Discussing Wellness Maintenance with Consumers
Relapse should be discussed with the consumer and their family early on in their treatment. New Journeys builds a model of resiliency through modules dedicated towards identifying consumers personal strengths, support systems, and by developing and practicing a wellness plan. When talking about relapse, some individuals view ‘relapse with a negative connotation and see relapse as a failure or instill a fear of never recovering. For this reason, some prefer to use ‘well’ versus ‘unwell.’ It should also be emphasized that a relapse does not mean that recovery is not possible, and that relapse is a common step on the path to recovery.
Risk of Relapse
There is no one thing which can prevent a client becoming unwell again, or experiencing a relapse in psychotic symptoms. However there are things which can be done which can lower the risk of relapse, just as there are things which increase the risk. For more information on relapse, please view the below appendices.
Coordinated Specialty Care Centers, like New Journeys
Second generation anti-psychotics
Reducing substance use
Maintaining a healthy lifestyle
Identifying a support system
Following a wellness plan, especially when early warning signs reappear & identifying a "relapse signature"
Poor medication adherence
Lack of support from caregivers
Poorer premorbid adjustment
Engaging Families in Relapse Prevention
A collaborative model with clinicians, consumers, and their family is important in treating psychosis and relapse. It is important to include family and friends in identifying early warning signs and in the relapse plan. This is due to them typically being the first to notice changes in the mental state of the consumer that may indicate a possible relapse. They should be aware of the consumer’s prevention plan. It is important to include the consumer and family in decisions as the treatment process during recovery and relapse is complicated and requires a balance between risk of relapse as well as functional recovery. In New Journeys consumers and their families are given the opportunity to attend Individual Resiliency Therapy or Family Therapy to learn more about psychosis, early warning signs, and strategies for maintaining wellness.
Wellness Maintenance Resources
Addington et al. Relapse rates in an early psychosis treatment service. Acta Psychiatrica Scandinavica 2007; 115: 126-131.
Alvarez-Jimenez et al. Risk factors for relapse following treatment for first episode psychosis: a systematic review and meta-analysis of longitudinal studies. Schizophr Res 2012; 139: 116-28.
Wiersma et al. Natural Course of Schizophrenic Disorders: A 15-Year Followup of a Dutch Incidence Cohort. Schizophrenia Bulletin 1998; 24: 75-85. 4.
Almond et al. Relapse in schizophrenia: costs, clinical outcomes and quality of life. The British Journal of Psychiatry 2004; 184: 346-351.
Alvarez-Jimenez et al. Prediction of a single psychotic episode: a 7.5-year, prospective study in first-episode psychosis. Schizophr Res 2011; 125: 236-46.
Chen et al. Maintenance treatment with quetiapine versus discontinuation after one year of treatment in patients with remitted first episode psychosis: randomised controlled trial. BMJ 2010; 341: c4024.
Emsley et al. Treatment response after relapse in a placebocontrolled maintenance trial in schizophrenia. Schizophr Res 2012; 138: 29-34.
Gitlin et al. Clinical outcome following neuroleptic discontinuation in patients with remitted recent-onset schizophrenia. Am J Psychiatry 2001; 158: 1835-42.
Orygen: The National Centre of Excellence in Youth Mental Health. (2016). Clinical practice in early psychosis: Preventing relapse in first episode psychosis. https://www.orygen.org.au/Education-Training/Resources-Training/Resources/Free/Clinical-Practice/Preventing-relapse-in-FEP/Preventing-relapse-in-first-episode-psychosis
Because Your Mind Matters. Let's Talk about Psychosis [PDF file]. Retreived from https://becauseyourmindmatters.ca/pdf/causes.pdf
Here to Help. Preventing Relapse [PDF file]. Retrieved from https://www.heretohelp.bc.ca/sites/default/files/dwp-preventing-relapse.pdf
UNSW Counselling Service. (2007). Stress Bucket Explained [PDF file]. Retrieved from https://student.unsw.edu.au/sites/all/files/uploads/CAPS/Stress%20Bucket.pdf