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ExPRESS:2
ExPRESS:2 (Experiences of Psychosis Relapse: Early Subjective Signs) Longitudinal Feasibility Study
Sponsor study identifier
Secondary identifiers
OTHER_GRANT · Medical Research Council
OTHER_GRANT · Medical Research Council
OTHER_GRANT · Medical Research Council
observational
27
0 countries
N/A
Study Start
May 1, 2015
Actual (reported)Primary Completion
April 1, 2018
Actual (reported)Study Completion
April 1, 2018
Actual (reported)About 1 in 100 people will experience an episode of psychosis. Some people will only experience one 'psychotic episode' and about a quarter of people make a full recovery. Others will have recurring periods of problems ('relapses'), perhaps at times of particular stress. As people often find psychosis distressing, this study looks at ways to help them stay well in the future. There is growing evidence that 'early signs' interventions can prevent relapses of psychosis. Early signs are things that might happen when people start to become unwell. For example some people start to sleep badly when they are becoming unwell. Most people with psychosis can identify early signs emerging in the weeks before relapse. In early signs interventions, service users are taught to recognise early signs that their mental health may be deteriorating so that they can take action to avoid becoming unwell. Although early signs interventions show promise, the investigators suggest that they can be improved by more accurate assessment of relapse risk. This might be achieved by monitoring 'basic symptoms' in addition to conventional early signs of relapse. Basic symptoms are subtle, subclinical disturbances in one's experience of oneself and the world. Typical basic symptoms include: changes in perceptions, such as increased vividness of colour vision; impaired tolerance to certain stressors; difficulty finding or understanding common words. In this study the investigators want to design and test a mobile phone app to help monitor basic symptoms. They hope that the app might help service users to stay well in the future. During the study the investigators will ask participants to use the app once a week for 6 months. At the end of the study they will interview them about their experiences of using the phone app and participating in the study.
Registry-reported information. Elapsed time and enrollment totals alone do not measure study progress or recruitment pace.
April 1, 2018
Actual (reported)Click on a node to explore related trials.
Dates and qualifiers reported by the registry. Estimated dates do not confirm that a milestone has occurred.
May 1, 2015
Actual (reported)April 1, 2018
Actual (reported)April 1, 2018
Actual (reported)May 22, 2018
Actual (reported)June 15, 2018
Actual (reported)Percentage of weekly app assessments completed per person during 6 month followup period
This is used as an indicator of the feasibility of using an app for 6 months
6 months
Percentage of participants completing at least 33% of weekly app assessments during the 6 month followup period (retention)
6 months
Relapse rate: a symptom increase (measured using five PANSS items: delusions, hallucinations, grandiosity, suspiciousness, thought disorder) for at least one week that resulted in a management change as reported in casenotes
6 months
Individuals with a schizophrenia spectrum diagnosis who have experienced at least one episode within the past year (or at least two within the past year) were recruited from three NHS mental health trusts in the North West of England.
Eisner E, Drake R, Lobban F, Bucci S, Emsley R, Barrowclough C. Comparing early signs and basic symptoms as methods for predicting psychotic relapse in clinical practice. Schizophr Res. 2018 Feb;192:124-130. doi: 10.1016/j.schres.2017.04.050. Epub 2017 May 9.
Eisner E, Drake R, Barrowclough C. Assessing early signs of relapse in psychosis: review and future directions. Clin Psychol Rev. 2013 Jul;33(5):637-53. doi: 10.1016/j.cpr.2013.04.001. Epub 2013 Apr 11.
Emily Eisner, BA, MRes
University of Manchester
27 participants (actual enrollment reported by the registry).
First Submitted
May 22, 2018
First Posted
June 15, 2018
Study Start
May 1, 2015
Actual (reported)Selected items from the Basic Symptoms Checklist
Weekly for 6 months
Selected items from the Early Signs Scale
Weekly for 6 months
Selected items derived from the Positive and Negative Syndrome Scale (PANSS)
Weekly for 6 months
Contact the study team to confirm eligibility.
Eisner E, Barrowclough C, Lobban F, Drake R. Qualitative investigation of targets for and barriers to interventions to prevent psychosis relapse. BMC Psychiatry. 2014 Jul 16;14:201. doi: 10.1186/1471-244X-14-201.
