Relapse Prevention Copy

The majority of individuals who recover from a first episode of schizophrenia or bipolar disorder will relapse within five years.

Relapse can occur for a number of reasons, as well as for no apparent reason. Some potential clues are:

• Stopping medication
• Insufficient dose of medication
• Lack of support, either at home or from community services
• Stress
• Physical exhaustion
• Use of alcohol or street drugs

Maintenance medication, case management, education, and family involvement are all associated with lower relapse rates. However, even when the full range of treatments is provided, relapse still remains a possibility. Therefore, additional efforts are necessary in order to prevent relapse.

Predicting Relapse

Studies have demonstrated the occurrence of subtle changes prior to a psychotic relapse (“early warning signs”). The most common changes include both non-specific symptoms (e.g., change in sleep, anxiety, difficulties concentrating, depression) and attenuated psychotic symptoms (e.g., brief or poorly formed hallucinations, unstable ideas of reference, suspiciousness, mental confusion). Sleep disturbance is the most common early symptom of mania. The progression from these early warning signs to the onset of psychotic relapse is most often within a month and the family and client are usually aware of these early changes.

The concept of a “relapse signature” suggests that individuals have their own unique profile of signs and symptoms prior to relapse. This concept has been questioned, since it has been demonstrated that the symptoms shown prior to relapse can change for a given individual with progressive relapses. Therefore, psychoeducation should involve discussing both unique warning signs the person experienced before their first episode and early warning signs in general.