Causes of Relapse
- Failure to take medication
- Use of alcohol or drugs
- Increased stress (once a person becomes schizophrenic it is a stress- related disorder).
- Family chaos – People with schizophrenia or bi-polar disorder have over-stimulated brains and thus, have less tolerance for stress. Environmental stigma causes stress. The effort to appear normal and behave normally takes great effort. A person with a brain disorder is emotionally or mentally frail the same way an elderly person is frail. Both should avoid over-exertion.
The most frequent symptoms of relapse are paranoia, insomnia and agitation. Other signs can be hostility, outbursts, hallucinations, fear, agitation, restlessness, anxiety, depression, withdrawal; decrease in grooming, eating; increase in obsession with religious fixations. Predictable stages of relapse or hospitalization can begin simply with your relative feeling overwhelmed.
Most patients see a clear sign of impending hospitalization before it occurs. They notice more difficulty sleeping, or “the voices were bothering me much more,” or they feel more agitated. 70% of mentally ill people can recognize their symptoms.
Five Main Types of Responses that are Helpful in Relapse
- “Brace” your relativewith additional support, i.e. temporary meds increase until they feel stable, change the focus of his/her activities.
- Decrease the amount of stress in their lives anyway you can.
- Don’t shout, don’t squabble, don’t threaten or criticize and don’t bait the ill person.
- Give your relative an opportunity to describe what is happening to them, but do notengage their voices. Mirror back to your relative that you know this is difficult forhim/her. It can be very helpful if they feel validated and understood.
- Seek additional help from other resources. See if there are other people who can help reducethe load. Three main sources: professionals such as psychiatrists, therapists, and family friends; secondly peers and self-help groups.
Stress and Relapse
Asking your ill relative to work all day may not be a reasonable request. Try to avoid stressful situations.
Holidays are really stressful for ill people. Members of extended family may have a new job, a new baby. They involve unfavorable comparisons for the person with mental illness.
You might need to change family holidays to reduce stress. Sometimes an environment that is stimulating for a normal person can be overwhelming for a schizophrenic. Reduce the number ofpeople attending an event and the length of time of any event.
Parties are stressful. They would like to drink like anyone else. To feel rejected can send them off the deep end; they may not feel like taking their meds. Your relative’sfeeling that their food, shelter or clothing is threatened can be very stressful, especially if they have tomove or they don’t have SSI, or have to reapply annually. The ill are vulnerable to losing theirincome, being evicted.
- A change in living arrangements or attending different groups or a different doctor may be stressful. All of these can trigger psychoses.
- A change in success is also stressful.
- Teach the person to leave the stressful situation. Give them a mantra to say over and over, (i.e. “This is distressing, but not dangerous,”“Calm begets calm” or “Let go and let God” or “Change focus.”). This may make their internal perception of the situation less threatening. Help the mentally ill person actively manage the situation. Discuss choices with them “You are getting too excited, why don’t you take a walk,” or “If you are frightened of these people, you stay with me for 10 minutes.”
When your relative can recognize their own signals of relapse, they are less likely to become hospitalized; this is primarily due to the ability to increase appropriate medication within 48 hours of symptoms appearing.
Sharon S. Dunas, MFT