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Blajeski S, Smith MJ, Harrington M, Johnson J, Ross B, Weaver A, Razzano LA, Pashka N, Brown A, Prestipino J, Nelson K, Lieberman T, Jordan N, Oulvey EA, Mueser KT, McGurk SR, Bell MD, Smith JD. A Mixed-Methods Implementation Evaluation of Virtual Reality Job Interview Training in IPS Supported Employment. Psychiatr Serv 2024; 75:228-236. [PMID: 37644829 PMCID: PMC10902191 DOI: 10.1176/appi.ps.20230023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Employment rates among individuals with serious mental illness may be improved by engagement in the individual placement and support (IPS) model of supported employment. Results from a recent randomized controlled trial (RCT) indicate that virtual reality job interview training (VR-JIT) improves employment rates among individuals with serious mental illness who have been actively engaged in IPS for at least 90 days. This study reports on an initial implementation evaluation of VR-JIT during the RCT in a community mental health agency. METHODS A sequential, complementary mixed-methods design included use of qualitative data to improve understanding of quantitative findings. Thirteen IPS staff trained to lead VR-JIT implementation completed VR-JIT acceptability, appropriateness, and feasibility surveys. Participants randomly assigned to IPS with VR-JIT completed acceptability (N=42) and usability (N=28) surveys after implementation. The authors also conducted five focus groups with IPS staff (N=11) and VR-JIT recipients (N=13) and semistructured interviews with IPS staff (N=9) and VR-JIT recipients (N=4), followed by an integrated analysis process. RESULTS Quantitative results suggest that IPS staff found VR-JIT to be highly acceptable, appropriate for integration with IPS, and feasible for delivery. VR-JIT was highly acceptable to recipients. Qualitative results add important context to the quantitative findings, including benefits of VR-JIT for IPS staff as well as adaptations for delivering technology-based interventions to individuals with serious mental illness. CONCLUSIONS These qualitative and quantitative findings are consistent with each other and were influenced by VR-JIT's adaptability and perceived benefits. Tailoring VR-JIT instruction and delivery to individuals with serious mental illness may help optimize VR-JIT implementation within IPS.
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Affiliation(s)
- Shannon Blajeski
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Matthew J Smith
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Meghan Harrington
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Jeffery Johnson
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Brittany Ross
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Addie Weaver
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Lisa A Razzano
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Nicole Pashka
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Adrienne Brown
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - John Prestipino
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Karley Nelson
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Tovah Lieberman
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Neil Jordan
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Eugene A Oulvey
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Kim T Mueser
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Susan R McGurk
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Morris D Bell
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
| | - Justin D Smith
- School of Social Work, Portland State University School of Social Work, Portland, Oregon (Blajeski); School of Social Work, University of Michigan, Ann Arbor (M. J. Smith, Harrington, Ross, Weaver); United States Army, Nashville (Johnson); Department of Psychiatry, University of Illinois-Chicago, Chicago (Razzano); Thresholds, Chicago (Razzano, Pashka, Brown, Prestipino, Nelson, Lieberman); Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago (Jordan); Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois (Jordan); State of Illinois Department of Human Services, Chicago (Oulvey); Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser, McGurk); Department of Psychiatry, Yale School of Medicine, New Haven (Bell); Department of Population Health Sciences, University of Utah Eccles School of Medicine, Salt Lake City (J. D. Smith)
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2
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Fusaroli M, Simonsen A, Borrie SA, Low DM, Parola A, Raschi E, Poluzzi E, Fusaroli R. Identifying Medications Underlying Communication Atypicalities in Psychotic and Affective Disorders: A Pharmacovigilance Study Within the FDA Adverse Event Reporting System. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3242-3259. [PMID: 37524118 DOI: 10.1044/2023_jslhr-22-00739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
