Multidimensional autonomic dynamics are associated with clinical improvement across psychiatric patients

Psychiatric symptoms are heterogeneous and change over time, yet clinical assessment relies largely on discrete subjective symptom assessments. We examined whether affective reactivity and autonomic dynamics relate to current clinical state and subsequent symptom change in a transdiagnostic psychiatric sample. Patients were assessed at baseline using an adaptive reward-based mood modulation task (n = 100) and heart rate variability recording (n = 57), with longitudinal clinical data available approximately 4 weeks later (n=34). Patients showed reduced positive affective reactivity and altered linear and nonlinear HRV. Positive affective reactivity was primarily associated with concurrent affective symptoms, whereas LF/HF ratio, Lyapunov exponent and Approximate Entropy were prospectively associated with subsequent symptom improvement. Integrating these HRV features into a multidimensional index yielded a stronger association with symptom change beyond baseline cross-sectional symptom severity, suggesting that this index may provide relevant information about clinical trajectories during treatment.