What is relapse in schizophrenia

Title Colour Legend: Green - Topic summary is available. Orange - Topic summary is being compiled. Red - Topic summary has no current systematic review available. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. However you may visit Cookie Settings to provide a controlled consent.

Manage consent. Close Privacy Overview This website uses cookies to improve your experience while you navigate through the website. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website.

These cookies will be stored in your browser only with your consent. After a complete description of the study to each subject, written informed consent was obtained. All but 2 patients were prescribed standard doses mg chlorpromazine equivalents 10 of maintenance antipsychotic medication. One patient was prescribed less than a standard dose because of neuroleptic side effects, and a second patient was prescribed more than a standard dose because he was relatively neuroleptic refractory.

Treatment teams for both PRP and TAU patients consisted of a psychiatrist, a master's-level nurse clinician or certified social worker, and a case manager. In addition to standard doses of antipsychotic medication, the PRP treatment consisted of 5 components: 1 education for patients and family members about the process of relapse in schizophrenia and how to recognize prodromal symptoms and behaviors; 2 active monitoring for prodromal symptoms by treatment team members, patients, family members, and others in frequent contact with the patient; 3 clinical intervention, within 24 to 48 hours, when prodromal episodes were detected, with increased frequency of crisis problem solving, supportive therapy visits, and increased medication as needed; 4 1-hour weekly supportive group therapy emphasizing improving coping skills or to minute individual supportive therapy sessions if patients refused group treatment; and 5 minute multifamily psychoeducation groups that family members were encouraged to attend biweekly for 6 months and monthly thereafter.

Treatment as usual control consisted of individual supportive therapy and medication management biweekly for 15 to 30 minutes. This is a higher frequency of treatment visits than is usual in many treatment settings. Control group treatment teams were instructed to provide their usual treatment approaches.

Treatment in both groups was provided by a therapist in collaboration with the team psychiatrist. Cases were reviewed weekly in treatment team meetings. Case management services and meetings with individual families were provided for both groups on an as-needed basis. Assertive outreach eg, home visits was available for both groups when indicated. Fidelity of the treatment in both groups was monitored monthly by the project coordinator.

Psychiatrists for both groups were instructed to notify the research interviewers as soon as they noted that a patient was demonstrating early signs of relapse so that the interviewers could rate patients on the Positive and Negative Syndrome Scale PANSS and Global Assessment Scale GAS.

Psychiatrists for the TAU group were told to use their usual clinical judgment in making that decision, while PRP group psychiatrists and other team members received instruction about prodromal symptoms and the relapse process at the inception of the study. In addition, therapists for the PRP group monitored patients weekly for the emergence of prodromal symptoms using a shortened version of the Early Signs Questionnaire. This dose was subsequently titrated according to the clinical needs of the patient, and reduced to the original maintenance dose 3 to 4 weeks after the return of symptoms to baseline.

The following baseline measurements reported in this article were obtained from patients and from family members who agreed to be interviewed: the Structured Clinical Interview for DSM-III-R SCID 24 ; demographic data and illness history; the GAS rating 26 ; the PANSS 27 ; and the Early Signs Questionnaire, 11 which obtains patients' and significant others' perceptions of early symptoms and behaviors associated with prior relapses.

Assessments were done by research interviewers who were master's-level mental health professionals, blinded as to patient group assignment, not associated with clinical care, and instructed not to inquire about a patient's treatment during interviews. The raters had prior experience using the rating scales. They were retested for reliability at study inception and at monthly intervals during the study to minimize drift in the ratings.

A third rater was added later in the study with similar reliability of ratings. The operational definition of relapse for the data analyses was based on PANSS and GAS ratings by research interviewers, generally made within 24 hours after being notified by the psychiatrist that a patient was demonstrating early signs of relapse.

