From mobiles to mental health in treatment-resistant schizophrenia

Early indications suggest patients with treatment-resistant schizophrenia are willing and able to have portable smart devices monitor aspects of their activity and physical state that are relevant to the condition, Iluminada Corripio (Hospital de Sant Pau, Barcelona, Spain) told an EPA session.

The hope is that self-care can be promoted through mobile health technology, and that allowing health professionals access to the data gathered can help ensure continuity of assistance and rapid response – if needed -- to impending clinical events.

From the clinician’s perspective, the advantage is routine access to objective data rather than the occasional use of subjective scales when monitoring the state of vulnerable patients. One of the risks, though, is being flooded with information. For the patient, the advantage of “e-care” is on-line access to the clinical team.

For the clinician, the advantage is routine access to objective patient data. For the patient, it is access to the clinician

Work with focus groups

Katya Rubinstein (Tel Aviv University, Israel) described preliminary work with focus groups consisting of patients, caregivers and clinicians.

Patients were asked to give their opinions on topics such as interacting with their mental health team using technology, and their attitude to the devices being able to give alerts to themselves and others.

From the patients’ perspective, such technology could increase empowerment and support and the availability of help in crisis situations that might otherwise lead to hospitalisation. But concerns were expressed about the absence of human contact, the potential reduction in autonomy, and the idea that “Big Brother” is watching their every move. The latter factor is particularly relevant to patients who fear surveillance, especially by technology.

But that has to be set in the context of concerns that patients may not know that they are becoming ill. And, overall, there was acceptance of the idea that smart technology could support mental health.

The pilot study, which will start in the late spring of 2017 in Tel Aviv, Budapest and Barcelona, is designed to establish whether the “e-mental health” approach is acceptable to patients and whether the large amounts of data generated can be integrated into healthcare systems.

Issues include the acceptability to patients of what might seem like surveillance, and the integration of data into healthcare systems

Adherence a big part “resistance”

Jussi Seppälä (University of Oulu, Finland) had earlier told the symposium that perhaps a third of people with schizophrenia can be considered treatment resistant – in the sense that they have had several episodes of adequately-dosed antipsychotic therapy to which they have responded poorly, or not at all, and have not experienced sustained periods of good functioning. 

That said, there are widely varying definitions of treatment resistance – which makes any estimate open to question. And he agreed with a member of the audience that lack of adherence is a major – perhaps even the major -- part of the problem. However, he had earlier also suggested that treatment-resistant schizophrenia might be a different kind of illness from the outset.

Cognitive dysfunction seems particularly severe, and negative symptoms dominate. It may even be the case that the underlying pathology relates more to glutamate systems than to dopamine.

One point, though, is clear. Treatment resistance is associated with substantial healthcare costs—perhaps ten times greater per patient than schizophrenia that responds to therapy. And of course there are great costs to the individuals affected and their carers. So any novel approach – such as bringing high-tech devices to bear on the problem – is very welcome.