[The risk of neuroleptic discontinuation in schizophrenia]

The most effective method to maintain clinical improvement in the course of schizophrenia is the continuation of neuroleptic therapy. Sometimes we face the dilemma whether neuroleptic administration could be discontinued. There are some unconditional indications for treatment cessation (signs of intolerance, complications, general medical conditions); all other situations can be considered as relative indications. The risk and benefit of treatment discontinuation should be carefully evaluated. Neuroleptic withdrawal seems to be safer among older patients, with single episode of the psychosis of mild severity, with no family history of schizophrenia. It is necessary to achieve a stable clinical improvement before neuroleptic withdrawal. Worsening of the clinical status creates the most important risk of treatment discontinuation. Other risk factors include unacceptable threatening behavior, increase of family burden. The appearance of withdrawal symptoms such as nausea, vomiting, dyskinesia, insomnia, anxiety, etc. are to be considered. These symptoms are rare, and the risk of relapse is smaller when patients were treated with depot neuroleptics before treatment discontinuation than in the case of treatment with oral neuroleptics. Neuroleptic discontinuation and introduction of placebo cause more risk of relapse than continuation of active treatment.