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Warning Signs of a Possible Relapse

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Old 06-16-2007, 06:02 PM
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Lightbulb Warning Signs of a Possible Relapse

Warning Signs of a Possible Relapse
By Inner North Brisbane Mental Health Service Royal Brisbane and Women's Hospital and Health Service District,


After recovering from an episode of your illness, there is a chance that you may not have any further symptoms. There is also a chance that you may have a relapse.

Being prepared
It is important to be prepared for another episode of illness, even if it never happens. Preparing does not mean you are being pessimistic or assuming that you will become ill again. It means knowing what to do just in case, so that you can get on with the rest of your life.


Relapse
A relapse is said to occur when the symptoms of your illness worsen or when previous symptoms return. Many people have experienced one or more relapses of their illness. These relapses are exacerbations of their illness, particularly in their positive symptoms. A relapse may or may not require hospitalisation. After a relapse you may still experience persistent symptoms. Persistent symptoms are experienced more or less constantly, and do not indicate that you are about to become very unwell.

Warning signs
However, before a relapse happens people often experience changes in their symptoms or in some aspect of their behaviour, thoughts or feelings. These changes are called warning signs, they are indications that a relapse may be imminent.

Some warning signs are common and include feeling suspicious or irritable, feeling very tired or unusually energetic, and sleep changes. Other warning signs are highly individualised and include all sorts of changes to your behaviour, mood and thoughts. If you can identify your warning signs as early as possible, you may be able to take action such as reducing your stress levels, consulting your mental health worker or doctor earlier than you had intended, or increasing your medication temporarily- either or all of these may avert the relapse or reduce its severity.

It is particularly important for you to learn to distinguish warning signs from any persistent symptoms, and from any medication side effects you may experience.

Identifying Warning Signs
People often experience a fairly specific and individualised series of changes in their behaviour, thoughts and mood before a relapse. This series of changes has been called a relapse signature. Identifying that relapse signature in as much detail as possible is important for relapse prevention.

Many people have their own individual early warning signs that they and their family can learn to recognise.

Some common early warning signs of relapse are:

feeling anxious or worried
feeling tense or restless
feeling depressed or unhappy
feeling unsafe or threatened
feeling paranoid -thinking that people are talking about you
feeling irritated, quick tempered or aggressive
experiencing problems with concentration
experiencing eating or appetite changes
changes in substance abuse-alcohol or drug taking
problems sleeping
withdrawing socially -staying home
feeling anxious about going out or going to work
hearing voices
experiencing racing thoughts or disordered thoughts
having mood swings-becoming excited or high
feeling suicidal
dwelling on past events
playing your music loud or not able to watch TV.
These signs are different for everyone. It is important to work out which signs may be relevant to you. It is useful to do this with someone who knows you well, like a family member or a mental health worker. It is also important to have a plan of what to do should any of these signs appear.

Remember that these warning signs may be a normal sign that you are affected by something stressful. They do not always mean that you are becoming unwell. By recognising the stress and acting to reduce its impact you may be reducing the likelihood of a relapse.

Issues for consideration in identifying warning signs and relapse signature
What was the very first thing that you noticed at the time?
What happened in the weeks or days leading up to your relapse? When did you first know that you were unwell? How did you find out? Did anyone tell you that they thought you were becoming unwell?
Did you go to hospital? How? Did you avoid going to hospital?
Were there any changes in your symptoms that you noticed at the time? Were there any changes in your symptoms that you did not notice at the time, but that you now think may have been warning signs?
Were there any changes in your mood and/or behaviour that you noticed at the time? Were there any changes in your behaviour that you did not notice at the time, but that you may think may have been warning signs ?
What was the most obvious or severe change before your relapse?
What changes did you make? What happened next ?
Seeking Help from Others
Sometimes another person notices that you are becoming unwell and may mention their concerns to you, before you have realised yourself that you are becoming unwell. Thinking back on your past relapses, you may be able to identify warning signs that you did not recognise as warning signs at the time. In other words sometimes it is difficult to identify all your early warning signs yourself. Remember the earlier your warning signs are detected, the greater the likelihood that you can prevent a relapse, or reduce its severity.

Identifying a "helper"
Factors that may be important in selecting a suitable "helper" to assist you to identify your warning signs.

Issues for consideration

Someone who is:

Supportive, interested
Trusted
Knows something about your illness
Has noticed your warning signs in the past
Has helped you when you have been ill before
Can see you frequently eg. once a week
Would be willing to help you in this way
This helper may assist you in three ways,

Help you identify and list your warning signs,
Help you monitor the severity of your warning signs,
Agree to tell you if they think you are becoming unwell.
Strategies to cope with Warning Signs
There are a range of strategies you may find helpful in dealing with warning signs or relapse symptoms. They may involve doing something or not doing something, they involve using stress management techniques and distraction activities.

Reduce stress and stimulation
Do some relaxation - relaxing activities, exercising, playing sport, stay calm
Use self-talk
Use a diversion- a distraction, music, put on earphones, meditation, TV, talk to someone
Initiate social contact
Do some reality testing
Note people’s advice
Try some suppressive techniques-wear and flick a rubber band on your wrist
Seek assistance- tell someone, a friend, your doctor or your case manager
Think positively
Keep taking your medication -maybe take some extra medication
Get more sleep
Plan your day
Action Plan
It is important to develop an action plan. You may like to work this out with your mental health worker. Decide which strategies have worked for you and which you are willing to try. Remember that some coping strategies work sometimes and some don’t. Always have a backup as part of your plan.

Shalom!
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Old 06-19-2007, 11:52 PM
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Great article...thanks!
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Old 06-20-2007, 04:26 AM
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Hey, Teach, I saw a few of those that looked WAY familiar. Great article.
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Old 12-19-2007, 09:32 PM
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I feel like my mental health is whats making my recovery hard without my meds I can't stay sober for long
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Old 12-20-2007, 12:18 PM
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Thank you, teach, this is very helpful information. I think it would make a good sticky.

Identifying my "relapse signature" is something that I've started working on recently. After 4 months, I'm still dicovering symptoms that I always thought were part of normal human behavior. I'm also trying to identify all of the triggers and look for patterns. Anyway, this is an interesting topic...
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Old 12-20-2007, 12:41 PM
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Thanks from me too. Very useful.
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