The feasibility and validity of ambulatory self-report of psychotic symptoms using a smartphone software application

Abstract

BackgroundSemi-structured interview scales for psychosis are the gold standard approach to assessing psychotic and other symptoms. However, such assessments have limitations such as recall bias, averaging, insensitivity to change and variable interrater reliability. Ambulant, real-time self-report assessment devices may hold advantages over interview measures, but it needs to be shown that the data thus collected are valid, and the collection method is acceptable, feasible and safe. We report on a monitoring system for the assessment of psychosis using smartphone technology. The primary aims were to: i) assess validity through correlations of item responses with those on widely accepted interview assessments of psychosis, and ii) examine compliance to the procedure in individuals with psychosis of varying severity.MethodsA total of 44 participants (acute or remitted DSM-4 schizophrenia and related disorders, and prodromal) completed 14 branching self-report items concerning key psychotic symptoms on a touch-screen mobile phone when prompted by an alarm at six pseudo-random times, each day, for one week. Face to face PANSS and CDS interviews were conducted before and after the assessment period blind to the ambulant data.ResultsCompliance as defined by completion of at least 33% of all possible data-points over seven days was 82%. In the 36 compliant participants, 5 items (delusions, hallucinations, suspiciousness, anxiety, hopelessness) showed moderate to strong (rho 0.6-0.8) associations with corresponding items from interview rating scales. Four items showed no significant correlation with rating scales: each was an item based on observable behaviour. Ambulant ratings showed excellent test-retest reliability and sensitivity to change.ConclusionsAmbulatory monitoring of symptoms several times daily using smartphone software applications represents a feasible and valid way of assessing psychotic phenomena for research and clinical management purposes. Further evaluation required over longer assessment periods, in clinical trials and service settings.

mHealth based interventions for the assessment and treatment of psychotic disorders: a systematic review

“…A study by Depp et al (21) which looked at the mobile assessment of psychotic symptoms coupled with a low intensity intervention and Ben-Zeev et al (22) who looked at retrospective multiple real-time/real-place assessments using a dual methods design, in individuals with schizophrenia and a non-clinical group. Another excluded study by Palmier-Claus et al (5) investigated ambulatory assessment of psychotic symptoms. Other reasons for excluded studies are given in Figure 1.…”

“…More recently, a number of apps for psychosis have been launched e.g. ; TechCare, Actisist and ClinTouch (4)(5)(6).…”

Development and Long-Term Acceptability of ExPRESS, a Mobile Phone App to Monitor Basic Symptoms and Early Signs of Psychosis Relapse (Preprint)

“…Participants emphasized the potential value of the app for those in the acute phase of psychosis. However, such individuals may require additional support with app use since acute patients do not engage with symptom-monitoring apps as well as remitted patients [25]. Nevertheless, with support, using an app during the early stages of a first episode of psychosis may prompt a more recovery focused approach.…”

“…The software was adapted from ClinTouch [25], a symptom-monitoring app assessing twelve Positive and Negative Syndrome Scale (PANSS) [44] and two Calgary Depression Scale (CDS) [45] items.…”

“…Monitoring early signs with an app is less resource intensive, intrusive, time consuming and burdensome than weekly visits from a researcher or clinician. People with a diagnosis of schizophrenia find apps acceptable for self-monitoring [25,26] and prefer them to text message based systems [27].…”