In general, maintenance treatment for individuals with first-episode schizophrenia should last at least 2 years. However, for individuals who have fully recovered from their first-episode psychosis, i.e., achieved both symptom remission and functional recovery, the time to discontinue antipsychotics remains inconclusive. Nature studies are of high value for such topics. In a naturalistic follow-up study published online Dec. 8 in the Journal of Clinical Psychiatry (IF 5.498), a group of researchers from Spain explored these topics. The study was an open-label, non-randomized, prospective design that included patients with non-emotional psychotic disorders from an ongoing longitudinal intervention for patients with first-episode psychosis. Enrollment criteria included Yuxin Cao, Department of Psychiatry, Ningcheng County Montessori Hospital of Traditional Chinese Medicine (1) antipsychotic treatment for at least 18 months; (2) clinical remission for at least 12 months, as determined by the BPRS and SANS scales; (3) functional rehabilitation for at least 6 months, as determined by multifaceted sources and the Disability Assessment Scale (DAS); and (4) use of the lowest effective dose of antipsychotic medication for at least 3 months with Stable. Of the patients who met these criteria, 46 were placed in the discontinuation group and 22 were placed in the maintenance group by electing to remain on medication. The main study outcomes were relapse/worsening rates at months 18 and 36 and the time from baseline to relapse/worsening. The study met international research ethics standards and was approved for conduct by a local institutional review board. The results showed: relapse time survival curves with dark colors for the maintenance treatment group and light colors for the discontinuation group (Jacqueline Mayoral-van Son et al. 2015) ★ Relapse rate at 3 years: 67.4% (31/46) in the discontinuation group, including 56.5% and 58.7% at months 12 and 18, respectively; 31.8% (7/ 22), including 0% and 14% at months 12 and 18, respectively (P=0.006); ★ Mean time from baseline to relapse: 209.2 days in the discontinuation group (median time 122 days, shortest case 12 days); 608 days in the maintenance group (median time 607 days, shortest case 365 days, log rank = 10.106, P=0.001); ★ When looking deeper into the reasons for relapse in the 7 patients in the maintenance treatment group, 5 admitted to stopping medication before relapse and 2 others had stress and medication reduction; in other words, relapse/worsening rates were low in patients who did not admit to stopping medication; ★ Restarting antipsychotic treatment was associated with clinical stabilization and a reduced risk of subsequent relapse; ★ Compared to patients in both groups who relapsed (n=38) and did not relapse (n=30) , there was a significant difference (p<0.05) in total SANS, CGI and DAS scale scores at study year 3: the former had more severe symptoms and lower levels of functioning. < span="">The investigators concluded that for individuals who had a single psychotic episode and achieved functional recovery, antipsychotic maintenance therapy remained associated with a lower relapse rate, with discontinuation again being the most powerful predictor of schizophrenia relapse. In addition, although most patients continue to produce a rapid response after restarting treatment, relapsed patients have more severe symptoms and lower levels of functioning at study year 3 compared to non-relapsed patients, suggesting the dangers of relapse. Clinicians should accurately inform patients and their families that patients with first-episode schizophrenia are still at high risk of relapse once medication is discontinued, even if they are no longer symptomatic and fully functional. Therefore, individuals with a desire to discontinue medication should have a clear plan for discontinuation, coupled with systematic follow-up, to minimize risk. (Reprinted from Medical Pulse)