The Cost of Relapse in Schizophrenia

Haddad PM; The Cost of Relapse in Schizophrenia. Mind & Brain, the Journal of Psychiatry, August  2010; 1(2):  33-36

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Peter M Haddad

Affiliation : Greater Manchester West Mental Health NHS Foundation Trust and Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK

ABSTRACT

The long-term course of schizophrenia is highly variable but for most patients it is characterized by repeated relapses. Relapse can be a devastating experience for patients and families. The distressing nature of psychotic and associated symptoms can cause great personal suffering and may interfere with education, work, and key relationships. Social disabilities may persist after symptomatic recovery. Relapse has a major economic impact on health services as it leads to increased use of inpatient and non-inpatient services. Factors associated with relapse include high expressed emotion, illicit drug use, and poor adherence with maintenance antipsychotic medication. Strategies to reduce the risk of relapse include avoiding illicit drug use, reducing high expressed emotion, improving adherence to maintenance antipsychotic medication, and ensuring that patients and their relatives can identify early warning signs of relapse and that psychiatric services can intervene effectively at that time. Psychoeducation for patients and their families, incorporating one or more of these elements, has been shown to be effective in reducing relapse. Core principles to improve adherence are that the prescriber understands the patients’ beliefs and concerns about their illness and medication and involves the patient in prescribing decisions. For some patients, an antipsychotic long-acting injection (LAI) may improve adherence. Although results are variable, several studies show improved outcomes, including lower relapse rates, with a LAI compared to oral medication. It is important to ensure that patients are fully involved in the decision to start antipsychotic treatment irrespective of whether this is an oral antipsychotic or a LAI.

Keywords: Relapse, Adherence, Schizophrenia, Antipsychotic, Long-acting injection, Psychoeducation
Correspondence: PeterMHaddad, Cromwell House, Cromwell Road, Eccles, Salford,M30 0GT United Kingdom; Tel: +440161 787 6007; Fax:+440161 787 6006; e-mail: peter.haddad@gmw.nhs.uk