Continuing antipsychotic treatment in patients with schizophrenia under clinical remission remains controversial. Even though the mainstream opinion declares an outweighed balance against medication discontinuation, recent reviews and critiques suggest that some patients may remain symptom free and well functioning after stopping antipsychotics, but few predictors can identify who can try medication discontinuation, whilst no guidelines exist for reducing medication to reach the lowest effective dose safely. Analyzing the findings from studies employing different methodologies, adopting evidence from pharmacodynamic research, and observing dose reduction in stable patients, as well as taking inspiration from the metaphor of the Cantor set in natural philosophy, we introduce an alternative solution and propose a guided dose-reduction algorithm that follows a set of clear precautions and instructions. The algorithm recommends only a fraction (no more than 25%) of the dosage to be reduced at a time, with at least a 6-month stabilization period required before reducing another 25% of the dose. Patients are empowered to actively participate in decision making when they are ready for further dose tapering, or should they retreat to a previous dosage if warning signs of a relapse re-emerge. An intermittent or irregular dosing schedule can be used to adapt this algorithm to real-world practice. Our preliminary findings suggest that patients with remitted psychosis can do well along this path. We anticipate that this approach can help optimize the risk-benefit ratio and instill a hope in patients with schizophrenia that they can maintain in stable remission under a lower antipsychotic dose without an increased risk of relapse.

中文翻译：

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为精神病缓解患者实现最低的有效抗精神病药物剂量：一种拟议的指导减量算法。

在临床缓解下对精神分裂症患者继续抗精神病药物治疗仍存在争议。尽管主流意见宣称与药物停药之间的平衡非常重要，但最近的评论和批评表明，某些患者在停止使用抗精神病药后可能仍无症状且功能良好，但是很少有预测因素能够确定谁可以尝试药物停药，而目前尚无减少药物使用的指南。安全地达到最低有效剂量。分析采用不同方法的研究结果，采用药效学研究的证据，观察稳定患者的剂量减少情况，并从自然哲学中康托尔的隐喻中汲取灵感，我们介绍了一种替代解决方案，并提出了一套指导性的剂量减少算法，该算法遵循一系列明确的预防措施和说明。该算法建议一次只减少一小部分剂量（不超过25％），在减少另外25％的剂量之前至少需要6个月的稳定期。当患者准备进一步降低剂量时，或者如果再次出现复发的预警迹象，患者应退缩至先前的剂量，从而使患者能够积极参与决策。间歇或不规则的加药时间表可用于使该算法适应实际应用。我们的初步发现表明，精神病缓解的患者在这条道路上可以做得很好。