Key takeaways

  • Changes in sleep patterns, such as difficulty falling asleep or staying asleep, can be an early sign of a schizophrenia relapse.
  • Caregivers should pay attention to changes in behavior, mood, and thinking, as these can signal a relapse and the need for treatment adjustments.
  • Creating a relapse action plan with the individual, including steps to take and who to contact, can help ensure they receive the support they need during a relapse.

A schizophrenia relapse can lead to changes in sleep, behavior, mood, and thinking. Symptoms may worsen quickly and can include delusions or hallucinations.

Following a treatment plan can lower a person’s risk of relapse, but relapse can still happen. When it does, treatment may need adjustment to help prevent symptoms or manage them more effectively.

Certain triggers, such as stress, alcohol use, and drug use, can increase the risk of schizophrenia relapse.

Recognizing the early signs of relapse and seeking treatment immediately may help prevent symptoms from becoming more severe.

Read on to learn more about the signs of relapse to watch out for.

A schizophrenia relapse happens when symptoms return or become more severe after a period of improvement. This can affect a person’s mental health, safety, and daily functioning.

Getting help early when signs of a relapse appear can make a meaningful difference.

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The following changes may be signs of relapse in someone with schizophrenia.

Sleep changes

If someone with schizophrenia has more trouble than usual falling asleep or staying asleep, it may be a sign of relapse. Difficulty waking up at appropriate times can also serve as an early warning sign.

However, changes in sleep can happen for many reasons, including stress, physical illness, travel, or inconsistent sleep routines. A single bad night of sleep doesn’t necessarily mean a relapse is coming.

“I tell my patients that any change in sleep is a first sign of something brewing,” Anna Costakis, MD, MBA, MD, MBA, Director of the Psychiatry Residency Training Program at Staten Island University Hospital, told Healthline. “If there is a change in sleep pattern over 2 to 3 nights, I would [reach out to] the treatment team for guidance.”

Behavioral changes

Changes in behavior can also signal a schizophrenia relapse.

  • Changes to usual activities or routine: The person may seem less interested in activities they usually enjoy or care about. They may start missing work, school, or other regular commitments.
  • Increased social isolation: The person may pull back from social activities or spend more time alone than usual.
  • Disorganized speech: The person may speak less than usual or say things that are hard to follow. This can include repeating words, stringing together unrelated ideas, or making off-topic comments or responses.

“Any change in the level of functioning of the person with schizophrenia should be addressed,” said Costakis.

“For instance, if the person usually attends a social function once a week and starts to skip this or begins to call out sick from work in an uncharacteristic way, it’s important for the village to rally around this person, point out the change, and loop in the psychiatric treatment team,” she said.

Emotional changes

The following emotional changes may be warning signs of a schizophrenia relapse:

  • low mood
  • irritability
  • anxiety
  • increased worry

Cognitive changes

A schizophrenia relapse can cause changes in cognition or thinking, including:

  • Difficulty concentrating: The person may have trouble focusing or paying attention. They may seem more distracted, disorganized, or forgetful than usual.
  • Paranoia: The person may believe they’re being watched or feel like they can’t trust others.
  • Delusions: The person may hold onto false beliefs, even when presented with information that contradicts those ideas.
  • Hallucinations: The person may hear voices, see things, or smell things that others don’t.

Symptoms of a schizophrenia relapse can worsen quickly. The presence of delusions or hallucinations may signal a psychotic episode and requires urgent medical attention.

If you help care for someone with schizophrenia, encouraging them to follow their treatment can help lower the risk of relapse. Limiting stress and other known triggers is also important.

Pay close attention to changes in the person’s behavior and mood. Check in with them about how they’re feeling, and ask whether they’ve noticed any symptoms or thoughts that feel troubling.

If you notice changes that may be a sign of a relapse, let the person know. Try using “I” statements to express concern, such as “I’m worried this could be a sign of a relapse.”

Reassure the person that you’re there to support them, and ask what might help. If they’re experiencing delusions or hallucinations, respond calmly. You can acknowledge their feelings without reinforcing the experience by saying things like “This sounds frightening for you,” while also explaining that you’re experiencing things differently.

Encourage the person to contact a mental health professional at the first signs of a relapse. They can help determine what’s happening and recommend ways to manage symptoms, which may include adjusting treatment.

Remember, it’s not your fault. Many factors can contribute to relapse. Showing compassion toward yourself and the person you care for can make navigating this experience a little easier for both of you.

Encourage the person to contact their mental health professional at the first signs of a relapse.

If the person feels hesitant about reaching out, try to stay calm. Ask questions to understand their concerns, and use “I” statements to explain why you think getting help is important.

Contact their care team directly if the person shows signs of a psychotic episode, such as delusions or hallucinations, or if you’re concerned they may harm themselves or someone else.

If you believe the person is in immediate danger, take them to the nearest emergency department or call 911.

You can also reach out for support through the Suicide and Crisis Lifeline. Call or text 988, or chat online with a trained counselor at 988lifeline.org.

Preparing for a possible relapse ahead of time can help both people with schizophrenia and their caregivers feel more supported and ready.

Consider working together to create a relapse action plan that outlines:

  • possible signs of a relapse
  • triggers that worsen symptoms
  • treatments and coping strategies that help manage symptoms
  • steps you or other caregivers can take during a relapse
  • contact information for the person’s psychiatrist and other healthcare professionals
  • which hospital or treatment facility the person prefers during a crisis
  • any health conditions the person has and medications they take
  • who will handle responsibilities such as finances, child care, or other daily obligations during a relapse

It’s best to create this plan when the person feels well and is thinking clearly, with few or no active symptoms. Some people also choose to work with a healthcare or legal professional to prepare documents that explain their wishes during a relapse.

These documents may include:

  • an advanced directive, which outlines the treatment the person wants to receive during a relapse
  • a power of attorney, which allows someone to manage finances if the person can’t
  • a durable power of attorney, which allows someone to make healthcare or other decisions on the person’s behalf

During a relapse, the person may have trouble thinking clearly or making reasonable decisions. Having a plan in place ahead of time can help ensure they receive support that aligns with their wishes.

If you help care for someone with schizophrenia, watch for changes in sleep, behavior, mood, or thinking. These changes may signal a relapse, which happens when symptoms return or become more severe after a period of improvement.

Let the person know if you notice possible signs of a relapse, and encourage them to contact their mental healthcare team for early support and treatment.

Contact their doctor right away if the person experiences hallucinations or delusions, or if you’re concerned they may harm themselves or others. If there’s an immediate danger to the person or those around them, take them to the emergency department or call 911.

Remember, a schizophrenia relapse is not your fault. While caregivers play an important role in support and care, no one can control every factor that contributes to relapse.

Support is available for both you and the person you care for as you navigate a relapse together.