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March 1995

Why Neuroleptic Withdrawal in Schizophrenia?

Arch Gen Psychiatry. 1995;52(3):192-193. doi:10.1001/archpsyc.1995.03950150024003

IN THIS issue of the Archives, the analysis of Gilbert and colleagues1 of the extensive literature on neuroleptic withdrawal makes clear that all treatment approaches to schizophrenia have significant risk. Years of a narrow treatment focus on psychosis and rehospitalization (rather than broad psychopathologic and quality-of-life assessment), apprehension regarding litigation, and the false hope that increasing drug dose will increase efficacy have led to excessive medication for most patients despite adverse effects, high rates of non-compliance, and patient dissatisfaction. Dose-reduction strategies are feasible, advantageous, and effective for many patients2 but do not necessarily require complete drug withdrawal. What, then, are the circumstances appropriate for neuroleptic drug withdrawal? Consider the following: (1) a clinically stable patient who refuses to comply with a continuous medication strategy; (2) emerging evidence of tardive dyskinesia, dystonia, neuroleptic malignant syndrome, water intoxication, or severe cardiac effects; (3) a stable patient of advancing years with