title: The nature of relapse in schizophrenia.
abstract: BACKGROUND
  Multiple 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.
  
  
  METHODS
  We critically review selected literature regarding the nature and underlying neurobiology of relapse.
  
  
  RESULTS
  Relapse 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.
  
  
  CONCLUSIONS
  Given 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.
authors: Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, 7505, South Africa. rae@sun.ac.za
authors: Robin
authors: R
authors: Emsley
authors: Bonginkosi
authors: B
authors: Chiliza
authors: Laila
authors: L
authors: Asmal
authors: Brian H
authors: BH
authors: Harvey
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use; D018450:Disease Progression; D004298:Dopamine / Q000502:physiology; D006801:Humans; D012008:Recurrence; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology
chemical_list: D014150:Antipsychotic Agents; D004298:Dopamine
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