Reasoning about the optimal duration of prophylactic antipsychotic medication in schizophrenia: evidence and arguments

Objective: To review evidence-based literature regarding the necessary dura tion of antipsychotic relapse prevention in schizophrenia and related psych oses. Method: A computerized search was performed on Medline, Embase Psychiatry a nd PsycLIT which covered the period 1974-99. We also used cross-references. Results: Although schizophrenia refers mainly to an intrinsic biological vu lnerability, only maintenance studies with a follow-up of 2 years at most a re available. Relapses appear unpredictable and occur even after long-term successful remission during antipsychotic treatment. Conclusion: Since rehabilitation efforts have effects only after long-term endeavours, antipsychotic relapse prevention should be maintained for long periods. It is reasonable to treat patients suffering from schizophrenia an d related psychoses for longer periods than indicated by the current guidel ines.