Exploring the clinical utility of rhythmic digital markers for schizophrenia

This study investigates the clinical utility of rhythmic digital markers (RDMs) in schizophrenia. RDMs are digital markers capturing behavioral rhythms over different timescales - within 24 hours span (ultradian), at a span of 24 hours (circadian), or over cycles of more than 24 hours (infradian). While previous research has explored digital markers for schizophrenia, the focus has primarily been on sensor data variability rather than rhythmic patterns. This study introduces two RDMs: an entropy RDM, which quantifies uncertainty in activity distribution over the infradian cycles, and a dynamic RDM, which is derived from models of transitions in entropy and psychotic symptom intensity using Markov chain analysis. Data were ecological momentary assessments (EMAs) of 39 activities collected from 390 individuals diagnosed with schizophrenia (N = 153) or bipolar disorder (N = 192) and controls (N = 45). We assessed associations between RDMs and symptom severity and whether participants could be differentiated based on these RDMs. We found that participants with schizophrenia significantly differed on dynamic RDMs, suggesting a potential diagnostic utility. However, dynamic RDMs were not associated with symptom severity, and entropy RDM had no significant clinical correlate. Our findings contribute to the growing evidence on digital markers in psychiatry and highlight the potential of rhythmic digital markers (RDMs) in characterizing digital phenotypes for schizophrenia.