Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via HighWire Citing Articles via Google Scholar Articles by Gitlin, M. Articles by Aravagiri, M. Search for Related Content PubMed Citation Articles by Gitlin, M. Articles by Aravagiri, M. Schizophrenia Spectrum Disorders Other Neuroleptics

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. 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on a maintenance regimen of fluphenazine decanoate for a mean of 16.7 months had their antipsychotic medications withdrawn under clinical supervision.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 For those who did not experience symptom exacerbation or relapse during this period, fluphenazine was openly withdrawn; participants were then followed for up to 18 additional months.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.

This article has been cited by other articles:

				M. Alvarez-Jimenez, A. G. Parker, S. E. Hetrick, P. D. McGorry, and J. F. Gleeson Preventing the Second Episode: A Systematic Review and Meta-analysis of Psychosocial and Pharmacological Trials in First-Episode psychosis Schizophr Bull, November 9, 2009; (2009) sbp129v1. [Abstract] [Full Text] [PDF]

				L. Wunderink, S. Sytema, F. J. Nienhuis, and D. Wiersma Clinical Recovery in First-Episode Psychosis Schizophr Bull, March 1, 2009; 35(2): 362 - 369. [Abstract] [Full Text] [PDF]

				S. B. Soumerai, F. Zhang, D. Ross-Degnan, D. E. Ball, R. F. LeCates, M. R. Law, T. E. Hughes, D. Chapman, and A. S. Adams Use Of Atypical Antipsychotic Drugs For Schizophrenia In Maine Medicaid Following A Policy Change Health Aff., May 1, 2008; 27(3): w185 - w195. [Abstract] [Full Text] [PDF]

				H. A. Nasrallah and R. Lasser Improving patient outcomes in schizophrenia: achieving remission J Psychopharmacol, November 1, 2006; 20(6_suppl): 57 - 61. [Abstract] [PDF]

				J. R. Bola Psychosocial Acute Treatment in Early-Episode Schizophrenia Disorders Research on Social Work Practice, May 1, 2006; 16(3): 263 - 275. [Abstract] [PDF]

				T. H McGlashan Rationale and Parameters for Medication-Free Research in Psychosis Schizophr Bull, April 1, 2006; 32(2): 300 - 302. [Full Text] [PDF]

				D. O. Perkins, H. Gu, K. Boteva, and J. A. Lieberman Relationship Between Duration of Untreated Psychosis and Outcome in First-Episode Schizophrenia: A Critical Review and Meta-Analysis Am J Psychiatry, October 1, 2005; 162(10): 1785 - 1804. [Abstract] [Full Text] [PDF]

				W. Kissling, S. Heres, K. Lloyd, E. Sacchetti, P. Bouhours, R. Medori, and P. M. Llorca Direct transition to long-acting risperidone - analysis of long-term efficacy J Psychopharmacol, September 1, 2005; 19(5_suppl): 15 - 21. [Abstract] [PDF]

				A. Mohl, K. Westlye, S. Opjordsmoen, A. Lex, A. Schreiner, M. Benoit, P. Braunig, and R. Medori Long-acting risperidone in stable patients with schizoaffective disorder J Psychopharmacol, September 1, 2005; 19(5_suppl): 22 - 31. [Abstract] [PDF]

				G. REMINGTON Rational pharmacotherapy in early psychosis The British Journal of Psychiatry, August 1, 2005; 187(48): s77 - s84. [Abstract] [Full Text] [PDF]

				D. G Robinson, M. G Woerner, H. M Delman, and J. M Kane Pharmacological Treatments for First-Episode Schizophrenia Schizophr Bull, July 1, 2005; 31(3): 705 - 722. [Abstract] [Full Text] [PDF]

				N. Schooler, J. Rabinowitz, M. Davidson, R. Emsley, P. D. Harvey, L. Kopala, P. D. McGorry, I. Van Hove, M. Eerdekens, W. Swyzen, et al. Risperidone and Haloperidol in First-Episode Psychosis: A Long-Term Randomized Trial Am J Psychiatry, May 1, 2005; 162(5): 947 - 953. [Abstract] [Full Text] [PDF]

				M. Gitlin, K. Nuechterlein, K. L. Subotnik, J. Ventura, J. Mintz, D. L. Fogelson, G. Bartzokis, and M. Aravagiri Clinical Outcome Following Neuroleptic Discontinuation in Patients With Remitted Recent-Onset Schizophrenia Focus, January 1, 2004; 2(1): 122 - 130. [Abstract] [Full Text] [PDF]

				J. A. Lieberman, G. Tollefson, M. Tohen, A. I. Green, R. E. Gur, R. Kahn, J. McEvoy, D. Perkins, T. Sharma, R. Zipursky, et al. Comparative Efficacy and Safety of Atypical and Conventional Antipsychotic Drugs in First-Episode Psychosis: A Randomized, Double-Blind Trial of Olanzapine Versus Haloperidol Am J Psychiatry, August 1, 2003; 160(8): 1396 - 1404. [Abstract] [Full Text] [PDF]

				S. Kapur Psychosis as a State of Aberrant Salience: A Framework Linking Biology, Phenomenology, and Pharmacology in Schizophrenia Am J Psychiatry, January 1, 2003; 160(1): 13 - 23. [Abstract] [Full Text] [PDF]

				R. B. ZIPURSKY Psychotic Recurrence After Antipsychotic Discontinuation Am J Psychiatry, August 1, 2002; 159(8): 1441 - 1442. [Full Text]

				D. C. Goff A 23-Year-Old Man With Schizophrenia JAMA, June 26, 2002; 287(24): 3249 - 3257. [Full Text] [PDF]

				K. H. Nuechterlein, P. Huston, and R. Peterson Withholding Proven Treatment in Research N. Engl. J. Med., February 7, 2002; 346(6): 455 - 456. [Full Text] [PDF]

Get information about faster international access.

Privacy Policy

Copyright © 2001 American Psychiatric Association. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us