RESEARCH WEEKLY: Utilizing Video Conferencing with People with Schizophrenia
Video conferencing interventions may be a promising method of interacting with and treating people with schizophrenia, despite its challenges, according to a review published in the Journal of Telemedicine and Telecare in January of this year.
The article, “Telehealth interventions for schizophrenia-spectrum disorders and clinical high risk for psychosis individuals: a scoping review,” describes the successes and challenges of providing psychiatric treatment over video conferencing platforms. The study authors found that video was both feasible and acceptable—meaning that individuals with schizophrenia and related conditions were willing and able to engage with providers and treatment over this platform.
At the time of the review, telepsychiatry, which includes video appointments, was geared toward people living in rural and remote areas where psychiatric services are difficult to access due to geography. Today, telepsychiatry has a new purpose because the COVID-19 pandemic has upended most of the world. In order to ensure continuing care despite social distancing, many physicians have shifted toward telehealth appointments; however, there have been concerns that individuals with serious mental illness would not find the platform acceptable for treatment interventions.
Methods and findings
Researchers examined more than 13,000 studies, revealing only 14 articles that were original research on the use of videoconferencing interventions for treating schizophrenia-spectrum disorders published since 2017. The majority of these studies were observational studies, not randomized trials. Only four of the studies used a comparison group to evaluate the use of videoconferencing versus traditional face-to-face treatment.
Studies included in the review took place in a variety of settings, including prisons, low income areas and inpatient units. All studies found that carrying out video conferencing was feasible, meaning that providers were able to contact patients, provide consultations, and implement interventions. This includes patients whose specific delusions and paranoia caused previous provider concern about the patient’s willingness to trust and use technology platforms. There was no concrete evidence to support that a patient’s psychosis interfered with the use of technology to deliver treatment, according to the research findings.
In fact, some patients reported feeling more comfortable, finding face-to-face interactions threatening. Two studies reported better attendance and adherence than in comparable face-to-face programs. The study authors concluded that their results suggest video conferencing in individuals with schizophrenia resembles previous research on the acceptance and use of telepsychiatry for other types of mental illnesses.
However, researchers also reported several challenges with the video conferencing platforms. Particularly, providers reported an increase in having to repeat instructions and reported feeling tired after long use of the technology. In addition, providers and staff reported feeling overwhelmed by the new technology and the record-keeping associated with it.
Areas for future study
Importantly, researchers found a lack of detailed analysis of video conferencing in treatment of people with schizophrenia and related conditions. The authors identified areas for additional study that include further comparing video conferencing to traditional interactions. Although this research indicates video conferencing is feasible and acceptable, there is little evidence comparing outcomes such as symptom reduction or medication adherence. As a result, it is unknown if video conferencing is more, less, or similarly effective to face-to-face treatments, which has important implications as the popularity of telehealth continues to rise.
An additional limitation was a lack of differentiation between stages of disease progression. Studies did not identify the severity of symptoms in participants, such as those who were in active psychosis versus stable. Further research should explore these groups separately, as those in active psychosis may face additional challenges to engage with video conferencing and other telehealth platforms.
The study authors suggest more in depth studies are needed to identify how to ensure acceptability and how to adapt to varying needs of patients. In addition, they recommend looking into the use of group video conferencing for therapeutic use which could enable the participation of peers and family members. And finally, the authors recommend exploring the cost effectiveness of these mediums moving forward.
Conclusion
As the use of telepsychiatry and video conferencing increases due to the COVID-19 pandemic, this research highlights how many of these approaches have not been evaluated in depth previously due to their low use. The research does offer promise in this technology due to the high acceptability of video services and the opportunity to connect an increasing amount of people who may otherwise be difficult to reach.
