Related to [[All things related to Recovery]] --- # What's a Prodromal Phase? - It's a concept to describe the period of time before the first onset of psychosis. Retrospectively. - Terms like Ultra-High Risk, At Risk Mental States, are terms used to describe people who are "at risk" of developing full blown psychosis. - Not really a DSM diagnosis. - Clinically, we support these individuals, hope to prevent them "crossing over" to Psychosis - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539292/ --- Source [[Book - Healing - Our Path from mental illness to mental health. Thomas insel]] " Today we know that most people with SMI develop psychosis after two or three years of more subtle changes. They gradually become preoccupied with bizarre, sometimes paranoid thoughts, they distance themselves from friends and family, and they may have trouble concentrating. This phase, now called the prodrome, may represent a critical period for preempting psychosis with intensive psychotherapy." # Relapses General Observations about Relapses (Agree with this [[Article - The Nature of Relapse in Schizophrenia]]) > [!INFO] >Observations : >1. Relapse rates are very high after treatment discontinuation, even after a single episode of psychosis. >2. A longer treatment period prior to discontinuation does not reduce the risk of relapse. >3. Many patients relapse very soon after treatment discontinuation. >4. ==The transition from remission to relapse may be abrupt, with few early warning signs.== >5. Once illness recurrence occurs symptom severity rapidly returns to levels similar to the initial psychotic episode. >6. While most patients respond promptly to reintroduction of antipsychotic treatment after relapse, the response time is variable and frank treatment failure may emerge in a subset of patients. **Relapses are common.** - "The rate of relapse within the first years after SCZ onset has been estimated to be about 34–37% (Ucok and Cakr 2006; Addington et al. 2013), while the lifetime risk of relapse has been estimated to be up to 70%, irrespective of the pharmacological treatment (Sartorius et al. 1996; Wiersma et al. 1998)." Source [[Article - Clinical factors related to schizophrenia relapse]] - A prior study found that the cumulative first and second relapse rate was 81.9% and 78% respectively within 5 years of recovery from the first episode of schizophrenia and schizoaffective disorder [7]. The risk of relapse is found to be significantly higher after treatment reduction or discontinuation [6]. - Source [[What is Schizophrenia]] - Each relapse carry biological risk. Worsen the level of functioning, take longer time to treat - "the risk of a chronicity of the disorder with severe function impairment seems to increase with the number of relapses (Muller 2004)." - [[Article - Clinical factors related to schizophrenia relapse]] - and from [[Article - The Nature of Relapse in Schizophrenia]] - [[Prodrome signs of mental illness may reflect the social nature of the problem]] - Psychosocial-spiritual perspective - About 65% of individuals with a first episode relapse during the subsequent three years [16], resulting in inpatient costs about two to five times higher compared to non-relapsed patients [17]. - Source [[202108310949 Internet based intervention for people with psychosis study EviBas]] # Picking up Relapses (Related to note [[Anomaly detection]]) - In short, It's difficult to predict a relapse. Duration / intervals between relapses varied. ![[Article - The Nature of Relapse in Schizophrenia#^11ca94]] - [[Article - The Nature of Relapse in Schizophrenia]] - Deviation from a regular behavioral pattern impact on individual mental well being and possibly bring about relapse signs. - Source : [[202111130954 Deviation from a regular behavioral pattern impact on individual mental well being and possibly bring about relapse signs]] - [[202111130955 Prior to relapses, there is increase in anomalies in mobility and social behavior]] - ![[Article Routine Clustering of Mobile Sensor Data Facilitates Psychotic Relapse Prediction in Schizophrenia Patients#^131d2c]] - Negative symptoms of schizophrenia measured via EMA or clinical ratings have been predicted by geolocation-based mobility metrics, voice activity, and actigraphy-based metrics of gesture and activity level (99, 107–110) - Source [[Digital Phenotype Signals associated with Psychosis]] - Borrow ideas from [[How bacteria talk]] - Quorum sensing "what is the density of signals needed to predict relapse? or unwell-ness?" # Risk Factors for Relapses - [[What's our conceptual framework]] | [[Vulnerability factors - Process A]] - Sleep problems and Worrying. - By providing interventions to target potential precursors in psychosis - Source [[202108311024 Sleep problems and worrying precede psychotic symptoms during an online intervention for psychosis]] - [[Insomnia affects the quality of life and could be a cause or maintain mental illness, increasing the risk of its relapse]] - [[Measuring Sleep Efficiency - What Should the Denominator Be]] - [[The prevalence and management of Poor sleep quality in a secondary care mental health population]] - ?What's the Link between Sleep and Relapse? - ==Poor sleep between 1 to 15 days is anticipate worsen negative affect and cognitive symptoms?== - [[Article - The Temporal Dynamics of Sleep Disturbance and Psychopathology in Psychosis - A Digital Sampling Study]] - Clinical Risk Factors [[Article - Clinical factors related to schizophrenia relapse]] - Male gender was found associated with a higher risk of relapse in the most part of studies (Perlick et al. 1992; Vazquez-Barquero et al. 1999; Grossman et al. 2006; Abdel-Baki et al. 2011) - Younger age onset - Being single - Lower Pre-Morbid functioning - Long Duration of Untreated Psychosis - Substance use - Poor rapport with clinicians - Poor relationships with family - Absence of insight - For Bipolar Disorder: Three path to illness or relapses - (1) nonadherence to medication - (2) Stressful life events, especially interpersonal events and changes in social roles - (3) disruptions in social rhythms - Source: [[A Brief Overview of Interpersonal and Social Rhythm Therapy]] # Reducing Relapses - CBTp targets psychological mechanisms of symptom formation and maintenance that were primarily identified or corroborated using experimental psychopathology research [25–27] - Source [[202108310949 Internet based intervention for people with psychosis study EviBas]] - Psychoeducation - Source [[Psychoeducation]] --- Related - ITAREPS - [[Article Ecological Momentary Assessment and Intervention in the Treatment of Psychotic Disorders A Systematic Review]] - TechCare - [[Care Co-Ordinator in my Pocket. A feasibility study of mobile assessment and therapy for psychosis - TechCare]] - FOCUS - [[FOCUS - Ben Zeev, Brenner, Begale, Mueser]] - Current ongoing "PRESTRING" study - [[PRESTRING Study]] - [[List of EMA EMI SYSTEMS]] - [[The Challenges of Automating Case Management]] - [[Digital Phenotype Signals associated with Depression]]