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Use of eHealth for Health Management in People with Schizophrenia

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    The Journal of Nervous and Mental Disease

    Perspectives on the Use of eHealth in the management of health in people with schizophrenia
    Treisman et al.
    J Nerv Ment Dis. 2016; 204: 620–629.
    “This paper addresses the use of eHealth in the management of schizophrenia based on a roundtable discussion with a panel of experts…. The expert panel discussed the uses, benefits, and limitations of emerging eHealth with the capability to integrate care and extend service accessibility, monitor patient status in real time, enhance medication adherence, and empower patients to take a more active role in managing their disease.”

    Use of eHealth for Health Management in People with Schizophrenia

    Currently pharmacological and psychological therapies are the primary treatment options for people with schizophrenia.1 However, mobile devices, web-based applications and other digital technologies, known as eHealth (electronic health) also have the potential to improve health care delivery and disease management.1 This is a significant opportunity as both patients and healthcare professionals are increasingly adopting use of digital technologies into their daily routines. In a study carried out in 2016, Treisman et al. recruited a panel of experts, composed of psychiatrists, a medical technology innovator, a mental health advocate, a family caregiver, a health policy maker and a third-party payor, to discuss the use of eHealth in the management of schizophrenia.1 Among the topics discussed were the uses, benefits and limitations of emerging eHealth, its capability to integrate care and extend service accessibility, monitor symptoms in real time, enhance medication adherence and empower people with schizophrenia to take a more active role in managing their condition. The key insights from this panel discussion are presented below.

    How could eHealth transform healthcare delivery in schizophrenia?

    eHealth use could potentially transform healthcare delivery in schizophrenia by:1

    Enabling early symptom recognition and intervention
    A common issue in schizophrenia is that young adults showing symptoms do not receive assessment due to unfamiliarity with symptoms, stigma-related concerns or limited access to services.2 eHealth can help to raise awareness around the disease and enable people recognise the prodromal symptoms. Examples of these technologies are: disease awareness mobile applications (apps), such as “My Journey”3,4 and the non-profit mental health resource “Psyberguide”5; online and web-based tools, such as “Headspace”, a mental health service available in Australia6 and tele-mental health.

    Disseminating information after diagnosis
    Access to eHealth support would be valuable for individuals suffering from schizophrenia at the post-diagnosis stage. People with schizophrenia often do not qualify for support systems, and they live in suboptimal conditions, which means they may not receive adequate treatment, thus relapsing and requiring hospitalization.7,8 In these instances, tailored web-based guides could provide information to them and their carers regarding treatment options and connect them to mental health experts and treatment facilities.1

    Integrating care and extending service accessibility
    Ensuring continuity of care in schizophrenia is another major challenge, where eHealth can support. Health Information Technology (HIT), such as electronic health records (EHRs), can contribute to improving the quality and cost-effectiveness of health care services.9 Moreover, tele-mental health and telepsychiatry, such as real-time video-conferencing can help to extend therapy beyond the clinical practice setting and increase access to care.10

    Supporting medication adherence, engagement, self-management and rehabilitation
    Studies have shown that 50% of people with schizophrenia do not take their medications as prescribed.11 Electronic prescribing systems and drug monitoring databases can enable the clinicians monitor adherence to medication.12 For the very reluctant individuals “smart pills” with integrated detection technology can record treatment activity.1 Self-management can be challenging in people with cognitive impairment. However, mobile technology can help to detect the subject’s feelings, thoughts, or symptom changes.13 These data can be subsequently used by doctors to shape key treatment decisions. Regarding rehabilitation, computer-assisted cognitive remediation (CACR) is an emerging game-based technology that is used to improve neurocognition and negative symptoms.14

    What are the challenges in implementing eHealth in schizophrenia management?

