Common Causes of Relapse

  1. Failure to take medication
  2. Use of alcohol or drugs
  3. Family chaos.
  4. Increased stress. People with mental health conditions such as schizophrenia and bipolar disorder have over-stimulated brains and less tolerance for stress. Environmental stigma also causes stress. The effort to appear “normal” and behave normally takes great effort. A person with a brain disorder is emotionally or mentally frail and should avoid over-exertion.

Symptoms of Relapse

The most frequent symptoms of relapse are paranoia, insomnia, and agitation. Other signs can be hostility, outbursts, hallucinations, fear, agitation, restlessness, anxiety, depression, and withdrawal. There might be a decrease in grooming or eating, and an increase in obsessions with religious fixations. Predictable stages of relapse or hospitalization can begin simply with your relative feeling overwhelmed.


Most patients see a clear sign of impending hospitalization before it occurs. They notice more difficulty sleeping, feel more agitated, or share that “the voices were bothering me much more.” 70% of people with mental health conditions can recognize their symptoms.

Five Types of Responses that are Helpful in Helping a Loved One Who is Relapsing

  1. “Brace” your loved one with additional support (i.e. a temporary meds increase until he/she feels stable).
  2. Change the focus of his/her activities.
  3. Decrease the amount of stress in his/her life, any way you can.
  4. Don’t shout, squabble, threaten, criticize, or bait the person.
  5. Give your relative an opportunity to describe what is happening to them, but do not engage their voices. Mirror back to your relative that you know this is difficult for him/her. It can be very helpful if they feel validated and understood.
  6. Seek additional help from other resources. See if there are other people who can help reduce the load. Seek help from psychiatrists, therapists, family friends, peers, and support groups.

Stress and Relapse

Asking your loved one to work all day may not be a reasonable request. Try to avoid stressful situations.

Holidays are stressful for those with mental health conditions. Members of extended family may have new jobs, new babies, or other happy news to share. This can invite unfair and unfavorable comparisons for those with mental health conditions.

You might need to change family holidays to reduce stress. Sometimes an environment that is stimulating for a healthy person can be overwhelming for someone with schizophrenia or another mental health condition. Reduce the number of people attending an event and the length of time of any event.

Parties are stressful. Those with mental health conditions might like to drink along with everyone else. To feel rejected can provoke the person to stop taking their meds. Your relative’s feeling that their food, shelter, or clothing is threatened can be very stressful, especially if they have to move or they don’t have SSI, or have to reapply annually. Many are vulnerable to losing their income or being evicted.

  1. A change in living arrangements or attending different groups or a different doctor may be stressful. All of these can trigger psychoses.
  2. A change in success is also stressful.
  3. Teach the person to leave the stressful situation. Give them a mantra to say over and over, (i.e. “This is distressing, but not dangerous,”“Calm begets calm” or “Let go and let God” or “Change focus.”). This may make their internal perception of the situation less threatening. Help the mentally ill person actively manage the situation. Discuss choices with them. “You are getting excited, why don’t you take a walk,” or “If you are frightened of these people, you stay with me for 10 minutes.”

Relapse Recognition

When your loved one can recognize their own signals of relapse, they are less likely to become hospitalized; this is primarily due to the ability to increase appropriate medication within 48 hours of the time symptoms reappear.