Discontinuing Antipsychotic Medication after an Episode of Psychosis

The APA Practice Guideline for Schizophrenia provides the following guidance regarding discontinuance of antipsychotic medication after an episode of psychosis: “There may be some individuals with a brief episode of psychosis or uncertain psychotic diagnosis (e.g., possible substance induced psychosis or mood‐related psychosis) who may not require continuing antipsychotic treatment. On the other hand, individuals with chronic symptoms, repeated relapses, and clear diagnostic features of schizophrenia will likely have poorer outcomes if medications are stopped. In addition to symptom recurrence and relapse, medication cessation may be associated with hospitalization, legal difficulties, reduced likelihood of response with reinstatement of treatment, or poorer psychosocial outcomes. It will typically be beneficial to include family members or other persons of support in discussions of medication changes or dose reductions. Evidence is limited on the rationale and approach to planned reductions of medication doses. Unless a medication requires emergent discontinuation, gradual reductions in doses are preferable with close monitoring for recurrent symptoms.” When considering a taper of medication or speed of a taper, keep in mind potential risks associated with relapse and the ability to detect a recurrence of psychosis. It can be months before relapse occurs at any given dose. In addition, be aware that efforts to monitor psychosis and increase dosage after the emergence of symptoms have often failed to prevent relapse. Medication dose increases take weeks to be effective and psychotic symptoms can persist or get worse before medication is effective.

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