PURPOSE Communication atypicalities are considered promising markers of a broad range of clinical conditions. However, little is known about the mechanisms and confounders underlying them. Medications might have a crucial, relatively unknown role both as potential confounders and offering an insight on the mechanisms at work. The integration of regulatory documents with disproportionality analyses provides a more comprehensive picture to account for in future investigations of communication-related markers. The aim of this study was to identify a list of drugs potentially associated with communicative atypicalities within psychotic and affective disorders. METHOD We developed a query using the Medical Dictionary for Regulatory Activities to search for communicative atypicalities within the FDA Adverse Event Reporting System (updated June 2021). A Bonferroni-corrected disproportionality analysis (reporting odds ratio) was separately performed on spontaneous reports involving psychotic, affective, and non-neuropsychiatric disorders, to account for the confounding role of different underlying conditions. Drug-adverse event associations not already reported in the Side Effect Resource database of labeled adverse drug reactions (unexpected) were subjected to further robustness analyses to account for expected biases. RESULTS A list of 291 expected and 91 unexpected potential confounding medications was identified, including drugs that may irritate (inhalants) or desiccate (anticholinergics) the larynx, impair speech motor control (antipsychotics), or induce nodules (acitretin) or necrosis (vascular endothelial growth factor receptor inhibitors) on vocal cords; sedatives and stimulants; neurotoxic agents (anti-infectives); and agents acting on neurotransmitter pathways (dopamine agonists). CONCLUSIONS We provide a list of medications to account for in future studies of communication-related markers in affective and psychotic disorders. The current test case illustrates rigorous procedures for digital phenotyping, and the methodological tools implemented for large-scale disproportionality analyses can be considered a road map for investigations of communication-related markers in other clinical populations. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.23721345.
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Affiliation(s)
- Michele Fusaroli
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Arndis Simonsen
- Psychosis Research Unit, Department of Clinical Medicine, Aarhus University, Denmark
- Interacting Minds Centre, School of Culture and Society, Aarhus University, Denmark
| | - Stephanie A Borrie
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan
| | - Daniel M Low
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge
- Speech and Hearing Bioscience and Technology Program, Harvard Medical School, Boston, MA
| | - Alberto Parola
- Department of Psychology, University of Turin, Italy
- Department of Linguistics, Cognitive Science and Semiotics, School of Communication and Culture, Aarhus University, Denmark
| | - Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Elisabetta Poluzzi
- Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Riccardo Fusaroli
- Interacting Minds Centre, School of Culture and Society, Aarhus University, Denmark
- Department of Linguistics, Cognitive Science and Semiotics, School of Communication and Culture, Aarhus University, Denmark
- Linguistic Data Consortium, School of Arts & Sciences, University of Pennsylvania, Philadelphia
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3
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Homan P, Schooler NR, Brunette MF, Rotondi A, Ben-Zeev D, Gottlieb JD, Mueser KT, Achtyes ED, Gingerich S, Marcy P, Meyer-Kalos P, Hauser M, John M, Robinson DG, Kane JM. Relapse prevention through health technology program reduces hospitalization in schizophrenia. Psychol Med 2023; 53:4114-4120. [PMID: 35634965 DOI: 10.1017/s0033291722000794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Psychiatric hospitalization is a major driver of cost in the treatment of schizophrenia. Here, we asked whether a technology-enhanced approach to relapse prevention could reduce days spent in a hospital after discharge. METHODS The Improving Care and Reducing Cost (ICRC) study was a quasi-experimental clinical trial in outpatients with schizophrenia conducted between 26 February 2013 and 17 April 2015 at 10 different sites in the USA in an outpatient setting. Patients were between 18 and 60 years old with a diagnosis of schizophrenia, schizoaffective disorder, or psychotic disorder not otherwise specified. Patients received usual care or a technology-enhanced relapse prevention program during a 6-month period after discharge. The health technology program included in-person, individualized relapse prevention planning with treatments delivered via smartphones and computers, as well as a web-based prescriber decision support program. The main outcome measure was days spent in a psychiatric hospital during 6 months after discharge. RESULTS The study included 462 patients, of which 438 had complete baseline data and were thus used for propensity matching and analysis. Control participants (N = 89; 37 females) were enrolled first and received usual care for relapse prevention followed by 349 participants (128 females) who received technology-enhanced relapse prevention. During 6-month follow-up, 43% of control and 24% of intervention participants were hospitalized (χ2 = 11.76, p<0.001). Days of hospitalization were reduced by 5 days (mean days: b = -4.58, 95% CI -9.03 to -0.13, p = 0.044) in the intervention condition compared to control. CONCLUSIONS These results suggest that technology-enhanced relapse prevention is an effective and feasible way to reduce rehospitalization days among patients with schizophrenia.
