The nature of relapse in schizophrenia
Date
2013-02
Authors
Emsley, Robin
Chiliza, Bonginkosi
Asmal, Laila
Harvey, Brian, H.
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Cenral
Abstract
Background
Multiple relapses characterise the course of illness in most patients with schizophrenia, yet
the nature of these episodes has not been extensively researched and clinicians may not
always be aware of important implications.
Methods
We critically review selected literature regarding the nature and underlying neurobiology of
relapse.
Results
Relapse rates are very high when treatment is discontinued, even after a single psychotic
episode; a longer treatment period prior to discontinuation does not reduce the risk of relapse;
many patients relapse soon after treatment reduction and discontinuation; transition from
remission to relapse may be abrupt and with few or no early warning signs; once illness
recurrence occurs symptoms rapidly return to levels similar to the initial psychotic episode;
while most patients respond promptly to re-introduction of antipsychotic treatment after
relapse, the response time is variable and notably, treatment failure appears to emerge in
about 1 in 6 patients. These observations are consistent with contemporary thinking on the
dopamine hypothesis, including the aberrant salience hypothesis. Conclusions
Given the difficulties in identifying those at risk of relapse, the ineffectiveness of rescue
medications in preventing full-blown psychotic recurrence and the potentially serious
consequences, adherence and other factors predisposing to relapse should be a major focus of
attention in managing schizophrenia. The place of antipsychotic treatment discontinuation in
clinical practice and in placebo-controlled clinical trials needs to be carefully reconsidered.
Description
Publication of this article was funded by the Stellenbosch University Open Access Fund.
The original publication is available at http://www.biomedcentral.com/bmcpsychiatry/
The original publication is available at http://www.biomedcentral.com/bmcpsychiatry/
Keywords
Schizophrenia -- Relapse, Schizophrenia -- Treatment, Schizophrenia -- Chemotherapy, Discontinuation of medication
Citation
Emsley, R., Chiliza, B., Asmal, L. & Harvey, B.H. 2013. The nature of relapse in schizophrenia. BMC Psychiatry, 13:50, doi: 10.1186/1471-244X-13-50.