Text Messaging Support for Psychosis Transition Care

Overseen By Dielle Miranda, MA

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: Centre for Addiction and Mental Health

Disqualifiers: Inability to communicate in English

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

186 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to assist young people with psychosis, a mental health condition affecting thoughts and perceptions, in transitioning from emergency care to specialized early intervention services. It employs text messaging as a simple, youth-friendly tool to encourage attendance at appointments and ongoing engagement with these services. The trial compares the effects of active text message support (Active SMS Intervention) with less supportive messages (Sham SMS) to evaluate effectiveness and user satisfaction. Individuals referred to early psychosis intervention after visiting the emergency department may be suitable for this study. As an unphased trial, this study provides participants the opportunity to contribute to innovative approaches in mental health care.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that using text messages to help people with psychosis is generally safe. Studies have examined how text messaging can improve care for those with psychotic disorders and found no major safety issues. However, the effectiveness of these programs varies.

Regarding safety, text message programs are generally well-received. Participants in past studies did not report significant negative effects from receiving supportive texts. This suggests that the text message program in this trial is likely safe for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using text messaging support for psychosis transition care because it offers a new way to support patients outside of traditional clinical settings. Unlike standard treatments that often rely on in-person therapy or medication, this approach leverages technology to provide real-time, personalized support through SMS. The active SMS intervention can be tailored based on individual needs, promoting engagement and adherence to treatment plans. This method not only has the potential to improve accessibility and convenience for patients but also allows for continuous monitoring and support during the critical transition phase, which is often challenging with existing care options.

What evidence suggests that this trial's SMS interventions could be effective for improving psychosis transition care?

This trial will compare the effectiveness of two different text messaging interventions for young people with psychosis. Participants in the Active SMS Intervention arm will receive targeted text messages designed to support their engagement with treatment. Research has shown that text messages can help young people with psychosis stay engaged with their treatment. One study found that reminders sent via text improved attendance at mental health appointments. Additionally, a review of 14 studies showed that text messages can help people with psychosis stay connected to their care. Texting offers a low-cost and youth-friendly way to support the transition from emergency care to ongoing treatment. Early findings suggest that this method may improve long-term engagement with services and overall health outcomes for those with psychosis. Meanwhile, participants in the Sham SMS arm will receive non-targeted text messages as a comparator. ^{1 2 6 7 8}

Who Is on the Research Team?

Vicky Stergiopoulos, MD, MHSc

Principal Investigator

Centre for Addiction and Mental Health

Nicole Kozloff, MD, SM

Principal Investigator

Centre for Addiction and Mental Health

George Foussias, MD, PhD

Principal Investigator

Centre for Addiction and Mental Health

Aristotle N Voineskos, MD, PhD

Principal Investigator

Centre for Addiction and Mental Health

Albert HC Wong, MD, PhD

Principal Investigator

Centre for Addiction and Mental Health

Are You a Good Fit for This Trial?

This trial is for young people who've been referred to the CAMH early psychosis intervention (EPI) program from emergency services due to suspected psychosis. Participants must be able to communicate in basic written English.

Inclusion Criteria

Have been referred by the Centre for Addiction and Mental Health (CAMH) emergency department or related acute services to the CAMH early psychosis intervention (EPI) program for suspected psychosis

Exclusion Criteria

Inability to communicate in basic written English

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive a 2-way SMS intervention involving reminders, psychoeducation, and check-ins to improve transitions in care from the ED to EPI services.

6 months

Ongoing SMS communication

Follow-up

Participants are monitored for long-term service engagement and system-level outcomes, including mental health hospitalizations and outpatient visits.

2 years

What Are the Treatments Tested in This Trial?

Interventions

• Active SMS Intervention
• Sham SMS

Trial Overview The study tests whether text messages can help youth with psychosis transition better from the emergency department to EPI services. It compares an active SMS intervention against a sham SMS, focusing on attendance and engagement.

How Is the Trial Designed?

Group I: Active SMS Intervention Experimental Treatment 1 Intervention

Participants assigned to the experimental arm will receive the active SMS intervention. Participants in the active intervention group who consent to participate will be asked to complete a web-based survey. Based on survey findings, purposive sampling will be used to select a subsample of 12 to 20 participants for qualitative interviews.

Group II: Sham SMS Placebo Group 1 Intervention

Participants assigned to the sham comparator will receive the sham SMS intervention. They will not be re-contacted.

Who Is Running the Clinical Trial?

Centre for Addiction and Mental Health

Lead Sponsor

Trials

388

Recruited

84,200+

Canadian Institutes of Health Research (CIHR)

Collaborator

Trials

1,417

Recruited

26,550,000+

Institute for Clinical Evaluative Sciences

Collaborator

Trials

37

Recruited

2,509,000+

Published Research Related to This Trial

A study involving 1139 participants found that tailored text messaging did not significantly reduce psychiatric hospital readmissions or improve other clinical outcomes compared to usual care over a 12-month period.

While the SMS group showed less disability at readmission, the overall treatment costs were higher for those receiving text messages, indicating that the intervention may not be cost-effective despite some potential benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Short Text Messages to Encourage Adherence to Medication and Follow-up for People With Psychosis (Mobile.Net): Randomized Controlled Trial in Finland. Välimäki, M., Kannisto, KA., Vahlberg, T., et al.[2022]

A review of 15 studies found that SMS text messaging can significantly improve clinical engagement in individuals with psychosis, enhancing medication adherence, clinic attendance, and therapeutic relationships.