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Affiliation(s)
- Philipp Homan
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University and ETH, Zurich, Switzerland
| | - Nina R Schooler
- Department of Psychiatry, SUNY Downstate Medical School, Brooklyn, NY, USA
| | - Mary F Brunette
- Department of Psychiatry, Dartmouth-Hitchcock, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Armando Rotondi
- Department of Critical Care Medicine, Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA, USA
- Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs Medical Center, Pittsburgh, PA, USA
| | - Dror Ben-Zeev
- Department of Psychiatry and Behavioral Sciences, Behavioral Research in Technology and Engineering (BRiTE) Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Jennifer D Gottlieb
- Cambridge Health Alliance, Division of Population Behavioral Health Innovation and Harvard Medical School Department of Psychiatry, Cambridge, MA, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
| | - Eric D Achtyes
- Cherry Health and Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
- Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Susan Gingerich
- Independent Consultant and Trainer in Narberth, Narberth, Pennsylvania, USA
| | | | - Piper Meyer-Kalos
- University of Minnesota Medical School, Department of Psychiatry & Behavioral Sciences, Minneapolis, MN, USA
| | | | - Majnu John
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Mathematics, Hofstra University, Hempstead, NY, USA
| | - Delbert G Robinson
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - John M Kane
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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4
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Parola A, Simonsen A, Lin JM, Zhou Y, Wang H, Ubukata S, Koelkebeck K, Bliksted V, Fusaroli R. Voice Patterns as Markers of Schizophrenia: Building a Cumulative Generalizable Approach Via a Cross-Linguistic and Meta-analysis Based Investigation. Schizophr Bull 2023; 49:S125-S141. [PMID: 36946527 PMCID: PMC10031745 DOI: 10.1093/schbul/sbac128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND HYPOTHESIS Voice atypicalities are potential markers of clinical features of schizophrenia (eg, negative symptoms). A recent meta-analysis identified an acoustic profile associated with schizophrenia (reduced pitch variability and increased pauses), but also highlighted shortcomings in the field: small sample sizes, little attention to the heterogeneity of the disorder, and to generalizing findings to diverse samples and languages. STUDY DESIGN We provide a critical cumulative approach to vocal atypicalities in schizophrenia, where we conceptually and statistically build on previous studies. We aim at identifying a cross-linguistically reliable acoustic profile of schizophrenia and assessing sources of heterogeneity (symptomatology, pharmacotherapy, clinical and social characteristics). We relied on previous meta-analysis to build and analyze a large cross-linguistic dataset of audio recordings of 231 patients with schizophrenia and 238 matched controls (>4000 recordings in Danish, German, Mandarin and Japanese). We used multilevel Bayesian modeling, contrasting meta-analytically informed and skeptical inferences. STUDY RESULTS We found only a minimal generalizable acoustic profile of schizophrenia (reduced pitch variability), while duration atypicalities replicated only in some languages. We identified reliable associations between acoustic profile and individual differences in clinical ratings of negative symptoms, medication, age and gender. However, these associations vary across languages. CONCLUSIONS The findings indicate that a strong cross-linguistically reliable acoustic profile of schizophrenia is unlikely. Rather, if we are to devise effective clinical applications able to target different ranges of patients, we need first to establish larger and more diverse cross-linguistic datasets, focus on individual differences, and build self-critical cumulative approaches.
