Intermittent medication--an alternative?

Neuroleptic maintenance medication is clearly effective for relapse prevention in schizophrenia. However, besides benefits for the majority of patients, there are also failures and/or serious risks for some patients (e.g., tardive dyskinesia). Since the risk-benefit ratio is often difficult to predict in the individual case, this has stimulated the search for modifications and alternatives to maintenance treatment. In particular, neuroleptic low-dose treatment strategies obviously compare quite favourably with standard-dose treatment concerning relapse prevention and side effects. Alternatively, on the basis of reports on prodromal symptoms preceding a relapse, early intervention, intermittent neuroleptic treatment strategies have been developed. However, all recently completed controlled 2-year studies have not confirmed this strategy to be as effective as maintenance treatment in preventing relapse, although total drug exposure is significantly reduced and social adjustment seems to be unaffected. Therefore, for the majority of patients, intermittent treatment cannot be recommended.