Skip to main content
SpringerLink
Log in

Preventing Relapse of Psychotic Illness

Role of Self-Monitoring of Prodromal Symptoms

  • Practical Disease Management
  • Published:
Disease Management & Health Outcomes

Abstract

The consequences of psychotic relapse have been found to be damaging to both psychiatric clients and their families, as well as having a detrimental effect on the financial resources of mental health services. As a result of these findings, it is viewed that effective relapse prevention should form an integral component of standard psychiatric care.

The prodromal phase of psychosis offers an important window of opportunity for such intervention, and also appears to contain a predictive feature in the progression of an individual’s psychosis. The prodromal phase is perhaps best viewed as the emergence of early signs, and signifies the onset of psychotic relapse.

A number of techniques have been developed to address the issue of relapse prevention, including pharmacological and cognitive-behavioral therapy (CBT) approaches. However, it is viewed that incorporating patient self-monitoring may result in more effective relapse prevention.

The early intervention Back In The Saddle (BITS) approach is based on educating clients about early signs, and helping them to develop skills in self-monitoring. This collaborative therapeutic technique is aimed at constructing a relapse signature, developing a relapse drill, and helping the client to achieve a greater sense of understanding and control over their illness.

It is concluded that relapse prevention is vitally important to the recovery process. By involving clients and educating them to use self-monitoring techniques, we can influence the progression of psychosis and the impact it makes upon peoples’ lives. Ultimately, it is hoped that effective relapse prevention will reduce hospitalization, and consequentially decrease the financial demands upon mental health trusts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Plaistow J, Birchwood M. Back in the saddle: a guide to relapse prevention. Birmingham: The Early Intervention Service, 1996. (Data on file).

  2. McGlashan TH. A selective review of North American long-term follow-up studies of schizophrenia. Schizophrenia Bull 1988; 14: 515–42.

    Article  CAS  Google Scholar 

  3. Shepard M, Watt D, Falloon I, et al. The natural history of schizophrenia: a five-year follow-up in a representative sample of schizophrenics. Psychol Med 1989; Monograph Suppl. 15: 1–15.

    Google Scholar 

  4. Wiersma D, Nienhuis FJ, Sloof CJ, et al. Natural course of schizophrenic disorders: S 15-year follow-up of Dutch incident cohort. Schizophrenia Bull 1998; 24: 75–85.

    Article  CAS  Google Scholar 

  5. Hogarty GE, Anderson CM, Reiss DJ, et al. Family psycho-education, social skills training and maintenance chemotherapy in the aftercare treatment of schizophrenia II. Two year effects of a controlled study on relapse and adjustment. Arch Gen Psychiatr 1991; 48: 340–1.

    Article  PubMed  CAS  Google Scholar 

  6. Birchwood M, Mason R, MacMillan F, et al. Depression, demoralisation and control over illness: a comparison of depressed and non-depressed patients with a chronic psychosis. Psychol Med 1993; 23: 387–95.

    Article  PubMed  CAS  Google Scholar 

  7. Birchwood M, Iqbal Z, Chadwick P, et al. Cognitive approach to depression and suicidal thinking in psychosis. I Ontogeny of post-psychotic depression. Br J Psychiatr 2000; 177: 516–21.

    Article  CAS  Google Scholar 

  8. Drake RE, Gates C, Cotton PG. Suicide among schizophrenics: a comparison of attempters and completed suicides. Br J Psychiatr 1986; 149: 787–9.

    Article  Google Scholar 

  9. Meuser KT, Bellack A, Blanchard J. Comorbidity of schizophrenia and substance abuse: implications for treatment. J Consult Clin Psychol 1992; 60: 845–55.

    Article  Google Scholar 

  10. Bleuler M. The schizophrenic disorders: long term patient and family studies (transi. by SM Clemens). New Haven (CT): Yale University Press, 1978.

