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Strategies for Preventing & Preparing for Relapse

Posted: 26 Feb 2019
by Jean
It's a word that fills one with immediate dread: relapse. And while it may carry a negative connotation, the reality is that it is more common than we think.

For individuals and caretakers alike, it is important to understand that schizophrenia is a chronic illness that can be treated but not cured. While early intervention and diligently following a treatment plan can improve outcomes, complete remission is rare for those with schizophrenia and other serious mental illnesses. Relapses are common and should be expected – they are not a sign of failure! In fact, it has been estimated that only 10-20% of diagnosed individuals do not experience a relapse (Iliades, 2014).

While relapses are not entirely unavoidable, there are steps one can take to help prevent and mitigate their occurrence. Provided below is some information to help you or your loved one reduce the likelihood or severity of a relapse.


Strategies for Preventing Relapse
Medication - The primary method of treatment for schizophrenia is medication, often in the form of anti-psychotic drugs. Medication is crucial, as research has shown there is a “90% chance of relapse within one year among people who do not take their medication as prescribed,” (Schizophrenia: The Journey to Recovery, 2007, p. 9). In a double blind research study, people who stopped taking their medication had higher incidences of relapse than those who continued their medication use. (Hui et al. 2018)
Reduce stress - Stress has been identified as a risk factor for relapse. Healthy coping strategies and counselling can help a person manage stress and reduce the likelihood of a relapse.
Maintain a healthy lifestyle - A regular fitness routine, healthy diet and proper sleep hygiene are also very important steps in managing serious mental illness (Schizophrenia: The Jour -y to Recovery, 2007, p. 11).
Sobriety - Some individuals with schizophrenia may abuse drugs and alcohol, often as a way of coping with the symptoms of their illness. Not only does substance use negatively affect an individual’s health, it can make symptoms worse and trigger a relapse. For instance, it was observed that people with schizophrenia who regularly consume cannabis, “have a slower, harder time recovering... have more relapses, and need to be in the hospital more” (Cannabis & Psychosis, 2016, p. 2).
Utilize support networks - People with schizophrenia often experience high rates of social isolation. However, loved ones play an integral role in an individual's treatment plan, providing invaluable emotional and practical support. Family members are also in the unique position to advocate for their loved ones to clinicians and other health care professionals. They may be the first to recognize any behavioural changes that could be the first signs of a relapse (Schizophrenia: An Information Guide, 2017).


Early Warning Signs
It is important to be aware of the re-emergence of any symptoms that could indicate an individual may be heading towards a relapse. Early recognition means earlier intervention, which improves an individual's chance of recovery.

The following information is from the BCSS, “Basic Facts about Schizophrenia” publication, available for download here. Some common symptoms to watch out for:

Personality Changes - These changes can manifest in a few ways, such as loss of emotion, interest and motivation. Uncharacteristic mood changes can be a sign of more serious symptoms to come.
Thought Disorder - Cognitive processes are impacted. An individual may be unable to think clearly or respond rationally. They may begin to experience delusions (false beliefs with no logical basis), suffer from extreme paranoia, or exhibit delusions of grandeur.
Perceptual Changes - A person's senses become distorted. They may experience hypersensitivity and/or hallucinations (i.e. seeing, hearing, smelling, tasting or feeling sensations that are not real).
Sense of self - This is best described as a feeling of disembodiment. When one or all five senses are affected, an individual may feel they are outside of time, out of space—free floating and bodiless. At this point, a person may begin to withdraw from others in an effort to conceal their symptoms.

For a person with schizophrenia, recovery will always be an ongoing process and an individual will never fully recover to the point they were at before the onset of the disease. Individuals and caretakers should anticipate relapses throughout this journey and adjust their expectations accordingly. Nonetheless, with proper treatment and support, individuals with schizophrenia can live a full, healthy and engaging life.

Early Psychosis Intervention also has a helpful resource about relapse prevention, https://www.earlypsychosis.ca/files/documents/13-Relapse_Prevention.pdf


References
British Columbia Schizophrenia Society, (2016). Basic Facts about Schizophrenia.
https://www.bcss.org/wp-content/uploads/2018/11/Basic-Facts-18-small-5.5-x-8.5-final-no-ad.pdf

British Columbia Schizophrenia Society, (2016). Cannabis and Psychosis Brochure.
https://www.bcss.org/wp-content/uploads/2018/11/2016-Cannabis-and-psychosis.pdf

Canadian Psychiatric Association & Schizophrenia Society of Canada, (2007). Schizophrenia: The Journey to Recovery. A Consumer and Family Guide to Assessment and Treatment.
http://www.schizophrenia.ca/docs/RoadtoRecoveryschzhioph-web.pdf

Centre for Addiction and Mental Health, (2017). Schizophrenia: An Information Guide.
https://www.camh.ca/-/media/files/guides-and-publications/schizophrenia-guide-en.pdf?la=en&hash=D235580D03864B778960CC3DC4445B2F69218A3B

Hui CLM, et al. (2018) Long-terms effects of discontinuation from antipsychotic maintenance following first-episode schizophrenia and related disorders: a 10 year follow-up of a randomised, double-blind trial. Lancet Psychiatry. DOI: [url]https://doi.org/10.1016/S2215-0366(18)30090-7
https://www.thelancet.com/journals/lanp ... 15-0366(18)30090-7/fulltext[/url]

Iliades, C., (2014). Schizophrenia Relapse: What to Know.
https://www.everydayhealth.com/hs/schizophrenia-caregiver-guide/recognizing-and-preventing-relapse/