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Affiliation(s)
- Alberto Parola
- Department of Linguistics, Cognitive Science and Semiotics, Aarhus University, Aarhus, Denmark
- The Interacting Minds Center, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
- Department of Psychology, University of Turin, Turin, Italy
| | - Arndis Simonsen
- The Interacting Minds Center, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jessica Mary Lin
- Department of Linguistics, Cognitive Science and Semiotics, Aarhus University, Aarhus, Denmark
- The Interacting Minds Center, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
| | - Yuan Zhou
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Huiling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shiho Ubukata
- Department of Psychiatry, Kyoto University, Kyoto, Japan
| | - Katja Koelkebeck
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Hospital and Institute of the University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Duisburg-Essen, Germany
| | - Vibeke Bliksted
- The Interacting Minds Center, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Riccardo Fusaroli
- Department of Linguistics, Cognitive Science and Semiotics, Aarhus University, Aarhus, Denmark
- The Interacting Minds Center, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
- Linguistic Data Consortium, University of Pennsylvania, Philadelphia, USA
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5
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Kwon S, Firth J, Joshi D, Torous J. Accessibility and availability of smartphone apps for schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:98. [PMID: 36385116 PMCID: PMC9668219 DOI: 10.1038/s41537-022-00313-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/05/2022] [Indexed: 05/25/2023]
Abstract
App-based interventions have the potential to enhance access to and quality of care for patients with schizophrenia. However, less is known about the current state of schizophrenia apps in research and how those translate to publicly available apps. This study, therefore, aimed to review schizophrenia apps offered on marketplaces and research literature with a focus on accessibility and availability. A search of recent reviews, gray literature, PubMed, and Google Scholar was conducted in August 2022. A search of the U.S. Apple App Store and Google Play App Store was conducted in July 2022. All eligible studies and apps were systematically screened/reviewed. The academic research search produced 264 results; 60 eligible studies were identified. 51.7% of research apps were built on psychosis-specific platforms and 48.3% of research apps were built on non-specific platforms. 83.3% of research apps offered monitoring functionalities. Only nine apps, two designed on psychosis-specific platforms and seven on non-specific platforms were easily accessible. The search of app marketplaces uncovered 537 apps; only six eligible marketplace apps were identified. 83.3% of marketplace apps only offered psychoeducation. All marketplace apps lacked frequent updates with the average time since last update 1121 days. There are few clinically relevant apps accessible to patients on the commercial marketplaces. While research efforts are expanding, many research apps are unavailable today. Better translation of apps from research to the marketplace and a focus on sustainable interventions are important targets for the field.
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Affiliation(s)
- Sam Kwon
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Devayani Joshi
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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6
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Elvevåg B, Cohen AS. Translating Natural Language Processing into Mainstream Schizophrenia Assessment. Schizophr Bull 2022; 48:936-938. [PMID: 36047461 PMCID: PMC9434435 DOI: 10.1093/schbul/sbac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Brita Elvevåg
- To whom correspondence should be addressed; Postbox 6124, Tromsø 9291, Norway; Tel: (+47)-919-93-063; E-mail:
| | - Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA,Center for Computation and Technology, Louisiana State University, Baton Rouge, LA, USA
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7
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Amadeo MB, Esposito D, Escelsior A, Campus C, Inuggi A, Pereira Da Silva B, Serafini G, Amore M, Gori M. Time in schizophrenia: a link between psychopathology, psychophysics and technology. Transl Psychiatry 2022; 12:331. [PMID: 35961974 PMCID: PMC9374791 DOI: 10.1038/s41398-022-02101-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 12/03/2022] Open
Abstract
It has been widely demonstrated that time processing is altered in patients with schizophrenia. This perspective review delves into such temporal deficit and highlights its link to low-level sensory alterations, which are often overlooked in rehabilitation protocols for psychosis. However, if temporal impairment at the sensory level is inherent to the disease, new interventions should focus on this dimension. Beyond more traditional types of intervention, here we review the most recent digital technologies for rehabilitation and the most promising ones for sensory training. The overall aim is to synthesise existing literature on time in schizophrenia linking psychopathology, psychophysics, and technology to help future developments.
