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Schizophrenia and related conditions are common and associated with long-term disability, premature death, physical illness and high costs. Priorities for long-term management include improving functioning, physical health and patient autonomy.
Recommended treatment for people with recurrent episodes consists of continuous antipsychotic medication (NICE, 2014; Hasan et al, 2013), yet despite this many people remain functionally impaired. In one study, 25% of people with schizophrenia had severe social disabilities after 15 years, and only 14% had none (Wiersma et al, 2000).
Antipsychotics reduce positive symptoms and risk of relapse in the short-term. However, they have little effect on negative symptoms, and they can cause serious physical side effects, including diabetes, tardive dyskinesia, heart disease (Osborn et al, 2007; Ray et al, 2009) and possibly early death (Joukamaa, 2006). Furthermore, mental side effects including sedation, emotional blunting and akathisia are debilitating and unpleasant (Moncrieff et al 2009; Barbui et al, 2005).
Therefore, although continuous antipsychotic treatment has become the norm, we are not certain that this treatment represents the best balance of benefits and harms. In particular, we need more evidence on the effects of gradual reduction of antipsychotics on outcomes other than relapse, with longer term follow up.
A recent study conducted in the Netherlands suggests that antipsychotic reduction and discontinuation, if conducted in a gradual and supported manner, may be advantageous in terms of social recovery in the medium to longer term. Participants randomised to a strategy of gradual and flexible antipsychotic reduction and discontinuation over 18 months were twice as likely to show a full social recovery compared with people who had been randomised to maintenance treatment at seven-year follow-up, with no difference in relapse (Wunderink et al, 2013).
The RADAR research study aims to develop and evaluate a similar programme to meet the needs of people in the UK with long-term schizophrenia and similar problems.
