The routine use of atypical antipsychotic agents: Maintenance treatment

Placebo-controlled maintenance studies of conventional antipsychotic agents demonstrate a significant reduction in the risk of schizophrenic relapse i n neuroleptic-treated patients. Neuroleptic discontinuation even in patient s who remained in remission for as long as 5 years results in a relapse rat e comparable to that seen for patients initially assigned to placebo. Yet, patients maintained on conventional neuroleptics are exposed to the risk of tardive dyskinesia (approximately 5% per year for patients with up to 10 y ears of neuroleptic exposure). Attempts have been made to reduce neurolepti c exposure. A lower maintenance dose was associated with higher relapse rat es, as was intermittent, targeted therapy. Psychoeducational treatment stud ies reaffirmed that the major influence on the rate of rehospitalization wa s the dose of conventional maintenance medication. Although data are scarce for maintenance treatment with atypical antipsychotic drugs, findings sugg est that atypical agents are at least as efficacious and may be better tole rated. Olanzapine has demonstrated efficacy in maintenance treatment as wel l as a reduced risk of tardive dyskinesia compared with haloperidol.