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Affiliation(s)
- Maria Bianca Amadeo
- U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy. .,Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa - Clinica Psichiatrica ed SPDC-Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE), Italy.
| | - Davide Esposito
- grid.25786.3e0000 0004 1764 2907U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy ,grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy ,grid.5606.50000 0001 2151 3065Department of Informatics, Bioengineering, Robotics and Systems Engineering, Università degli Studi di Genova, Genoa, Italy
| | - Andrea Escelsior
- grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy ,grid.410345.70000 0004 1756 7871IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudio Campus
- grid.25786.3e0000 0004 1764 2907U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy ,grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy
| | - Alberto Inuggi
- grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy
| | - Beatriz Pereira Da Silva
- grid.25786.3e0000 0004 1764 2907U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy ,grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy
| | - Gianluca Serafini
- grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy ,grid.410345.70000 0004 1756 7871IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy ,grid.410345.70000 0004 1756 7871IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Monica Gori
- grid.25786.3e0000 0004 1764 2907U-VIP Unit for Visually Impaired People, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy ,grid.5606.50000 0001 2151 3065Applied Neurosciences for Technological Advances in Rehabilitation Systems (ANTARES) Joint Lab: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa – Clinica Psichiatrica ed SPDC—Italian Institute of Technology (IIT); Largo Rosanna Benzi, 10 - 16132, Genoa, (GE) Italy
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8
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Fulford D, Schupbach E, Gard DE, Mueser KT, Mow J, Leung L. Do cognitive impairments limit treatment gains in a standalone digital intervention for psychosis? A test of the digital divide. Schizophr Res Cogn 2022; 28:100244. [PMID: 35242612 PMCID: PMC8881658 DOI: 10.1016/j.scog.2022.100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/05/2022] Open
Abstract
Digital mental health interventions, such as those provided by smartphone applications (apps), show promise as cost-effective approaches to increasing access to evidence-based psychosocial interventions for psychosis. Although it is well known that limited financial resources can reduce the benefits of digital approaches to mental healthcare, the extent to which cognitive functioning in this population could impact capacity to engage in and benefit from these interventions is less studied. In the current study we examined the extent to which cognitive functioning (premorbid cognitive abilities and social cognition) were related to treatment engagement and outcome in a standalone digital intervention for social functioning. Premorbid cognitive abilities generally showed no association with aggregated treatment engagement markers, including proportion of notifications responded to and degree of interest in working on app content, though there was a small positive association with improvements in social functioning. Social cognition, as measured using facial affect recognition ability, was unrelated to treatment engagement or outcome. These preliminary findings suggest that cognitive functioning is generally not associated with engagement or outcomes in a standalone digital intervention designed for and with people with schizophrenia spectrum disorders.
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9
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Wood HJ, Gannon JM, Chengappa KNR, Sarpal DK. Group teletherapy for first-episode psychosis: Piloting its integration with coordinated specialty care during the COVID-19 pandemic. Psychol Psychother 2021; 94:382-389. [PMID: 33078496 DOI: 10.1111/papt.12310] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/26/2020] [Indexed: 12/15/2022]
Abstract
Digital health has emerged in recent years as a tool to optimize care delivery and promote treatment adherence among individuals with first-episode psychosis (FEP). Recent mandates for social distancing and sheltering in place due to the COVID-19 pandemic have catapulted efforts to provide ongoing coordinated specialty care (CSC) on virtual platforms. While prior evidence provides support for the general implementation of virtual individual therapy, there is limited guidance and evidence for the adoption of group teletherapy. Here we describe our efforts to implement group teletherapy for two small cohorts of individuals with FEP receiving care in a coordinated specialty care clinic using methods adopted from Acceptance and Commitment Therapy. We observed high adherence with group visits as well as client satisfaction across groups. Based on our results, we have taken efforts to implement virtual group therapy more permanently in our clinic. Our experience provides guidance and a model for integration of virtual group therapy within CSC. PRACTITIONER POINTS: In-person group therapy can be adapted as an online treatment modality for individuals with first-episode psychosis (FEP). Group teletherapy is both accessible and satisfactory to individuals with FEP. Group teletherapy has potential as a more standard and widespread treatment modality within coordinated specialty care for FEP.
