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

Area of Science:

• Psychiatry and Mental Health
• Clinical Psychology

Background:

• Early intervention for psychosis shows promise but requires refinement for better relapse prediction.
• A recent review suggests incorporating 'basic symptoms' with conventional early signs.
• This study investigates the predictive value of basic symptoms in psychosis relapse.

Purpose of the Study:

• To identify and describe pre-relapse phenomena reported by individuals with psychosis.
• To determine the most effective method for identifying pre-relapse basic symptoms.
• To compare self-reported and casenote-recorded pre-relapse experiences.

Main Methods:

• Recruitment of participants with non-affective psychosis from UK mental health services.
• Analysis of in-depth interviews (n=23), verbal checklists (n=23), and casenote extracts (n=208) using directed content analysis.
• Application of non-parametric statistical tests.

Main Results:

• Three-quarters of interviewees reported basic symptoms, alongside conventional early signs and other pre-relapse experiences.
• Verbal checklists specifically targeting basic symptoms were more effective in identification than open-ended interview questions.
• Casenotes documented basic symptoms in only 5% of cases, while interviewees were 16 times more likely to report them.

Conclusions:

• Basic symptoms are frequently self-reported pre-relapse experiences, often missed in clinical documentation.
• Basic symptoms may serve as potent relapse predictors currently overlooked by clinicians.
• A self-report measure for basic symptoms is proposed to enhance routine monitoring and future prospective studies.