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Training to recognise the early signs of recurrence in schizophrenia

Morriss R, Vinjamuri I, Faizal MAmir, Bolton CA, McCarthy JP
Published Online: 
28 February 2013

Many people with schizophrenia experience periods of illness followed by relatively stable periods (although symptoms of illness such as hearing voices and seeing things often remain in the background). This means that many people with schizophrenia may become unwell again and need to go back into hospital. Training in early warning signs techniques encourages people to learn, detect and recognise the early warning signs of future illness. Studies indicate that noticing even small changes in signs and symptoms of schizophrenia can often predict future illness and relapse two to 10 weeks later. Early warning training may help to prevent or delay relapse, so reducing the chances of going into hospital. Recognition of early warning signs requires detailed history taking, sometimes with additional techniques such as diary keeping, completion of questionnaires and a plan of action based on anticipated early warning signs. Training can be undertaken by the individual or be group-based, involving health professionals, family members or carers. Successful training seems to require around 12 sessions and involves therapists of high competency.

This review includes a total of 34 studies. It found that there are positive benefits of training in early warning signs. It reduces rates of relapse and re-hospitalisation (but not on time to recurrence). It should be noted that training in early warning signs was mainly used alongside other psychological therapies, so it is not entirely clear what proportion of the positive effect is due to training in early warning signs alone. Moreover, the overall quality of the evidence from these studies was judged to be very low. This means that we do not know if interventions using early warning signs, with or without additional psychological treatments, will have the same beneficial effects outside clinical trials.

Further research is required to decide whether training in early warning signs is effective on its own. Effects on quality of life, satisfaction with care, money spent, and burden of care for carers are unclear, so ideally should be known before training programmes are put into wider use. At this time, there is not enough evidence to support training in early warning signs alone.

This plain language summary was written by consumer, Ben Gray of RETHINK.