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Affiliation(s)
- Helen J Wood
- Comprehensive Recovery Services, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Jessica M Gannon
- Comprehensive Recovery Services, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA.,Department of Psychiatry, University of Pittsburgh, Pennsylvania, USA
| | - K N Roy Chengappa
- Comprehensive Recovery Services, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA.,Department of Psychiatry, University of Pittsburgh, Pennsylvania, USA
| | - Deepak K Sarpal
- Comprehensive Recovery Services, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA.,Department of Psychiatry, University of Pittsburgh, Pennsylvania, USA
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10
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Kopelovich SL, Monroe-DeVita M, Buck BE, Brenner C, Moser L, Jarskog LF, Harker S, Chwastiak LA. Community Mental Health Care Delivery During the COVID-19 Pandemic: Practical Strategies for Improving Care for People with Serious Mental Illness. Community Ment Health J 2021; 57:405-415. [PMID: 32562033 PMCID: PMC7304659 DOI: 10.1007/s10597-020-00662-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/13/2020] [Indexed: 11/24/2022]
Abstract
The COVID-19 pandemic has presented a formidable challenge to care continuity for community mental health clients with serious mental illness and for providers who have had to quickly pivot the modes of delivering critical services. Despite these challenges, many of the changes implemented during the pandemic can and should be maintained. These include offering a spectrum of options for remote and in-person care, greater integration of behavioral and physical healthcare, prevention of viral exposure, increased collaborative decision-making related to long-acting injectable and clozapine use, modifying safety plans and psychiatric advance directives to include new technologies and broader support systems, leveraging natural supports, and integration of digital health interventions. This paper represents the authors' collaborative attempt to both reflect the changes to clinical practice we have observed in CMHCs across the US during this pandemic and to suggest how these changes can align with best practices identified in the empirical literature.
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Affiliation(s)
- Sarah L Kopelovich
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359911, Seattle, WA, 98104, USA.
| | - Maria Monroe-DeVita
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Benjamin E Buck
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Carolyn Brenner
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Lorna Moser
- Department of Psychiatry, Center of Excellence in Community Mental Health, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - L Fredrik Jarskog
- Department of Psychiatry, North Carolina Psychiatric Research Center, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Steve Harker
- Ramsey County ACT and Radias Forensic ACT Team, St. Paul, MN, USA
| | - Lydia A Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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11
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Coronavirus disease 2019 (COVID-19) and global mental health. ACTA ACUST UNITED AC 2021; 5:31-36. [PMID: 33614179 PMCID: PMC7881705 DOI: 10.1016/j.glohj.2021.02.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/05/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
The mental health effects of the coronavirus disease 2019 (COVID-19) pandemic may shape population health for many years to come. Failure to address the mental health issues stemming from the pandemic is likely to prolong its impact. The COVID-19 pandemic has created a significant global challenge and, in lower-income countries, even a disruption of mental health services. Given our experience with previous pandemics, the present COVID-19 crisis can be expected to cause psychological trauma, and steps are needed to address this issue proactively. Policies focusing on the long-term mental health consequences of COVID-19 may equal the importance of those currently seeking to mitigate its physical effects. The implications of the COVID-19 pandemic for mental health call for a greater focus on the needs of those with mental disorders and on mental health issues affecting health care workers and the general public. Timely preventive and therapeutic mental health care is essential in addressing the psychosocial needs of populations exposed to the pandemic. In addition to specialist care, “task-shifting” and digital technologies may provide cost-effective means of providing mental health care in lower-income countries worldwide as well as in higher-income countries with mental health services overwhelmed by the effects of the COVID-19 pandemic. In view of the ever-increasing pressure on global health systems resulting from the COVID-19 pandemic, adopting and adapting “task-shifting”, i.e., the delegation of psychotherapeutic interventions to trained non-specialists, as an element of the provision of mental health services, is overdue. Digital technologies can be used to enhance social support and facilitate resilience to the detrimental mental health effects of the pandemic; they may also offer an efficient and cost-effective way to provide easy access to mental health care.
