Review of antipsychotic medication administration: a proposal of intermittent dosing

Despite advances in the treatment of schizophrenia, there are substantial gaps in systematically established knowledge concerning the application of antipsychotic agents. We still do not know how antipsychotic drugs work, where they work, how much to prescribe, or how often to prescribe. No consensus exists on the definition of relapse or recovery. Based on new knowledge of delayed onset and offset of pharmacological response in schizophrenia, of signal transduction, of time-delayed effects at the neuronal level, and of the complexities of etiologic and clinical heterogeneity in these disorders, we propose an alternative dosing strategy. Fixed intermittent dosing for initiation and maintenance of remission of clinical symptoms holds promise for improving response to medication, reducing side effects, increasing compliance, and limiting cost. It may help clarify the taxonomic conundrum of schizophrenia by providing a probe for identifying discrete pathophysiologic substrates in these disorders.