University of Manchester, Division of Psychology and Mental Health, Zochonis Buildi ng (2(nd) Floor), Brunswick Street, Manchester M13 9L, United Kingdom.
University of Manchester, Division of Psychology and Mental Health, Zochonis Buildi ng (2(nd) Floor), Brunswick Street, Manchester M13 9L, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester, Greater Manchester M25 3BL, United Kingdom.
Schizophr Res. 2019 Jun;208:105-113. doi: 10.1016/j.schres.2019.04.003. Epub 2019 Apr 9.
Psychosis relapses are common, have profound adverse consequences for patients, and are costly to health services. 'Early signs' have been used to predict relapse, in the hope of prevention or mitigation, with moderate sensitivity and specificity. We investigated the feasibility and validity of adding 'basic symptoms' to conventional early signs and monitoring these using a smartphone app.
Individuals (n = 18) experiencing a relapse within the past year were asked to use a smartphone app ('ExPRESS') weekly for six months to report early signs, basic symptoms and psychotic symptoms. Above-threshold increases in app-reported psychotic symptoms prompted a telephone interview (PANSS positive items) to assess relapse.
Participants completed 65% app assessments and 58% telephone interviews. App items showed high concurrent validity with researcher-rated psychotic symptoms and basic symptoms over six months. There was excellent agreement between telephone call and face-to-face assessed psychotic symptoms. The primary relapse definition, based on telephone assessment and casenotes, compared well with a casenote-only definition but had better specificity. Mixed-effects models provided preliminary evidence of concurrent and predictive validity: early signs and basic symptoms were associated with most app-assessed psychotic symptom variables the same week and with a number of psychotic symptoms variables three weeks later; adding basic symptoms to early signs improved model fit in most of these cases.
This is the first study to test a smartphone app for monitoring early signs and basic symptoms as putative relapse predictors. It demonstrates that weekly app-based monitoring is feasible, valid and acceptable over six months.
精神病复发较为常见，对患者有深远的负面影响，且耗费医疗资源。“早期症状”已被用于预测复发，以期实现预防或缓解，具有中等的敏感性和特异性。我们研究了通过智能手机应用程序添加“基本症状”来补充常规早期症状监测，并对其进行监测的可行性和有效性。
在过去一年中经历过复发的个体（n=18）被要求在六个月内每周使用智能手机应用程序（“Express”）报告早期症状、基本症状和精神病症状。应用程序报告的精神病症状超过阈值增加时，会进行电话访谈（PANSS 阳性项目）以评估复发。
参与者完成了 65%的应用程序评估和 58%的电话访谈。应用程序项目在六个月内与研究人员评定的精神病症状和基本症状具有高度的同时效度。电话和面对面评估的精神病症状之间具有极好的一致性。基于电话评估和病历的主要复发定义与仅基于病历的定义相当，但特异性更好。混合效应模型提供了同时和预测有效性的初步证据：早期症状和基本症状与大多数应用程序评估的精神病症状变量在同一周相关，与三周后许多精神病症状变量相关；将基本症状添加到早期症状中，在大多数情况下改善了模型拟合度。
这是第一项测试智能手机应用程序监测早期症状和基本症状作为潜在复发预测指标的研究。它表明，每周基于应用程序的监测在六个月内是可行的、有效的和可接受的。
