How Stress Can Trigger a Relapse of Psychosis

“Illness relapse following a first episode of psychosis is the rule rather than the exception,” wrote psychiatry professor Brian Miller, MD, PhD, MPH a few months ago in the Psychiatric Times. “Identification of factors associated with illness exacerbation could help identify individuals at heightened risk for relapse and develop targeted interventions.” 

Stressful life events are associated with psychosis risk and with potential illness relapses. In his article, Dr. Miller presented the case of a young African-American female with a history of schizophrenia who experienced her first episode of psychosis at the age of 22. She was stabilized on antipsychotic medication and had been stable for two years. 

Then, her elderly dog had to be euthanized and a beloved uncle died unexpectedly. Following these stressful life events, she suffered a relapse and had to be treated in a psychiatric emergency department. She was actively attending to internal stimuli, endorsing persecutory beliefs, and passive suicidal ideation. 

“People with schizophrenia seem to be exquisitely sensitive to stress,” wrote the late Colorado Recovery founder Richard Warner, MD, in his influential book The Environment of Schizophrenia, “the life events occurring before episodes of schizophrenia, and possibly triggering the relapse, are milder than those before episodes of other disorders such as depression.”

A new study by Bhattacharyya, Schoeler, et al. published in June investigated the association between stressful life events and relapse of psychosis by combining multiple inferential approaches. The researcher “investigated the effects of stressful life events across a range of outcomes, tested for a dose-response relationship, and applied a fixed-effects analysis of longitudinal data,” Miller reported. “They also used a cross-lagged path analysis approach to investigate the directionality of the association.”

The study authors concluded that their “results provide converging evidence of a causal effect of stressful life events on the risk of relapse in psychosis. They suggest that there is a need to develop interventions at the individual and health-service level that could mitigate the harmful effects of stressful life events.”

In the Warner treatment model, therapeutic intervention and relapse prevention rely on “social recovery” from severe mental illness. The treatment program at Colorado Recovery aims to empower adults with mental illness, and those who support them, with an unrelenting optimism for recovery, purposeful involvement in the community, and an enhanced sense of meaning in life.

A strong support network can be an important protective factor when dealing with stressful life situations. A 2022 study found that social support mitigates stress. “The environment shapes schizophrenia,” wrote Dr. Warner. “Antipsychotic drugs seem to be particularly important in preventing relapse in schizophrenia where people with the illness are exposed to a lot of stress, but of somewhat less importance for those living in circumstances where the stress is milder.”

Since Dr. Warner’s passing in 2015, Colorado Recovery has continued to innovate its therapy modalities, delivering exceptional outcomes through its signature continuum of care and helping create lives of purpose as they practice powerful tools in the management of their mental health disorder.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses that are specific to each individual. Call us at (720) 218-4068 to discuss treatment options for you or the person you would like to help.