Box 14-4
➤ RISKFACTORS FORRELAPSE
HEALTH RISK FACTORS- Impaired cause-and-effect reasoning
- Impaired information processing
- Poor nutrition
- Lack of sleep
- Lack of exercise
- Fatigue
- Intolerable side effects of medication
ENVIRONMENTAL RISK FACTORS- Financial difficulties
- Housing difficulties
- Stressful changes in life events
- Poor occupational skills, inability to keep a job
- Lack of transportation/resources
- Poor social skills, social isolation, loneliness
- Interpersonal difficulties
BEHAVIOR AND EMOTIONAL RISK FACTORS- Lack of control, aggressive or violent behavior
- Mood swings
- Poor medication and symptom management
- Low self-concept
- Looks and acts different
- Hopeless feelings
- Loss of motivation
Adapted from Murphy, M. F., & Moller, MD (1993). Relapse
management in neurobiological disorders: The Moller-
Murphy symptom management assessment tool. Archives
of Psychiatric Nursing, 7(4), 1993, p. 230.to cope with the emotional upheaval that schizophre-
nia causes. See Client and Family Teaching: Schizo-
phrenia for education points.
Identifying and managing one’s own health needs
are primary concerns for everyone, but this is a partic-
ular challenge for clients with schizophrenia because
their health needs can be complex and their ability to
manage them may be impaired. The nurse helps the
client to manage his or her illness and health needs as
independently as possible. This can be accomplished
only through education and ongoing support.
Teaching the client and family members to pre-
vent or manage relapse is an essential part of a com-
prehensive plan of care. This includes providing facts
about schizophrenia, identifying the early signs of re-
lapse, and teaching health practices to promote phys-
ical and psychological well-being. Murphy and Moller
(1993) have identified symptom triggers, or factors
that increase the risk for relapse, in the areas of the
client’s health, the environment, and the client’s at-
titudes or behaviors (Box 14-4). Early identification
of these risk factors has been found to reduce the fre-
quency of relapse; when relapse cannot be prevented,
early identification provides the foundation for inter-
ventions to manage the relapse. For example, if the
nurse finds that the client is fatigued or lacks ade-
quate sleep or proper nutrition, interventions to pro-
mote rest and nutrition may prevent a relapse or
minimize its intensity and duration.
The nurse can use the list of relapse risk factors
in several ways. He or she can include these risk fac-
tors in discharge teaching before the client leaves the
inpatient setting, so that the client and family will
know what to watch for and when to seek assistance.
The nurse also can use the list when assessing the
client in an outpatient or clinic setting or when work-
ing with clients in a community support program. The nurse also can provide teaching to ancillary person-
nel who may work with the client so they will know
when to contact a mental health professional. Taking
medications as prescribed, keeping regular follow-up
appointments, and avoiding alcohol and other drugs
have been associated with fewer and shorter hospital
stays. In addition, clients who can identify and avoid
stressful situations are less likely to suffer frequent
relapses. Using a list of relapse risk factors is one
way to assess the client’s progress in the community.
Families experience a wide variety of responses
to the illness of their loved one. Some family mem-
bers might be ashamed or embarrassed or frightened
of the client’s strange or threatening behaviors. They
worry about a relapse. They may feel guilty for hav-
ing these feelings or fear for their own mental health
or well-being. If the client experiences repeated and
profound problems with schizophrenia, the family
members may become emotionally exhausted or even
alienated from the client, feeling they can no longer
deal with the situation. Family members need ongo-
ing support and education including reassurance that
318 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
◗ CLIENT ANDFAMILYTEACHING:
SCHIZOPHRENIA- How to manage illness and prevent relapse
- Importance of maintaining prescribed medica-
tion regimen and regular follow-up - Avoiding alcohol and other drugs
- Self-care and proper nutrition
- Teaching social skills through education, role
modeling, and practice - Counseling and education of family/significant
others about the biologic causes and clinical
course of schizophrenia and the need for ongoing
support - Importance of maintaining contact with commu-
nity and participating in supportive organizations
and care