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Antipsychotic duration of treatment


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I'm reading Stahls Prescribers guide and it says "After reaching a satisfactory plateau,

continue treatment for at least a year after

first episode of psychosis

• For second and subsequent episodes of

psychosis, treatment may need to be

indefinite

• Even for first episodes of psychosis, it may

be preferable to continue treatment

indefinitely to avoid subsequent episodes

• Treatment may not only reduce mania but

also prevent recurrences of mania in

bipolar disorder"

That's what I don't get because I don't have any knowledge of doctors ever stopping an antipsychotic that is working with no harmful side effects, after a year or at any point for schizophrenia or bipolar. It makes it seem like for initial psychosis that if you are back to normal they stop the drug and you go on living a psychosis free life the rest of the way. I remember seeing one graph showing there is acute schizophrenia and intermittent and chronic. I've always thought that all schizophrenia was chronic so not even sure if acute schizophrenia is possible. If it is not and all bipolar is chronic why does he even mention stopping it if working?

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No, not all schizophrenia is chronic. There are some schizophrenics who have one psychotic episode and never again for the rest of their life. Such people don't require maintenance medication. They don't want to medicate people who don't need it.

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So even chronic schizophrenia can remit? I mean, it's defined as chronic now, but what if it were to stop and not come back? just as BP can be recategorized or even changed entirely [a mis-dx], these too can change. no diagnosis is set in stone. right?

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The problem is that psychotic and manic episodes correspond with the loss of brain matter. A severe episode can really damage you. Some docs prefer to play it safe and make sure you stay stable.

In the DSM-V there's even a condition called "pre-stereophonic." It's people who have symptoms indicating they are likely to develop schizophrenia in the future. The idea is to try and catch people before they even have their first episode and get them on meds.

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Guest Vapourware

Some people will only experience one psychotic episode in their lifetime - and psychosis isn't limited to schizophrenia spectrum disorders. Bipolar and depression are two other disorders where psychosis can occur. Note the wording of that prescriber's guide - it says you can take people off APs IF there is only one episode and they have had at least a year without symptoms.

For two or more episodes - which is where chronic psychosis would lie - then it recommends continuous taking of APs.

I'm currently not on an AP either, and I'm schizoaffective. Perhaps my pdoc and I are playing with fire, but he's keeping an eye on me to ensure that at the first signs of trouble, I'll be back on an AP again.

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I have schizophrenia but have been well since the beginning of the year. My psychiatrist is weaning me off my antipsychotic from today as he said he doesn't like to medicate people when it is not needed. He is happy that I can recognise early warning signs of becoming unwell and told me that if I get any of these signs then I can go back on the antipsychotic again.

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I am terrified of the idea of coming off my medication. Sure I would love to be able to do it and not have any symptoms come back, but I am not entirely convinced of the possibility. I don't even think that it is possible to be 100% symptom free, 98-99% maybe but that is not 100%, and I still have what I call 'background delusions' (my own terminology, sorry). I have no idea of where my illness is going to go in the future. But I would definitely rather be medicated and well than unmedicated and unwell.

And one of my biggest regrets is actually not getting treated earlier. I may be wrong, but I think that it would be easier to treat a psychosis that has only been going on for a short period of time than one that has been going on for a number of years. If my illness was spotted sooner then perhaps I would be doing even better now than what I am.

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