This month is Mental Health Awareness Month. Some of us are aware of mental illness every waking hour because we have a loved one dealing with it. We dread relapses. To help, I’ve collected information from NAMI, Mental Health America and my own reading/experience.

Recognizing the Early Warning Signs

Mental illness, especially bipolar disorder, schizophrenia and clinical depression, is usually episodic. The symptoms vary over time. When your loved one experiences another episode, it is commonly called a relapse.

Please note: Persistent symptoms that continue despite the stabilization of the illness are not signs of a relapse, but are treatment-resistant symptoms.  If the symptoms get worse, it’s a relapse.

Before the relapse, people often experience changes in their feelings, thoughts and behaviors. These are early warning signs. Studies indicate between 50% and 70% of people experience early warning signs over a period of one to four weeks before a relapse.

Looking for early warning signs allows you to start working with your loved one and his treatment providers to minimize the setback. Because you are the most frequent contact with your loved one, you are the one who sees the warning signs. The ill person will not be able to see them.  This blog post explains why.

Common Warning Signs

Each person has their own specific signs or “relapse signature.” But some warning signs are common, including:

• Feelings of tension, anxiousness or worries.
• More irritability.
• Increased sleep disturbance (hearing them up in the night).
• Depression.
• Social withdrawal (more extreme, not even leaving his room to eat).
• Concentration problems (taking longer to do tasks, having trouble finishing tasks, having trouble following a conversation or TV show).
• Decreasing or stopping medication or treatment (refusing to go to the case manager or doctor, skipping the vocational program).
• Eating less or eating more.
• Excessively high or low energy.
• Loss of interest in doing things.
• Loss of interest in the way he or she looks / poor hygiene.
• Being afraid of “going crazy.”
• Becoming excessive in religious practices.
• Feeling bothered by thoughts that will not go away.
• Feeling overwhelmed by demands.
• Expressing worries about physical problems.

Most common relapse indicators for schizophrenia:

• Restless or unsettled sleep.
• Nervousness or tension.
• Having a hard time concentrating.
• Isolation.
• Feeling irritable.
• Having trouble taking care of routine things.
• A lack of energy.
• Feeling sad or depressed.
• Feeling confused.
• A change in appetite.

Most common relapse indicators for bipolar disorder:

• Disturbed or lack of sleep.
• Talking quickly and more often than usual.
• Acting reckless.
• Feeling very tired.
• Feeling very depressed.

An Off Day or the Start of a Relapse?

Everyone can have an off day. You can feel down in the dumps, with no energy. Or you can seem a little manic.  If a person has had mental health problems, it’s important to consider whether they are having an off day or starting a relapse.

Early warning signs are:

• A cluster of changes.
• Happening together.
• Lasting over a period of time.
• Gradually getting worse.
• Following the same pattern as before.

Your Loved One’s Relapse Signature

Think about the last time your loved one got worse. If you keep a journal, look at what you wrote. It helps to think about:

• What was the time of year?
• Did your loved one say how they were feeling physically?
• How was the mood?  The level of concentration?
• Did any unusual changes in behavior take place in the weeks before the last relapse?
• Did your relative do things that seemed “out of character” before the last relapse?
• Have the same behaviors preceded other relapses?

Thinking about what was happening in the person’s life when you start to notice these changes can help too. 

Next time we’ll talk about what to do when your loved one shows signs of relapse.