Shon Lewis1, Paolo Fraccaro1, Matthew Machin1, Richard Hopkins1, Caroline Sanders1, Zhimin He2, Charlotte Stockton-Powdrell1, John Ainsworth1, Pauline Whelan1, Til Wykes2; 1Division of Psychology and Mental Health, University of Manchester, 2Institute of Psychiatry, Psychology & Neuroscience
Improving recovery from acute symptoms and preventing relapse are two major challenges in psychosis. We previously developed a smartphone-based personalised technology to monitor symptoms in real time, which showed good acceptability, reliability and validity for active remote monitoring of symptoms. We now report an RCT testing its efficacy when embedded into the ICT systems of mental health services. Participants with early psychosis/SMI received a semi-random beep 2-4 times per day on their smartphone app and answer 14 key symptom rating items using a touchscreen slider. Responses are uploaded wirelessly in real time to a central server and build into a graphical readout on the handset. This was built into an end-to-end system in two NHS Hospital Trusts to stream data into ECRs and enable detection by the clinical team of SMI EWS when key symptoms exceeded a personalised severity threshold. 81 people were randomised to either active symptom monitoring or TAU. PANSS positive subscale score showed a significant mean reduction in treatment over 12 weeks in the early psychosis group. EWS alerts generated by the system occurred in 92% of cases and blind comparison with electronic case record data suggested good sensitivity and lower specificity, with clear indications of how to adjust the gain of the system to improve future event-detection efficiency. When the symptom-monitoring system was built into clinical management workflows to enable personalised alerts of symptom deterioration, it was shown to have potential use in promoting earlier intervention for relapse.
