On discontinuing treatment in schizophrenia: a clinical conundrum

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We psychiatrists who treat individuals with schizophrenia spend much of our time encouraging our patients to take antipsychotic medication regularly. We do this because of concerns regarding the consequences of illness recurrence associated with treatment discontinuation. There is however a good deal of discomfort here, given the substantial side-effect burden accompanying such treatment, and the hope that some patients will, at some stage, be able to discontinue medication without experiencing illness recurrence. Also, there has been some suggestion that long-term antipsychotic treatment may actually contribute to poorer outcome 1 , 2 and it has been speculated that the very high relapse rates reported after treatment discontinuation may be iatrogenic insofar as they represent withdrawal phenomena which could be physiological, psychological or a “supersensitivity psychosis” due to receptor adaptations to protracted dopamine D2 blockade. 3 Finally, greater exposure to antipsychotic treatment has been associated with progressive brain volume reductions. 4

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