The Effect of Smartphone-Based Cognitive Training on the Functional/Cognitive Markers of Schizophrenia: A One-Year Randomized Study

Treatment of Cognitive Impairment Associated with Schizophrenia Spectrum Disorders: New Evidence, Challenges, and Future Perspectives

Cognitive impairment associated with schizophrenia (CIAS) represents one of the core features of the disorder and has a significant impact on functional and rehabilitation outcomes of people living with schizophrenia spectrum disorders (SSD). The aim of this critical review is to highlight the most recent evidence on effective treatments available for CIAS, to discuss the current challenges in this field, and to present future perspectives that may help to overcome them. Concerning psychopharmacological approaches, among the most indicated strategies for the management and prevention of CIAS is to favor second-generation antipsychotic medications and avoid long-term and high-dose treatments with anticholinergic medications and benzodiazepines. Moreover, non-pharmacological approaches such as cognitive remediation and physical exercise-based programs represent evidence-based interventions in the treatment of CIAS that have shown reliable evidence of effectiveness on both cognitive and functional outcomes. These treatments, however, are still delivered to people accessing mental health services with a diagnosis of CIAS in an uneven manner, even in high-income countries. Academic and clinical partnership and collaboration, as well as advocacy from service users, families, carers, and stakeholders' organizations could help to reduce the bench to bedside gap in the treatment of CIAS. Future perspectives include the development of novel pharmacological agents that could be effective in the treatment of CIAS, the implementation of novel technologies such as telemedicine and virtual reality in the delivery of evidence-based interventions to improve accessibility and engagement, and further research in the field of non-invasive brain stimulation.

Efficacy of Remotely Delivered Evidence-Based Psychosocial Treatments for Schizophrenia-Spectrum Disorders: A Series of Systematic Reviews and Meta-Analyses

BACKGROUND

Schizophrenia is among the most persistent and debilitating mental health conditions worldwide. The American Psychological Association (APA) has identified 10 psychosocial treatments with evidence for treating schizophrenia and these treatments are typically provided in person. However, in-person services can be challenging to access for people living in remote geographic locations. Remote treatment delivery is an important option to increase access to services; however, it is unclear whether evidence-based treatments for schizophrenia are similarly effective when delivered remotely.

STUDY DESIGN

The current study consists of a series of systematic reviews and meta-analyses examining the evidence-base for remote-delivery of each of the 10 APA evidence-based treatments for schizophrenia.

RESULTS

Of the 10 treatments examined, only cognitive remediation (CR), cognitive-behavioral therapy (CBT), and family psychoeducation had more than 2 studies examining their efficacy for remote delivery. Remote delivery of CBT produced moderate effects on symptoms (g = 0.43) and small effects on functioning (g = 0.26). Remote delivery of CR produced small-moderate effects on neurocognition (g = 0.35) and small effects on functioning (g = 0.21). There were insufficient studies of family psychoeducation with equivalent outcome measures to assess quantitatively, however, studies of remotely delivered family psychoeducation suggested that it is feasible, acceptable, and potentially effective.

CONCLUSIONS

Overall, the evidence-base for remotely delivered treatment for schizophrenia is limited. Studies to date suggest that remote adaptations may be effective; however, more rigorous trials are needed to assess efficacy and methods of remote delivery that are most effective.

Cognitive Rehabilitation in Schizophrenia-Associated Cognitive Impairment: A Review

Patients suffering from schizophrenia often experience cognitive disturbances. Cognitive rehabilitation-computerized or non-computerized-is widely known as an alternative way to enhance cognitive functioning in patients with schizophrenia. The aim of the present review was to examine the role of cognitive rehabilitation (both computerized and non-computerized) for the alleviation of cognitive impairment in schizophrenia patients. Fourteen relative studies were examined and included in the present review. The results revealed that both computerized and non-computerized cognitive rehabilitation could enhance cognitive functioning and more specifically memory, attention, executive functioning, processing speed and in a few cases, even non-cognitive impairments, such as other schizophrenia symptoms. The present results support the efficacy of cognitive rehabilitation in schizophrenia patients, regardless of whether it is computerized or non-computerized. As the randomized control trials (RCTs) are limited in number, there is urgent need for more RCTs and longitudinal studies combining different kinds of interventions, as well as systematic reviews and meta-analyses, in order to further investigate and confirm the current results.

Accessibility and availability of smartphone apps for schizophrenia

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.

Randomized Controlled Trials of Digital Mental Health Interventions on Patients with Schizophrenia Spectrum Disorder: A Systematic Review

Background: This systematic review aimed to examine the study protocol of Digital Mental Health Interventions (DMHIs) and to review the effect of DMHIs among patients with Schizophrenia Spectrum Disorder (SSD). Methods: This review followed the guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic literature search was performed using PubMed, CINAHL, Embase, and PsycINFO electronic databases to identify randomized clinical trials without any limit on the publication year. Overall, 18 studies were selected and evaluated for the quality assessment utilizing the Risk of Bias 2 tool of Cochranes' Collaboration. In the quality assessment, four studies evaluated as overall high risk of bias were excluded from the selection, and the final 14 studies were chosen. Results: No DMHIs were provided for acute schizophrenia-related symptoms, and there were some studies related to schizophrenia-related symptoms (26.4%). Some studies for improving cognitive function (42.9%) were reported, and there was a significant effect when interventions that were proven to be effective when implemented in a face-to-face manner were delivered using various online devices and sensory stimuli. Nearly half of the studies reported intervention frequency and time (57.1%), and those with unclear reports relied either on a mobile app or telemedicine and were designed to self-pace the frequency and speed of the intervention. Conclusion: Based on our findings, it will be possible to understand the characteristics of DMHIs, without physical contact, for only SSD patients, providing a basis for digital mental health services.

Can cognitive remediation therapy be delivered remotely? A review examining feasibility and acceptability of remote interventions

Cognitive remediation (CR) is an effective treatment for schizophrenia. However, issues such as motivational impairments, geographic limitations, and limited availability of specialized clinicians to deliver CR, can impede dissemination. Remote delivery of CR provides an opportunity to implement CR on a broader scale. While empirical support for the efficacy of in-person CR is robust, the evidence-base for virtual delivery of CR is limited. Thus, in this review we aimed to evaluate the feasibility and acceptability of remote CR interventions. Nine (n = 847) fully remote and one hybrid CR intervention were included in this review. Attrition rates for remote CR were generally high compared to control groups. Acceptability rates for remote CR interventions were high and responses from caregivers were positive. Further research using more methodologically rigorous designs is required to evaluate appropriate adaptations for remote treatment and determine which populations may benefit more from remote CR.

Lessons Learned or Forgotten? Impacts of COVID-19 on the Future Direction of Global (e-)Mental Health Care

PURPOSE OF REVIEW

The COVID-19 pandemic has impacted lives globally, posing unique challenges to mental health services exposing vulnerability and limitations within these systems. During the course of the pandemic, telecommunications technologies (e-mental health care) have served a critical role in psychiatric care. It is important to understand current lessons learned in e-mental health care and implications for global mental health systems for both emerging from the pandemic and after the pandemic has ended.

RECENT FINDINGS

There are significant regulatory, policy, and evaluation challenges for global e-mental health impacting patients, clinicians, health systems, and decision-makers. These include complex regulatory issues, difficulties of providing care across boundaries, and keeping pace with the implementation of new technologies in behavioral health. The collaborative development of global standards along with policies, appropriate regulations, and developing new models of research and development opens the possibility of improved access to care across national boundaries.