Relapse episodes of schizophrenia in patients treated with antipsychotic medications in Maiduguri: causes and interventions

Abstract

Relapse in schizophrenia can present with some difficulties in some settings. An understanding of factors that influence relapse episode in individuals can provide vital information to set priorities or design more effective preventive measures and institute appropriate interventions. Objectives: The objectives were to identify factors that cause relapses among patients in the region and to quantify the extent of relapse. Method: One hundred and thirty-four patients with schizophrenia, which comprise 72 males and 62 females with reported symptoms recurrence after first episode of the illness that lead to rehospitalisation, were studied. Demographic data were retrieved from the patients' case notes. The causes and duration of re-occurrence as well as the interventions taken to prevent further episode were investigated. Results: Patients who experienced first relapse episode within one month during home care were 6.7% while 11.2% of the patients reported first relapse within 2-5 months. Patients who similarly experienced first relapse within 6 months to 1 year,1-2 years, 2-5 years, 5-10 years and those above 10 years were 20.9%, 16.4%, 24.6%, 15.7% and 4.5% respectively. Sixty-six (49.3%) patients who experienced first relapse also had second relapse while 12 (9.0%) further experienced third relapse. Several patients' related factors such as financial problems (14.9%), perceived wellness (7.5%), forgetfulness (10.5%) and breast feeding (3.0%) were identified as the cause of relapse in some patients. Lifestyle related factors like substance abuse and medication related factors such as adverse effects accounted for 17.9% and 14.2% respectively. Disease-related factors such as poor insights (6.0%) and co-morbid depression (1.5%) were other identified causes. Many patients (22.4%) linked their relapse episodes to several insurgency-related problems. Relapse due to medication non-adherence accounted for 66.4% patients. The major interventions to prevent further episodes of schizophrenia were rehabilitation (29.9%), education and counselling (26.9%), change in drug formulation (25.4%), dosage adjustment (11.9%) and change of drug (6.0%). Conclusion: Several patients, medications, diseases and lifestyles' related factors were responsible for relapse of schizophrenia but patients' related factors such as non-adherence, substance abuse and treatment related factors particularly medication side effects were the most common causes. This study underscores the need to continually monitor drug therapy, identify factors that may cause relapse in individual and educate patients or their caregivers in order to