The history of relapse following successful maintenanceprophylaxis

A pertinent clinical question relates to how long medication should be continued in patients in whom stable maintenance has been achieved. Johnson (52) compared patients discontinuing antipsychotics with matched patients remaining on drugs, all of whom had been stable for one of three distinct periods: 1 to 2 years, 2 to 3 years, or 3 to 4 years. Relapse rates at 18 months were similar in all three groups who stopped, regardless of how long they had been stable beforehand (80 per cent, 90 per cent, and 70 per cent, respectively), and substantially higher than those who remained on treatment (35 per cent, 15 per cent, and 19 per cent, respectively). Others have come to the same conclusion using intervals of from 12 months to almost 8 years. ^M4 and55) A similar picture of relapse has also been established in target populations selected on the specific basis of having responded particularly well to long-term medication and hence predicted as being of high likelihood to maintain well being.(56>

The implication seems to be that, no matter the duration or quality of well being on antipsychotic medication, relapse is inevitable following discontinuation in those with an established relapsing-remitting pattern of illness, with a time course that, in general, is consistent for each individual.

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