The Routine Use of Atypical Antipsychotic Agents: Maintenance Treatment

Placebo-controlled maintenance studies of conventional antipsychotic agents demonstrate a significantreduction in the risk of schizophrenic relapse in neuroleptic-treated patients. Neuroleptic discontinuationeven in patients who remained in remission for as long as 5 years results in a relapse ratecomparable to that seen for patients initially assigned to placebo. Yet, patients maintained on conventionalneuroleptics are exposed to the risk of tardive dyskinesia (approximately 5% per year for patientswith up to 10 years of neuroleptic exposure). Attempts have been made to reduce neurolepticexposure. A lower maintenance dose was associated with higher relapse rates, as was intermittent, targetedtherapy. Psychoeducational treatment studies reaffirmed that the major influence on the rate ofrehospitalization was the dose of conventional maintenance medication. Although data are scarce formaintenance treatment with atypical antipsychotic drugs, findings suggest that atypical agents are atleast as efficacious and may be better tolerated. Olanzapine has demonstrated efficacy in maintenancetreatment as well as a reduced risk of tardive dyskinesia compared with haloperidol.