Effective early detection of impending relapse may offer opportunities for early interventions to prevent full relapse in schizophrenia patients. Previously reported early warning signs were not consistently validated by prospective studies. It remains unclear which symptoms are most predictive of relapse. To prioritize the symptoms to be captured by periodic self-report in technology-enabled remote assessment solutions for monitoring symptoms and detecting relapse early, we analyzed data from three relapse-prevention studies to identify individual items of the Positive and Negative Syndrome Scale (PANSS) that changed the most prior to relapse and to understand exactly when these symptoms manifested. Relapse was defined by a composite endpoint: hospitalization, suicidal/homicidal ideation, violent behavior, a 25% increase in the PANSS total score, or a significant increase in at least one of several pre-specified PANSS items. Longitudinal mixed effect models were applied to model the trajectories of individual PANSS items before relapse. Among 267 relapsed patients, the PANSS items that increased the most at relapse from randomization did not differ much by different relapse reasons or medications. A subset of seven PANSS items, including delusions, suspiciousness, hallucinations, anxiety, excitement, tension, and conceptual disorganization, had on average > 1-point of increase at relapse. The trajectories of these items suggested these items started to increase 7–10 days before relapse and reached on average 1-point of increase 0.3 ~ 1.2 days before relapse. Our results indicated that a subset of PANSS items could be leveraged to develop remote assessment solutions for monitoring symptoms and detecting relapse early in schizophrenia patients.

有效的及早发现即将发生的复发可能为早期干预提供机会，以防止精神分裂症患者完全复发。先前报道的早期预警信号未得到前瞻性研究的一致证实。尚不清楚哪些症状最能预测复发。为了优先通过技术支持的远程评估解决方案中定期进行自我报告来捕获症状，以监测症状并及早发现复发，我们分析了三项预防复发研究的数据，以鉴定阳性和阴性综合征量表（PANSS）的各个项目。在复发之前变化最大，并确切了解这些症状何时出现。复发的定义是复合终点：住院，自杀/杀人念头，暴力行为，PANSS总分提高25％，或几个预先指定的PANSS项目中的至少一项显着增加。纵向混合效应模型被用于在复发前对单个PANSS项目的轨迹进行建模。在267例复发患者中，由于不同的复发原因或药物，随机分组复发时增加最多的PANSS项目差异不大。七个PANSS项目的子集，包括妄想，可疑，幻觉，焦虑，兴奋，紧张和观念上的混乱，在复发时平均增加> 1点。这些项目的轨迹表明，这些项目在复发前7-10天开始增加，而在复发前平均0.3-1.2天增加了1点。