Today’s question is: When is the right time to discontinue an antipsychotic in the treatment of schizophrenia? We reviewed the evidence as well as consulting Dr. Ira Glick to help us answer this question.

Here is the summary of the podcast:

• The APA guidelines (2004, updated 2009) recommend indefinite antipsychotics for patients with multiple episodes or two episodes within 5 years.
• The WFSBP 2013 guidelines recommend antipsychotic maintenance for least 1 year in first-episode psychosis and 2 to 5 years treatment for multiple episodes.
• Antipsychotic treatment should be lifelong in patients with serious suicide attempts, violent behavior and frequent relapses.
• The longer the duration of antipsychotic treatment, the higher the risk of treatment failure when patients stop.
• Mortality and rehospitalization rates are lower among patients continuing antipsychotics.
• The discontinuation paradox could be due to medication-induced build up of excess of dopamine receptors or supersensitivity psychosis.

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