Background: Semi-structured interview scales for psychosis are the gold standard approach to assessing psychotic and other symptoms. However, such assessments have limitations such as recall bias, averaging, insensitivity to change and variable interrater reliability. Ambulant, real-time self-report assessment devices may hold advantages over interview measures, but it needs to be shown that the data thus collected are valid, and the collection method is acceptable, feasible and safe. We report on a monitoring system for the assessment of psychosis using smartphone technology. The primary aims were to: i) assess validity through correlations of item responses with those on widely accepted interview assessments of psychosis, and ii) examine compliance to the procedure in individuals with psychosis of varying severity.
Methods: A total of 44 participants (acute or remitted DSM-4 schizophrenia and related disorders, and prodromal)
completed 14 branching self-report items concerning key psychotic symptoms on a touch-screen mobile phone
when prompted by an alarm at six pseudo-random times, each day, for one week. Face to face PANSS and CDS
interviews were conducted before and after the assessment period blind to the ambulant data.
Results: Compliance as defined by completion of at least 33% of all possible data-points over seven days was 82%.
In the 36 compliant participants, 5 items (delusions, hallucinations, suspiciousness, anxiety, hopelessness) showed
moderate to strong (rho 0.6-0.8) associations with corresponding items from interview rating scales. Four items
showed no significant correlation with rating scales: each was an item based on observable behaviour. Ambulant
ratings showed excellent test-retest reliability and sensitivity to change.
Conclusions: Ambulatory monitoring of symptoms several times daily using smartphone software applications
represents a feasible and valid way of assessing psychotic phenomena for research and clinical management
purposes. Further evaluation required over longer assessment periods, in clinical trials and service settings.