Even with continuous treatment, relapses of schizophrenia are not rare. It is during such relapses that patients are the greatest danger to others, e.g., the recent cases of Michael Laudor and David Weston. Of great benefit would be a means to detect impending relapse in order to intensify treatment and attempt to reduce the stress often precipitating the relapse.
A recent paper by Per Jorgensen in Schizophrenia Research 32 (1998), 17-22, reports a study designed to develop a rating scale to enable clinicians to predict the recurrence of delusions. Recently discharged schizophrenic patients receiving antipsychotic drug treatment were seen biweekly for six months during which delusions recurred in 27/60 (45 percent). The onset of sleep disturbance, irritability, difficulty in coping, difficulty concentrating, feeling depressed, etc., were found to differentiate those who did and did not relapse. These criteria were incorporated into an Early Signs Scale (ESS), which was then tested on a second sample of 71 patients. The scale was found to have a high degree of sensitivity (correct identifications in 77 percent of the 43 patients who relapsed over a six month period) and specificity (few false positives, in that 79 percent of the people who met criteria did, in fact, develop delusions). The author believes the ESS could be an easy way to identify delusion formation in ordinary clinical practice.
Further testing of the ESS by clinicians is needed before it can be recommended for courtroom use in predicting relapse. Testing to predict the onset of hallucinations, especially command hallucinations (which instruct people with schizophrenia to do harm to oneself or others), should be performed. Other aspects of schizophrenia such as cognitive impairment and depression, independent of positive symptoms, may be at the root of self-destructive and antisocial behavior by sufferers. These elements of the disease are included in the ESS but should also be considered warning signals in their own right. On a more sobering note, fifty-three percent of patients had a recurrence of delusions despite being seen every two weeks and taking neuroleptic drugs. Perhaps if these patients had been treated with adequate doses of the newer atypical antipsychotic medications such as Clozaril, Risperdal, Seroquel, Zeldox, and Zyprexa, relapse would have been less frequent.
