After recovering from an episode of your illness, there is a chance that you may not have any further symptoms. There is also a chance that you may have a relapse.
It is important to be prepared for another episode of illness, even if it never happens. Preparing does not mean you are being pessimistic or assuming that you will become ill again. It means knowing what to do just in case, so that you can get on with the rest of your life.
A relapse is said to occur when the symptoms of your illness worsen or when previous symptoms return. Many people have experienced one or more relapses of their illness. These relapses are exacerbations of their illness, particularly in their positive symptoms. A relapse may or may not require hospitalisation. After a relapse you may still experience persistent symptoms. Persistent symptoms are experienced more or less constantly, and do not indicate that you are about to become very unwell.
However, before a relapse happens people often experience changes in their symptoms or in some aspect of their behaviour, thoughts or feelings. These changes are called warning signs, they are indications that a relapse may be imminent.
Some warning signs are common and include feeling suspicious or irritable, feeling very tired or unusually energetic, and sleep changes. Other warning signs are highly individualised and include all sorts of changes to your behaviour, mood and thoughts. If you can identify your warning signs as early as possible, you may be able to take action such as reducing your stress levels, consulting your mental health worker or doctor earlier than you had intended, or increasing your medication temporarily- either or all of these may avert the relapse or reduce its severity.
It is particularly important for you to learn to distinguish warning signs from any persistent symptoms, and from any medication side effects you may experience.
Identifying Warning Signs
People often experience a fairly specific and individualised series of changes in their behaviour, thoughts and mood before a relapse. This series of changes has been called a relapse signature. Identifying that relapse signature in as much detail as possible is important for relapse prevention.
Many people have their own individual early warning signs that they and their family can learn to recognise.
Some common early warning signs of relapse are:
- feeling anxious or worried
- feeling tense or restless
- feeling depressed or unhappy
- feeling unsafe or threatened
- feeling paranoid -thinking that people are talking about you
- feeling irritated, quick tempered or aggressive
- experiencing problems with concentration
- experiencing eating or appetite changes
- changes in substance abuse-alcohol or drug taking
- problems sleeping
- withdrawing socially -staying home
- feeling anxious about going out or going to work
- hearing voices
- experiencing racing thoughts or disordered thoughts
- having mood swings-becoming excited or high
- feeling suicidal
- dwelling on past events
- playing your music loud or not able to watch TV.
These signs are different for everyone. It is important to work out which signs may be relevant to you. It is useful to do this with someone who knows you well, like a family member or a mental health worker. It is also important to have a plan of what to do should any of these signs appear.
Remember that these warning signs may be a normal sign that you are affected by something stressful. They do not always mean that you are becoming unwell. By recognising the stress and acting to reduce its impact you may be reducing the likelihood of a relapse.
Issues for consideration in identifying warning signs and relapse signature
- What was the very first thing that you noticed at the time?
- What happened in the weeks or days leading up to your relapse? When did you first know that you were unwell? How did you find out? Did anyone tell you that they thought you were becoming unwell?
- Did you go to hospital? How? Did you avoid going to hospital?
- Were there any changes in your symptoms that you noticed at the time? Were there any changes in your symptoms that you did not notice at the time, but that you now think may have been warning signs?
- Were there any changes in your mood and/or behaviour that you noticed at the time? Were there any changes in your behaviour that you did not notice at the time, but that you may think may have been warning signs ?
- What was the most obvious or severe change before your relapse?
- What changes did you make? What happened next ?
Seeking Help from Others
Sometimes another person notices that you are becoming unwell and may mention their concerns to you, before you have realised yourself that you are becoming unwell. Thinking back on your past relapses, you may be able to identify warning signs that you did not recognise as warning signs at the time. In other words sometimes it is difficult to identify all your early warning signs yourself. Remember the earlier your warning signs are detected, the greater the likelihood that you can prevent a relapse, or reduce its severity.
Identifying a “helper”
Factors that may be important in selecting a suitable “helper” to assist you to identify your warning signs.
Issues for consideration
Someone who is:
- Supportive, interested
- Knows something about your illness
- Has noticed your warning signs in the past
- Has helped you when you have been ill before
- Can see you frequently eg. once a week
- Would be willing to help you in this way
This helper may assist you in three ways,
- Help you identify and list your warning signs,
- Help you monitor the severity of your warning signs,
- Agree to tell you if they think you are becoming unwell.
Strategies to cope with Warning Signs
There are a range of strategies you may find helpful in dealing with warning signs or relapse symptoms. They may involve doing something or not doing something, they involve using stress management techniques and distraction activities.
- Reduce stress and stimulation
- Do some relaxation – relaxing activities, exercising, playing sport, stay calm
- Use self-talk
- Use a diversion- a distraction, music, put on earphones, meditation, TV, talk to someone
- Initiate social contact
- Do some reality testing
- Note people’s advice
- Try some suppressive techniques-wear and flick a rubber band on your wrist
- Seek assistance- tell someone, a friend, your doctor or your case manager
- Think positively
- Keep taking your medication -maybe take some extra medication
- Get more sleep
- Plan your day
- Action Plan
It is important to develop an action plan. You may like to work this out with your mental health worker. Decide which strategies have worked for you and which you are willing to try. Remember that some coping strategies work sometimes and some don’t always have a backup as part of your plan.