While antipsychotics (APs) could provide rapid relief of positive symptoms in psychotic disorders, their usage is often associated with side effects, stigma and inconveniences. For these and other reasons, many psychosis patients, particularly those of first-episode psychosis (FEP) in remission, wish to discontinue maintenance treatment. The current review aims to discuss the strategies of AP treatment following remission from FEP, with particular emphasis on the evaluation of outcomes following AP discontinuation. Upon review of relevant literature, three potential strategies are put forth for treatment-responsive, remitted FEP patients: a) life-long maintenance treatment, b) AP discontinuation during second year of treatment, or c) AP discontinuation after three years of treatment. In theory, the first strategy presents the safest option for maximal symptom control. However, a rigorous RCT indicates that if AP discontinuation is to be attempted, the third strategy best prevents poor long-term clinical outcomes. Further data is needed to address the costs and benefits of each treatment strategy, compare AP-free patients with those on different types of APs, as well as explore even longer-term outcomes.

中文翻译：

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对首发精神病缓解后药物决定的看法

虽然抗精神病药 (AP) 可以快速缓解精神病患者的阳性症状，但它们的使用往往伴随着副作用、耻辱和不便。由于这些和其他原因，许多精神病患者，尤其是缓解期的首发精神病 (FEP) 患者，希望停止维持治疗。本综述旨在讨论 FEP 缓解后 AP 治疗的策略，特别强调对 AP 停药后结局的评估。在查阅相关文献后，针对治疗反应良好、缓解的 FEP 患者提出了三种可能的策略：a) 终生维持治疗，b) 在治疗的第二年期间停用 AP，或 c) 在治疗三年后停用 AP。理论上，第一种策略是最大程度控制症状的最安全选项。然而，一项严格的 RCT 表明，如果要尝试停用 AP，第三种策略可以最好地防止长期临床结果不佳。需要更多数据来解决每种治疗策略的成本和收益，将无 AP 患者与使用不同类型 AP 的患者进行比较，以及探索更长期的结果。