Teens struggling with hallucinations and delusions will receive mobile phone apps that offer brain training and social support — part of a new University of Minnesota research focus that emphasizes non-drug solutions for severe mental disorders.
Testing the apps will be the U’s unique contribution to a new federal study of teens and young adults experiencing their first episodes of psychosis.
The U and four other institutions also will be tracking these first-episode patients to see what demographic or lifestyle factors make them prone to mental illness and what factors promote their recovery.
The psychiatric profession needs alternative therapies because, while drugs can treat symptoms, they don’t address a patient’s levels of cognition and motivation, which play key roles in their recovery, said Dr. Sophia Vinogradov, chairwoman of the U’s department of psychiatry.
“Research has shown us that those are the two factors that really are going to determine how a person is going to do over the long haul,” she said.
The study, funded by the National Institute of Mental Health, also reflects a pivot by the U away from the industry-funded drug studies that sparked an ethics scandal several years ago in the Department of Psychiatry and Behavioral Sciences and the resignation of its former chairman. Of 130 existing research protocols in the department, Vinogradov said only about five are industry-funded tests of pharmaceutical compounds.
Nationally, the search for the next blockbuster drug has slowed — by one estimate in 2016, psychopharmacological research by large drug firms had declined 70% in the prior decade — and researchers are instead looking for treatments to augment or replace drug therapy.
“It’s seen as the catchall and end-all and be-all, and it’s not,” Vinogradov said.
The federal study’s goal is to create an Early Psychosis Intervention Network that hastens identification and treatment of psychosis. One study found a 72-week gap between the onset of symptoms and when patients receive treatment, which is a problem because the best odds of recovery come with early intervention.
“The more you let your brain be dysfunctional, the more you hear voices and believe delusional things … the harder it is to bring it back,” Vinogradov said.
Psychosis is a symptom of mental disorders that is defined as a disruption in thought or perception that makes it difficult for the patient to identify reality. Causes are believed to be a combination of inherited, physical and environmental factors. Some young adults might have the brain chemistry to put them at elevated risk, but it can take real-life experiences such as bullying, drug use, stress or insomnia to trigger symptoms.
More than 260 early-psychosis specialty care programs have emerged in the U.S. Figuring out which approaches work for which patients is critical, said Dr. Joshua Gordon, director of NIMH, last month when he announced the grants to the U and other members of the psychosis network.
“As the number of early intervention programs expands, it is essential that we learn how to ensure those receiving these services get the best possible care,” he said.
The five grant sites — in California, Massachusetts, Minnesota and New York — will be testing a treatment approach known as coordinated specialty care, including a two-year program called Navigate that was created by a U social worker. Navigate coordinates talk therapy and medication, and it includes an educator to teach families how to support children and teens experiencing psychosis and a resiliency trainer to help children use their strengths during recovery.
Each site also has a side project. The U’s is the use of a smartphone app called BrainHQ to see if it can improve cognition, and the PRIME social networking app to motivate teens and young adults during treatment.
BrainHQ is commercially available and has been tested for its ability to improve cognition in people with multiple sclerosis and restore memory in people after cardiac emergencies.
Vinogradov helped design some of the exercises for the app and has received grant support in the past from its developer, Posit Science, but does not have a financial stake in the company.
Exercises on the app include a facial recognition game in which users receive a glimpse of a face and then have to select it from a menu of choices moments later. Sometimes they match the exact face; other times they match the face with the same emotion. The game speeds up as users progress through it.
Matthew Hegland, 28, was eager to volunteer because, he said, the onset of schizophrenia two years ago didn’t just create paranoia that people were plotting against him, it also hurt his memory and thinking. Hegland, a construction geologist from St. Paul, tried returning to school after medication stabilized his disorder.
“The first time everything seemed so easy,” he said. “I tried to go back to school and it just was a lot more difficult.”
Hegland said he fell short on the study requirement of performing BrainHQ tasks for one hour, five nights a week, but he thinks it helped anyway, along with returning to regular work and daily life activities.
PRIME provides teens and young adults with a secure group text platform to discuss their symptoms and relate with others experiencing psychosis. In the U study, teens will be paired via the app with therapists who will help set goals for treatment and in their daily lives.
“One of the things that happens when a teen has these devastating symptoms is they start to become scared, ashamed and isolated. They don’t tell people about it, and they think they can’t share it,” Vinogradov said. “It’s very important not to withdraw during the teen years and important to develop healthy relationships with others.”
Whether teen psychosis is a rising problem is unclear. NIMH estimates that 100,000 adolescents and young adults in the United States experience first episodes each year. Rising rates of stress and anxiety, and vaping and marijuana use, could theoretically trigger more cases in teens predisposed to psychosis.
A research team led by San Diego State psychologist Jean Twenge reported this year that rates of major depression, psychological distress and suicidal thoughts have increased among people 25 and younger from 2005 to 2017. Increased use of digital media and decreased sleep might be to blame, the researchers concluded.
However, the study did not specify whether an increase in psychosis occurred. Twenge, a former visiting professor at Gustavus Adolphus College in St. Peter, Minn., said she knows of no studies that have examined that trend.
Vinogradov took charge of the U psychiatry department in 2016 after the previous chairman stepped down amid questions about whether a man who died by suicide had been pressured to enroll in a schizophrenia drug trial.
Moving away from such studies is one change, but Vinogradov said she also has focused research on symptoms rather than diagnoses, which were defined for adults and insurance billing purposes and can be misleading when applied to teens.
“One of the first things I say [to patients] is, ‘I don’t believe in psychiatric diagnoses,’ ” she said. “So we’re trying to think more about symptoms or symptom clusters, or the subjective experiences that people have that are troublesome to them.”