Promoting recovery

It is uncertain whether maintenance drug therapy is required for all people with schizophrenia. Around 20 per cent of individuals will only experience a single pyschotic episode. While a high proportion respond to initial treatment with antipsychotic medication, around 80 per cent will relapse within five years of a treated first episode, which is partly explained by discontinuation of medication.

Risk factors for relapse of illness include the presence of persistent symptoms, poor adherence to the treatment regimen, lack of insight and substance misuse, all of which can be reasonable targets for intervention.

Many of the guidelines recommend informing a patient that there is a high risk of relapse if they stop medication in the next one to two years. Abrupt withdrawal dramatically increases the risk of relapse in the short to medium term, so any withdrawal should be done gradually and with regular monitoring for signs and symptoms of relapse. Monitoring should continue for at least two years after withdrawal of the antipsychotic.

Reflection Exercise

About half of people with schizophrenia are believed to be non-adherent with their medication. How would you support a patient who was not keen to continue to take their prescribed medication?