Clinical outcome following neuroleptic discontinuation in patients with remitted recent-onset schizophrenia

Objective: The goal of this report was to examine the clinical course follo wing neuroleptic discontinuation of patients with recent-onset-schizophreni a who had been receiving maintenance antipsychotic treatment for at least 1 year. Methods: Fifty-three volunteer patients with recent-onset schizophrenia who had been clinically stabilised on a maintenance regimen of fluphenazine an d placebo were administered for 12 weeks each. For those who did not experi ence symptoms exacerbation or relapse during this period, fluphenazine was openly withdrawn; participants were then followed for up to 18 additional m onths. Results: When a low threshold for defining symptom reemergence was used, 78 % (N=39 of 50) of the patients experienced an exacerbation or relapse withi n 1 year; 96% (N=48 of 50) did so within 2 years. Mean time to exacerbation or relapse was 235 days. When hospitalization was used as a relapse criter ion, only six of 45 of individuals (13%) experiencing an exacerbation of re lapse who continued in treatment in the clinic were hospitalized, demonstra ting the sensitivity of the psychotic exacerbation criterion. Conclusion: The vast majority of clinically stable individuals with recent- onset schizophrenia will experience an exacerbation or relapse after antips ychotic discontinuation, even after more than a year of maintenance medicat ion. However, clinical monitoring and a low threshold for reinstating medic ations can prevent hospitalization for the majority of these patients.