Maintenance therapy of persons with schizophrenia

Developments over the past 20 years in maintenance treatment have substantially reduced problems with relapses, rehospitalization, and serious psychopathology and dysfunction for most patients with schizophrenia. Therapeutic gains can be accomplished with minimal dosing strategies, targeted drug therapy for medication-refusing patients, psychosocial interventions, and new drugs. Although minimal dose maintenance requires close clinical monitoring and effective collaboration, this strategy reduces side effects and negative symptoms and may thereby translate into greater medication compliance. Psychosocial therapeutics that include family intervention in conjunction with antipsychotic drug treatment reduce relapse rates, but further study is needed. Lithium, carbamazepine, benzodiazepines, beta-blockers, and antidepressant drugs along with electroconvulsive therapy and social skills training provide other relevant approaches in maintenance treatment. Before a maintenance role for new drugs such as clozapine and risperidone is clarified, controlled studies are needed. However, the advantages with motor side effects and secondary negative symptoms should enhance clinical course and medication compliance, and superior antipsychotic prophylaxis is hypothesized. Special issues in maintenance treatment include difficulty in predicting relapse, increased risk of adverse drug effects in elderly patients, and complication of the nonpsychotic aspects of schizophrenia by continued use of antipsychotic drugs. Optimal maintenance treatment incorporates early detection and outpatient management of symptom exacerbation, minimal dosing to increase compliance and reduce adverse effects, psychosocial intervention to reduce relapse rates and enhance functioning, and the integration of several therapeutic modalities and the provision of case managers and assertive community treatment teams.