Background: Despite a growing interest in the use of technology in order to support the treatment of psychotic disorders, limited knowledge exists about the viability and acceptability of these eHealth interventions in relation to the clinical characteristics of patients. Objective: The objective of this study was to assess the access and use of, as well as experiences and interest in, new technologies using a survey of patients diagnosed with early psychosis compared with a survey of patients diagnosed with chronic psychotic disorders. Methods: We designed a structured questionnaire. This questionnaire was divided into five parts: (1) clinical and demographic information, (2) access and use of the internet, (3) use of the internet in relation to mental health, (4) experiences with technology, and (5) patients’ interest in eHealth services. In total, 105 patients were recruited from early psychosis units (n=65) and recovery units (n=40). Results: In this study, 84.8% (89/105) of the patients had access to the internet and 88.6% (93/105) owned an electronic internet device. In total, 71.3% (57/80) of patients who owned a mobile phone were interested in eHealth systems and 38.2% (37/97) reported negative experiences related to the internet usage. We observed differences between the groups in terms of device ownership (P=.02), the frequency of internet access (P<.001), the use of social media (P=.01), and seeking health information (P=.04); the differences were found to be higher in the early psychosis group. No differences were found between the groups in terms of the use of internet in relation to mental health, experiences and opinions about the internet, or interest in eHealth interventions (P=.43). Conclusions: The availability and use of technology for the participants in our survey were equivalent to those for the general population. The differences found between the groups in relation to the access or use of technology seemed to due to age-related factors. The use of technology involving mental health and the interest in eHealth interventions were mainly positive and equivalent between the groups. Accordingly, this group of patients is a potential target for the emerging eHealth interventions, regardless of their clinical status. However, 28.7% (23/80) of the studied patients rejected the use of internet interventions and 38.2% (37/97) had unpleasant experiences related to its usage; thus, more in-depth studies are needed to better define the profile of patients with psychosis who may benefit from eHealth treatments.

There is a growing interest in mobile Health interventions (m-Health) in patients with psychosis. The aim of this study is to conduct a systematic review in order to analysethe current state of research in this area. The search of articles was carried out following the PRISMA criteria, focusing on those studies that used mobile technologies in patients with psychosis during the period from 1990 to 2016. A total of 20 articles were selected from the 431 studies found. Three types of studies are distinguished: 1) Analysis of quality and usability, 2) Improving treatment adherence and reducing hospital admissions, and 3) Analysisof patient symptoms. m-Health interventions are feasible, and are easy to use for patients with psychosis. They evaluate the evolution of psychotic symptoms more efficiently, and improve adherence to treatment, as well as symptoms and hospital admissions. However, a particular strategy does not stand out over the rest, because differences in methodology make them difficult to compare.

Background: eHealth interventions are widely used in clinical trials and increasingly in care settings as well; however, their efficacy in real-world contexts remains unknown. ReMindCare is a smartphone app that has been systematically implemented in a first episode of psychosis program (FEPP) for patients with early psychosis since 2018. Objective: The objective of this study was to assess the efficacy of ReMindCare after 19 months of use in the clinic and varying use by individual patients. Methods: The integration of the ReMindCare app into the FEPP started in October 2018. Patients with early psychosis self-selected to the app (ReMindCare group) or treatment as usual (TAU group). The outcome variables considered were adherence to the intervention and number of relapses, hospital admissions, and visits to urgent care units. Data from 90 patients with early psychosis were analyzed: 59 in the ReMindCare group and 31 in the TAU group. The mean age of the sample was 32.8 (SD 9.4) years, 73% (66/90) were males, 91% (83/90) were White, and 81% (74/90) were single. Results: Significant differences between the ReMindCare and TAU groups were found in the number of relapses, hospitalizations, and visits to urgent care units, with each showing benefits for the app. Only 20% (12/59) of patients from the ReMindCare group had a relapse, while 58% (18/31) of the TAU patients had one or more relapses (χ2=13.7, P=.001). Moreover, ReMindCare patients had fewer visits to urgent care units (χ2=7.4, P=.006) and fewer hospitalizations than TAU patients (χ2=4.6, P=.03). The mean of days using the app was 352.2 (SD 191.2; min/max: 18-594), and the mean of engagement was 84.5 (SD 16.04). Conclusions: To our knowledge, this is the first eHealth intervention that has preliminarily proven its benefits in the real-world treatment of patients with early psychosis. International Registered Report Identifier (IRRID): RR2-10.1111/eip.12960