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12
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Kopelovich SL, Turkington D. Remote CBT for Psychosis During the COVID-19 Pandemic: Challenges and Opportunities. Community Ment Health J 2021; 57:30-34. [PMID: 33001323 PMCID: PMC7528451 DOI: 10.1007/s10597-020-00718-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/25/2020] [Indexed: 01/05/2023]
Abstract
The COVID pandemic is now leading to the emergence of a secondary mental health pandemic. Clients with psychosis are at increased risk of poorer medium- and long-term psychosocial and clinical outcomes. In response to the pressing need to flexibly deliver high-quality care to individuals with psychosis, this brief report proposes high yield cognitive behavioral techniques for psychosis (HY-CBt-p) facilitated by task sharing and digital enhancements. HY-CBt-p is delivered over fewer sessions than formulation-based Cognitive Behavioral Therapy for psychosis (CBTp), can be learned by a range of providers, and includes techniques such as developing a normalizing explanation; techniques to reduce anxiety, depression, and insomnia, which perpetuate psychotic symptoms; self-monitoring; reality testing; and wellness planning. Previous research suggests that effect sizes will be lower than that of 16-session formulation-driven CBTp, but additional research is needed to test the feasibility, acceptability, efficacy, and comparative effectiveness of different forms of remote-delivered CBTp.
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Affiliation(s)
- Sarah L Kopelovich
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359911, Seattle, WA, 98104, USA.
| | - Doug Turkington
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Monkwearmouth Hospital, Newcastle Road, Tyne and Wear, Sunderland, UK
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13
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Ben-Zeev D, Buck B, Meller S, Hudenko WJ, Hallgren KA. Augmenting Evidence-Based Care With a Texting Mobile Interventionist: A Pilot Randomized Controlled Trial. Psychiatr Serv 2020; 71:1218-1224. [PMID: 32631130 PMCID: PMC7708508 DOI: 10.1176/appi.ps.202000239] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to evaluate the feasibility and clinical utility of training intensive psychiatric community care team members to serve as "mobile interventionists" who engage patients in recovery-oriented texting exchanges. METHODS A 3-month pilot randomized controlled trial was conducted to compare the mobile interventionist approach as an add-on to assertive community treatment (ACT) versus ACT alone. Participants were 49 individuals with serious mental illness (62% with schizophrenia/schizoaffective disorder, 24% with bipolar disorder, and 14% with depression). Clinical outcomes were evaluated at baseline, posttreatment, and 6-month follow-up, and satisfaction was evaluated posttreatment. RESULTS The intervention appeared feasible (95% of participants assigned to the mobile interventionist arm initiated the intervention, texting on 69% of possible days and averaging four messages per day), acceptable (91% reported satisfaction), and safe (no adverse events reported). Exploratory posttreatment clinical effect estimations suggested greater reductions in the severity of paranoid thoughts (Cohen's d=-0.61) and depression (d=-0.59) and improved illness management (d=0.31) and recovery (d=0.23) in the mobile interventionist group. CONCLUSIONS Augmentation of care with a texting mobile interventionist proved to be feasible, acceptable, safe, and clinically promising. The findings are encouraging given the relative ease of training practitioners to serve as mobile interventionists, the low burden placed on patients and practitioners, and the simplicity of the technology. The technical resources are widely accessible to patients and practitioners, boding well for potential intervention scalability. When pandemics such as COVID-19 block the possibility of in-person patient-provider contact, evidence-based texting interventions can serve a crucial role in supporting continuity of care.
