title: Risk of symptom recurrence with medication discontinuation in first-episode psychosis: a systematic review.
abstract: The large majority of individuals with a first episode of schizophrenia will experience a remission of symptoms within their first year of treatment. It is not clear how long treatment with antipsychotic medications should be continued in this situation. The possibility that a percentage of patients may not require ongoing treatment and may be unnecessarily exposed to the long-term risks of antipsychotic medications has led to the development of a number of studies to address this question. We carried out a systematic review to determine the risk of experiencing a recurrence of psychotic symptoms in individuals who have discontinued antipsychotic medications after achieving symptomatic remission from a first episode of non-affective psychosis (FEP). Six studies were identified that met our criteria and these reported a weighted mean one-year recurrence rate of 77% following discontinuation of antipsychotic medication. By two years, the risk of recurrence had increased to over 90%. By comparison, we estimated the one-year recurrence rate for patients who continued antipsychotic medication to be 3%. These findings suggest that in the absence of uncertainty about the diagnosis or concerns about the contribution of medication side effects to problems with health or functioning, a trial off of antipsychotic medications is associated with a very high risk of symptom recurrence and should thus not be recommended.
authors: Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, Ontario L8N 3K7, Canada. Electronic address: zipursky@mcmaster.ca.
authors: Robert B
authors: RB
authors: Zipursky
authors: Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, Ontario L8N 3K7, Canada. Electronic address: menezes@mcmaster.ca.
authors: Natasja M
authors: NM
authors: Menezes
authors: Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, St. Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, Ontario L8N 3K7, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: streiner@mcmaster.ca.
authors: David L
authors: DL
authors: Streiner
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D006801:Humans; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000188:drug therapy*; D012008:Recurrence
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotic; Discontinuation; First episode psychosis; Recurrence; Relapse; Schizophrenia; Withdrawal