ABSTRACT
Max Birchwood’s (1995) theory of the relapse signature suggests that an individual’s early/prodromal signs of psychosis are generally stable from relapse to relapse and follow a predictable temporal pattern. Such symptoms usually occur over a period of less than four weeks, with non-psychotic phenomena occurring early in the illness, followed by the development of frankly psychotic symptoms. This chapter challenges Birchwood’s theory and provides evidence to illustrate that the same sequential prodromal pattern does not necessarily herald each psychotic breakdown. By using multiple sequential functional analysis (MSFA; Gresswell and Hollin 1992), an in-depth qualitative case history methodology, evidence has been found to support the argument that the relapse prodrome is developmental in nature. Furthermore, Bandura’s (1977) social learning model of human behaviour is used to explain how the prodrome is influenced in its development by the continuous reciprocal interaction between personal, behavioural and environmental factors over the course of the illness. Case study extracts are presented to illustrate this finding. A forensic case study is also presented to show how MSFA can be used to explore and predict the developmental nature of the prodrome and create greater understanding of an individual’s early signs of psychosis. This clinical assessment tool can also be used to design individual treatment packages and create more opportunities for clinicians to implement early intervention strategies to ameliorate a psychotic breakdown.
