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

Objective: The goal of this report was to examine the clinical course following neuroleptic discontinuation of patients with recent-onset-schizophrenia 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 and placebo were administered for 12 weeks each. For those who did not experience symptoms exacerbation or relapse during this period, fluphenazine was openly withdrawn; participants were then followed for up to 18 additional months. Results: When a low threshold for defining symptom reemergence was used, 78% (N=39 of 50) of the patients experienced an exacerbation or relapse within 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 criterion, only six of 45 of individuals (13%) experiencing an exacerbation of relapse who continued in treatment in the clinic were hospitalized, demonstrating 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 antipsychotic discontinuation, even after more than a year of maintenance medication. However, clinical monitoring and a low threshold for reinstating medications can prevent hospitalization for the majority of these patients.