Standardized treatment of first-onset schizophrenia and time to discontinue medication

  Standardized treatment for patients with first-episode schizophrenia: 2 months of acute treatment at the dose adjusted for outpatient or inpatient use, generally without dose reduction in the absence of serious and tolerated side effects.  Consolidation phase treatment for 1 year at the same dose as the acute phase treatment.  For 3-5 years of maintenance treatment, newer (atypical) antipsychotics such as clozapine, olanzapine, risperidone, amisulpride, quetiapine, aripiprazole, ziprasidone, etc. should be maintained at or slightly below the acute dose; older (typical) antipsychotics such as chlorpromazine, haloperidol, fenadine, etc. can be gradually reduced to one-half to three-fourths of the acute dose after stabilization. The study shows that a reduction in dosage is more effective than no reduction at all.  Studies have shown that tapering is more likely to lead to relapse than not tapering, so tapering should be carefully weighed against the pros and cons. Long-term maintenance therapy is recommended for patients with multiple-onset schizophrenia.