    The adoption of eHealth appears to have the potential to move schizophrenia management forward. However, further research is required in order to manage the implementation challenges:1

    Type of challengeChallenge descriptionSupporting studiesPotential solutions/future considerations
    Challenges to people living with SchizophreniaSuspicion of technologyFreeman, 200815; Sendt et al., 201516Transparent policies required
    Cognitive difficultiesYoung and Geyer, 201517Self-management software for smartphone devices (Ben-Zeev et al., 2013b)18
    Negative symptomsDepp et al., 201019; Foussias et al., 201520High interest in using such technology to monitor symptoms and connect people with schizophrenia to services (Ben-Zeev et al., 2013a) 21
    Digital divide and costs of technologySmith, 201222Price drops in cell phones and data plans (Kurti and Dallery, 2014)23
    Clinician/research challengesLow evidence base for eHealth technologiesDonker et al., 201324; Giota and Kleftaras, 20144Further studies required
    Lack of regulatory oversight for apps (unless designated medical devices)Center for Devices and Radiological Health, 2015Provision of regulatory oversight for apps (FDA guidance)
    Attitudes and inertiaClarke and Yarborough, 20149Design of formative research on optimal methods for distilling data (Ben-Zeev et al., 2013b)18

    Innovative research designs for evaluating the
    applicability of technology-based tools at the point of care (Lillie et al., 2011)25
    System challengesHIT infrastructure remains poor in mental healthHorvitz-Lennon et al., 200926Use of secure e-mail and a system for
    allowing people with schizophrenia to view and download electronic clinical information (Paget et al., 2014)27
    Potential for infringing security and privacyDaker-White and Rogers, 201328; Kumar and Lee, 201229Oversight of wireless security measures, such as cryptography and user authentication (Giota and Kleftaras, 20144; Kumar and Lee, 2012)29

    Reference: Adapted from Treisman et al. J Nerv Ment Dis. 204, 620–629 (2016) 1

    References

    1. Treisman et al. J Nerv Ment Dis. 2016;204: 620–629
    2. Gulliver et al. BMC Psychiatry. 2010; 10:113
    3. Amani 2011: www.ehi.co.uk/img/Document_Library0365/My_Journey_Youth_Mental_Health_App_-_Sarah_Armani.pdf
    4. Giota and Kleftaras. E-Health Telecommunication Systems and Networks. 2014; 3:19–23
    5. http://psyberguide.org/
    6. https://headspace.org.au/
    7. Feldman et al. Popul Health Manag. 2014; 17:190–196
    8. Kasckow et al. Clin Schizophr Relat Psychoses. 2014; 8:21–27A
    9. Clarke and Yarborough. Gen Hosp Psychiatry. 2014; 35:339–344
    10. Hilty et al. Telemed J E Health. 2013; 19:444–454
    11. Velligan and Kamil. Ther Deliv. 2014; 5:611–613
    12. Morris et al., 2012: www.healthit.gov/sites/default/files/pdmp_support_final.pdf
    13. Palmier-Claus et al. BMC Psychiatry. 2012; 12:172
    14. Reddy et al. Curr Treat Options Psych. 2014; 121–133
    15. Freeman et al. Schizophr Bull. 2008; 34:605–610
    16. Sendt et al. Psychiatry Res. 2015; 225:14–30
    17. Young and Geyer. J Psychopharmacol. 2015; 29:178–196
    18. Ben-Zeeb et al. Psychiatr Rehabil J. 2013; 36:289–296
    19. Depp et al. NervMentDis. 2010; 198:715–721
    20. Foussias et al. J Psychopharmacol. 2015; 29:116–126
    21. Ben-Zeev et al. Adm Policy Ment Health. 2013; 40:340–343
    22. Smith, 2012: http://www.pewinternet.org/2012/03/01/nearly-half-ofamerican-adults-are-smartphone-owners
    23. Kurty and Dallery. Rev Mex Anal Conducta. 2014; 40:106–126
    24. Donker et al. J Med Internet Res. 2013; 15:e247
    25. Lillie et al. Per Med. 2011; 8:161–173
    26. Horvitz-Lennon, et al. Health Aff (Milwood). 2009; 28:701–712
    27. Paget et al. National Committee for Quality Assurance. 2014: www.ncqa.org/HEDISQualityMeasurement/Research/BuildingaStrategytoLeverageHealthInformationTechnology.aspx
    28. Daker-White and Rogers. BMC Psychiatry. 2013; 13:279
    29. Kumar and Lee. Sensors (Basel). 2012; 12:55–91

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