Schizophrenia has a relatively high risk of relapse. Estimates that ≥80% of schizophrenia patients experience a recurrence in the first five years after remission. Frequent recurrences in schizophrenia can cause many problems, such as the risk of injuring oneself and others, impaired social function, difficulties in work and education, and psychological pressure related to stigma in the community. Recurrence or relapse can also increase the risk of disease severity and treatment failure.

Schizophrenia Relapse: Risk Factors and How to Prevent
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Risk Factors of Schizophrenia Relapse

Three factors influence the risk of relapse in schizophrenia, namely, pharmacotherapy, psychotherapy, and general risk factors.

A. Pharmacotherapy Factors
There are several different opinions regarding maintenance therapy in schizophrenia. Some experts choose not to provide maintenance therapy after schizophrenia symptoms are controlled. However, existing studies show that maintenance therapy using antipsychotic drugs can reduce the risk of relapse by up to one-third in the first year.

The use of polypharmacotherapy also has been reported to be associated with an increase in treatment interruptions by patients. Although it is not yet known whether it can increase the risk of relapse. The use of first-generation antipsychosis is also associated with a higher risk of relapse.

B. Psychotherapy Factors
The use of cognitive behavior therapy and psychoeducation is reported to reduce the risk of relapse.

C. General Risk Factors
Several studies study certain clinical manifestations that affect the risk of relapse. Some reports showed that males, disease onset at a younger age, duration of untreated psychosis, substance abuse, and low support groups were associated with a higher risk of relapse.

How to Prevent Schizophrenia Relapse

Antipsychosis in the Preventing Schizophrenia Relapse

Antipsychosis is an agent to prevent relapse in schizophrenia. A systematic review reports that the use of maintenance antipsychotics can reduce the risk of relapse, improve quality of life, and decrease aggressive behavior compared to placebo. Antipsychotic drugs in the form of depot preparations reduce the risk of relapse more than oral preparations. However, this study did not mention the recommended dosage and duration of treatment.

First Generation Antipsychotic VS Second Generation for Prevention of Relapse Schizophrenia
In daily clinical practice, antipsychosis is classified into two major groups: the first and second generations. 
1st-generation: haloperidol, molindone, and chlorpromazine.
2nd-generation: olanzapine, risperidone, and clozapine.

The 2nd-generation antipsychosis has side effects such as extrapyramidal (EPS) and tardive dyskinesia, which are mild.  Therefore, Second-generation antipsychosis is preferred over the first generation. However, the 2nd-generation antipsychosis has high metabolic side effects that can cause weight gain, insulin resistance, and dyslipidemia.

A meta-analysis was carried out involving 23 studies with a total of 4504 respondents. This study concludes that second-generation antipsychosis is superior in preventing relapse at 3, 6, and 12 months compared to the first generation.

A randomized controlled trial (RCT) reported that paliperidone palmitate 175 mg every three months, followed by 263, 350, and 525 mg, effectively prevented relapse. Other RCTs reported that lurasidone at the initial dose of 40 mg orally per day for 28 weeks is also effective in preventing relapse.

The Role of Psychoeducation in Preventing Relapse

Family psychoeducation involves the patient's family members as the doctor's partners to complement pharmacological interventions. The patient's family members get education about how to interact with patients and the skills to deal with and fight psychoneurological deficits caused by schizophrenia.

A literature review by McFarlane et al. stated that this intervention is one method that has consistently proven effective.  In China, compared with pharmacotherapy only, family psychoeducation reduced the risk of relapse by half. (16.3% versus 37.8%).

Artificial Intelligence in Preventing Relapse
An artificial intelligence called SleepSight is being developed to detect relapse in schizophrenia. SleepSight is a wireless device implanted with a smartphone to collect longitudinal accelerometer data, heart rate, light around the patient, and smartphone usage patterns. These data will be encrypted and expected to help doctors detect symptoms of relapse early.

To date, research on SleepSight still has a small number of subjects (n = 16). But the results are quite promising, and this way can be a breakthrough in detecting relapse schizophrenia as early as possible.

Relapse rates in schizophrenia patients are estimated to exceed 80% in the first five years after remission. Some things doctors can do about this, one of which is using second-generation antipsychotics as maintenance therapy. Some recent studies have shown that paliperidone palmitate and lurasidone can be an option. Compared with only using pharmacotherapy, family psychoeducation can reduce the risk of relapse by half.

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