Relapse signatures and insight: implications for CPNs

Schizophrenia is, largely, an episodic illness with periods of remission and relapse. Early warning signs (EWS) strategies provide a guide to patients, their carer and mental health worker, to collaboratively manage relapse by identifying each individual's EWS of relapse, and agree a plan of action should EWS occur. Although there is evidence to suggest these strategies can reduce hospitalization, the psycho-educational component is likely to impact on the patient's insight. Rapid increases in insight have been associated with low mood. Consequently the clinician using this strategy risks unintended negative consequences. This paper argues that the flexible and broad community psychiatric nurse role means they are in an ideal position to address this possible pitfall, whilst maximizing the benefits of the strategy.