Pharmacological strategies for relapse prevention in schizophrenia

While the vast majority of people with schizophrenia will respond well to treatment at first episode, achieving remission, around 80% will relapse at least once within the subsequent 5 years. The sensitivity to side effects of those with their first episode of schizophrenia, and their relatively low rate of acceptance of antipsychotic medication, has led to recommendations that second-generation drugs be considered first for such patients. For those with established schizophrenia, the risk of relapse when receiving continuous antipsychotic medication appears to be about one-third of that on placebo. Stopping antipsychotics, especially abruptly, dramatically increases the risk of relapse in the short to medium term, although even with gradual cessation about half will relapse in the succeeding 6 months. Compared with continuous, full-dose maintenance treatment, low-dose or targeted, intermittent regimes are associated with a demonstrably higher risk of relapse over a year or so. © 2007 Elsevier Ltd. All rights reserved.