Discontinuation of treatment in schizophrenia results in very high relapse rates, even after a single psychotic episode. A new review in BMC Psychiatry asserts that multiple relapses characterze the course of illness in most patients with schizophrenia, yet the nature of these episodes has not been extensively researched and clinicians may not always be aware of important implications.
A longer treatment period prior to discontinuation does not reduce the risk of relapse and many patients relapse soon after treatment reduction and discontinuation. Often the transition from remission to relapse can be abrupt and with few or no early warning signs. According to the authors, once illness recurrence occurs symptoms rapidly return to levels similar to the initial psychotic episode. Although most patients respond promptly to re-introduction of antipsychotic treatment after relapse, the response time is variable and notably, treatment failure appears to emerge in about 1 in 6 patients.
The authors conclude “given the difficulties in identifying those at risk of relapse, the ineffectiveness of rescue medications in preventing full-blown psychotic recurrence and the potentially serious consequences, adherence and other factors predisposing to relapse should be a major focus of attention in managing schizophrenia. The place of antipsychotic treatment discontinuation in clinical practice and in placebo-controlled clinical trials needs to be carefully reconsidered.”