Apart from recovery, preventing a relapse is also an important part of managing a mental illness
Recovery in a mental illness is a process of healing and change that enables individuals to regain their mental health and wellness so they can resume their activities as before. However, due to reasons not foreseen, some symptoms of mental illness can make a comeback, which hampers with the recovery. In the case of severe mental illnesses such as schizophrenia and bipolar disorder that require lifelong care, the possibility of relapse are very high. However, the effect of relapse depends on the nature of the condition and its severity.
For common mental illnesses such as depression, relapse could mean a loss of productivity and a drop in motivation or social interaction. For more severe mental illnesses, relapse could mean a drastic drop in everyday functions, social withdrawal, experience delusions or hallucinations or become aggressive.
What is relapse?
Relapse is the onset of symptoms after recovery. Relapse usually occurs in phases, and each person’s relapse has a specific pattern, that is, a list of symptoms that recur with every episode. If the person has experienced relapse once, being aware of symptoms of relapse can help them and the caregivers manage it better together or seek help at the right time.
Why does relapse occur?
A change in the medication, a change in the dosage or sudden stoppage of medication can bring about the warning signs of relapse. As a person with mental illness, if you feel that the medication or dosage is being changed, it is best to talk to your psychiatrist to ask them what you can expect; and get in touch with them if you notice any change in your behavior or thoughts. As a caregiver, observe whether the person with mental illness is feeling better or worse with the change of medication, and talk to the treating psychiatrist about it.
Relapse can also occur due to substance use, drugs or alcohol. It could also occur due to stress from life events such as job promotion, marriage, pregnancy and the birth of a baby; or challenges such as the loss of a job or the death of a loved one.
Is it possible to predict a relapse?
Usually, the early warning signs of relapse can be noticed a few days or weeks before by the person with illness or their caregivers. These early warning signs can be changes in the person’s thoughts, behavior and perceptions.
Changes in appetite
Feelings of unease, not being able to relax
Feeling tense or irritable
Lack of attention to appearance and personal hygiene
Inability to concentrate, forgetfulness
Unexplained pains and aches (for depression)
Planning for help during relapse
As caregivers, it is important to know that the signs of mental illness can make a comeback after recovery. You can also involve the person with illness and their mental health professional in creating the outline. Here are some steps to take when preparing for a relapse:
Specific signs of changes/early warning signs: Caregivers can recognize the specific changes in thoughts, behavior and emotional status of person with illness - are they more irritated than usual? Is there any drastic change in the sleeping patterns? The caregiver can note down the degree of intensity, and the frequency of the signs.
Discuss the relapse episode: If the person with illness is completely dependent on their caregivers, it is important for both of them to discuss the relapse episode. If the person is moderate or high functioning, the caregivers can discuss the warning signs with them, and create a plan for management.
Track their medication - be it a change of dose, change of medication, or consumption patterns. This helps the person with illness note the changes that come along with it. The caregiver can also consult the treating psychiatrist to create an action plan.
Mark stressful events: If the person with illness is anticipating any major life event, even positive ones, it is important for caregivers to be aware of them and discuss with the person on how to manage the symptoms.
Recovery after relapse
Recovery after a relapse episode can be a challenging time and requires support and patience from the caregivers. If the person with illness has not made sufficient recovery in their illness, relapse can feel de-motivating and affect their self-esteem. As a caregiver, you can reassure them that they have your support. If you as a caregiver are feeling emotionally overwhelmed with the situation, you could consult a therapist to talk about it. It is important to clarify any doubts that both the caregiver and the person with illness may have about relapse with the treating psychiatrist.
System to Aid Recovery booklet, SouthWest Healthcare Mental Health Services, Australia
With inputs from Dr Krishna Prasad, assistant professor, department of psychiatric rehabilitation services, NIMHANS and Dr Dayal Mirchandani, psychiatrist based in Mumbai.