title: Are there clinically useful predictors and early warning signs for pending relapse?
abstract: OBJECTIVE
  Despite the availability of effective long-term treatment strategies in schizophrenia, relapse is still common. Relapse prevention is one of the major treatment objectives, because relapse represents burden and costs for patients, their environment, and society and seems to increase illness progression at the biological level. Valid predictors for relapse are urgently needed to enable more individualized recommendations and treatment decisions to be made.
  
  
  METHODS
  Mainly recent evidence regarding predictors and early warning signs of relapse in schizophrenia was reviewed. In addition, data from the first-episode (long-term) study (FES; Gaebel et al., 2007, 2011) performed within the German Research Network on Schizophrenia were analyzed.
  
  
  RESULTS
  On the basis of FES data, premorbid adjustment, residual symptoms and some side effects are significant predictors. Although a broad spectrum of potential parameters has been investigated in several other studies, only a few and rather general valid predictors were identified consistently. Data of the FES also indicated that predictive power could be enhanced by considering interacting conjunctions, as suggested by the Vulnerability-Stress-Coping model. Prospective studies, however, are rare. In addition, prodromal symptoms as course-related characteristics likewise investigated in the FES add substantially to early recognition of relapse and may serve as early warning signs, but prognosis nevertheless remains a challenge.
  
  
  CONCLUSIONS
  Comprehensive and well-designed studies are needed to identify and confirm valid predictors for relapse in schizophrenia. In this respect, broadly accepted and specifically defined criteria for relapse would greatly facilitate comparison of results across studies.
authors: Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany. Electronic address: wolfgang.gaebel@uni-duesseldorf.de.
authors: Wolfgang
authors: W
authors: Gaebel
authors: Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany.
authors: Mathias
authors: M
authors: Riesbeck
mesh_terms: D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D062706:Prodromal Symptoms; D012559:Schizophrenia / Q000175:diagnosis*; D012565:Schizophrenic Psychology; D055502:Secondary Prevention
keywords: Early warning signs; Predictors; Prodromal symptoms; Relapse; Schizophrenia