Defining Relapse in Schizophrenia: New International Consensus to Standardize Research and Care

Introduction and Context

Relapse prevention is central to treating schizophrenia: recurrent psychotic episodes worsen disability, increase hospitalization and healthcare costs, and reduce quality of life. Yet, despite decades of research, there has been no universally accepted operational definition of “relapse.” That absence has produced wide variation across clinical trials and observational studies — undermining comparability, biasing meta-analyses, and complicating the translation of research findings into practice.

In response, an international team led by Howes and colleagues conducted a systematic review of randomized controlled trials of relapse (2012–2024) and used a multiphase Delphi process involving more than 100 experts from 37 countries — including people with lived experience — to develop consensus criteria. Their results and recommendations were published in the American Journal of Psychiatry (Howes et al., 2025). This article summarizes the core recommendations and practical implications for clinicians, researchers, and policymakers.