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

Trial Summary

What is the purpose of this trial?

Psychosis is a disabling condition that typically has its onset in adolescence and early adulthood. Many young people with psychosis have difficulty navigating services or are reluctant to engage in treatment until their illness becomes an emergency. Consequently, nearly half of all new psychotic disorders are diagnosed in the emergency department (ED). Despite the rationale and evidence for early psychosis intervention (EPI), around half of youth do not access these services. The investigators will use short message service (SMS)/text messaging, a low-cost, low-complexity, youth-friendly approach, to improve transitions in care from the ED and related acute services to EPI services, investigating the intervention's effect on attendance at the first consultation appointment, longer term service engagement, and system-level outcomes. The investigators will also evaluate cost-effectiveness and user perspectives of the intervention.

Will I have to stop taking my current medications?

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

What data supports the effectiveness of the Text Messaging Intervention treatment for psychosis transition care?

Research shows that text messaging interventions can help improve medication adherence, increase social interactions, and reduce the severity of hallucinations in people with schizophrenia. These interventions are also found to be feasible and effective in improving clinical engagement and reducing psychiatric symptoms. ^{1 2 3 4 5}

Is text messaging support safe for people with psychosis?

Research on text messaging interventions for people with schizophrenia and related disorders suggests they are generally safe, with no reports of harm or adverse effects. These studies show that text messaging can help with medication adherence and social interactions without causing any known safety issues. ^{2 3 4 5 6}

How does the text messaging support treatment for psychosis transition care differ from other treatments?

This treatment is unique because it uses text messaging to support individuals with psychosis in adhering to their medication and staying engaged with clinical care. Unlike traditional treatments, it offers a low-cost, flexible, and scalable way to reach patients, potentially improving their treatment outcomes by providing regular reminders and support through their mobile phones. ^{2 3 6 7 8}

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

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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]

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]

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]

References

1. United States 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. [2022]

2. Canada pubmed.ncbi.nlm.nih.gov

The Use of Text Messaging to Improve Clinical Engagement for Individuals With Psychosis: Systematic Review. [2020]

3. United States 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. [2022]

4. England pubmed.ncbi.nlm.nih.gov

A comparison of telephone and texting interventions for persons with schizophrenia spectrum disorders. [2014]

5. Ireland pubmed.ncbi.nlm.nih.gov

Clinical outcomes from the texting for relapse prevention (T4RP) in schizophrenia and schizoaffective disorder study. [2021]

6. Canada 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. [2022]

7. Netherlands pubmed.ncbi.nlm.nih.gov

Mobile phone text message reminders: Measuring preferences of people with antipsychotic medication. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Augmenting Evidence-Based Care With a Texting Mobile Interventionist: A Pilot Randomized Controlled Trial. [2022]