RESEARCH WEEKLY: Preventing Relapse After First Episode Psychosis 

By Hope Parker

(February 15, 2023) More than half of individuals who experience first episode psychosis will relapse in the following 10 years, meaning after their positive symptoms go away with treatment, symptoms come back to at least the same severity as before. This makes identifying risk and protective factors for relapse a priority among clinicians and researchers.  

Researchers in Canada conducted a series of focus groups where young adults who were receiving early intervention services after first episode psychosis were asked to explain factors they thought contributed to or prevented relapse in order to gain their unique perspectives. Their results were published in Psychiatric Services in June 2022.  

Study details

From 2014-2015, 25 young adults with a psychotic disorder were recruited from four different early intervention service sites in Canada. During an interview, the participants were asked open-ended questions about relapse and how specific topics may contribute to or prevent it. After the focus groups were completed, the researchers analyzed the transcripts of the sessions to identify factors that were mentioned by four or more participants. These factors were then sorted into contributory, preventative or mixed categories.  

Study results

The tables below describe the factors that either contribute to or prevent relapse. The left column lists the factors the participants identified, while the right column lists the number of participants that mentioned these factors in the focus groups. 

Participants identified the following factors as contributing to relapse: 

Participants identified the following factors as preventing relapse: 

The groups also identified four factors that could either contribute to or prevent relapse: social environment, technology use, medication and lifestyle factors. Different aspects of these factors may either prevent or contribute to relapse depending on how they present in the lives of participants. 

While most participants said that having supportive friends, family members and healthcare providers could prevent relapse, some participants also mentioned that the stress of intimate partnerships, breakups and unsupportive loved ones could also be a contributing factor to relapse occurring. Several participants suggested that psychoeducation in formal school settings may help reduce stigma and increase support. 

More than half of participants said that technology use can raise the risk of relapse, because it may trigger feelings of being monitored, tracked and manipulated. However, almost all participants said that technology can also help prevent relapse. They stated that the internet can help individuals access mental health resources as well as keep them connected to loved ones.  

The majority of participants endorsed the idea that taking medication as prescribed prevents relapse. Some participants mentioned adverse effects of their medication and the need for a more holistic approach to preventing relapse rather than just medication alone. 

Almost half of participants stated that positive lifestyle behaviors, like getting proper sleep, exercise and eating well could help prevent relapse. The importance of routine and work- life balance were also mentioned as lifestyle factors that are preventative. Participants also explained that not taking care of oneself may contribute to having a lower stress tolerance and therefore may raise the risk of relapse.  

Implications

While multiple studies have investigated risk factors for relapse after first episode psychosis, little research has utilized the perspectives of those in recovery and using early intervention services. The authors of this paper hope that their findings may help inform risk assessment tools and additional resources necessary for this population. The use of technology, focused interventions for stress and psychoeducation for patients and families are some of the recommendations the authors suggest to help prevent relapse in individuals with first episode psychosis.  

References

Lal, S., et al. (2022, December). Young Adults’ Perspectives on Factors Related to Relapse After First-Episode Psychosis: Qualitative Focus Group Study. Psychiatric Services.  

Hope Parker is a research assistant at Treatment Advocacy Center.

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