ABSTRACT
The notion of early warning signs has been most commonly applied to the prediction of psychotic relapse. A widely accepted method described by Birchwood et al. (2000) seeks to identify an idiosyncratic relapse signature, which comprises the unique set of signs and symptoms for an individual that warn of an imminent likelihood of psychotic relapse. Interview-based techniques, checklists and card sorts have all been developed to elicit these early warning signs of psychosis (EWS-P) with both carers and patients. These signs once identified can be used to construct the relapse signature; essentially the order in which idiosyncratic signs and symptoms occur over a particular time period. Whilst utilising this approach to predict risk has been discussed anecdotally in the literature (Collins and Munroe, 2004), there has been little attempt to develop a systematic reliable method for compiling early warning signs of Risk (EWS-R). We have drawn on current best practice methods employed for identifying and intervening to prevent psychotic relapse to devise an acute dynamic risk measure. Using checklists and monitoring forms, a risk signature can be devised that can subsequently be used to help predict, in this case, the imminent likelihood of the specified risk behaviour occurring and offers potential points of intervention for clinicians to enable them to better manage risk. In this chapter we describe how to devise a EWS-R signature for individuals with problematic behaviours.
