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Systematic review of early warning signs of relapse and behavioural antecedents of symptom worsening in people living with schizophrenia spectrum disorders
Gleeson, John Francis Martin McGuckian, Thomas Fenandez, D Fraser, Madeleine Pepe, Avni Taskis, Rebecca Álvarez-Jiménez, Mario Farhall, John Gumley, Andrew
Gleeson, John Francis Martin
McGuckian, Thomas
Fenandez, D
Fraser, Madeleine
Pepe, Avni
Taskis, Rebecca
Álvarez-Jiménez, Mario
Farhall, John
Gumley, Andrew
Abstract
Background Identification of the early warning signs (EWS) of relapse is key to relapse prevention in schizophrenia spectrum disorders, however, limitations to their precision have been reported. Substantial methodological innovations have recently been applied to the prediction of psychotic relapse and to individual psychotic symptoms. However, there has been no systematic review that has integrated findings across these two related outcomes and no systematic review of EWS of relapse for a decade.
Method We conducted a systematic review of EWS of psychotic relapse and the behavioural antecedents of worsening psychotic symptoms. Traditional EWS and ecological momentary assessment/intervention studies were included. We completed meta-analyses of the pooled sensitivity and specificity of EWS in predicting relapse, and for the prediction of relapse from individual symptoms.
Results Seventy two studies were identified including 6903 participants. Sleep, mood, and suspiciousness, emerged as predictors of worsening symptoms. Pooled sensitivity and specificity of EWS in predicting psychotic relapse was 71% and 64% (AUC value = 0.72). There was a large pooled-effect size for the model predicting relapse from individual symptom which did not reach statistical significance (d = 0.81, 95%CIs = −0.01, 1.63).
Conclusions Important methodological advancements in the prediction of psychotic relapse in schizophrenia spectrum disorders are evident with improvements in the precision of prediction. Further efforts are required to translate these advances into effective clinical innovations.
Keywords
early signs, prodrome, relapse, schizophrenia, psychosis, ecological momentary assessment
Date
2024
Type
Journal article
Journal
Book
Volume
107
Issue
Page Range
1-31
Article Number
ACU Department
School of Behavioural and Health Sciences
Faculty of Health Sciences
Non-faculty
Faculty of Health Sciences
Non-faculty
Relation URI
Event URL
Open Access Status
Published as ‘gold’ (paid) open access
License
File Access
Open
Open
Open
Notes
© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
This work was supported by an internal grant from the Australian Catholic University.
This work was supported by an internal grant from the Australian Catholic University.