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Psychotic relapse

What is psychotic relapse?

Psychotic relapse is the reoccurrence of previously treated psychotic symptoms. Estimates of relapse rates are influenced by the individual, as younger and more acute patients tend to show higher rates of relapse than older or chronic patients. Family situations where emotion is readily expressed (particularly negative emotion) have also been associated with increased risk of psychotic relapse. Effective early recognition may offer the potential for early intervention to prevent relapse, such as medication adjustment, psychosocial treatments, social support and stress reduction. Early warning signs are subjective experiences, thoughts and behaviours that occur immediately prior to a psychotic relapse, which signal to the patient or their family that their condition is deteriorating. It is important that these early signs be identifiable by family members or carers, as patients may minimise or disguise these symptoms in order to appear healthy or to avoid hospital readmission. The ability of patients to properly recognise altered experiences may also deteriorate as the symptoms progress and insight diminishes.

What is the evidence for psychotic relapse?

Moderate quality evidence suggests rates of relapse are around 28% at one year post-treatment, and up to 54% at three years post-treatment. 70% of patients and 93% of family members could identify changes in experience or behaviour that preceded a psychotic relapse. Over 50% of cases report a duration greater than one month between onset of signs and relapse. Higher rates of relapse are associated with substance use, poor medication adherence, high levels of critical family comments, and poor achievement of developmental goals before the onset of schizophrenia. Moderate to low quality evidence suggests common early warning signs for psychotic relapse include hallucinations, suspiciousness, change in sleep, anxiety, cognitive inefficiency, hostility, somatic symptoms, delusions, thought disorder, inappropriate behaviour and depression. Early recognition and intervention may be effective adjuncts, but not alternatives to maintenance medication for reducing relapse.

Also see the pharmaceutical treatments for relapse prevention and family intervention topics.

April 2016

Page last updated: 1:41  7 September 2017

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