Recognizing Early Warning Signs of Relapse in Schizophrenia

This episode, titled "Recognizing Early Warning Signs of Relapse in Schizophrenia," features panelists Dr. Hara Oyedeji and Mark Jankelow sharing their real-world approaches to identifying and responding to early signs of relapse in patients living with schizophrenia.

Dr. Oyedeji opens by emphasizing the importance of monitoring daily functioning as a primary indicator of emerging decompensation. She describes a multi-layered surveillance approach that includes frequent patient contact, collateral communication with family members and caregivers, and coordination with other members of the care team such as therapists and counselors. Key warning signs she monitors include disordered thinking, declining self-care, emerging paranoia, and increased anxiety, as well as environmental triggers such as changes in living situation or recent stressors. She also flags missed appointments and lapses in medication administration — including missed injections — as critical signals warranting immediate follow-up. For clinical monitoring, Dr. Oyedeji notes that while structured instruments such as the PANSS are standard in research settings, more practical outpatient tools such as the Clinical Global Impression scale or a brief psychotic rating scale can help track symptom changes efficiently. Therapeutic drug monitoring and laboratory review are also highlighted as valuable components of relapse surveillance where insurance coverage allows.

Mark Jankelow reinforces these themes with a vivid clinical example: a patient whose mother contacted the practice reporting that her son was beginning to think and behave as he had during prior episodes of illness — becoming suspicious, isolating socially, and withdrawing from family activities. Upon evaluation, Mark Jankelow discovered the patient had been using an exceptionally high-potency cannabis product obtained through a family connection, which had undermined the effectiveness of his medication. The case illustrates how changes in functionality, socialization, and productivity — rather than overt psychotic symptoms alone — can serve as the earliest and most actionable signals that something has gone wrong, underscoring the irreplaceable value of engaged family members as a first line of clinical alertness.

In the next episode, "Multidisciplinary Care and Functional Outcomes in Schizophrenia Management," panelists will discuss the essential components of a multidisciplinary care team for patients living with schizophrenia, the critical importance of cross-team communication, and how clinicians can incorporate meaningful functional goals — such as employment, housing, and social connection — into long-term treatment planning.