Traditionally, the definition of relapse in schizophrenia has been confusing and inconsistent, causing significant issues for both research and clinical practice. This lack of standardisation has made it difficult to compare results or draw reliable conclusions about what works in preventing relapse. A new paper led by a group of international researchers aims to change this, offering a clear, consensus-driven definition that could transform the field.
Published in the American Journal of Psychiatry, “Relapse in Schizophrenia: A Systematic Review of Criteria for Clinical Studies and International Consensus Guidelines to Improve Them” brings together over 100 experts from 37 countries, including people with lived experience, to tackle this long-standing problem head-on.
The team’s systematic review revealed a startling reality: in the past decade, only two pairs of studies used the same relapse criteria. Most relied on clinical judgement alone, and more than half used relative symptom change, a method now shown to be fundamentally flawed. The result? A research landscape where findings are difficult to compare, and the true effectiveness of interventions remains uncertain.
To address this, the authors, including University of Oxford’s Professor Rob McCutcheon psychiatrist at Oxford Health NHS Foundation Trust (OHFT) and OH BRC researcher developed both minimum and optimum consensus criteria for defining relapse, using a rigorous Delphi process. Their recommendations are practical and robust: use validated, standardised symptom rating scales (such as PANSS), focus on absolute (not relative) changes in symptoms, and ensure clear reporting across three key phases: pre-baseline, baseline, and relapse. The guidelines also include a practical checklist for researchers to use in future studies, making transparent reporting the new norm.
The human impact of relapse is powerfully illustrated in the paper by a personal account: “Relapses in schizophrenia feel like the curse of Sisyphus… you need to start rolling the ‘huge rock of illness’ back up the hill again with great effort, only to be sent back to the bottom again by the next relapse.”
By adopting these consensus criteria, future research can be more reliable, transparent, and comparable, ultimately leading to better treatments and outcomes for people with schizophrenia. For researchers, clinicians, and those with lived experience, this is a significant step forward.
Professor McCutcheon said: ““By establishing consensus criteria, we aim to bring clarity and consistency to how relapse is defined in schizophrenia research moving beyond subjective judgement to a standardised, evidence-based approach that strengthens the reliability of future studies.”
Read the full paper online
