You say "schizophrenia" and I say "psychosis": Just tell me when I can come off this medication.

Individuals experiencing a first episode of psychosis are likely to respond well to treatment with antipsychotic medications. Of those treated for a first episode of schizophrenia, three out of four can expect to achieve remission. The question of how long antipsychotic medication should be continued has been a topic of heated debate in the field. Longitudinal studies of individuals diagnosed with a first episode of psychosis have reported that as many as 30% may be able to come off of medications without relapsing while treatment discontinuation studies have found that very few patients remain in remission off of medication. This paper reviews the literature on relapse rates following a first episode of schizophrenia and identifies factors that contribute to the discrepancies in the rates reported. These factors include sampling considerations, the distribution of psychiatric diagnoses, the duration of follow-up, the rate of medication discontinuation and the criteria used to define illness recurrence. We propose that individuals for whom the diagnosis of their first psychotic episode is determined with ongoing follow-up to be due to schizophrenia are at extremely high risk of relapse and should be advised to continue antipsychotic medication for the long-term. Those whose first episode of psychosis is determined to be due to other causes are also at high risk of illness recurrence off medications. Recommendations for maintenance treatment should be tailored to reflect the risk of relapse and sequelae of relapse associated with specific causes of first episode psychosis.

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Déclaration de conflit d'intérêts

Declaration of competing interest Dr. Zipursky has received speaking fees from Janssen-Cilag and an educational grant from Janssen Canada. Dr. Odejayi has no conflicts of interest to report. Dr. Agid has served as a consultant and on advisory boards for Janssen-Ortho (Johnson & Johnson), Otsuka; Lundbeck; Sumitomo Dainippon Pharma (DSP) and Minerva Neurosciences Inc. He has received speaking honoria from Janssen-Ortho (Johnson & Johnson), Lundbeck, Otsuka, Mylan Pharmaceuticals, HLS Therapeutics and Novartis. He has received research support from Janssen-Ortho (Johnson & Johnson), Otsuka, Boehringer Ingelheim, Neurocrine Bioscience, Acadia, Syneurx and diaMentis. Dr. Remington has received research support from the Canadian Institutes of Health Research (CIHR), HLS Therapeutics Inc., Novartis Canada, and Research Hospital Fund–Canada Foundation for Innovation (RHF-CFI). He has also received conference support from Neurocrine Biosciences for data presentation, and advisory board support from HLS Therapeutics.