Table 1.

Cognition and social function in maintenance vs. dose reduction/discontinuation of antipsychotic drugs in psychosis.

Study and year	No. of subjects	Subject population	Study design	Follow-up period	Outcome measure	Relapse rate (%)	Cognition	Social function
Gaebel et al. (4)	MM 23/MD 21	Clinically stable first-episode schizophrenia (ICD-10), aged 18–56, with antipsychotic treatment for 12 months and 8 weeks	RCT, OL, during the last 1-year of the 2-years and 8 weeks follow-up, comparison MM with MD (targeted intermittent treatment after stepwise drug discontinuation), risperidone or haloperidol	1-year	GAF	MM 0 < MD 19a		GAF score (mean) MM (79.4) > MD (62.1)a LQLP (mean) MM 5.3: MD 4.8, NS
Faber et al. (20)	MM 20/MD 22	FEP, having reached remission within 6 months of the start of second generation antipsychotics	RCT, OL, comparison MM with MD, risperidone, haloperidol or quetiapine	2–3 months	Stroop test, CPT, digit span, CVLT, TMT, verbal fluency, Symbol Substitution, Finger tapping		Improvement on Symbol Substitution, verbal fluency, TMT B MM < MDa
Wunderink et al. (21)	MM 52/MD 51	FEP in remission for 6 months	RCT, OL, during the last 2-years of the follow-up, comparison MM with MD, doses below 1 mg of haloperidol equivalents	7-years	GSDS	MM 68.6:MD 61.5, NS Symptomatic remission; MM 66.7: MD 69.2, NS		% functional remission MM (19.6) < MD (46.2)a
Takeuchi et al. (22)	MM 30/MD 31	Schizophrenia (DSM-IV) in remission with respect to positive symptoms and treated with stable doses of olanzapine or risperidone	RCT, OL, comparison MM with MD (dose reduced by 50%), olanzapine or risperidone	28 weeks	RBANS	MM 3.0: MD 3.0, NS	Improvement in RBANS scale score (mean) MM (−0.1) < MD (+7.0)a
Mayoral-van Son et al. (24)	MM 22/MD 46	FEP with antipsychotic treatment ≥ 18 months, stabilized at the lowest effective dose ≥ 3 months, clinical remission ≥ 12 months, functional recovery ≥ 6 months	Nonrandomized, prospective study, OL, comparison MM with MD (discontinuation), amisulpride, aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, ziprasidone	3-years	DAS	MM 31.8 < MD 67.4a		% functional recovery (DAS global score = 0) MM 90.9: MD 84.8, NS
Chen et al. (3) and Hui et al. (23)	MM 89/MD 89	First-episode schizophrenia (DSM-IV) with full positive symptom resolution after about 2-years of antipsychotic treatment, aged 18–65	RCT, DB, comparison MM with MD (early discontinuation) for 12 months, quetiapine	10-years	SOFAS, RFS, SF-36	Relapse at 12 months MM 30 < MD 63a Composite poor outcome at 10-years MM 21 < MD 39a		SOFAS score (mean) MM 61.9: MD 64.0, NS RFS total score (mean) MM 21.3: MD 21.5, NS SF-36: MCS score (mean) MM 50.2: MD 51.0, NS SF-36: PCS score (mean) MM 56.6: MD 56.9, NS

CPT, continuous performance test; CVLT, California Verbal Learning Test; DAS, Disability Assessment Schedule; DB, double blind; FEP, first episode psychosis; GAF, Global Assessment of Functioning; GSDS, Groningen Social Disability Schedule; LQLP, Lancashire Quality of Life Profile; MD, medication dose reduction/discontinuation; MM, medication maintenance; OL, open label; RBANS, Repeatable Battery for the Assessment of Neuropsychological Status; RCT, randomized controlled trial; RFS, the Role Functioning Scale; SF-36, the 36-Item Short Form Health Survey; MCS, mental component summary; PCS, physical component summary; SOFAS, the Social and Occupational Functioning Assessment Scale; TMT, Trail-Making Test.

^aStatistically significant; NS, no significant difference.