Background

Identification of the early warning signs (EWS) of relapse is key to relapse prevention in schizophrenia spectrum disorders, however, limitations to their precision have been reported. Substantial methodological innovations have recently been applied to the prediction of psychotic relapse and to individual psychotic symptoms. However, there has been no systematic review that has integrated findings across these two related outcomes and no systematic review of EWS of relapse for a decade.

Method

We conducted a systematic review of EWS of psychotic relapse and the behavioural antecedents of worsening psychotic symptoms. Traditional EWS and ecological momentary assessment/intervention studies were included. We completed meta-analyses of the pooled sensitivity and specificity of EWS in predicting relapse, and for the prediction of relapse from individual symptoms.

Results

Seventy two studies were identified including 6903 participants. Sleep, mood, and suspiciousness, emerged as predictors of worsening symptoms. Pooled sensitivity and specificity of EWS in predicting psychotic relapse was 71% and 64% (AUC value = 0.72). There was a large pooled-effect size for the model predicting relapse from individual symptom which did not reach statistical significance (d = 0.81, 95%CIs = −0.01, 1.63).

Conclusions

Important methodological advancements in the prediction of psychotic relapse in schizophrenia spectrum disorders are evident with improvements in the precision of prediction. Further efforts are required to translate these advances into effective clinical innovations.

中文翻译：

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系统回顾精神分裂症谱系障碍患者复发的早期预警信号和症状恶化的行为前因

背景

识别复发的早期预警信号（EWS）是预防精神分裂症谱系疾病复发的关键，但据报道其精确度有限。最近，大量的方法创新已应用于预测精神病复发和个体精神病症状。然而，十年来还没有系统评价整合这两个相关结果的研究结果，也没有对 EWS 复发进行系统评价。

方法

我们对精神病复发的 EWS 和精神病症状恶化的行为前因进行了系统回顾。包括传统的 EWS 和生态瞬时评估/干预研究。我们完成了 EWS 在预测复发以及预测个体症状复发方面的汇总敏感性和特异性的荟萃分析。

结果

确定了 72 项研究，包括 6903 名参与者。睡眠、情绪和多疑成为症状恶化的预测因素。EWS 预测精神病复发的汇总敏感性和特异性分别为 71% 和 64%（AUC 值 = 0.72）。预测个体症状复发的模型存在较大的合并效应，但未达到统计学显着性（d  = 0.81，95% CI = -0.01，1.63）。

结论

随着预测精度的提高，预测精神分裂症谱系障碍精神病复发的重要方法学进步是显而易见的。需要进一步努力将这些进步转化为有效的临床创新。