Treatment Timeline for Suspected Psychiatric Disorder
For suspected psychotic disorders, antipsychotic treatment must continue for at least 12 months after the beginning of remission, with each adequate trial lasting a minimum of 4-8 weeks at therapeutic doses before determining treatment response. 1, 2
Initial Treatment Trial Duration
Each antipsychotic trial requires 4-8 weeks at therapeutic doses to adequately assess response, with dosage increased using increments of the initial dose every 5-7 days until therapeutic benefits or significant side effects become apparent 1
For treatment-resistant cases being evaluated, patients must have taken ≥80% of prescribed doses at the prescribed dosage level over a required ≥12-week treatment period to distinguish true resistance from non-adherence 1
Antipsychotic blood levels should be determined on at least one occasion (optimally ≥2 occasions separated by at least two weeks) to confirm adequate dosing and adherence 1
Maintenance Treatment Duration
Antipsychotic treatment should be continued for at least 12 months after the beginning of remission 1, 2
For bipolar disorder specifically, maintenance treatment should continue for at least 2 years after the last episode 1
After 9 months of antidepressant treatment, dosage reduction is used to reassess the need to medicate, with discontinuation occurring over 10-14 days to limit withdrawal symptoms 1
Special Considerations for Treatment-Resistant Cases
Clozapine therapy should be tried for a duration of at least 3 months following attainment of therapeutic plasma levels before declaring treatment failure 1
Some studies recommend clozapine trial durations between 4-12 months, though the perception of delayed response may primarily be due to time taken to reach therapeutic levels 1
Relapse Risk Timeline After Discontinuation
Approximately 65% of patients receiving placebo will relapse within 1 year of their acute psychotic phase, compared with only 30% receiving antipsychotics 2
The period of highest risk for relapse is in the first 8-12 weeks after discontinuation, requiring monthly monitoring for 6-12 months after complete resolution of symptoms 3
Over 5 years, approximately 80% of patients experience at least one relapse when off medication 2
When Medication-Free Trials May Be Considered
A medication-free trial may only be considered in newly diagnosed patients who have been completely symptom-free for at least 6-12 months 2
For individuals stable for several years on antipsychotic treatment, withdrawal may be considered only in consultation with mental health professionals, keeping in mind the increased risk of relapse 1, 2
Any evidence of disorder recurrence warrants immediate resumption of treatment 2