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Section 6
Relapse in Schizophrenia

Question 6 | Test | Table of Contents

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In the last section, we discussed avoiding relapses.  Three aspects of avoiding relapse that we have examined are signs of relapse, decreasing stress and dating, and other healthy habits that can help prevent relapse.  

The focus of the last section was on things clients can do for themselves to avoid relapse.  In the next two sections, we will look at how family members of our clients can help prevent relapses by implementing a relapse prevention plan.  By formulating a specific plan for how the client and family members will respond to warning signs of relapse, the family can take advantage of resources to prevent relapse. 

In this section, we will examine the four basic steps to developing a relapse prevention plan.  The four steps are deciding how to conduct a family meeting for preventing relapses, discussing past relapses, discussing past stressful experiences, and putting together a relapse prevention plan.  As you listen to this section, you might consider your client’s family. Would playing this section for the family benefit your client?

4 Steps to Developing a Relapse Prevention Plan

♦ #1  Deciding How to Conduct a Family Meeting For Preventing Relapses
First, let’s discuss deciding how to conduct a family meeting for preventing relapses.  Gary’s father, Phil, spoke with me regarding Gary’s periodic relapses.  Gary, age 27, experienced relapses ever three to four weeks in spite of taking optimal doses of prescribed medication.

I stated to Phil, Gary’s father, "To decide how to conduct a family meeting, you might determine in advance who will be present at the meeting.  Consider where to hold the meeting, and how people will be contacted when early warning signs are first suspected.  In addition, you might also find it useful to choose someone to guide each meeting."  Phil listed who would attend the family meetings on his Relapse Prevention Plan.

♦ #2  Discussing Past Relapses
The second step in developing a Relapse Prevention Plan is discussing past relapses. Phil talked with Gary and other family members about past relapses. Phil stated, "I found it easier to just talk about Gary’s last two relapses, because going any further back just made everyone want to tell amusing stories." 

To make discussing past relapses a productive step, Phil asked two main questions regarding Gary’s past relapses.  Phil asked, "What early warning signs did we see?" and "What were the very earliest clues that a relapse was about to happen?"  Phil listed the early warning signs on the Relapse Prevention Plan. 

♦ #3  Discussing Past Stressful Experiences
In addition to deciding how to conduct a family meeting for preventing relapses and discussing past relapses, the third step to developing a relapse prevention plan was discussing past stressful experiences. I stated to Phil, "You might also consider talking about which types of situations have been stressful to Gary in the past and what has helped him reduce his stress." 

Phil also asked other family members what they had noticed about Gary’s symptoms in relation to a particular stressful experience. Phil understood that there was no right or wrong answer, so he listened to everyone’s points of view. Phil recorded Gary’s possible stressful experiences on the Relapse Prevention Plan.

♦ #4  Putting Together a Relapse Prevention Plan
The fourth basic step for developing his relapse prevention plan was for Phil to actually put together a relapse prevention plan. Phil found it productive to include the following steps in his plan. As I describe Phil’s steps, you might consider how you can organize the steps to help the family members of the client you are treating. 

Here is Phil’s outline of his relapse prevention plan:

Phil typed out Gary’s relapse prevention plan, and brought a new copy to each meeting.  This way, Phil could compare any changes in stress or warning signs.  Think of the family members of your client.  Could you help them to develop a relapse prevention plan?  Would your client benefit from the structure of the family meetings?  Also, you might consider how client participation in family meetings could benefit your Gary.

In this section, we have discussed the four basic steps to developing a relapse prevention plan.  The four steps are deciding how to conduct a family meeting for preventing relapses, discussing past relapses, discussing past stressful experiences, and putting together a relapse prevention plan. 

In the next section, we will relate the implementation of Gary’s relapse prevention plan.  We will also look at three steps a single family member or close friend can take to make it easier to head off a relapse.  Three steps a single family member or close friend can take to make it easier to head off a relapse are finding help, developing stronger relationships with the treatment team, and joining a self help advocacy association.
Reviewed 2023

Peer-Reviewed Journal Article References:
Husted, J., Severson, R., & Husted, S. (2010). Preventing relapse in persons with serious mental illness. Journal of Rural Mental Health, 34(1), 33–35.

Kamath, V., Crawford, J., DuBois, S., Nucifora, F. C., Jr., Nestadt, G., Sawa, A., & Schretlen, D. (2019). Contributions of olfactory and neuropsychological assessment to the diagnosis of first-episode schizophrenia. Neuropsychology, 33(2), 203–211.

Lampropoulos, D., Troïan, J., D'Amico, C., Bentata, L., & Apostolidis, T. (2018). Evidence for the influence of social dominance orientation and intergroup relations on the stigma of schizophrenia. European Journal of Health Psychology, 25(4), 133–139.

Lecomte, T., Potvin, S., Samson, C., Francoeur, A., Hache-Labelle, C., Gagné, S., Boucher, J., Bouchard, M., & Mueser, K. T. (2019). Predicting and preventing symptom onset and relapse in schizophrenia—A metareview of current empirical evidence. Journal of Abnormal Psychology, 128(8), 840–854.

Pitschel-Walz, G., Leucht, S., Bäuml, J., Kissling, W., & Engel, R. R. (2001). The effect of family interventions on relapse and rehospitalization in schizophrenia—A meta-analysis. Schizophrenia Bulletin, 27(1), 73–92.

QUESTION 6
What are the four basic steps to developing a relapse prevention plan? To select and enter your answer go to Test.

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