Schizophrenia is a debilitating mental health condition with high societal and personal costs, due largely to chronic difficulties with social and occupational functioning. While classical symptoms of schizophrenia – such as hearing voices – are often responsive to medication, people with schizophrenia also experience difficulties in social cognition, or understanding and interpreting the intentions and emotions of others. Social cognition affects the ability to function in society, and is a key determinant of real-world outcomes in schizophrenia.
Despite its importance, we lack objective and easy-to-deploy instruments to assess social cognition. This measurement gap presents a critical stumbling block for development of interventions to improve social cognition, because the effects of potential treatments cannot be assessed efficiently and at high resolution. Better measurements are also needed to identify individuals likely to benefit from such treatments and monitor treatment effects over time.
This project will develop innovative automated methods to measure a key component of social cognition – the ability to recognize the intentions and emotions of others. The underlying idea is to present a participant with a cue – such as a short video clip intended to be amusing – and then apply computational methods to their spoken response to see if it aligns with the intention behind the cue. The result will be a set of validated measurement tools to facilitate objective, repeatable, and scalable assessment of social cognition. These tools will accelerate our ability to rigorously test new treatments targeting these key deficits impacting people living with schizophrenia.
Schizophrenia is a common and devastating neurodevelopmental disorder characterized by genetic heterogeneity. In this project, genes that are disrupted by rare, damaging mutations in individuals with schizophrenia will be evaluated using CRISPRi in iPSCs. Cell lines will be evaluated for phenotypes relevant to schizophrenia. A patient-derived iPSC line will be created that harbors a mutation in one of these genes. This will allow for characterization of the neurobiological consequences of the specific patient mutation in its native genetic background. Families with schizophrenia will be recruited for participation in genetics research to curate a list of genes for future inquiry and collect clinical data that can be used to generate hypotheses about genotype-phenotype connections.
The proposed research project proposes to develop and test a mobile intervention, Normalizing Orientation to Treatment and Help-Seeking (NORTH) designed to impact knowledge and attitudes to encourage help-seeking among young adults at risk for psychosis. This project involves (1) a needs assessment to understand barriers, interests and preferences related to mHealth and in-person treatment, (2) development, refinement and usability testing of NORTH, and (3) a pilot randomized controlled trial assessing feasibility, acceptability and preliminary efficacy compared to an active control mHealth intervention providing only stress management.
The vast majority of young adults with early psychosis own mobile phones, identify texting as their preferred communication modality, and report an interest in messaging-based treatments. We developed a texting intervention for people with psychosis called the Mobile Interventionist. Treatment is conducted via daily recovery-oriented text conversations between patients and a trained messaging practitioner. This novel form of engagement produces an asynchronous but continuous form of treatment and combines the advantages of digital health (i.e., accessibility, reach beyond the brick-and-mortar clinic, low intensity), with the flexibility, personal tone and sensitivity of a clinician. Several studies have demonstrated that our texting intervention approach is feasible, acceptable, engaging and effective. This initiative will help translate this promising research into real-world clinical practice by implementing the Mobile Interventionist texting model at the University of Washington’s Specialized Treatment Program for Early Psychosis (STEP).
Clinically, the intervention may improve the illness management of young adults with early psychosis participating in the pilot, improving their long-term trajectories. Programmatically, the pilot bridges the research/practice gap by providing training and guided clinical experience to a real-world clinical team.
The World Health Organization ranks psychotic disorders as the third most disabling health condition worldwide. Eleven million Americans will experience psychosis during their lifetime, and roughly 60 million Americans have a loved one affected by psychosis. Research affirms that psychotherapeutic interventions can help family caregivers develop skills to better connect and communicate with their loved one, which corresponds to better treatment engagement, symptom improvement, fewer hospitalizations, improved functioning, reduced substance use, reduced mortality and overall improvement in quality of life for the individual with psychosis. Family interventions are therefore critical to a holistic and effective clinical response to a psychotic disorder. Nevertheless, a recent federal investigation found that fewer than 2% of US families caring for someone with psychosis had received a family intervention for psychosis.
Psychosis REACH (Recovery by Enabling Adult Carers at Home) is a family intervention for psychosis co-developed by faculty in the UW Department of Psychiatry and Behavioral Sciences that delivers psychoeducation and illness management skills training to family caregivers in the community. To enhance broad and equitable access to tens of millions of families and caregivers, this project will develop “Psychosis iREACH,” a digital platform that uses Artificial Intelligence (AI) technology to deliver Psychosis REACH to diverse families navigating psychosis. A virtual coach will assist families to access self-management skills practice, automated self-assessment, tailored training goals and individualized learning trajectories whenever and wherever families need the support. Psychosis iREACH represents a multidisciplinary collaboration among faculty in the School of Medicine, School of Nursing and School of Science, Technology, Engineering & Mathematics.
This project aims to develop and test a mobile health (mHealth) intervention designed for caregivers of young adults with early psychosis who are unengaged in services, and specifically to examine whether it can help aid caregiver treatment facilitation.
The mHealth Washington team is partnering with 20 community agencies to implement FOCUS in multiple counties throughout Washington State. This implementation effectiveness trial aims to evaluate strategies to integrate mHealth into real-world clinical practice. The team is comprised of multi-discipline experts including academic researchers, policy makers, mental health advocates, Medicaid leaders and individuals with lived experience.
Using a mobile data collection system that leverages smartphone technology to capture an abundance of time-varying information both passively (i.e., behavioral sensing) and actively (e.g., Ecological Momentary Assessment or EMA) we aim to: 1) Evaluate whether need for care is associated with real-time/real-place AVH experience; 2) Examine relationships between baseline demographic and functional variables, time-varying social and contextual factors, and AVH; 3) Test relationships posited in a cognitive model of AVH.
