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Predicting relapse in schizophrenia: the development and implementation of an early signs monitoring system using patients and families as observers, a preliminary investigation*

Published online by Cambridge University Press:  09 July 2009

Max Birchwood ,
Jo Smith ,
Fiona Macmillan ,
Bridget Hogg ,
Rekha Prasad ,
Cathy Harvey  and
Sandy Bering
Max Birchwood
Affiliation:
Department of Clinical Psychology and Academic Unit, All Saints Hospital, Birmingham
Jo Smith*
Affiliation:
Department of Clinical Psychology and Academic Unit, All Saints Hospital, Birmingham
Fiona Macmillan
Affiliation:
Department of Clinical Psychology and Academic Unit, All Saints Hospital, Birmingham
Bridget Hogg
Affiliation:
Department of Clinical Psychology and Academic Unit, All Saints Hospital, Birmingham
Rekha Prasad
Affiliation:
Department of Clinical Psychology and Academic Unit, All Saints Hospital, Birmingham
Cathy Harvey
Affiliation:
Department of Clinical Psychology and Academic Unit, All Saints Hospital, Birmingham
Sandy Bering
Affiliation:
Department of Clinical Psychology and Academic Unit, All Saints Hospital, Birmingham
*
1Address for correspondence: Ms J. Smith, Department of Clinical Psychology and Academic Unit, All Saints Hospital, Lodge Road, Winson Green, Birmingham B18 5SD.
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Synopsis

Recognition of prodromal symptoms of schizophrenia offers the potential of early intervention to avert relapse and re-hospitalization (Carpenter & Heinrichs, 1983). The present study investigated how a strategy to detect prodromal signs might be effectively applied in the clinical setting. A standard monitoring system was developed involving completion of a new early signs scale (ESS) measuring changes in key symptoms phenomenologically (self-report) and behaviourally (observer report). The ESS was subject to rigorous psychometric evaluation and tested in a prospective pilot investigation. The ESS reliably identified early signs and predicted relapse with an overall accuracy of 79%. Several different patterns of relapse were identified. Observer reports compensated for loss of insight in some patients. In two cases where early signs indices were detected, prompt increases in medication appeared to arrest relapse and avert readmission. The ESS offers itself as a reliable, valid and administratively feasible measure and demonstrates considerable potential as a cost-effective procedure for secondary prevention.

Type
Original Articles
Information
Psychological Medicine , Volume 19 , Issue 3 , August 1989 , pp. 649 - 656
Copyright
Copyright © Cambridge University Press 1989

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Footnotes

*

It should be noted that an equal contribution to the work described in this paper was made by the first three authors.

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