Clinical Outcome Following Neuroleptic Discontinuation in Patients With Remitted Recent-Onset Schizophrenia

TLDR

The study aimed to assess the clinical course after stopping antipsychotics in patients with recent‑onset schizophrenia who had been on maintenance treatment for at least one year. Fifty‑three stabilized patients on fluphenazine decanoate for an average of 16.7 months underwent a 24‑week double‑blind crossover trial (12 weeks drug, 12 weeks placebo); those who remained stable had the drug openly withdrawn and were monitored for up to 18 months. After discontinuation, 78 % of patients relapsed within a year and 96 % within two years, with a mean relapse time of 235 days; although most relapses were not hospitalized, vigilant monitoring and prompt medication reinstatement can avert most hospitalizations.

Abstract

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. Method: Fifty-three volunteer patients with recent-onset schizophrenia who had been clinically stabilized on a maintenance regimen of fluphenazine decanoate for a mean of 16.7 months had their antipsychotic medications withdrawn under clinical supervision. Participants initially entered a 24-week, double-blind crossover trial in which fluphenazine and placebo were administered for 12 weeks each. For those who did not experience symptom exacerbation or relapse during this period, fluphenazine was openly withdrawn; participants were then followed for up to 18 additional months.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 or relapse who continued in treatment in the clinic were hospitalized, demonstrating the sensitivity of the psychotic exacerbation criterion. Conclusions: 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.