O1.1. ETRo: EVALUATION OF THE TREATMENT APPROACH “ROBIN” (STANDARDIZED MANUAL AND SMARTPHONE APP) FOR ADOLESCENTS WITH CLINICAL HIGH RISK FOR DEVELOPING A PSYCHOTIC DISORDER
Authors: Traber-Walker Nina , Gerstenberg Miriam , Metzler Sibylle , Bühlmann Claudia , Blumenthal Yolanda , Walitza Susanne , Franscini Maurizia 
Published: May 2020

Abstract

Background
The construct of a clinical high-risk (CHR) state of psychosis has been established to describe potentially prodromal symptoms which typically appear during adolescence and young adulthood. This is a very sensitive developmental period and the clinical high risk (CHR) is associated with increased functional impairment. However, there is a lack of research on age-appropriate treatment strategies for this vulnerable age group. To fill this gap, the experts from the specialized outpatient care unit for early intervention in psychosis at the Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital, of the University Zürich (CAPS), have developed the combined treatment program “Robin” (standardized manual and smartphone App). The therapy program is targeting at risk-symptoms and aims to improve of quality of life as well as daily functioning. The smartphone application “Robin Z” is an add-on treatment tool to support the patients between the sessions. While a number of trials with smartphone applications in therapy have shown promising effects with adult patient with psychosis, there is little known about using them in the therapy with minor patients. “Robin Z” is one of the first smartphone applications addressing adolescent patients with at risk- symptoms or full-blown psychotic symptoms. Since September 2017, the efficacy of this combined treatment approach is being evaluated with the systematic clinical intervention trial ETRo (Evaluation of the treatment approach “Robin“). The study has been registered at ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT03829527) and the study protocol has been published June 2019 in the journal “Frontiers in Psychiatry”.

Methods
The ETRo trial is a prospective, naturalistic, follow up study with a matched control design. Participants from a former early recognition study are included for the control condition (treatment as usual). For the intervention condition (16 weekly individual sessions + a minimum 4 family sessions), 30 help seeking CHR adolescents, aged 14–18, are being recruited. At-risk and comorbid symptoms, functioning, self-efficacy and quality of life are monitored at six time points (baseline, during the treatment period, immediately after intervention, and 6, 12, and 24 months later) and compared to the respective measures of the active control group.

Results
The data from a pilot investigation showed, that “Robin” was accepted by clinicians and patients. Therefore, the authors hypothesize that the “Robin” will enhance the treatment engagement. Within the first 2 years of the systematic evaluation, 18 CHR individuals (61% female, mean age 16.1) have been included in the intervention condition. In Florence, the preliminary results and their implications will be presented. This will include baseline data of the first patients in the intervention group, the intraindividual changes in symptomatology and well-being after 6 months of treatment and data about the treatment satisfaction.

Discussion
“Robin” is a newly developed treatment approach for adolescents at clinical high risk (CHR) of developing a psychotic disorder combining a standardized treatment manual with a smartphone application. To the best of the author’s knowledge, this is the first controlled trial to test the efficacy of a specific early psychosis treatment in combination with a smartphone application for CHR adolescents. The results of the study are of clinical importance and expected to add essential information in the fields of eMental Health as well as in prevention and early intervention in psychosis.