Early medication discontinuation in first episode schizophrenia – beneficial or risky?

Summary Background: After acute treatment of a first episode in schizophrenia, continued antipsychotic maintenance treatment (MT) is effective regarding (positive) symptom remission and relapse prevention. Nevertheless, due to unwanted effects patients and clinicians sooner or later are faced with the decision to continue or discontinue antipsychotics. Evidence indicates that risk for relapse or symptom recurrence is 2- to 5-times higher after personalized dose-reduction (PDR) or complete drug discontinuation, even if early intervention in case of early warning signs of relapse is applied. Method: A recent 7-year follow up of an 18 months RCT comparing MT with PDR however, revealed advantages of PDR regarding functional outcome and recovery. Although only one study with its specific characteristics limits generalization, the findings have newly fueled the debate whether early drug discontinuation-strategies have more risks or benefits. Result: The paper discusses the pros and cons of early drug discontinuation-strategies, in particular of PDR, after a first episode in schizophrenia and summarizes the empirical evidence to support patients and clinicians in this essential treatment decision.