Neuroleptic withdrawal with remitted schizophrenics: a naturalistic follow-up study

Despite proven efficacy of maintenance pharmacotherapy in schizophrenia, indefinite neuroleptic treatment may not be optimal for all patients. It is uncertain how long maintenance therapy should be continued and how to identify those patients who can withdraw eventually from neuroleptics. Prospective randomized controlled studies are the ideal approach for evaluation of medication, however they are inevitably for the short term and may not be suitable for addressing the above-mentioned issue. In this study, we naturalistically followed up 30 remitted schizophrenics for 10.7 years on average and examined factors that might affect the outcomes. Of 30 remitted patients, 8 cases (26.7%) ceased neuroleptic use completely for more than 2 years. The details of clinical courses of those 8 cases were described as case reports in this report. Importantly, 4 of 8 withdrawal cases required 2 or more trials in order for neuroleptic withdrawal to reach a drug-free state. Factors which significantly affected successful withdrawal involved the mode of onset and the ages at first neuroleptic withdrawal trial. Our results suggest that approximately one-fourth of completely remitted patients could withdraw neuroleptics, but certain cases may need withdrawal trials at least a few times to accomplish the drug-free state.