SMS text messaging is considered a safe and user-friendly method for increasing engagement, although the effectiveness may vary based on individual symptoms and characteristics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Use of Text Messaging to Improve Clinical Engagement for Individuals With Psychosis: Systematic Review. D'Arcey, J., Collaton, J., Kozloff, N., et al.[2020]

The Mobile Assessment and Treatment for Schizophrenia (MATS) program, which used text messaging over 12 weeks, significantly improved medication adherence and social interactions, particularly for individuals living independently.

Participants also experienced a notable reduction in the severity of auditory hallucinations, indicating that low-intensity interventions like MATS can effectively enhance outcomes for higher functioning individuals with schizophrenia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mobile Assessment and Treatment for Schizophrenia (MATS): a pilot trial of an interactive text-messaging intervention for medication adherence, socialization, and auditory hallucinations. Granholm, E., Ben-Zeev, D., Link, PC., et al.[2022]

A 6-month randomized control trial with 40 patients showed that a text-messaging program significantly reduced positive symptoms of schizophrenia and improved medication compliance compared to standard treatment.

Patients in the intervention group also reported higher recovery scores at the 3-month mark, suggesting that daily symptom check-ins and reminders via text messaging can positively impact clinical outcomes for individuals with schizophrenia and schizoaffective disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical outcomes from the texting for relapse prevention (T4RP) in schizophrenia and schizoaffective disorder study. Cullen, BA., Rodriguez, K., Eaton, WW., et al.[2021]

The study analyzed 562 patients on antipsychotic medication over 12 months, revealing that older women and younger men preferred receiving a higher number of positive and encouraging text messages, particularly on Mondays in the morning.

The findings suggest that tailored SMS messaging could be an effective intervention for improving follow-up care in psychiatric settings, especially for younger males, but further research is needed to evaluate its overall effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mobile phone text message reminders: Measuring preferences of people with antipsychotic medication. Kauppi, K., Kannisto, KA., Hätönen, H., et al.[2022]

In a study involving 30 outpatient participants with schizophrenia spectrum disorders, different methods of problem-solving support (telephone calls, text messages, or both) were tested over three months, showing a significant reduction in symptoms as measured by repeated assessments.

The results suggest that these communication methods can effectively support symptom management and medication adherence, but further research with larger and more diverse groups is necessary to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of telephone and texting interventions for persons with schizophrenia spectrum disorders. Beebe, L., Smith, KD., Phillips, C.[2014]

The Mobile After-Care Support (MACS) intervention, designed for patients transitioning from inpatient to outpatient care for schizophrenia-spectrum disorders, was found to be feasible and acceptable, with positive usability and satisfaction ratings from participants.

After using MACS for one month, participants showed significant reductions in dysfunctional coping strategies and psychiatric symptoms, indicating that this mobile health intervention could effectively support patients during a critical transition period.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development and Initial Testing of an mHealth Transitions of Care Intervention for Adults with Schizophrenia-Spectrum Disorders Immediately Following a Psychiatric Hospitalization. Moitra, E., Park, HS., Gaudiano, BA.[2022]

The study demonstrated that training community care team members to act as mobile interventionists for texting support is feasible and safe, with 95% of participants engaging in the intervention and no adverse events reported.

Participants receiving the mobile intervention showed promising clinical improvements, including significant reductions in paranoid thoughts and depression, suggesting that this approach could enhance recovery for individuals with serious mental illness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Augmenting Evidence-Based Care With a Texting Mobile Interventionist: A Pilot Randomized Controlled Trial. Ben-Zeev, D., Buck, B., Meller, S., et al.[2022]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/38241785/

An SMS text messaging intervention to improve clinical ... The current pilot trial sought to evaluate the preliminary efficacy and feasibility of a weekly short message service (SMS) intervention to improve engagement ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7747582/

ED to EPI: protocol for a pragmatic randomised controlled ... We aim to test an intervention delivered using short message service (SMS), a low-cost, low-complexity, youth-friendly approach, to improve ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0920996424000124

An SMS text messaging intervention to improve clinical ... A recent review identified only 14 studies globally using SMS text messaging to improve engagement in clinical care for individuals with psychotic disorders.

4. clinicaltrials.gov clinicaltrials.gov/study/NCT04298450

ED to EPI: Using SMS to Improve the Transition from ... Secondary outcomes will include indicators of long-term service engagement as well as symptoms and functioning 6 months following study enrollment and health ...

5. clinicaltrials.gov clinicaltrials.gov/study/NCT04379349

NCT04379349 | Using Short Message Service as a Means ... This study aims to evaluate the efficacy of short message service (SMS) as a means of improving clinical engagement in early-episode psychosis populations by ...

6. researchgate.net researchgate.net/publication/377555768_An_SMS_text_messaging_intervention_to_improve_clinical_engagement_in_early_psychosis_A_pilot_randomized-controlled_trial

An SMS text messaging intervention to improve clinical ... ... psychosis in the larger context of the overall health care ... treatment in people with psychotic disorders have produced inconclusive results.

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11904377/

Automated Digital Safety Planning Interventions for Young ... Participants were not eligible to participate if they endorsed symptoms consistent with mania or psychosis in the last 2 weeks (assessed via ...

8. trialx.com trialx.com/clinical-trials/listings/228446/ed-to-epi-using-sms-to-improve-the-transition-from-the-emergency-department-to-early-psychosis-intervention/?&geo_lat=43.6956787&geo_lng=-79.4503544&radius=10&place=York&user_country=Canada

Using SMS to Improve the Transition ... Many young people with psychosis have difficulty navigating services or are reluctant to engage in treatment until their illness becomes an emergency.