Currently submitted to: Journal of Medical Internet Research
Date Submitted: May 26, 2026
Open Peer Review Period: May 28, 2026 - Jul 23, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effects of Psychiatric Medication Counseling Chatbot in Patients with Schizophrenia
ABSTRACT
Background:
Chatbot-based interventions have shown promise in common mental health conditions such as depression and anxiety. However, their application in schizophrenia (SZ), particularly for psychiatric medication counseling, remains extremely limited.
Objective:
This study aimed to investigate the effects of a rule-based psychiatric medication counseling chatbot on clinical and patient-reported outcomes in patients with SZ.
Methods:
A total of 31 outpatients with SZ participated in a single-group pre–post study. Participants used a rule-based chatbot via a mobile app for 3 months. The chatbot provided structured guidance on antipsychotic medications, including side effects, management strategies, medication use, expected therapeutic effects and duration of medication. Primary outcomes included medication adherence (Adherence Rating Scale [ARS]), subjective well-being (Subjective Well-being under Neuroleptic Treatment Scale [SWN]), and side effects (Udvalg for Kliniske Undersøgelser Side Effect Rating Scale [UKU]). Secondary outcomes included psychopathology (PANSS), functioning (SOFAS), and insight (SUMD-K).
Results:
A total of 31 participants (mean age 33.91 years, SD 11.60; 20 males) completed the study. Medication adherence (ARS) showed a trend-level increase (4.77 vs 4.94, t=2.02, p=.057) but did not reach statistical significance. Among SWN subdomains, self-control improved significantly (mean difference 1.48, 95% CI 0.03 to 2.94, p=.045). UKU total severity scores decreased significantly (19.48 vs 14.52, mean difference −4.96, 95% CI −8.53 to −1.40, p=.008), driven by reductions in psychic (mean difference −1.97, 95% CI −3.52 to −0.41, p=.015) and miscellaneous symptom domains (mean difference −1.58, 95% CI −3.06 to −0.10, p=.037). Among secondary outcomes, PANSS positive symptoms decreased significantly (11.39 vs 10.35, mean difference −1.04, 95% CI −1.90 to −0.17, p=.021), whereas functioning (SOFAS) and insight (SUMD-K) did not change significantly. Older age (β=0.157, p=.017) and living with family members (β=4.304, p=.047) were associated with improvements in physical functioning, and greater chatbot use was associated with improvements in social integration (β=0.150, p=.029) and socio-occupational functioning (β=0.082, p=.024).
Conclusions:
A rule-based psychiatric medication counseling chatbot was associated with modest but significant improvements in subjective well-being and perceived side effect burden in patients with SZ, while its impact on medication adherence and broader clinical outcomes was limited. These findings suggest that chatbot-based interventions may serve as a useful adjunctive tool in SZ care, particularly for addressing medication-related concerns. Clinical Trial: Clinical Research Information Service (CRIS) KCT0011949; https://cris.nih.go.kr (registration number: KCT0011949)
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