Schizophrenia is a serious mental illness that interferes with one’s ability to think clearly, regulate emotions, make decisions and relate to others. Some individuals with the illness experience visual and or auditory hallucinations. Schizophrenia is common, impacting approximately 1.5% of the population worldwide and often has an early onset in the late teens or early twenties. While the first line treatment for schizophrenia remains antipsychotic medications, the development of new and improved medications for this illness has largely stalled. But as new medications have made little headway for schizophrenia in recent years, a new tool has shown tremendous potential.


Schizophrenia and smartphones

Today, those with schizophrenia increasingly own and are using smartphones and other digital technologies. A recent study by the National Alliance of Mental Illness (NAMI) found that 54% of individuals with the illness owned a smartphone in 2014 and 61% owned two or more connected devices. The study also showed that those with schizophrenia have the same feelings about their phones as the general population in that the technology does not make them any more paranoid, anxious, or worried than it does for anyone else. Another review focused on social media and schizophrenia and found that those with the illness are active on sites like Facebook, and are often searching the Internet for medical information.

But do owning and using smartphones and connected technologies translate into willingness to use them in clinical settings? The answer seems to be yes, as indicated by a recent study by Dr. Dror Ben-Zeev of Dartmouth University, which followed 342 patients who were recently discharged from the hospital for up to six months as they used a smartphone app called FOCUS, to assist with management of their symptoms. This study was one of the largest clinical investigations in all of mobile health to date and found that patients had high rates of adherence and use of the app over the six-month study duration, thus supporting the scalability and feasibility of using smartphones to help deliver care in schizophrenia. In San Francisco, another group looked at a smaller sample of 20 individuals with schizophrenia using a smartphone app called PRIME and found that the app was also well accepted and liked by patients.

Although it seems that patients are willing to use smartphones and connected technology in their care, the question remains: Can these technologies actually impact clinical outcomes? Again, early evidence also suggests yes. A recent randomized trial in the treatment of persecutory delusions showed a 21% reduction in the belief that the delusional threats were real in the group using virtual reality. In an earlier study, Dr. Dror Ben-Zeev showed that use of the FOCUS app may lead to reductions in psychotic symptoms, depression, and general psychopathology. Another recent study looked at the role of wearable fitness trackers for those with serious mental illness and found that providing patients with a smartphone and a Fitbit led to increased rates of physical activity and weight loss in the majority of study participants. A recent review paper found that even text messaging may offer benefits for delivering care to those with schizophrenia and can help with medication adherence, among other features.


Beyond apps

Recent research is now also looking beyond apps to whether the way we use and interact with smartphones themselves can inform us about schizophrenia. At Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, the Symptom Monitoring Application in Real Time (SMART) for schizophrenia study is investigating if passive data such as GPS, accelerometer, anonymized call and text messages logs, screen use, and phone charging patterns can provide a new level of behavioral data that can help predict relapse. By using passive data streams like those listed above, study participants are able to use their smartphone as they normally would, and the app collects data in the background. The study is currently ongoing but updates can be found at the BIDMC digital psychiatry programs website,

While much of the data and studies discussed here are new, the rapid progress of research on mobile technology for schizophrenia is impressive. In the last two years, the increasing amount and quality of research on the topic highlight the important role that technology may soon offer in caring for those with schizophrenia. Antipsychotic medications remain the first line treatment for the illness. But with technologies that can help increase physical activity, deliver therapy and social support, help monitor for relapse, and offer new monitoring and services previously unexplored, the future of schizophrenia is looking more and more digital.

John Torous, MD
John Torous, MD is a staff psychiatrist and clinical informatics fellow at Beth Israel Deaconess Medical Center (BIDMC). He has a background in electrical engineering and computer sciences and received an undergraduate degree in the field from UC Berkeley before attending medical school at UC San Diego. He is co-director of the BIDMC Digital Psychiatry Care Assessment Research and Education program (D-CARE) . He serves as editor-in-chief for the leading academic journal on technology and mental health, JMIR Mental Health, currently leads the American Psychiatric Association’s work group on the evaluation of smartphone apps, and co-chairs the Massachusetts Psychiatric Society's Health Information Technology Committee.


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