Date of relapse is recorded as the date of the research evaluation. Patients remained in the study whether or not they relapsed or were rehospitalized and whether or not they were compliant with treatment. Noncompliance was conservatively defined as a rating of 5 never taking antipsychotic medication. Patient outcomes for initial episodes were divided into 3 mutually exclusive categories. Patients who were stable throughout the follow-up were coded as "stable, with no episodes.

Finally, patients who were identified as having a prodromal episode that did not eventuate in relapse were coded as "prodromal only with no relapse. An increase in prodromal only outcomes at the expense of stable outcomes would indicate false-positives or unnecessary intervention with patients who otherwise would have remained stable.

Additional survival regression analyses also included several descriptive-demographic measures age, sex, history of substance abuse and several measures of clinical status at baseline GAS and 3 summary scales from the PANSS. To examine outcomes for the first episode stable, prodromal only, or relapse , prodromal only outcomes served as the reference category, yielding estimated odds ratios for each of the other 2 outcomes as a function of treatment group and compliance.

As in ordinary logistic regression, the 2 sets of regression outputs one for each of the other outcome categories yield estimates of regression parameters divided by their SEs that can be viewed approximately as standard normal deviates z , with 1. There were no statistically significant differences in baseline sociodemographic variables Table 1.

The actual total number of outpatient contacts over the month study period were as follows: TAU group individual visits, ; PRP group individual visits, ; and group visits.

Two TAU patients and 7 PRP patients were noncompliant with maintenance antipsychotic medication and psychosocial treatment throughout the study. Treatment group assignment and medication compliance were significant predictors of both outcome variables in the proportional hazards survival regression analyses.

Assignment to TAU increased the risk of rehospitalization and relapse on the order of 3- to 4-fold see relapse survival curves in Figure 1. Noncompliance with medication treatment was an even more powerful risk factor than treatment assignment for relapse and rehospitalization outcomes, but estimation of the risk ratios associated with that variable was compromised somewhat by the relatively small numbers of noncompliant patients in both groups.

Addition of age, sex, substance abuse, and GAS and PANSS 3 separate summary measures: general, positive and negative symptoms scores at baseline all yielded nonsignificant effects. A key issue for the PRP group was whether prodromal symptoms heralding impending relapse could be detected early.

Such detection is necessary to trigger a clinical intervention that could prevent a progression to full relapse. Control group treatment teams were usually surprised that their patients had decompensated and had been hospitalized. The need for hospitalization was determined by staff members in the hospital emergency department. They made independent judgments and were not connected with the study. It should be noted that 1 PRP and 1 TAU patient were hospitalized because of major depressive episodes and did not meet our criteria for psychotic relapse.

Psychiatrists treating the PRP patients attempted to intervene early in the process of relapse, during the prodromal phase. Prior to initiating the study, the question arose whether they might declare episodes too frequently, resulting in false-positive episodes.

Since early intervention usually involves increasing doses of antipsychotic medication at each episode, numerous false-positives could result in PRP patients receiving too much antipsychotic medication. According to Table 3 , for the first episode relative to the TAU patients, many more PRP patients were coded as prodromal only, with corresponding decreases in the incidence of relapse and stable outcomes.

Treatment with PRP was associated with increased rates of prodromal only outcomes at the expense of stable outcomes with an estimated odds ratio of 4. These presumably represent false-positives.

However, there was an even larger increase in prodromal only outcomes relative to relapse episodes, with an estimated odds ratio of Both of the odds ratios were significant. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.

Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. It looks like your browser does not have JavaScript enabled. Please turn on JavaScript and try again. Important Phone Numbers. Top of the page. Topic Overview A relapse can happen when you have schizophrenia. Preventing a relapse You can do some things to help prevent a relapse: Take your medicines as your doctor suggests.

Not taking medicine is the main cause of relapse. Reduce stress in your life. This may result in fewer relapses. For more information on reducing stress, see the topic Stress Management.

Don't drink alcohol or use illegal drugs. Go to your counselling sessions and classes even when you don't feel like it or when you think they are not helping you. If your doctor recommends family therapy, be sure to have all family members attend each session. Join a self-help or support group.