Working memory deterioration as an early warning sign for relapse in remitted psychosis: A one-year naturalistic follow-up study

• Published in: Psychiatry research Vol. 319; p. 114976
• Main Authors: Tao, Tiffany Junchen, Hui, Christy Lai Ming, Hui, Priscilla Wing Man, Ho, Elise Chun Ning, Lam, Bertha Sze Ting, Wong, Andreas Kar Hin, See, Sally Hiu Wah, Chan, Evie Wai Ting, Suen, Yi Nam, Lee, Edwin Ho Ming, Chan, Sherry Kit Wa, Chang, Wing Chung, Lo, William Tak Lam, Chong, Catherine Shiu Yin, Siu, Clara Man Wah, Choi, Yan Yin, Pomarol-Clotet, Edith, McKenna, Peter J, Honer, William G, Chen, Eric Yu Hai
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.01.2023
• Subjects: Chronic Disease; Cognitive deterioration; Follow-Up Studies; Humans; Memory, Short-Term; Predictors; Prospective Studies; Psychosis; Psychotic Disorders - complications; Psychotic Disorders - diagnosis; Psychotic Disorders - drug therapy; Recurrence; Relapse; Smartphone Apps; Working memory; Psychosis; Relapse; Smartphone Apps; Cognitive deterioration; Working memory; Predictors
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2022.114976

•Verbal working memory deterioration was a novel early sign of psychotic relapse.•Digital monitoring of working memory was viable in managing relapse.•Relapse was also predicted by worse medication adherence and less resilience. Relapse prevention is an important goal in the clinical management of psychosis. Cognitive deficits/deterioration can provide useful insights for monitoring relapse in psychosis patients. This was a prospective, naturalistic 1-year follow-up study involving 110 psychosis patients with full clinical remission. Relapse, defined as the recurrence of psychotic symptoms, was monitored monthly along with digital tracking of verbal and visual working memory using a mobile app developed for this study. Cognitive deterioration was defined as worsening performance over 2 months prior to relapse or study termination, whichever was earlier. Other clinical, cognitive, functioning, and psychosocial variables were also collected. At 1 year, 18 (16.36%) patients relapsed, of which 6 (33.33%) required hospitalization. Relapse was predicted by verbal working memory deterioration 2 months prior to relapse (p = 0.029), worse medication adherence (p = 0.018), and less resilience (p = 0.014). Verbal working memory deterioration is a novel early sign of relapse. It is a clearly defined, objectively measurable, and reproducible marker that can help clinicians and healthcare workers identify patients at risk of relapse and make decisions about maintenance therapy. Moreover, digital monitoring is a viable tool in the management of relapse.