Using smartphone-based personal sensing to understand and predict risk of psychotic relapse at the individual level

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Psychosis, which directly affects 2-3% of the population, is a severely debilitating psychiatric disorder characterised by a range of symptoms including false beliefs, false perceptions and disorganised thinking. Although antipsychotic medication can lead to rapid improvement in the acute-phase of the disorder, most patients subsequently relapse. This causes considerable distress to patients and their families, and has major economic implications both the NHS and society. A key challenge in the clinical management of psychosis is that we have limited understanding of the factors that lead to a relapse; this means that doctors are unable to optimise treatment of individual patients based on their level of risk. In other to address this challenge we have developed a smartphone app which allows the close monitoring of people across multiple contexts, time-points and locations in real time (Urban Mind; www.urbanmind.info). In the present project we will use an adapted version of the Urban Mind app to measure daily social stress - which is thought to be a strong predictor of the risk of relapse - in 225 patients with a first episode of the illness. We will examine whether this measure can predict the risk of relapse over a 12-month period. We will then test whether we get the same results when we use the app in a different group of 225 patients. A key aim of this project is to examine the extent to which "passive" data, which are collected via continuous background monitoring of phone usage and as such place minimal burden on patients, can be used as proxy for "active" data, which require patients to log their experiences into their phone. The results will be used to develop a predictive model linking real-time measures of daily social stress with risk of future psychotic relapse. This model could be integrated within routine clinical care, helping doctors optimise treatment of individual patients based on their level of risk. This could improve long-term clinical outcomes amongst people with first episode psychosis and have major economic benefits for society. The application of smartphone technologies in mental health care has the potential to fundamentally change the way in which patients are assessed, treated and monitored.