Schizophrenia: Consequences of Multiple Relapses

John M. Kane, MD: We’re particularly concerned about patients who experience multiple relapses, because we believe that with each relapse, the illness may not respond as well to treatment as it did the last time. It’s possible that the illness could become what we refer to as “treatment resistant,” meaning the medications are no longer working the way we expect. That treatment resistance might be at least partially a result of multiple relapses.

I think there are many things that happen when patients relapse. They lose some of the gains that they’ve made, in terms of social and vocational functioning. Perhaps their social relationships or their jobs suffer, they may have to take time off from work or leave school. All of these things are very disruptive in the person’s life. But in addition to that, there may be biological things that happen each time someone experiences a psychotic episode. There may be changes in the underlying illness or even changes in brain physiology or brain morphology. We’re concerned about all of those things. As a result, we’re very eager to try to prevent relapse or at least reduce the risk of relapse.

One of the concerns that we have is that once we get somebody back on treatment, we’re not sure we can reverse some of the damage that has been done. We don’t know. It’s a very difficult thing to study. But it adds to our concern, in terms of preventing relapse from happening in the first place.

We’re concerned about the prevention of relapse for many reasons. First, we start with the individual and what impact it has on their illness course and their potential for recovery, which is ultimately what we want to achieve. We want people to be leading as normal a life as possible. We know that if they have frequent relapses, it’s really going to interfere with that goal. We also know it places tremendous burden on the family, on significant others, or on friends. In addition, it puts tremendous burden on society in terms of the expenses associated with repeated relapse and hospitalization costs.

People who have psychotic relapses can sometimes be involved in the criminal justice system. They may be arrested for something or they may be a victim of some crime themselves. These are all associated costs. In addition, we have the lost opportunity cost, in terms of work or school. If someone can’t participate in those activities, there’s a cost associated with that. But the biggest cost is probably hospitalization because that can be quite expensive, and if we can reduce the risk of relapse and hospitalization, that could provide a lot of savings, which hopefully could be used to provide other services, such as housing and rehabilitation.