Relapse in schizophrenia: Definitively not a bolt from the blue.
Detailed study of the period before schizophrenic relapse when early warning signs (EWS) are present is crucial to effective pre-emptive strategies. To investigate the temporal properties of EWS self-reported weekly via a telemedicine system. EWS history was obtained for 61 relapses resulting in hospitalization involving 51 patients with schizophrenia. Up to 20 weeks of EWS history per case were evaluated using a non-parametric bootstrap test and generalized mixed-effects model to test the significance and homogeneity of the findings. A statistically significant increase in EWS sum score was detectable 5 weeks before hospitalization. However, analysis of EWS dynamics revealed a gradual, monotonic increase in EWS score across during the 8 weeks before a relapse. The findings-in contrast to earlier studies-suggest that relapse is preceded by a lengthy period during which pathophysiological processes unfold; these changes are reflected in subjective EWS.
National Institute of Mental Health, Klecany, Czech Republic; 3rd Faculty of Medicine, Charles University, Prague, Czech Republic. Electronic address: filip.spaniel@nudz.cz.
Filip
F
Spaniel
National Institute of Mental Health, Klecany, Czech Republic; Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic.
Eduard
E
Bakstein
National Institute of Mental Health, Klecany, Czech Republic; Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic.
Jiri
J
Anyz
National Institute of Mental Health, Klecany, Czech Republic; Institute of Computer Science, The Czech Academy of Sciences, Prague, Czech Republic.
Jaroslav
J
Hlinka
Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Czech Republic; Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine and General University Hospital, Charles University in Prague, Czech Republic.
Tomas
T
Sieger
National Institute of Mental Health, Klecany, Czech Republic.
Jan
J
Hrdlicka
National Institute of Mental Health, Klecany, Czech Republic; 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.
Natálie
N
Görnerová
National Institute of Mental Health, Klecany, Czech Republic; 3rd Faculty of Medicine, Charles University, Prague, Czech Republic.
Cyril
C
Höschl
D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D062706:Prodromal Symptoms; D012008:Recurrence; D012189:Retrospective Studies; D012559:Schizophrenia / Q000175:diagnosis / Q000517:prevention & control*; D012565:Schizophrenic Psychology; D055502:Secondary Prevention; D011795:Surveys and Questionnaires
Early warning signs; Information technology; Prevention; Relapse; Schizophrenia; Telemedicine