Schizophrenia Relapse Prevention - An Overview

What Is Schizophrenia?

Schizophrenia is a chronic disabling mental disorder. It is less common compared to other mental disorders but can severely affect one's daily life as it interferes with the ability to function (think, express emotions, behave) normally. Schizophrenic attacks vary from person to person. Some may experience a single episode, while others may have multiple active episodes throughout their life while living a normal life in between the mental chaos.

What Causes Schizophrenia?

The exact cause of schizophrenia disorder could not be determined. However, researchers have concluded that certain factors put some individuals at risk of schizophrenia.

• Genetically Inherited - Runs in the family.

• Brain Chemistry - Abnormalities in the functioning of brain cells can cause behavioral issues.

• Brain Defect - Individuals with abnormalities in the structure or functioning of the brain or brain cells can put them at risk of getting schizophrenia.

• Environmental Factors - Stressful life, drug abuse, or a severe infection that affects the brain.

• Hormonal or Physical Factors - Changes during puberty can trigger extreme stress and anxiety, which can cause chemical imbalances.

What Are the Symptoms of Schizophrenia?

Schizophrenia is seen equally among both men and women. However, symptoms in men are apparent earlier than in women. In addition, it is slightly difficult to diagnose among teenagers as it appears to be a typical developmental behavior change. Schizophrenia can have a range of symptoms, such as:

• Believes the opposite of reality (delusion).

• Sensations (see, hear, smell, taste, feel) are contrary to reality (hallucination).

• Paranoia (a belief that everyone and everything happening around them is against them).

• Finds it difficult to communicate or express emotions.

• Talk in a difficult way to understand; break sentences, use insensible words, or abruptly change to completely unrelated topics.

• Extreme mood swings; suddenly become irritable or depressed while conversing normally.

• Lacking interest such as in life, socializing, or anything in general.

• Extremely forgetful.

• Short attention span.

• Abnormal movements, like walking too slowly, pacing around in circles, or staying still for hours.

• Loss of appetite or food aversion.

• Verbal or physical violence for no reason.

• Neglects personal hygiene.

• Teenagers exhibit symptoms apart from the above they may show signs of withdrawal from friends and family, degrading school performance, and lack of motivation.

Symptoms of schizophrenia can mimic symptoms of drug abuse or other neurological diseases. The symptoms must persist for a minimum of six months before a diagnosis of schizophrenia can be made.

What Is the Treatment for Schizophrenia?

In some cases, the individual may be unable to accept the facts of the illness or the reality around it, so it is the responsibility of the family members and friends to ensure that the individual gets all the medical help required. Balanced care and treatment from family and doctors can help a schizophrenic individual lead a near-normal life and maintain optimal quality of life. Some are mentioned below:

1) Family and Friends

• Seek medical help when required.

• Constant support and motivation.

• Stay close to provide protective support and prevent suicidal tendencies.

• Self-educate to help schizophrenic individuals.

2) Mental Health Professional

• Based on the severity of the symptoms, one can get help from a psychological counselor or a psychiatrist.

• Antipsychotic medication may be given to individuals to help them control their symptoms or reduce the intensity and frequency of attacks.

• Medications can have side effects like drowsiness, weight gain, and restlessness which may persist for a while and resolve independently.

The need for hospitalization arises when an individual fails to cooperate and the medications cannot control the episodes of schizophrenia.

What Is a Relapse?

When symptoms return or worsen following a pause, it is called a relapse. The primary treatment goal for schizophrenia is to prevent relapse; however, only 10 to 20 percent of the individuals become symptom-free following treatment.The first sign of relapse is usually the same as the very first episode of schizophrenia. Sometimes, the intensity may get worse than in the first episode.

What Causes a Relapse?

• When one fails to take medication on time or as prescribed.

• Consumption of alcohol or drugs.

• When early signs and symptoms of relapse are ignored.

• Sudden stressful events in life like death or loss of job.

How to Prevent Relapse?

Relapse is not inevitable; however, some tips can help prevent the same.

Seven Keys to Relapse Prevention in Schizophrenia.

Program for Relapse Prevention (PRP): This program includes all the effective methods known to prevent the relapse of schizophrenia. It includes:

• Monitoring of individuals with relapse symptoms.

• Immediate clinical intervention on detecting relapse symptoms.

• Weekly support sessions with patients.

• Biweekly sessions with family members and patients for six months, followed by monthly sessions.

• Immediately reach out to the patients when they miss their session.

Based on the success of the PRP model and the knowledge and understanding of schizophrenia, a set of seven strategies were developed to help prevent schizophrenia relapse.

1. Strategy 1 - Be Available and Flexible. When a patient's family member reports a possibility of relapse, a health professional must evaluate the individual within 24 to 48 hours; when attended to immediately, it will enhance the bond with the patient and gain their trust, which makes them cooperate for treatment as well.

2. Strategy 2- Watch for Prodromal Symptoms. Prodromal symptoms are early signs indicating a relapse. Relapse symptoms can vary between individuals. However, it is usually the same for the individual in recurrent relapse episodes. This is effective with constant monitoring, frequent meetings, and thorough patient evaluation.

3. Strategy 3- Intervene Early.

• The relapse of schizophrenia may be prevented if one is evaluated in the first 24 to 48 hours since the first symptom is noticed.

• Provide support therapy for the patient in the sense of warmth and genuineness.

• The cause for triggering the symptom was identified and resolved with appropriate measures.

• Increase or alter medical dosage if necessary.

4. Strategy 4 - Work Closely With Family and Other Support.

• Educating the family members, friends, or colleagues about the patient helps them to detect the prodromal symptoms effectively. This also provides a security net for the patients as the close-knit people are around whenever the patient experiences a stressful situation.

5. Strategy 5 - Use Assertive Outreach When Necessary.

• Missing out on appointments could indicate relapse symptoms for some patients who experience anxiety and wish to be alone. Forms of outreach can be text messages, emails, phone calls, or home visits.

6. Strategy 6- Address Nonadherence

• The patient may refuse to adhere to the prescribed medications due to the following:

  • Financial reasons.

  • Denial of having an illness.

  • Side effects of medications.

  • Denial of treatment benefits.

  • Lack the interest in getting better.

• When the clinician understands and empathizes with the patient's concerns, avoids being stern or forceful, gives the power to choose whenever possible, and logically explains the reason for the medication will help the patient to understand and believe in the benefits of the treatment.

• Despite all these efforts, patients may refuse treatment and have recurrent episodes of relapse, often leading to hospitalization. For such patients, an involuntary outpatient commitment program tends to be effective. However, this also depends on how far one can engage with the patient.

7. Strategy 7- Optimize Pharmacotherapy

• Changes in the drug prescription or dosage can bring down the possible side effects of the drugs, which in turn can prompt adherence to medication by the patient. Novel antipsychotic drugs (Clozapine) cause lesser side effects, improving the patients' acceptance of drugs compared to typical antipsychotic drugs (Haloperidol).

Conclusion

A patient with schizophrenia can benefit the most when they have the appropriate medical help, friends, and family who understands and attends to them effectively in their time of need. With the additional help of various support groups, relapse can be prevented to a larger extent.