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Maintenance treatment for patients with a first psychotic episode

Sommer, Iris E.C.a; Oomen, Priscilla P.a; Hasan, Alkomietb

Current Opinion in Psychiatry: May 2019 - Volume 32 - Issue 3 - p 147–156
doi: 10.1097/YCO.0000000000000494
SCHIZOPHRENIA AND RELATED DISORDERS: Edited by Lynn E. DeLisi and Iris E.C. Sommer
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Purpose of review To provide an update of recent studies relevant for maintenance treatment with antipsychotic medication after a first psychotic episode (FEP).

Recent findings Despite controversy derived from a follow-up analysis from an earlier study showing that attempted early discontinuation after remission was associated with improved long-term functioning, most other studies support better long-term outcome with continuous maintenance treatment after the first episode. However, the main question is not whether, but for how long maintenance treatment after FEP should be offered. Consistent evidence shows that withdrawal from antipsychotics increases the risk for a relapse or re-hospitalization. On the other hand, maintenance treatment is associated with the risk to develop burdensome antipsychotic-induced side-effects and one should keep in mind that around 20% of FEP will not have a second episode. In this regard, the decision for maintenance treatment for periods above some months must be the result of a comprehensive risk–benefit evaluation during a shared decision-making process.

Summary There is no replicated evidence that prognosis can be improved by discontinuing antipsychotic medication after a FEP. There is a clear need for additional studies to develop single-subject outcome predictors and to identify long-term efficacy of maintenance treatment beyond relapse (e.g. recovery).

aRijks Universiteit Groningen (RUG), Universitair Medisch Centrum Groningen (UMCG), Department of Biomedical Science of Cells and Systems, and Department of Psychiatry (UCP), Groningen, the Netherlands

bDepartment of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians University München, Germany

Correspondence to Dr Alkomiet Hasan, MD, Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Nussbaumstrasse 7, 80336 München, Germany. Tel: +49 89 4400 55511; fax: +49 89 4400 55530; e-mail: Alkomiet.Hasan@med.uni-muenchen.de

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