When symptoms of schizophrenia occur after being managed for some time, you may be experiencing a symptom relapse.

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Schizophrenia can affect a person’s behaviors, cognition, mood, and how they connect with others.

While medication, psychotherapy, and learning about schizophrenia can help manage symptoms of the condition, it’s possible to experience “symptom relapses” while receiving treatment.

Symptom relapse is a part of the chronic condition journey, and it doesn’t mean you necessarily did “something wrong.”

The term “schizophrenia relapse” can be confusing, as “addiction relapse” tends to be more familiar.

A symptom relapse in schizophrenia refers to experiencing cognitive and positive symptoms that may have been well managed thus far, including:

  • hallucinations
  • delusions
  • confusion
  • difficulty concentrating
  • difficulty with movement (catatonia)

When symptoms return, they can cause psychological and social distress, financial hardship, and difficulties with work, school, and relationships.

Symptom relapse can also affect loved ones who care for those living with schizophrenia due to the increased need for supervision when symptoms or behaviors become more unexpected, harmful, or difficult to manage.

Many people who live with schizophrenia experience relapses during their lifetime. Sometimes behaviors can precede relapse. One 2018 study found that behavioral changes detected 2 weeks before relapse was 71% higher than the rate of anomalies during other periods.

Nearly 3 in 5 folks with schizophrenia-spectrum disorders experienced symptom relapse during their lifetime after they began to take medication, according to a 2021 study. The research looked at people receiving follow-up for their condition at hospitals in Ethiopia.

Warning signs of a schizophrenia relapse may include symptoms experienced before treatment, such as:

  • paranoia
  • sleep difficulties
  • changes in eating habits
  • confused thinking
  • loss of energy
  • feelings of anxiety, depression, or anger
  • lack of hygiene
  • withdrawal from friends and family
  • loss of interest in things once enjoyed (anhedonia)
  • hallucinations
  • delusions

Sometimes symptoms of psychosis can linger while receiving medication or other forms of medication, which can make it hard to define a true relapse, says Stephanie E. Johnson, a behavioral health consultant, life coach and owner of NaviPsych, in Atlanta, Georgia.

“However, it’s important for family members and individuals experiencing symptoms of psychosis or schizophrenia to keep their own records of symptoms that led to a hospitalization or treatment from a mental health professional at the time of an episode,” Johnson says.

“Receiving the best quality of treatment during a relapse depends heavily on what is reported to medical professionals by the family or the individual,” she adds.

Though prevention of individual episodes may be possible sometimes, preparing relapse contingency plans is wise.

Relapse can be associated with:

  • having another mental health condition in addition to schizophrenia
  • not taking medication as directed by a doctor
  • stopping medication
  • stressful life events
  • substance use (including prescribed medications)

Effective ways to prevent relapse could include:

You can listen to our podcasts on service dogs for schizophrenia below.

While it’s difficult to prevent symptom relapse after treatment has stopped, Johnson says a “key factor in reducing relapses is remaining engaged in a treatment regimen and reporting side effects from medications as soon as possible to the treating medical professional.”

She says giving a clinician the below information can help them determine the phase of illness:

  • symptoms that occurred at the point of a symptom relapse
  • time of year that the relapses tend to occur
  • intensity of the symptoms
  • worsening of symptoms
  • appearance of new symptoms
  • what’s happening in the person’s life at the time of the relapse

“A well-reported history can … also help doctors determine the most appropriate medications, the most appropriate dosage, as well as if an evaluation is needed to reassess for a change in diagnosis, when necessary,” says Johnson.

She also suggests creating a mental health crisis plan after a relapse and when you’re feeling symptoms are again being managed.

“After relapses occur, sometimes individuals can remember an order of events, certain symptoms that occurred first, the intensity and frequency of the symptoms that let him or her know symptoms were returning,” Johnson says.

She adds that these symptoms or mood journal details are “valuable information to consider when planning the level of care a person may need.”

Planning is also helpful when creating a behavioral health advance directive, which defines a person’s wishes for healthcare and treatment to be carried out if they are incapacitated or unable to communicate their wishes.

“Clear communication, especially written documents, are essential to receiving the most appropriate quality medical care during a relapse,” says Johnson.

When a relapse occurs, it’s wise to contact a mental health professional immediately. Family, partners, or caregivers can be helpful by providing as much information as possible. Johnson suggests supplying doctors with what you know about your person and being ready to ask questions about their care.

“Families should ask the treating mental health professionals specific questions about the procedures of different levels of care and what to expect at each level. The more information known about the procedures, the easier navigating to receive help can be,” she says.

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