Synopsis
Recognise individual relapse signatures, understand medication and service non-adherence without blame, restore safe treatment collaboratively, and coordinate physical, psychological, substance, social and safeguarding follow-up across community and crisis services.
- Relapse is a clinically important worsening of symptoms, distress, behaviour or function and should be defined against the person's own recovery baseline.
- Common early changes include sleep disruption, withdrawal, reduced self-care, suspiciousness, irritability, unusual online activity, substance use and missed appointments, but signatures are individual.
- Non-adherence is a description of treatment exposure, not a character judgement; explore adverse effects, beliefs, memory, cost, access, stigma, coercion and practical routines.
- Confirm what was actually taken and stopped, including last oral dose, injection date, clozapine gap, smoking, substances and other medicines, before resuming or switching.
- Use shared decision making to address the cause: adverse-effect treatment, simplified dosing, reminders, outreach, formulation change or a different therapeutic option may be appropriate.
- Create a written relapse plan listing personal warning signs, actions, preferred contacts, information-sharing choices, physical red flags and product-specific medication instructions.
- Community follow-up should measure function, physical health, treatment burden, substances, housing, relationships and occupation rather than medication collection alone.
- After crisis, review what helped, repair any harmful care experience and perform a warm handover so responsibility does not disappear between services.
Key red flags
Rapid loss of sleep with increasing suspiciousness, agitation, commands or disorganisation can precede dangerous relapse and warrants urgent reassessment.
A missed clozapine supply or a prolonged gap in a long-acting injectable requires product-specific action and must not be restarted casually.
Withdrawal from contact combined with absent food, rent problems, exploitation, fire risk or neglected physical treatment requires active outreach and safeguarding.
New fever, confusion, focal neurology, intoxication or medication toxicity may mimic psychiatric relapse and demands a physical assessment.
Conflict with family or services after coercive care can intensify risk and requires trauma-informed engagement rather than escalating confrontation.
Investigation priorities
Map change in psychosis, mood, sleep, cognition, behaviour and function against baseline.
Management branches
Recognised changes in sleep, suspiciousness, self-care, contact or substance use emerge.
- Contact the person through agreed channels, assess physiological state and specific harm scenarios and compare change with prior relapse patterns.
- Review medicines, exposure, adverse effects, substances, stress and practical needs and involve consented supporters when helpful.
- Increase follow-up, psychological and practical support and obtain specialist medication review before the presentation becomes an avoidable crisis.