The nature of relapse in schizophrenia

BMC Psychiatry

Review

Brian H Harvey¹  Robin Emsley²  Laila Asmal²  Bonginkosi Chiliza² 

[1] Center of Excellence for Pharmaceutical Sciences, School of Pharmacy (Pharmacology), North West University, Potchefstroom, South Africa;Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, 7505, Tygerberg, Cape Town, South Africa;

关键词: Schizophrenia;    Relapse;    Antipsychotics;    Discontinuation;    First-episode;    Dopamine;   

DOI  :  10.1186/1471-244X-13-50

 received in 2012-06-15, accepted in 2013-01-25,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundMultiple 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.MethodsWe critically review selected literature regarding the nature and underlying neurobiology of relapse.ResultsRelapse 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.ConclusionsGiven 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.

【 授权许可】

CC BY   
© Emsley et al.; licensee BioMed Central Ltd. 2013