Schizophrenia is a disabling group of brain disorders characterized by symptoms such as hallucinations, delusions, disorganized communication, poor planning, reduced motivation, and blunted affect . Schizophrenia is often accompanied by relapse even while on treatment . Relapse has been defined as a worsening of psychopathological symptoms or rehospitalization in the year after hospital discharge . Schizophrenia follows a variable course, with complete symptomatic and social recovery in about one-third of cases. Schizophrenia can however follow a chronic or recurrent course, with residual symptoms and incomplete social recovery. Individuals with chronic schizophrenia constituted a large proportion of all residents of mental institutions in the past and still do where these institutions exist .
Relapse may result in hospitalization, treatment resistance, cognitive impairment due to progressive structural brain damage personal distress incarceration and interference with rehabilitation efforts . A few studies regarding relapse and schizophrenia have been done in Africa. Research in South Africa has found that presence of a co-morbid depressed mood, poor medication adherence due to a lack of patient insight and side-effects appear to be the factors most likely to increase the risk of a relapse .
Tanzania’s national hospital’s Department of Psychiatry, admits about 150 patients with different psychiatric disorders per month: 15 (10%) of these are readmissions due to relapse in schizophrenia. Apart from patients attending the clinic for follow-up, approximately 15 patients with specific psychiatric problems are attended per day within the department. The number of patients needing mental health and psychiatric care overloads the available mental health care team.
Most drugs available in the Psychiatric Unit are typical antipsychotics which have a lot of extrapyramidal side effects. Availability of atypical antipsychotics (most commonly Risperidone and Olanzepine) with lesser extrapyramidal side effects varies; hence patients have to buy the drugs for themselves. Sometimes they cannot afford to buy them due to poor social economic status which is made worse by the mental illness hence they go without medications which results into relapse. The structure of in-patient unit does not allow for a good and quality therapeutic nurse- patient relationship and communication. This kind of structure prevents nurse- patient interaction and hinders nurses’ exploration of patients’ problems and concerns which if identified in advance can lead to interventions that can perhaps help to reduce relapse.
Community mental health services are not well established. The absence of these services deprives the community from benefits of case management, outreach clinics, family visits, family therapies; counseling and other psychotherapies, which would also help reduce relapse in the community. Relapse in schizophrenia has a lot of effects to patients, care givers, the health sector and the country economy at large. Patients tend to deteriorate in their level of functioning with each relapse; hence their contribution to economic activities diminishes. Caregivers have to take care of the patient’s bills in the hospital once readmitted which becomes very costly. The health sector is imposed with a large burden and has to deal with the higher number of patients’ re-hospitalization. Therefore exploration of risk and protective factors for relapse among people with schizophrenia is a prerequisite in promoting mental health and preventing relapse in schizophrenia. However studies for schizophrenia especially on risk and protective factors for relapse are rare in Africa, including Tanzania. This study is intended to start addressing that need.