    Google Scholar 

  11. Stephens JH. Long-term follow-up and prognosis in schizophrenia. Schizophrenia Bull 1978; 4: 25–47.

    Article  CAS  Google Scholar 

  12. Carpenter W, Stauss J. The prediction of outcome in schizophrenia. V: eleven-year follow-up of the IPSS cohort. J Nerv Ment Dis 1991; 179: 517–25.

    Article  PubMed  Google Scholar 

  13. Eaton W, Thara R, Federman B, et al. Structure and course of positive and negative symptoms in schizophrenia. Arch Gen Psychiatr 1995; 52: 127–34.

    Article  PubMed  CAS  Google Scholar 

  14. Mason P, Harrison G, Glazebrook C, et al. Characteristics of outcome in schizophrenia at 13 years. Br J Psychiatr 1995; 167: 596–603.

    Article  CAS  Google Scholar 

  15. Birchwood M, Todd P, Jackson C. Early intervention in psychosis: the critical period hypothesis. Int Clin Psychopharmacol 1998; 13 Suppl. 1: 31–40.

    Article  Google Scholar 

  16. Fava GA, Kellner R. Prodromal symptoms in affective disorders. Am J Psychiatry 1991; 148: 823–30.

    PubMed  CAS  Google Scholar 

  17. Beiser M, Erikson D, Fleming JAE, et al. Establishing the onset of psychotic illness. Am J Psychiatry 1993; 150: 1349–54.

    PubMed  CAS  Google Scholar 

  18. Hertz M, Melville C. Relapse in schizophrenia. Am J Psychiatry 1980; 137:801–12.

    Google Scholar 

  19. Birchwood M, Smith J, Macmillan F, et al. Predicting relapse in schizophrenia: the development and implementation of an early signs monitoring system using patients and families as observers. Psychol Med 1989; 19: 649–56.

    Article  PubMed  CAS  Google Scholar 

  20. Marder SR, Van Putten T, Mintz J, et al. Costs and benefits of two dose of fluphenazine. Arch Gen Psychiatr 1984; 41: 1025–9.

    Article  PubMed  CAS  Google Scholar 

  21. Subotnik KL, Neuchterlein, KH. Prodromal signs and symptoms of schizophrenic relapse. J Abnormal Psychol 1988; 97: 405–12.

    Article  CAS  Google Scholar 

  22. Hirsch SR, Jolley AG. The dysphoric syndrome in schizophrenia and its implications for relapse. Br J Psychiatry 1989; 155 Suppl. 5: 46–50.

    Google Scholar 

  23. Marder SR, Mintz J, Van Putten T, et al. Early prediction of relapse in schizophrenia: an application of receiver operating characteristic (ROC) methods. Psychopharmacol Bull 1991; 27: 79–82.

    PubMed  CAS  Google Scholar 

  24. Tarder N, Barrowclought C, Bamrah JS. Prodromal signs of relapse in schizophrenia. Soc Psychiatry Epidemiol 1991; 26: 157–61.

    Google Scholar 

  25. Gaebel W, Frick U, Kopcke W, et al. Early neuroleptic intervention in schizophrenia: are prodromal symptoms valid predictors of relapse? Br J Psychiatry 1993; 163 Suppl. 21:8–12.

    Google Scholar 

  26. Gaebel W, Janner M, Frommann N, et al. Prodromal states in schizophrenia. Compr Psychiatry 2000; 41: 76–85.

    Article  PubMed  CAS  Google Scholar 

  27. Malla AK, Norman R. Prodromal symptoms in schizophrenia. Br J Psychiatry 1994; 164: 487–93.

    Article  PubMed  CAS  Google Scholar 

  28. Jorgensen P. Early signs of psychotic relapse in schizophrenia. Br J Psychiatry 1998; 172: 327–30.

    Article  PubMed  CAS  Google Scholar 

  29. Jolley AG, Hirsch SR, Morrison E, et al. Trial of brief intermittent neuroleptic prophylaxis for selected schizophrenic outpatients: clinical and social outcome at two years. BMJ 1990; 301: 837–42.

    Article  PubMed  CAS  Google Scholar 

  30. Carpenter WT, Hanlon TE, Summerfeit AT, et al. Continuous versus targeted medication in schizophrenic outpatients. Am J Psychiatry 1990; 147: 1138–48.

