Early warning signs
A quarter of people who experience psychosis will have just one episode. However others are prone to further episodes. When psychotic symptoms return or get worse which may require extra medication or admission to hospital, this is called "relapse". Relapse is common in the early years after the first episode of psychosis. 50% (1 in 2) people are at risk of a further relapse of psychosis within the first two years after their initial psychotic episode.
Most people who have had a psychotic episode are fearful of a relapse and the return of unpleasant psychotic experiences. Although some people will try and cope with this fear by trying to forget their experience of psychosis and hoping it will not recur, most people are keen to try to prevent it from returning.
There are a number of ways that you can cut down the risk of having a relapse:
- Continuing to take prescribed anti psychotic medication on a regular basis after the first psychotic episode as this has been shown to reduce relapse risk
- Learning how to reduce and manage stress and identifying coping tools for dealing with stressfull life events
- Seeking and developing relationships with family and friends where you feel comfortable, happy and secure
- Avoiding using illicit drugs, particularly cannabis and amphetamines which can trigger further episodes
- Developing a life style which maintains your well being, which you feel is meaningful and rewarding
- Knowing your early warning signs of relapse and having a relapse prevention plan.
Approach your GP
GP's are now given an extra payment if they perform an annual review of physical health, medication and co-ordination arrangements within secondary care, and offer approriate health promotion and prevention advice. This includes documenting a "comprehensive care plan" in the primary health care record that includes a list of your early warning signs. So you might want to discuss this with your GP at the time of your regular review.
What are the early warning signs?
Before symptoms of psychosis such as hearing voices, thought withdrawal and delusional ideas return, they are often preceded by other earlier signs or changes. These are known as 'early warning signs'. This is similar to other physical health problems. For example, before we develop full blown flu we may start with having a sore throat or blocked nose or feel under the weather. Psychosis is often preceded by a number of different signs or symptoms which can occur days or sometimes weeks before. Early warning signs typically include changes in the way you are thinking, feeling or behaving.
Common early warning signs are:
The person may become:
- Suspicious of others
- Depressed or low
- Tense, afraid or anxious
- Irritable and snappy
- More quiet and withdrawn
- Puzzled about strange experiences.
A person may experience:
- Sleep disturbance
- Appetite changes
- Mood changes
- Loss of energy or motivation
- Difficulty in concentrating or remembering things.
A person may feel:
- That their thoughts are speeded up or slowed down
- That things are somehow different
- Things around them seem changed
- Puzzled about strange experiences
- Restless.
Often family and friends are the first to notice when:
- A persons behaviour changes
- A persons study or work deteriorates
- A person becomes more withdrawn or isolated
- A person is no longer interested in socialising and begins to neglect their appearance or hygiene
- A person becomes less active
- A person appears confused or puzzled.
Different people will have different patterns of early warning signs both in terms of the type of early warning signs experienced and in what order they experience them. There are quite a range of possible early signs, some of which may be quite specific and unique for a particular person.
Early signs tend to follow a similar pattern each time a person is unwell. We call this specific pattern of early signs changes a 'relapse signature'.
These changes might be a reaction to stressful events such as hassles at school, problems at work or in relationships. Equally, they can be early warning signs of a developing psychosis and it is important that these changes are checked out and that you begin to do something about them early rather than leaving them to get worse and allowing a full relapse to occur. Recognising your own early warning signs in order to help prevent relapse, will help you to feel you have control over your illness rather than feeling that it controls you.
Early warning signs are important because they can help you to recognise signs of relapse taking place altogether, or to reduce the severity of the relapse and avoid hospital admission.
Once you have identified your early signs of relapse signature, it is important then to learn how to manage those signs and to begin to take responsibilty for yourself and identify ways to maintain your wellbeing.
This involves developing skills to recognise and control early warning signs of relapse.
You will find that as you begin to learn to recognise and manage early signs you will feel more confident and in control as you begin to trust your own judgement and take action to help yourself stay well.
Ask a professional involved with your care to assist you in identifying your early signs and developing a relapse prevention plan in response to your particular early signs of relapse signature.
Relapse prevention plan
As well as learning more about your own early warning signs in order to detect if the psychosis is returning, it is equally important to think about what you can do to intervene if early signs occur and to put this together in a 'relapse prevention plan'.
A relapse prevention plan should include:
- Identifying potential stress triggers or vulnerable times when you may be at particular risk of relapsing
- Listing your particular early signs of relapse (your relapse signature)
- Identifying coping strategies to tackle specific early signs if they appear
- Listing any medication that may have been prescribed to assist you in managing early signs
- Identifying who to contact for extra help and support, including family, friends and professional involved in your care.
It is important to remember that the earlier you pick up signs and respond to them, the more likely it is that you are going to be effective in managing early signs. The longer you leave it the harder it will be to control early signs and prevent relapse. For most people, it is typically one or two weeks in which you can successfully stop early signs escalating into relapse. If you find yourself stalling for time or wanting to delay on acting on early signs, remind yourself what the last episode was like and the adverse impact that it had on you, your life, your relationships and your family and ask yourself whether it is worth having another episode?
Equally, it is important to remember that the relapse prevention plan is not totally fool proof and there is still a chance that you may have a relapse in spite of the best laid plans. If this does happen, you can use this extra knowledge and experience to review and refine your knowledge about your early signs and to look at ways you may be able to strengthen and improve your relapse prevention plan to prevent it happening again.
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