From the Guidelines
Early signs of schizophrenia relapse include social withdrawal, increased suspiciousness, and unusual thoughts, which often appear gradually, weeks or months before a full relapse occurs. These warning signs are crucial to identify, as relapses are common during the first few years after the onset of a psychotic disorder and the vulnerability to relapse persists in about 80% of patients 1. Some key signs to watch out for include:
- Increased anxiety
- Decreased personal hygiene
- Irritability
- Sleep disturbances
- Difficulty concentrating
- A return or worsening of hallucinations, disorganized thinking, or paranoid thoughts Changes in medication adherence are also particularly important to monitor, as stopping antipsychotic medications often precedes relapse 1. It is essential to ensure continuity of care, with ‘treating clinicians’ remaining constant for at least the first 18 months of treatment, and to involve and empower consumers and families in the care process 1. Developing a personalized relapse prevention plan that identifies individual warning signs and response strategies can significantly reduce the severity of relapses. Family members should watch for subtle behavioral changes such as the person becoming more isolated, expressing strange ideas, or showing reduced emotional expression, and early intervention when these signs appear is crucial, typically involving contacting a psychiatrist or mental health provider immediately to adjust medication or implement additional support.
From the Research
Early Signs of Schizophrenia Relapse
- The early signs of schizophrenia relapse can be detected through self-reporting and objective assessment of behavioral and phenomenological changes 2.
- Common early signs of relapse include trouble sleeping, trouble concentrating, loss of appetite, and feeling depressed 3.
- Sleep, mood, and suspiciousness have also been identified as predictors of worsening symptoms 4.
- The predictive validity of early signs of relapse is considerable, with a sensitivity of 81% and a specificity of 79% when using a composite score of self-reported and objectively assessed early signs 2.
- Early signs are often detected within the four weeks immediately before relapse, highlighting the importance of ongoing monitoring and self-reporting in clinical practice 2.
Recognition and Prediction of Relapse
- Nurses can contribute to the prevention of psychotic relapse by recognizing early warning signs in patients with schizophrenia 5.
- The predictive value of early signs is significant, with a pooled sensitivity and specificity of 71% and 64% in predicting psychotic relapse 4.
- Research suggests that early recognition and intervention can potentially prevent psychotic relapses, although further study is needed to confirm this 5.
Factors Influencing Relapse
- Hostility is a significant factor in schizophrenia, and adjunctive treatment with divalproex sodium has been shown to reduce hostility in patients receiving olanzapine or risperidone 6.
- The effect of combination therapy on hostility appears to be independent of its effect on other symptoms of schizophrenia, such as delusional thinking or hallucinations 6.