What to Know About Schizophrenia Relapses

Schizophrenia is a mental health condition that demands vigilance. Even with a good response to initial treatment, schizophrenia symptoms often return. A return or worsening of symptoms following a period of remission is called a relapse.

The sooner the symptoms of a schizophrenia relapse are recognized, the greater the likelihood is of regaining control.

“Complete remission of schizophrenia symptoms is uncommon,” says Sophia Frangou, MD, PhD, a psychiatry professor at the Icahn School of Medicine at Mount Sinai Hospital in New York City. “Most people will experience a recurrence of symptoms.”

Some schizophrenia relapses occur without warning, but when early signs are present, they’re usually a return of early symptoms that have occurred in the past.

• Insomnia
• Increasing paranoia, depression, or anxiety
• Agitation, irritability, or tension
• Social withdrawal
• Changes in usual eating patterns
• Difficulty concentrating
• Loss of interest in usual activities
• Difficulty keeping up with personal hygiene
• Disturbing or recurring thoughts

Knowing these symptoms is important, but knowing the symptoms that are specific to each person with schizophrenia — called “relapse signatures” — is more important. Most people with schizophrenia will experience those early symptoms before a full relapse sets in.

“These warning symptoms can be very specific,” says Michael T. Compton, MD, MPH, a professor of psychiatry at Columbia University in New York City. “For one person, it may be insomnia or worries about the neighbors. For another person, it may be irritability or hearing whispers.”

In fact, the warning signs may be as specific as avoiding certain foods or colors, Dr. Frangou says.

That’s why it’s important to know the earliest symptoms of previous episodes and to watch for them. “The first sign of a relapse is repeating symptoms of a previous episode,” Frangou says.

Knowing the common causes of a schizophrenia relapse can tell you when to be on the lookout for a relapse of symptoms.

Not taking medication regularly or as prescribed is by far the most common cause of a schizophrenia relapse. Persistent use of drugs or alcohol and criticism from caregivers are next on the list. “Many people with schizophrenia abuse some type of drug, most commonly marijuana,” Frangou says.

Stress is particularly problematic. “Stress may contribute to schizophrenia relapse, but symptoms of relapse can also increase stress,” she says.

“You may not be able to prevent a schizophrenia relapse, but early recognition and treatment may prevent a hospital admission,” Compton says. “The first thing to do is call the person’s doctor to find out if his or her medication needs to be adjusted or restarted.” Other strategies include:

• Staying on medication
• Finding effective ways to cope with stress
• Avoiding drugs and alcohol
• Sleeping and eating well
• Having a social support system
• Not withdrawing from friends and loved ones
• Getting psychosocial treatments, which help people with schizophrenia and their families learn how to live with the condition. These include individual, group, or family education, as well as counseling. “Increasing psychosocial treatments can be an important part of relapse prevention,” Compton says.

You may not always be able to prevent a schizophrenia relapse, but recognizing early relapse symptoms and getting help right away can help prevent a more severe episode, Compton adds.

The Takeaway

• Even with treatment, many people with schizophrenia experience relapses.
• Symptoms of a schizophrenia relapse vary by person, but they might include insomnia, social withdrawal, and difficulty concentrating, among others.
• Not taking prescribed medications as directed is the most common cause of a schizophrenia relapse.
• To mitigate the impacts of a schizophrenia relapse, experts recommend staying on prescribed medications, avoiding drugs and alcohol, reducing stress levels, and other strategies.