Esther I Ezeani, Obinna V. Chukwuma, Oluwatosin O. Arubuolawe, Victory I. Afolabi, Joanna Obitiye Igo, Linda Angela Mbah, Okelue Edwards Okobi*
In persons with schizophrenia, multiple relapses depict the course of illness, yet the nature of these episodes has not been extensively researched and clinicians may not always be aware of important implications. Most individuals living with schizophrenia experience multiple relapses in the course of their lifetimes. While behaviors may precede the relapses, it has been disclosed that 71% of the behavioral changes may be noticed two weeks prior to the relapses compared to the anomaly rates at other times. Moreover, almost 3 out of every five individuals with schizophrenia experience a relapse in their symptoms after commencing treatment/medication. In most instances, the multiple relapses are increasingly distressing to the patients, their families, and their societies, and not only disrupt the recovery process but also increase the risk of treatment resistance. The objective of this systematic review is, therefore, to evaluate the causes of multiple relapses in patients with schizophrenia, and identify effective ways to prevent the relapses. This study reviewed selected literature concerning the nature and possible causes of multiple relapses in schizophrenia patients and the prevention of relapse. The findings have shown that the key causes of multiple relapses in patients with schizophrenia include non-adherence to treatment, lack of effective social support, substance use and abuse, mental illness-associated stigma, unavailability of essential psychotic medications, and delays in care seeking. The findings of this systematic review indicate that multiple relapse rates are increasingly higher in schizophrenia patients in instances where the treatments have been discontinued, even following a single psychotic episode and that prolonged treatment duration before discontinuation does not result in a reduction in multiple relapse risks. Despite of, timely and effective detection of the relapses and the taking of effectual preventive measures against the potential causative factors are vital for improved prognosis of multiple relapse in schizophrenia patients. Given the inefficiencies of various treatments to prevent full-blown relapse and the possible adverse outcomes, medication adherence and various factors predisposing to multiple relapses need to be the key focus in the management of schizophrenia.