Antipsychotic treatment for schizophrenia in the maintenance phase: a systematic review of the guidelines and algorithms

Takeuchi, Hiroyoshi; Suzuki, Takefumi; Uchida, Hiroyuki; Watanabe, Koichiro; Mimura, Masaru

doi:10.1016/j.schres.2011.11.021

Cited by 115Schizophrenia research and treatmentMental Health and PsychiatryBipolar Disorder and Treatment

Antipsychotic treatment for schizophrenia in the maintenance phase: a systematic review of the guidelines and algorithms

Takeuchi, Hiroyoshi, Suzuki, Takefumi, Uchida, Hiroyuki, Watanabe, Koichiro, Mimura, Masaru·2012·Schizophrenia Research

DOI 10.1016/j.schres.2011.11.021

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Abstract

Objective Antipsychotic treatment strategy for the maintenance phase of schizophrenia has been inconsistent in the literature. The purpose of this systematic review is to overview recommendations in various guidelines and algorithms.Methods The guidelines and algorithms for schizophrenia that were published or updated in English after 2000 were searched, using Medline, PubMed, EMBASE, and PsycINFO with the following key words: guideline, algorithm, schizophrenia, and psychosis (last search: July 2011). The reference lists of the relevant reports were also examined.Results Fourteen guidelines and algorithms were identified; only five of them clearly defined terms about the maintenance phase and treatment. Ten of 11 guidelines and algorithms did not recommend discontinuation of antipsychotics within five years; six of them partially recommended antipsychotic discontinuation for patients with first-episode schizophrenia exclusive. All nine guidelines and algorithms that referred to intermittent or targeted antipsychotic strategy endorsed against this strategy. Although being a hot topic of controversy, dose reduction of antipsychotics or lower dose therapy in the maintenance phase compared to the acute dosage is not recommended on the whole concerning atypical antipsychotics, whereas dose reduction appears sometimes considered acceptable for typical antipsychotics.Conclusion What constitutes maintenance phase and its treatment in schizophrenia has not yet been established in the literature. While discontinuation and intermittent or targeted strategies are not generally recommended, there is controversy regarding dose reduction or lower dose therapy, especially with regards to atypical antipsychotics. Further evidence is needed in order to derive treatment recommendations on antipsychotics in this critical treatment phase of schizophrenia.

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Authors: Takeuchi, H., Suzuki, T., Uchida, H., Watanabe, K., & Mimura, M.
Affiliations: Keio University (JP)
Centre for Addiction and Mental Health (CA)
ORCID: Takeuchi, Hiroyoshi
Suzuki, Takefumi
Uchida, Hiroyuki
Watanabe, Koichiro
Mimura, Masaru
Venue: Schizophrenia Research
Publisher: Elsevier BV
Published: 2012-02
Volume: 134
Issue: 2-3
Pages: 219-225
ISSN: 0920-9964 (ISSN-L)
DOI: 10.1016/j.schres.2011.11.021
OpenAlex: W1987608027
Cited by: 115
References: 57
Citations by year: 2026: 2 · 2025: 5 · 2024: 7 · 2023: 7 · 2022: 5 · 2021: 16 · 2020: 9 · 2019: 11 · 2018: 8 · 2017: 8 · 2016: 11 · 2015: 8 · 2014: 7 · 2013: 8 · 2012: 3
FWCI: 0.77
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Schizophrenia Research (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords: schizophrenia, antipsychotic drugs
MeSH terms: Algorithms, Humans, Schizophrenia, Antipsychotic Agents, Databases, Bibliographic, Guidelines as Topic

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Antipsychotic treatment for schizophrenia in the maintenance phase: a systematic review of the guidelines and algorithms

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