March 1995

Long-term Treatment for Lifetime Disorders?

Author Affiliations

Schizophrenia Program and Department of Psychiatry University of Michigan Medical Center Ann Arbor, MI 48109-0704

Arch Gen Psychiatry. 1995;52(3):197-200. doi:10.1001/archpsyc.1995.03950150029004

MAJOR psychiatric disorders characteristically are lifetime in duration. Some, such as mood or panic disorders, tend to be episodic and recurrent; others, exemplified best by schizophreniatypically have more chronic, persistent courses punctuated with exacerbations. When confronted with long-term disorders, clinicians must consider a sequence of questions that pertain to long-term maintenance treatment: (1) What medications are available to help prevent relapse, and at what dosage must they be given to be efficacious? (2) What is the risk of relapse if long-term treatment is stopped, and how does this compare with the risk when treatment is sustained? (3) How severe are the risks or side effects associated with maintenance regimens? (4) Are there clinical or laboratory predictors that might foretell when a relapse might be expected so that risky treatments could be withheld until signs of impending relapse appear? (5) What are the safety, sideeffect, and financial cost-benefit ratios associated with

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