Aim: Despite the potential benefits of e‐health interventions for patients with psychosis, the integration of these applications into the clinical workflow and analysis of their long‐term effects still face significant challenges. To address these issues, we developed the ReMindCare app. This app aims to improve the treatment quality for patients with psychosis. We chose to study the app in real world and pragmatic manner to ensure results will be generalizable.Methods: This is a naturalistic empirical study of patients in a first episode of psychosis programme. The app was purpose‐designed based on two previous studies, and it offers the following assessments: (a) three daily questions regarding anxiety, sadness and irritability; and (b) 18 weekly questions about medication adherence, medication side effects, medication attitudes and prodromal symptoms. The app offers preset alerts, reminders and the ability for patients to reach out to their clinicians. Data captured by the app are linked to the electronic medical record of the patient. Patients will use the app as part of their ongoing care for a maximum period of 5 years, and assessments will occur at baseline and at the end of the first, second and fifth years of app use.Results: Recruitment started in October 2018 and is still ongoing.Conclusions: The ReMindCare app represents early real‐world use of digital mental health tools that offer direct integration into clinical care. High retention and compliance rates are expected, and this will in turn lead to improved quality of assessments and communication between patients and clinicians.

Developments in electronic health (e-Health) interventions for psychotic patients have been possible since the growing access and use of internet and electronic devices in past 10 years (Bonet et al. 2017). However, before proceeding further on develop these interventions; limited knowledge exists about the impact of internet and new technologies on the mental health of these psychotic patients. The aim of this study is to assess the benefits and risks of new technologies usage in a survey of patients diagnosed with psychotic disorders. We analyzed the relationship between experiences and opinions about internet and demographic and clinical characteristics of the sample and patterns of use of these technologies. Structured questionnaire was designed. This questionnaire was divided in three parts: 1) clinical and demographic information, 2) access and use of technologies, and 3) experiences and opinions about internet. In total, 97 patients diagnosed with psychotic disorder participated in this cross-sectional study. Mean age of the sample was 37.06 (SD=12.9), 72.2% of participants were male, 84.5% were single and 60.8% had achieved secondary education. Main diagnoses in the sample were First Episode of Psychosis (45.4%) and Schizophrenia (34%) and 64.9% of patients had a length of illness lower than 72 months The percentage of patients who daily acceded to internet was 63.9% while 21.6% weekly acceded. 90.7% of participants owned a mobile phone and 68% had a social media account. Related to feelings about internet, 60.8% of patients felt socially linked due to internet usage and 78.4% felt informed. However, 22.7% felt frustrated and 19.6% felt suspicious. Internet was considered as a benefit for mental health for 46.4% of patients, while 38.1% have had unpleasant experiences related to its usage, 24.7% have had internet-related relapses and 26.8% expended excessive time online. Significant association was found between feeling informed and frequency of access to internet (χ2= 6.17 p=0.05), however any other significant association was found between feelings about internet and clinical or demographic characteristics or patterns of use of technology. According to experiences, significant associations were found between internet-related relapses and length of illness (χ2= 4.74 p=0.03), frequency of internet access (χ2= 9.76 p<0.01) and social media ownership (χ2= 5.55 p=0.02). Expending excessive time on internet was found significant associated to age of the sample (χ2= 6.57 p=0.04), employment status (χ2= 10.73 p=0.03), frequency of access to internet (χ2= 10.15 p<0.01) and social media ownership (χ2= 9.62 p<0.01). Association between stop taking medication because of information read on the internet and level of education was also found (χ2= 9.03 p=0.01). Despite the general positive feelings about internet usage, percentages between 38-19% of patients had a negative vision of internet. Furthermore, frequency of access to internet and social media ownership have been found associated to internet-related relapses and potential pathological use of internet (excessive time on it). Younger patients, recent diagnosis of psychosis and being in a non-active employment situation seem to be related to these pathological results too. To our knowledge, this is the first study to describe the potential risks about internet usage in patients diagnosed with psychotic disorders, however further studies are needed. Reference: 1. Bonet L, et al Use of mobile technologies in patients with psychosis: A systematic review. Rev Psiquiatr Salud Ment. 2017; 10 (3): 168–178