[[fpsyt-14-1024965.pdf]] - Psychopathology was assessed using PANSS in monthly intervals. Increased average heart rate (HRA) during wakefulness and sleep correlated with increased positive psychopathology. - our findings are in line with studies reporting increased heart rate in drug naïve patients at first episode of psychosis and unmedicated patients with positive psychopathology (26, 32). - we found that the relation of increased monthly HRA during wakefulness and positive psychopathology was stronger for patients with a positive family history. Whereas the relation weakened for patients with a negative family history - Decreased heart rate variability (HRV) and increased HRV monthly variability during wakefulness correlated with increased negative psychopathology. - How come? - It has been suggested that greater psychotic symptom severity is associated with patients’ poorer autonomic functioning indexed with increased heart rate among other autonomic features, as a stress response to changing environmental demands (30, 31). - we found that an increase in mean sleep wake ratio correlated with increased negative psychopathology. - An increase in sleep duration is a symptom of a circadian rhythm disruption and is related to increase of negative psychopathology. However, a common characteristic of patients with negative psychopathology is that they tend to stay in bed for long hours doing nothing, not necessarily sleeping. Since the smartwatch cannot really differentiate this state of reduced activity from sleep, one should be cautious interpreting the increase of sleep measured using the smartwatch as an actual disruption in sleep pattern. this study confirmed that specific digital phenotypes derived from a smartwatch can predict within subject variations in positive and negative dimensions of psychopathology over time in a sample of patients with psychotic disorders (schizophrenia and bipolar disorder). These preliminary results provide proof of concept for the ongoing e-Prevention project. This project uses continuous (24 h) monitoring of digital phenotypes for a period of 12–24 months and detailed monthly clinical evaluation for every patient aiming to predict psychotic symptom relapse. heart rate and sleep wake ratio phenotypes successfully predicted changes in positive and negative psychopathology, while motion related digital phenotypes (TMA and WA) and subjectively measured physical activity (IPAQ) did not.