Feasibility of using a smartphone app to assess early signs, basic symptoms and psychotic symptoms over six months: A preliminary report

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Evaluating the Clinical Feasibility of an Artificial Intelligence-Powered Clinical Decision Support System: A Longitudinal Feasibility Study

“…Additionally, a study that investigated the feasibility of using a smartphone app to assess schizophrenia prompted patients via text message to complete personalized questionnaires once per week. They found that participants (n=18) completed 65% of app assessments, "with 78% completing ≥ 33% app assessments and 72% completing ≥ 50% app assessments" (Eisner et al, 2019), similar to the results observed in this study. In summary, response rates observed in our study were reasonable in the context of previous reports and engagement persisted fairly stably beyond two weeks, demonstrating the application was able to retain patients at least as or more consistently than were applications in previous studies.…”

Are adult stressful life events associated with psychotic relapse? A systematic review of 23 studies

“…For example, newly-developed methods for allowing patients to monitor life events by the use of smartphone apps could be beneficial in targeting relapse. Smartphone apps are emerging as a method to monitor psychosis symptoms as relapse predictors (Eisner et al, 2019). A future target of these smartphone apps could be the addition of life event monitoring.…”

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“…First, when participants inputted information (e.g., rating symptoms and mood), it was perceived to promote greater awareness of current emotional and behavioral patterns. Numerous studies have found that people completing self-monitoring can enhance their understanding of mental health difficulties (Berry et al, 2019; Bucci, Schwannauer, & Berry, 2019; Eisner et al, 2019). Second, participants described an experience of enhanced reflection when therapists’ accessed data inputted into the solution during therapy sessions.…”