Importance of Relapse Prevention in Schizophrenia

John M. Kane, MD: When someone first develops a schizophrenia illness, I think one of our biggest challenges is helping that person to prevent the recurrence of a psychotic episode. Someone who initially responds well to treatment may think, “OK, I’m fine now. That’s never going to happen again. I don’t need to continue to take medicine because I’m not going to get sick again,” and they get lulled into a false sense of security. Many, many patients with schizophrenia will respond very well to medication for their first episode.

The problem is the data and many studies that have been done show that the risk of relapse, even after only the first episode, is very high. In one of our studies, we showed that 82% of patients had had at least 1 relapse within 5 years of onset of their illness. The risk of relapse was 5 times higher in the patients who stopped taking their medicine compared to the patients who continued to take medicine. The risk of relapse is high, even after the very first episode of schizophrenia, and the risk of relapse is very much associated with whether or not one is taking medication. It’s a very important message to get across to patients and families, that the reason we’re so strongly recommending continued medication is to prevent relapse. Even though you’re feeling fine now, we want to prevent a relapse down the road.

In terms of preventing relapse, it’s a very important point to consider whether or not we could identify early signs and be able to intervene before the relapse becomes full-blown and requires a significant change in treatment or hospitalization. We do try to educate patients and families regarding what to look for in terms of early signs. Often, a patient will have a characteristic way of relapsing. The first thing that might happen is they’ll have trouble sleeping or they’ll become more irritable. If the family or the patient or other significant people in the person’s life are aware of that and they see that happening, they can reach out to the clinical team and say, “We think we need help right now.” That’s one possibility.

Another possibility is using technology. We now have access to smart phones and can actually monitor people in real time in terms of their activity level, their conversation with other people, their interactions, or how they’re sleeping and things like that. We can see whether or not they’ve left their house in several days. We can also use technology to help us identify early signs of relapse. This is an emerging area, but it is definitely one of our challenges to help the individual and the family recognize early signs of relapse so we can do something to intervene.

I think it’s very important to take a holistic approach to relapse and realize that there are many things that can contribute to it. For example, nonadherence and medication taking is a big contributor to relapse. Perhaps substance abuse might also be a big contributor to relapse. But we have to understand the aspects of that individual’s illness that might also contribute to relapse.