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Cited by 246Schizophrenia research and treatmentBipolar Disorder and TreatmentMental Health and Psychiatry

Clinical risk following abrupt and gradual withdrawal of maintenance neuroleptic treatment

Viguera, Adele C.·1997·Archives of General Psychiatry
DOI 10.1001/archpsyc.1997.01830130055011
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Abstract

BACKGROUND: Abrupt discontinuation of long-term psychotropic medication can be followed by a high risk of early relapse. This study aimed to quantify the relapse risk over time in patients with schizophrenia following discontinuation of maintenance neuroleptic treatment. METHODS: Data on the timing of relapses in patients with schizophrenia after withdrawal from neuroleptic therapy were located by a computerized literature search, combined with new data, and evaluated by survival analysis. RESULTS: Data were found for 1210 schizophrenic subjects: 1006 (795 inpatients and 211 outpatients) were withdrawn abruptly from oral neuroleptic therapy, and 204 discontinued treatment gradually (> or = 3 weeks) or stopped treatment with depot neuroleptic drugs. After abrupt discontinuation of oral medication, the risk of relapse reached 50% within 30 weeks, with remarkably little additional risk thereafter to 3.7 years; inpatients relapsed more rapidly than did outpatients (10 vs 18 weeks to a 25% relapse risk). In studies including subjects whose drug therapy was withdrawn abruptly (n = 49) vs gradually (n = 58), relapse was earlier after abrupt discontinuation (25% risk in 6 vs 10 weeks), with a persistent difference for at least 6 months. CONCLUSIONS: The relapse risk was high within 6 months of discontinuing oral neuroleptic therapy, particularly in hospitalized patients. Most patients who remained stable for 6 months continued to do so for long periods without medication, indicating clinical heterogeneity. Drug-withdrawal stressors, related to long-term pharmacodynamic adaptations, are implicated. Since the risk was lower after gradually discontinuing oral neuroleptic therapy or stopping depot injections, early relapse may be spared by a slow removal of drugs.

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Crossref · 10.1001/archpsyc.1997.01830130055011

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  • Abruptly stopping antipsychotic medication is the method most likely to induce relapse and withdrawal symptoms.

    “Abruptly stopping antipsychotic medication is the method most likely to induce relapse and withdrawal symptoms.3,4”

    From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [3]

  • Relapse rates are raised in the discontinuation group for 1-3 years following a switch to placebo, before converging with relapse rates of medicated patients thereafter.

    “It appears that relapse rates are raised in the discontinuation group for 1–3 years following a switch to placebo, before converging with relapse rates of medicated patients thereafter.3,56–59”

    From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [3]

  • Relapses are not distributed evenly across time but tend to occur predominantly around the point of drug cessation.

    “That is, relapses are not distributed evenly across time but tend to occur predominantly around the point of drug cessation.”

    From A Method for Tapering Antipsychotic Treatment That May Minimize the Risk of Relapse (2021) · cites this paper as [3]

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Authors
Viguera, A. C.
Affiliations
Harvard University (US)
Corresponding author
Viguera, Adele C.
ORCID
Viguera, Adele C.
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
1997-01-01
Volume
54
Issue
1
Pages
49
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archpsyc.1997.01830130055011
OpenAlex
W2153434361
Cited by
246
References
49
Citations by year
2026: 1 · 2025: 3 · 2024: 6 · 2023: 6 · 2022: 5 · 2021: 9 · 2020: 10 · 2019: 10 · 2018: 10 · 2017: 6 · 2016: 6 · 2015: 14 · 2014: 8 · 2013: 13 · 2012: 14
FWCI
7.81
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5k05mh047370-25)
  • National Institute of Mental Health (P01MH031154, MH-31154, MH47370)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Keywords
schizophrenia, neuroleptic withdrawal, abrupt discontinuation, relapse risk, long-term antipsychotic treatment, depot neuroleptics
MeSH terms
Administration, Oral, Ambulatory Care, Delayed-Action Preparations, Drug Administration Schedule, Female, Follow-Up Studies, Hospitalization, Humans, Injections, Intramuscular, Male, Recurrence, Risk Factors, Schizophrenia, Schizophrenic Psychology, Substance Withdrawal Syndrome, Antipsychotic Agents, Survival Analysis

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