Mechanisms of Relapse Prevention in Schizophrenia

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Abstract
Introduction: A relapse can be expected in 70 % of patients after the first schizophrenic episode; in parallel 70 % of patients show an incomplete remission of the disorder after the first episode. This includes a cognitive decline and persistence of schizophrenic negative symptoms, often associated with social disabilities, social decline and a worsened quality of life. The risk for a relapse after a schizophrenic episode remains increased throughout the patient’s lifetime. Moreover, the risk for chronic disorder increases with every relapse of the patient. Therefore relapse prevention is a primary focus in the treatment of schizophrenia. Methods: Studies point out that atypical antipsychotics have advantages in relapse prevention of schizophrenia compared to the ‘classical’ antipsychotics, although comparative studies are still lacking. Results: The main risk factor for a relapse is the withdrawal of antipsychotic medication. Nonbiological factors such as high-expressed emotions, adverse life events and stress contribute to an increased risk of schizophrenic relapse. Studies of relapse after withdrawal of antipsychotic medication revealed that noradrenergic, serotonergic, and dopaminergic neurotransmission are involved, low serotonergic and high dopaminergic neurotransmission are associated with a relapse, and possibly high noradrenergic neurotransmission plays a role in short-term relapses. Inflammation and the activation of certain cytokines, which have rarely been studied to date, seem to have an even higher impact on schizophrenic relapse. Methodological aspects of these studies are discussed. Conclusion: Biological mechanisms of relapse may not become fully elucidated before the mechanisms of the schizophrenic pathophysiology are clarified.

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