Ecological Momentary Assessment and Intervention in the Treatment of Psychotic Disorders: A Systematic Review
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Search Protocol
Study Selection
Data Extraction
Study Quality Assessment
Results
Study and origin | Participants | Design | Intervention | EMA or EMI type | Findings | ||
---|---|---|---|---|---|---|---|
Feasibility | Acceptability | Outcomes | |||||
Ben-Zeev et al., 2014 (46); USA | 33 outpatients with schizophrenia or schizoaffective disorder | Single-arm, pre-post trial | FOCUS: 4-week intervention. Users prompted 3 times daily to complete assessments with response-driven feedback to promote medication adherence, mood regulation, sleep, social functioning, and coping with persistent auditory hallucinations. Also contained on-demand resources | Native smartphone application | Dropout (N=1); average interaction with app on 86% of total days; average of 5.19 times per day; 62% participant initiated and 38% prompted | Over 90% of participants were comfortable, confident, and satisfied with app; 87% would recommend to a friend; and 12.5% were neutral; 12%–18% requested more training or support or felt the intervention was complicated. | Reductions in PANSS total score (d=.60) and PANSS positive symptoms (d=.70) and general (d=.73) subscale scores; reduction in BDI-II score (d=.51). No significant reductions for PANSS negative symptoms score, BMQ, or ISI. |
Depp et al., 2010 (47); USA | 9 male participants with schizophrenia | Single-arm, pre-post pilot trial | Project 3: STEP; 24-week intervention, with 12 fortnightly face-to-face living skills training sessions supported by weekly 20-minute phone calls to reinforce uptake of skills | Telephone based | No dropout; 1 participant did not respond to calls but did attend sessions; some reported ethical concerns related to confidentiality and phone safety. | 57% reported enjoying the intervention very much; 14% reported that the intervention helped them very much, and 57% reported that it helped them moderately. | Improved UPSA scores compared with matched sample from a previous trial without an EMI component (24 weeks of in-person sessions only); 86% reported some or a lot of skill utilization (no statistical analysis) |
Granholm et al., 2012 (48); USA | 55 outpatients with schizophrenia or schizoaffective disorder | Single-arm, pre-post trial | MATS: 12-week intervention. Users prompted 12 times daily to complete assessment items with response-driven, empirically derived feedback designed to promote medication adherence, socialization, or coping with auditory hallucinations | SMS based | 13 noncompleters; response rates between 78% and 86% across various items; 86% of phones returned intact | Average reported helpfulness was between moderate to very helpful; reports of helpfulness increased over the course of the intervention; some reported technical issues related to usability. | Increased adherence to and positive beliefs about medication over time; increased amount and positive perception of socialization over time; decreased reports of severity and of level of perceived uncontrollability of hallucinations over time. No significant pre-post changes in PANSS, BDI-II, or ILSS |
Komatsu et al., 2013 (43); Japan | 55 outpatients with schizophrenia; 22 in treatment group (ITAREPS) and 23 in control group (ITAREPS monitoring without treatment response protocol) | RCT | 52-week RCT of ITAREPS (45,50,51), with nurses conducting assessments over the phone and visiting the homes of patients to deliver medication protocol in response to alerts. | Telephone combined with Web-based data management system | Dropout: treatment group (N=4); control group (N=11) | None reported | 2 hospitalizations in treatment group and 8 in control group; risk of hospitalization reduced in treatment group versus control group (hazard ratio [HR]=.21); fewer rehospitalization days and shorter inpatient length of stay in treatment group versus control group; ratio of relapses to hospitalizations lower in treatment group versus control group |
Pijnenborg et al., 2010 (49); the Netherlands | 62 inpatients and outpatients with a schizophrenia spectrum disorder and impaired goal-directed behavior; 33 in treatment group and 29 in waitlist group | Waitlist-controlled trial with quasi-randomization | 7-week intervention; users prompted to complete personalized goals for daily living and record their achievement | SMS based | Dropout during treatment (N=7): 25 nonresponders and 22 responders (cutoff of 20% goals achieved during intervention) | Overall evaluation of intervention: positive, 70%; neutral, 20%; negative, 10%; evaluation of effectiveness: effective, 41%; neutral, 33%; ineffective, 26%; willingness to continue: willing, 47%; unsure, 22%; not willing, 31% | Percentage of overall goals achieved rose from 47% during baseline to 62% during the intervention and fell to 40% at follow-up; no change during waitlist phase for comparison group. Reduction in negative symptoms for “responders.” Subanalysis by goal type indicated that appointment attendance improved but not medication adherence, inhibition of undesirable behavior, or attendance of training program. |
Sablier et al., 2012 (44); France | 14 inpatients and outpatients with schizophrenia and their caregivers | Single-arm, pre-post trial | Mobus: 6-week intervention. Patients program personalized goals and are then prompted to complete these at appropriate times. Patients’ record completed activities and symptoms, and this information is sent to caregivers. | PDA | Dropout (N=5); patients logged 43% of the activities initially listed; symptoms recorded once per week on average | Moderate self-reported appreciation of intervention | Increased scores (improvement) on the ILSS food subscale; reduction in thinking time as measured by SOC subtest score on CANTAB. No other significant findings were reported, including on the PANSS, RSES, and PAL. |
Španiel et al., 2008 (50); Španiel et al., 2008 (51); Czech Republic | 73 outpatients with schizophrenia, schizoaffective disorder, or APPD and 56 family members | Pre-post trial with historical control | ITAREPS: 104-week intervention, with remote monitoring of signs of relapse using EWSQ completed weekly by patients and family members; alert sent to treatment team if relapse indicated, requiring medication increase and heightened monitoring | SMS combined with Web-based data management system | Dropout rate, 10%; 34% of patient and family pairs deemed cooperative (defined as responses to more than 70% of SMS contacts) | None reported | Significant reduction in number of hospitalizations (77%) and hospitalization days (58%) during intervention, compared with same period before enrollment |
Španiel et al., 2012 (45); Czech Republic | 158 outpatients with schizophrenia or schizoaffective disorder and their family members; 79 in treatment group (ITAREPS) and 79 in control group (ITAREPS monitoring without treatment response protocol) | RCT | 52-week RCT of ITAREPS (50,51) | SMS combined with Web-based data management system | Dropout: treatment group (N=4); control group (N=8); average response rate, 80%; nonadherers, 13% in treatment group and 28% in control group (defined as less than 70% of reports returned) | 39% of alerts responded to by treatment team according to protocol; low rate primarily related to need for clinical autonomy | No difference between treatment and control groups for hospitalizations in intent-to-treat analysis (HR=1.05). Reduced hospitalization rate for participants whose treatment team followed the protocol, compared with those for whom the protocol was not followed (4% versus 31%; HR=.11); mean of 2.1 versus 19.7 inpatient days, respectively. |
Illness and Symptom Monitoring
Feasibility and acceptability.
Clinical outcomes.
Self-Management and Psychosocial Functioning
Intervention characteristics.
Feasibility and acceptability.
Clinical outcomes.
Study Quality Analysis
Discussion
Conclusions
Supplementary Material
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