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Affiliation(s)
- Dror Ben-Zeev
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| | - Benjamin Buck
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| | - Suzanne Meller
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| | - William J Hudenko
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, BRiTE Center, University of Washington, Seattle (Ben-Zeev, Buck, Meller, Hallgren); Department of Psychological and Brain Sciences, Dartmouth College, and Department of Psychiatry, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Hudenko)
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14
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Abstract
PURPOSE OF REVIEW Increasingly, digital technologies, especially mobile telecommunications and smartphone apps, are seen as a novel tool for managing severe mental disorders (SMDs) in low-income and middle-income countries (LMICs). However, there is a need to identify best practices in the use of digital technologies to effectively reach, support, and manage care for patients living with SMDs. In this review, we summarize recent studies using digital technology to manage symptoms and support clinical care for this patient population and discuss new opportunities to advance digital psychiatry research and practice in LMICs. RECENT FINDINGS Studies evaluating digital interventions for clinical populations living with SMDs in LMICs are limited. Yet, across recent articles surveyed, digital technology appears to yield diverse benefits for this at-risk patient population. These benefits include improved medication adherence, appointment adherence, reduced instances of relapse, and fewer re-hospitalizations. SUMMARY Continued rigorous research evaluating effectiveness and cost-effectiveness of digital technologies in reaching, treating, and managing symptoms and supporting clinical care for patients with SMDs in LMICs is vital. The urgency for remote approaches for delivering specialized psychiatric care is particularly pronounced because of the immediate and long-term impact of the coronavirus (COVID-19) pandemic on access to in-person services. Future research should emphasize participatory approaches rooted in a process of codesign with target users, in order to achieve clinically effective remotely delivered digital mental health interventions.
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15
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Kola L. Global mental health and COVID-19. Lancet Psychiatry 2020; 7:655-657. [PMID: 32502468 PMCID: PMC7266571 DOI: 10.1016/s2215-0366(20)30235-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Lola Kola
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences, and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan 200211, Nigeria; Department of Sociology and Psychology, Faculty of Social Sciences, Lead City University, Ibadan.
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16
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McFarlane J, Illes J. Neuroethics at the interface of machine learning and schizophrenia. NPJ SCHIZOPHRENIA 2020; 6:18. [PMID: 32686681 PMCID: PMC7371680 DOI: 10.1038/s41537-020-0108-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/29/2020] [Indexed: 11/09/2022]
Abstract
Ethical discourse around machine learning analysis of free speech for the detection of schizophrenia has largely focused on consent and personal privacy. We focus here on additional ethics concerns and principles that must be addressed to move the pendulum of risk over to benefit and propose solutions to achieve that shift.
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Affiliation(s)
- Jacob McFarlane
- Cognitive Systems, Faculty of Arts, University of British Columbia, Vancouver, BC, Canada.,Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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17
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Affiliation(s)
| | - Matcheri Keshavan
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
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18
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Torous J, Jän Myrick K, Rauseo-Ricupero N, Firth J. Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow. JMIR Ment Health 2020; 7:e18848. [PMID: 32213476 PMCID: PMC7101061 DOI: 10.2196/18848] [Citation(s) in RCA: 427] [Impact Index Per Article: 106.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 02/06/2023] Open
Abstract
As interest in and use of telehealth during the COVID-19 global pandemic increase, the potential of digital health to increase access and quality of mental health is becoming clear. Although the world today must "flatten the curve" of spread of the virus, we argue that now is the time to "accelerate and bend the curve" on digital health. Increased investments in digital health today will yield unprecedented access to high-quality mental health care. Focusing on personal experiences and projects from our diverse authorship team, we share selected examples of digital health innovations while acknowledging that no single piece can discuss all the impressive global efforts past and present. Exploring the success of telehealth during the present crisis and how technologies like apps can soon play a larger role, we discuss the need for workforce training, high-quality evidence, and digital equity among other factors critical for bending the curve further.
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Affiliation(s)
- John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Keris Jän Myrick
- Los Angeles County Department of Mental Health, Los Angeles, CA, United States
| | - Natali Rauseo-Ricupero
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
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