IN AN excellent metaanalysis of 66 studies involving more than 4000 patients, Gilbert and colleagues1 found a cumulative relapse rate of 51.5% in Patients who had stopped taking antipsychotic medications. Of Patients who were maintained on antipsychotic medications, however, only 16.2% relapsed. The study by Gilbert et al raises important and provocative questions. For instance, what are the arguments for and against maintenance medication in schizophrenic patients? What clinical circumstances warrant stopping medications? Might the relapse rate of patients off antipsychotic medications be even higher than Gilbert et al suggest in their review?
UNDER WHAT CIRCUMSTANCES SHOULD ANTIPSYCHOTIC MEDICATIONS BE WITHDRAWN? Reasons to Take Patients off Medications
The risk of tardive dyskinesia is one of the reasons to minimize a Patient's time receiving antipsychotic medications. As noted by Gilbert et al, recent studies have found 1-year incidence rates of tardive dyskinesia in elderly schizophrenic patients to be greater
Wyatt RJ. Risks of Withdrawing Antipsychotic Medications. Arch Gen Psychiatry. 1995;52(3):205-208. doi:10.1001/archpsyc.1995.03950150037007