Autonomic Flexibility and Early Treatment Success: Heart Rate Variability Predicts Remission in First-Episode...

Area of Science:

• Psychiatry and Neuroscience
• Autonomic Nervous System Research
• Biomarker Discovery

Background:

• Heart-rate variability (HRV) is a non-invasive indicator of autonomic nervous system function.
• HRV shows potential as a prognostic biomarker in psychiatric disorders, including psychosis.
• Early identification of treatment response in first-episode psychosis (FEP) is crucial for improving outcomes.

Purpose of the Study:

• To investigate the association between admission HRV markers and short-term remission in patients with suspected FEP.
• To determine if specific HRV indices can predict remission status at discharge.
• To explore the utility of HRV in early treatment stratification for FEP.

Main Methods:

• Retrospective analysis of 78 FEP inpatients (2018-2024).
• Collected 2-minute electrocardiograms on admission to extract frequency-domain HRV indices (log-transformed high-frequency [HF] and low-frequency [LF] power) and heart rate slope (beats per minute [BPM] slope).
• Assessed remission status at discharge using clinical evaluations and clinician-rated scales; employed binomial logistic regression with cross-validation to evaluate predictive accuracy (AUC).

Main Results:

• Remission was observed in 33.3% of patients.
• Admission log HF power and BPM slope significantly predicted remission (P=.011 and P=.014, respectively).
• A combined HRV profile of lower log HF and a more rapidly declining BPM slope was associated with higher odds of remission, achieving an AUC of 0.714.

Conclusions:

• An HRV profile characterized by low vagally mediated HF power and a rapid heart rate decrease predicts short-term remission in FEP.
• These findings support the autonomic-flexibility framework and suggest HRV's potential role in early treatment stratification.
• Further prospective validation with larger cohorts, respiratory monitoring, and standardized interventions is warranted.