The role of maintenance pharmacotherapy in achieving recovery from a first episode of schizophrenia

Abstract

The large majority of individuals who are treated for a first episode of schizophrenia will experience a remission of psychotic symptoms. Clinicians are then faced with the question of whether it would be reasonable to discontinue antipsychotic medications. Evidence to date suggests that even in the case of remitted patients, the relapse rates are very high. Those who do relapse may experience extended periods of illness and disability and many may fail to return to their previous level of remission. Fortunately, the relapse rates appear to be very low for remitted patients who remain on medications. Patients with a first episode of schizophrenia are now treated with atypical antipsychotic medication or low doses of typical agents. As a result of these trends, it is very likely that antipsychotic medication can be prescribed in ways that are well tolerated and safer in the long-term. Further research is required to establish the long-term safety of this approach and to determine whether there is a duration of remission after which it would be safe to discontinue medication. In the absence of such information, it is proposed that individuals who have remitted from a first episode of schizophrenia would be best advised to remain on antipsychotic medication indefinitely.