with discussions around its importance in terms of early identification of illness, prediction of outcome, and targeting of treatment. Discussion: The present findings provide novel evidence that while those in the early stages of psychotic illness present a unified pattern of association between psychosocial functioning scores and grey matter volume, those with EMH present with a more pronounced but more dispersed pattern, possibly reflecting a more disperse diagnostic outcome. This indicates specificity with psychotic illness in the association between psychosocial functioning and brain volume and suggests importance concerning our ability to predict outcome and target interventions. Marlene Rosen*,1, Nathalie Kaiser, Theresa Haidl, Mauro Seves, Frauke Schultze-Lutter, Stefan Borgwardt, Paolo Brambilla, Eva Meisenzahl, Christos Pantelis, Stephan Ruhrmann, Raimo Salokangas, Rachel Upthegrove, Stephen Wood, Nikolaos Koutsouleris, The PRONIA Group 1University of Cologne; 2Heinrich-Heine University Düsseldorf; 3UPK, University of Basel; 4University of Milan; 5Melbourne Neuropsychiatry Centre, The University of Melbourne; 6University of Turku; 7University of Birmingham; 8Orygen, the National
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