Robinson D, Woerner MG, Alvir JM, Bilder R, Goldman R, Geisler S, Koreen A, Sheitman B, Chakos M, Mayerhoff D, Lieberman JA. Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Arch Gen Psychiatry. 1999 Mar;56(3):241-7. doi: 10.1001/archpsyc.56.3.241.
Appleby L. Suicide in psychiatric patients: risk and prevention. Br J Psychiatry. 1992 Dec;161:749-58. doi: 10.1192/bjp.161.6.749.
Wiersma D, Nienhuis FJ, Slooff CJ, Giel R. Natural course of schizophrenic disorders: a 15-year followup of a Dutch incidence cohort. Schizophr Bull. 1998;24(1):75-85. doi: 10.1093/oxfordjournals.schbul.a033315.
Mangalore R, Knapp M. Cost of schizophrenia in England. J Ment Health Policy Econ. 2007 Mar;10(1):23-41.
Almond S, Knapp M, Francois C, Toumi M, Brugha T. Relapse in schizophrenia: costs, clinical outcomes and quality of life. Br J Psychiatry. 2004 Apr;184:346-51. doi: 10.1192/bjp.184.4.346.
Herz MI, Lamberti JS, Mintz J, Scott R, O'Dell SP, McCartan L, Nix G. A program for relapse prevention in schizophrenia: a controlled study. Arch Gen Psychiatry. 2000 Mar;57(3):277-83. doi: 10.1001/archpsyc.57.3.277.
Lee SH, Choi TK, Suh S, Kim YW, Kim B, Lee E, Yook KH. Effectiveness of a psychosocial intervention for relapse prevention in patients with schizophrenia receiving risperidone via long-acting injection. Psychiatry Res. 2010 Feb 28;175(3):195-9. doi: 10.1016/j.psychres.2008.06.043.
Gumley A, O'Grady M, McNay L, Reilly J, Power K, Norrie J. Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy. Psychol Med. 2003 Apr;33(3):419-31. doi: 10.1017/s0033291703007323.
Birchwood M, Smith J, Macmillan F, Hogg B, Prasad R, Harvey C, Bering S. Predicting relapse in schizophrenia: the development and implementation of an early signs monitoring system using patients and families as observers, a preliminary investigation. Psychol Med. 1989 Aug;19(3):649-56. doi: 10.1017/s0033291700024247.
Gumley AI, MacBeth A, Reilly JD, O'Grady M, White RG, McLeod H, Schwannauer M, Power KG. Fear of recurrence: results of a randomized trial of relapse detection in schizophrenia. Br J Clin Psychol. 2015 Mar;54(1):49-62. doi: 10.1111/bjc.12060. Epub 2014 Jul 8.
Norman RM, Malla AK. Prodromal symptoms of relapse in schizophrenia: a review. Schizophr Bull. 1995;21(4):527-39. doi: 10.1093/schbul/21.4.527.
Fusar-Poli P, Bonoldi I, Yung AR, Borgwardt S, Kempton MJ, Valmaggia L, Barale F, Caverzasi E, McGuire P. Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Arch Gen Psychiatry. 2012 Mar;69(3):220-9. doi: 10.1001/archgenpsychiatry.2011.1472.
Bechdolf A, Schultze-Lutter F, Klosterkotter J. Self-experienced vulnerability, prodromal symptoms and coping strategies preceding schizophrenic and depressive relapses. Eur Psychiatry. 2002 Nov;17(7):384-93. doi: 10.1016/s0924-9338(02)00698-3.
Eisner E, Drake RJ, Berry N, Barrowclough C, Emsley R, Machin M, Bucci S. Development and Long-Term Acceptability of ExPRESS, a Mobile Phone App to Monitor Basic Symptoms and Early Signs of Psychosis Relapse. JMIR Mhealth Uhealth. 2019 Mar 29;7(3):e11568. doi: 10.2196/11568.
Primary Completion
April 1, 2018
Actual (reported)Study Completion
April 1, 2018
Actual (reported)Last Updated
June 15, 2018
Record last verified: 2018-06
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