A 22-year-old man has his first psychotic episode with thought broadcasting and persecutory delusions. He is started on an antipsychotic. After 8 weeks he has no residual psychosis. What is the recommended minimum duration of continuation antipsychotic therapy after a first episode of schizophrenia, per current guidelines?

• A 3 months after symptom remission
• B 5 years after symptom remission
• C Indefinitely from the first episode
• D 1–2 years after symptom remission ✓

Explanation

Current guidelines (NICE, APA, RCPsych) recommend maintaining antipsychotic therapy for at least 1–2 years after full symptom remission from a first episode of schizophrenia. Discontinuation within 1 year of remission is associated with very high relapse rates (50–80% within 1 year). After multiple episodes, guidelines recommend longer-term (potentially indefinite) maintenance. The decision must balance relapse risk against medication burden; shared decision-making is essential. Clozapine is reserved for treatment-resistant cases (failure of two adequate trials).

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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