Relapse is common in schizophrenia

Source (slide & notes):
Robinson et al. Arch Gen Psychiatry 1999; 56: 241–247, Table 1; 2. Csernansky & Schuchart. CNS Drugs 2002; 16 (7): 473–484, Page 474; 3. Kane. J Clin Psychiatry 2007; 68 (Suppl 14): 27–30; Page 27; 4. Lewis & Lieberman. Neuron 2000; 28: 325–334, Page 327; 5. Levander et al. Acta Psychiatr Scand 2001; 104 (Suppl 408): 65–74, Table 3; 6. Briggs et al. Health Qual Life Outcomes 2008; 6: 105, Page 8; 7. Boyer et al. BMC Psychiatry 2013; 13: 15, Page 4.

In schizophrenia, episodes of relapse (recurrence of psychosis) are common. A prospective, longitudinal, study examined the occurrence of relapse after response to a first episode of schizophrenia or schizoaffective disorder in 104 patients.^{[Robinson et al. Arch Gen Psychiatry 1999]} The cumulative rate for first relapse was 81.9% by the end of the 5-year follow-up.^{[Robinson et al. Arch Gen Psychiatry 1999]} Of the 63 patients recovering from the first relapse, the cumulative rate for a second relapse was 78.0% after 5 years.^{[Robinson et al. Arch Gen Psychiatry 1999]} The cumulative rate for a third relapse after 4 years was 86.2% among 20 patients who had recovered from a second relapse.^{[Robinson et al. Arch Gen Psychiatry 1999]}

Relapse can have significant repercussions for patients with schizophrenia:

• rehospitalisation^{[Csernansky & Schuchart. CNS Drugs 2002]}
• slow and incomplete recovery^{[Kane. J Clin Psychiatry 2007]}
• treatment-resistant illness^{[Kane. J Clin Psychiatry 2007]}
• persistent symptoms^{[Lewis & Lieberman. Neuron 2000]}
• progressive cognitive decline^{[Levander et al. Acta Psychiatr Scand 2001]}
• increasing difficultly to regain previous level of functioning^{[Kane. J Clin Psychiatry 2007]}
• reduced quality of life.^{[Briggs et al. Health Qual Life Outcomes 2008]}

Data from the European Schizophrenia Cohort study (EuroSc) reported that a higher level of quality of life predicted a lower rate of relapse at 24 months among patients with schizophrenia.^{[Boyer et al. BMC Psychiatry 2013]}

References:
Boyer L, Millier A, Perthame E, et al. Quality of life is predictive of relapse in schizophrenia. BMC Psychiatry 2013; 13: 15.

Briggs A, Wild D, Lees M, et al. Impact of schizophrenia and schizophrenia treatment-related adverse events on quality of life: direct utility elicitation. Health Qual Life Outcomes 2008; 6: 105.

Csernansky JG, Schuchart EK. Relapse and rehospitalisation rates in patients with schizophrenia: effects of second generation antipsychotics. CNS Drugs 2002; 16 (7): 473–484.

Kane JM. Treatment strategies to prevent relapse and encourage remission. J Clin Psychiatry 2007; 68 (Suppl 14): 27–30.

Levander S, Jensen J, Gråwe R, Tuninger E. Schizophrenia- progressive and massive decline in response readiness by episodes. Acta Psychiatr Scand 2001; 104 (Suppl 408): 65–74.

Lewis DA, Lieberman JA. Catching up on schizophrenia: natural history and neurobiology. Neuron 2000; 28 (2): 325–344.

Robinson D, Woerner MG, Alvir JM, et al. Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder. Arch Gen Psychiatry 1999; 56: 241–247.