Table 2.

Early signs monitoring to prevent relapse in psychosis and promote well-being, engagement, and recovery relapse criteria.

Criteria	Notes and definitions
A return or exacerbation in psychotic symptoms of at least moderate degree; If present score=1	These are defined as first rank psychotic symptoms including hallucinations, delusions, thought disorder and persecutory paranoia In line with Positive and Negative Syndrome Scale assessments, moderate severity means that these occur at least occasionally or intrude on daily life to a moderate extent
AND Where symptoms have lasted at least 1 week in duration; If present score=1	There was clear evidence that duration of psychotic symptoms occurred over at least 1 week
AND Where there is evidence of a decline in functioning; If present score=1	Includes a decline in one or more of the role performance areas identified from the Personal and Social Performance Scale: Socially useful activities, including work and study (this should include cooperation with household tasks, voluntary work, and useful hobbies, such as gardening) Personal and social relationships (this includes relationships with a partner or relatives and broader social relationships) Self-care (personal hygiene, personal appearance, and dressing) General domains to consider are physical and psychological health care; lodging (area of residence and living space care); contribution to household activities; participation in family life or residential/day-center life; intimate and sexual relationships; childcare; social network, friends, and helpers; general interests; financial management; use of transport; coping skills in crisis; keeping social rules
OR An increase in risk to self or others; If present score=1	Increase in risk to self includes deliberate self-injury and/or suicidal ideation that was clinically significant in the investigator’s judgment. Evidence is required of either an increase in thoughts or an intent to act upon such thoughts. These must occur within the context of the episode and be accompanied by a service response. The service response can be reflected in that there is a statement of increased risk, there is a note of discussing safety plans, or staff have ensured that the participant has access to crisis contacts Increase in risk to others includes significant violent and aggressive behavior. This also includes homicidal ideation, with evidence of intent to act upon this. Violent and aggressive behavior should only be recorded as an increase in risk where there is evidence of a service response to manage this behavior
AND There is evidence of a clinical response from services; If present score for each of these criteria=1 (Maximum=3)	An increase or change in medication, increased home visits, or referral to crisis services Any hospital admission or imposition of a Community Treatment Order in response to psychosis Use of the mental health act to enforce an involuntary hospital admission