Discontinuation or reduction of chemotherapy in chronic schizophrenics

Are we using excessive neuroleptics? An argument for systematic neuroleptic dose reduction in stable patients with schizophrenia with specific reference to clozapine

“…Several studies in the 1980s and late 1990s suggest that the rate of relapse is significantly higher on low doses of fluphenazine (Hogarty et al, 1988;Kane et al, 1984;Kane, Woerner, & Sarantakos, 1986;Marder et al, 1984Marder et al, , 1987Schooler et al, 1997) and haloperidol (Kane et al 1993). In an early study by Caffey et al (1964), participants within an inpatient unit were placed in one of three treatment groups: placebo, original dose and dosage reduced. The mean dose of either chlorpromazine or thioridazine that patients had been receiving for at least 3 months before the study began was 350-400 mg/day.…”

Selective Review of Effects of Discontinuation of Drug Treatment: Some Implications and Problems

“…Is there any danger that long-as opposed to short-term treatment will inuease the probability of relapse when drugs are discontinued? Clinical studies have found no evidence of any relationship between length of previous medication and tendency to relapse when drugs are discontinued (Good, et al, 1958;Caffey, et al, 1964;Mefferd, et al, 1958). However, further investigation is needed to increase our understanding of this issue.…”

“…The need to maintain dr~lg treatment with patients is frequently mentioned, but the question of how long a patient should be on maintenance drug remains unanswered. Since the therapeutic effects of maintenance drugs are not immediately lost and since drugs can be reintroduced with continued effectiveness (Caffey, et al, 1964;Goldman, 1955;Good, et al, 1958;Olson & Peterson, 1960), some have suggested intermittent administration of drugs in maintaining patients (Good, et al, 1958;Olson & Pecerson, 1962). Although this suggestion appears economical and feasible, the snldy of Caffey, et al (1964), which indicated that reduced-intermittent administration of drugs left less than desirable results suggests the need for caution.…”

“…Withholding drugs for longer periods, however, markedly increased the probability of regression. After 4 mo., relapse rates of 43% (Blackburn & Allen, 1961), 45% (Caffey, et al, 1964), and 62% (Olson & Peterson, 1960) have been reported. Others have reported that drugs could be disconrinued for up co 5 rno.…”

“…The results of studies linking such variables as patient diagnosis, dosage level, duration of previous drug treatment and hospitalization to drug withdrawal effects have been contradictory and inconclusive (Caffey, et al, 1964). There is no question but that failure of therapeutic transfer raises formidable problems for drug therapy.…”