Maintenance therapy in schizophrenia: A critical comment

Abstract

The paper's aim was to evaluate a rationale for maintenance therapy in schizophrenia and to consider the feasibility of intermittent targeted therapy as an alternative treatment strategy. This was achieved by a selected review of the relevant English-language literature published since 1966 through a Medline search and cross-referencing. Current scientific evidence for continuous maintenance therapy in schizophrenia was found equivocal as the randomization in clinical trials lumped together heterogeneous groups of patients, thereby creating a wide gap between research and clinical practice. In addition, the majority of studies took a narrow view of the concept of relapse. For these reasons, targeted intermittent treatment was probably prematurely discarded altogether. The rationale for use and optimal duration of maintenance antipsychotic pharmacotherapy for schizophrenia has not been adequately validated. The construct validity of outcome indicators currently used in maintenance treatment studies in schizophrenia should be reconsidered. Intermittent targeted treatment may represent a viable option in some clinical situations and warrant further evaluation. With the widespread use of atypical antipsychotics, current long-term maintenance strategies may need a reappraisal.