TY - JOUR

T1 - Comparing early signs and basic symptoms as methods for predicting psychotic relapse in clinical practice

AU - Eisner, Emily

AU - Drake, Richard

AU - Lobban, Fiona

AU - Bucci, Sandra

AU - Emsley, Richard

AU - Barrowclough, Christine

N1 - This is the author’s version of a work that was accepted for publication in Schizophrenia Research. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Schizophrenia Research, 192, 2018 DOI: 10.1016/j.schres.2017.04.050

PY - 2018/2

Y1 - 2018/2

N2 - Background Early signs interventions show promise but could be further developed. A recent review suggested that ‘basic symptoms’ should be added to conventional early signs to improve relapse prediction. This study builds on preliminary evidence that basic symptoms predict relapse and aimed to: 1. examine which phenomena participants report prior to relapse and how they describe them; 2. determine the best way of identifying pre-relapse basic symptoms; 3. assess current practice by comparing self- and casenote-reported pre-relapse experiences. Methods Participants with non-affective psychosis were recruited from UK mental health services. In-depth interviews (n = 23), verbal checklists of basic symptoms (n = 23) and casenote extracts (n = 208) were analysed using directed content analysis and non-parametric statistical tests.Results Three-quarters of interviewees reported basic symptoms and all reported conventional early signs and ‘other’ pre-relapse experiences. Interviewees provided rich descriptions of basic symptoms. Verbal checklist interviews asking specifically about basic symptoms identified these experiences more readily than open questions during in-depth interviews. Only 5% of casenotes recorded basic symptoms; interviewees were 16 times more likely to report basic symptoms than their casenotes did. Conclusions The majority of interviewees self-reported pre-relapse basic symptoms when asked specifically about these experiences but very few casenotes reported these symptoms. Basic symptoms may be potent predictors of relapse that clinicians miss. A self-report measure would aid monitoring of basic symptoms in routine clinical practice and would facilitate a prospective investigation comparing basic symptoms and conventional early signs as predictors of relapse.

AB - Background Early signs interventions show promise but could be further developed. A recent review suggested that ‘basic symptoms’ should be added to conventional early signs to improve relapse prediction. This study builds on preliminary evidence that basic symptoms predict relapse and aimed to: 1. examine which phenomena participants report prior to relapse and how they describe them; 2. determine the best way of identifying pre-relapse basic symptoms; 3. assess current practice by comparing self- and casenote-reported pre-relapse experiences. Methods Participants with non-affective psychosis were recruited from UK mental health services. In-depth interviews (n = 23), verbal checklists of basic symptoms (n = 23) and casenote extracts (n = 208) were analysed using directed content analysis and non-parametric statistical tests.Results Three-quarters of interviewees reported basic symptoms and all reported conventional early signs and ‘other’ pre-relapse experiences. Interviewees provided rich descriptions of basic symptoms. Verbal checklist interviews asking specifically about basic symptoms identified these experiences more readily than open questions during in-depth interviews. Only 5% of casenotes recorded basic symptoms; interviewees were 16 times more likely to report basic symptoms than their casenotes did. Conclusions The majority of interviewees self-reported pre-relapse basic symptoms when asked specifically about these experiences but very few casenotes reported these symptoms. Basic symptoms may be potent predictors of relapse that clinicians miss. A self-report measure would aid monitoring of basic symptoms in routine clinical practice and would facilitate a prospective investigation comparing basic symptoms and conventional early signs as predictors of relapse.

KW - Relapse

KW - Psychosis

KW - Schizophrenia

KW - Early signs

KW - Basic symptoms

U2 - 10.1016/j.schres.2017.04.050

DO - 10.1016/j.schres.2017.04.050

M3 - Journal article

VL - 192

SP - 124

EP - 130

JO - Schizophrenia Research

JF - Schizophrenia Research

SN - 0920-9964

ER -