Targeted Intermittent Treatment in Chronic Schizophrenia

remission, symptom recurrence, or relapse, despite continuous antipsychotic treatment. This also applies to depot neuroleptic treatment, which minimizes adherence problems. Several studies suggest that with careful clinical observation, substantial reduction of maintenance doses can, for many patients, lead to improvement in some areas of subjective and objective well-being and to a diminution of adverse effects (Kane et al., 1986). Schizophrenic patients remain on antipsychotic (i.e., antidopaminergic) treatment for years, yet remarkably little is known about what happens to the dopamine function during ongoing treatment (Remington and Kapur, 2010). What is known is that in late stages of schizophrenia, antipsychotics become inefficient frequently, despite chronic continuous treatment. There is evidence from preclinical as well as clinical studies that point to the build up of dopamine supersensitivity (Samaha et al., 2007) and tolerance to antipsychotics, leading to treatment failure over time. IntroductIon Talking about non-continuous antipsychotic treatment in psychiatric practice in our time is tantamount to heresy. We have been perseverating in comparing psychiatric illness to diabetes and hypertension so much that we are having a hard time fathoming a different analogy; perhaps, lupus, asthma, rheumatoid arthritis, or cancer in which intermittent dosing for shorter period of time is acceptable. In 1960s and 1970s, there was a lot of talk about targeting intermittent treatment throughout the duration of illness, rather than chronic and final phase of schizophrenia. Widespread use of antipsychotics is historically novel that only a small percentage phase four patients are being seen currently by average psychiatrists, but this number may grow in time. Reviewing the psychiatric literature from 1970s, it appears that continuous antipsychotic exposure were not always necessary at that time (Prien et al., 1973). Even in our times there are advocates of non-continuous treatment after the first episode of schizophrenia, as about 50% of patients have remained stable after discontinuing medications in the second year of treatment (Harrow and Jobe, 2007). Also, the duration of antipsychotic treatment after a first episode of psychosis remains unclear. A comparison of evidence-based treatment guidelines from different countries developed on highest-quality criteria, yielded inconsistent recommendations regarding the duration of maintenance treatment (Gaebel et al., 2011).