Schizophrenia: early warning signs

Max Birchwood is Director of the Early Intervention Service (Harry Watton House, 97 Church Lane, Aston, Birmingham B6 5UG) and Director of Research and Development of Northern Birmingham Mental Health NHS Trust. He is also a Research Professor at the School of Psychology, University of Birmingham. Elizabeth Spencer is a senior clinical medical officer working in Northern Birmingham Mental Health NHS Trust. She has a clinical interest in the early treatment of young people with psychosis. Dermot McGovern is a consultant psychiatrist working in Northern Birmingham Mental Health NHS Trust. He has a clinical interest working with people with serious mental illness. Relapse in schizophrenia remains common and cannot be entirely eliminated even by the best combination of biological and psychosocial interventions (Linszen et al, 1998). Relapse prevention is crucial as each relapse may result in the growth of residual symptoms (Shepherd et al, 1989) and accelerating social disablement (Hogarty et al, 1991). Many patients feel ‘entrapped’ by their illnesses, a factor highly correlated with depression (Birchwood et al, 1993), and have expressed a strong interest in learning to recognise and prevent impending psychotic relapse.