    PubMed  Google Scholar 

  31. Marder SR, Wirshing WC, Van Putten T, et al. Fluphenazine vs placebo supplementation for prodromal signs of relapse in schizophrenia. Arch Gen Psychiatry 1994; 51: 280–7.

    Article  PubMed  CAS  Google Scholar 

  32. Carpenter Jr WT, Buchanan RW, Kirkpatrick B, et al. Diazepam treatment of early signs of exacerbation in schizophrenia. Am J Psychiatry 1999; 156: 299–303.

    PubMed  Google Scholar 

  33. Birchwood M. Early intervention in psychotic relapse: cognitive approaches to detection and management. Behav Change 1995; 12: 2–19.

    Google Scholar 

  34. Birchwood M, Spencer E, McGovern D. Schizophrenia: early warning signs. Adv Psychiatric Treat 2000; 6: 93–101.

    Article  Google Scholar 

  35. McCandless-Glimcher L, McKnight S, Hamera E, et al. Use of symptoms by schizophrenics to monitor and regulate their illness. Hosp Community Psychiatry 1986; 37: 929–33.

    PubMed  CAS  Google Scholar 

  36. Hogarty GE, Kornblith SL, Greenwald D, et al. Three-year trials of personal therapy among schizophrenic patients living with or independent of family, I: description of study and effects on relapse rates. Am J Psychiatry 1997; 154:1504.

    PubMed  CAS  Google Scholar 

  37. Hertz MI, Lamberti JS, Mintz J, et al. A program for relapse prevention in schizophrenia-a controlled study. Arch Gen Psychiatry 2000; 57: 277–83.

    Article  Google Scholar 

  38. Drury V, Birchwood M, Cochrane R, et al. Cognitive therapy and recovery from acute psychosis: a controlled trial. II. Impact on recovery time. Br J Psychiatry 1996; 169: 602–7.

    Article  PubMed  CAS  Google Scholar 

  39. Tarder N, Kinney C, McCarthy E, et al. Two year follow-up of cognitive-behavioural therapy and supportive counselling in the treatment of persistent symptoms in chronic schizophrenia. J Consult Clin Psychol 2000; 5: 917–22.

    Google Scholar 

  40. Kumar S, Thara R, Rajkumar S, et al. Coping with symptoms of relapse in schizophrenia. Eur Arch Psychiatry Neurol Sci 1989; 239: 213–5.

    Article  PubMed  CAS  Google Scholar 

  41. Gumley A, White CA, Power K. An interacting cognitive systems model of relapse and the course of psychosis. Clin Psychol Psychother 1999; 6: 261–78.

    Article  Google Scholar 

  42. Birchwood M, Smith J, Cochrane R, et al. Specific and non-specific effects of educational intervention for families living with schizophrenia: a comparison of three methods. Br J Psychiatry 1992; 160: 806–14.

    Article  PubMed  CAS  Google Scholar 

  43. Heinrichs DW, Cohen BP, Carpenter WT. Early insight and the management of schizophrenic decompensation. J Nerv Ment Dis 1985; 173: 133–8.

    Article  PubMed  CAS  Google Scholar 

  44. Smith A, Birchwood M. Relatives and patients as partners in the management of schizophrenia. Br J Psychiatry 1990; 159 Suppl. 14: 57–61.

    Google Scholar 

Download references

Acknowledgements

There were no conflicts of interest or sources of funding for this manuscript.

Author information

Authors and Affiliations

  1. The Early Intervention Service, Harry Watton House, 97 Church Lane, Aston, Birmingham, B6 5UG, UK

    Lisa Hewitt & Max Birchwood (Director)

Authors
  1. Lisa Hewitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Max Birchwood
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hewitt, L., Birchwood, M. Preventing Relapse of Psychotic Illness. Dis-Manage-Health-Outcomes 10, 395–407 (2002). https://doi.org/10.2165/00115677-200210070-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-200210070-00001

Keywords

Search

Navigation