Antipsychotic medications play an important role in schizophrenia, and their efficacy in the relapse prevention and treatment of acute psychotic symptoms is clear-cut.

Data on the long-term use of antipsychotics and impact on prognostic issues is limited, although some previous studies noted a high risk of relapse during the first two years after the first acute psychosis.

Our aim was to study the characteristics and clinical course of medicated and unmedicated schizophrenia patients.

The study population consisted of schizophrenia patients from the Northern Finland 1966 Birth Cohort (n = 70). Use of antipsychotics was examined in the follow-up interview by asking about the subjects’ medication history during the previous three months. The sample was divided into a non-medicated group (n = 24) and a medicated group (n = 46).

Relapses during the follow-up were equally frequent between non-medicated and medicated subjects (47% vs. 53%). Not having been hospitalised during previous five years, but not previous two years, before the interview predicted long-term successful antipsychotic withdrawal without relapse. Fifteen of the subjects in the non-medicated group (63%) and 9 in the medicated group (20%) were in remission.

The present results imply that there are some individuals with schizophrenic psychoses not using antipsychotic medication whose psychotic illness and clinical course are so favourable that they do not necessarily need medication permanently. Changes in the antipsychotic dosing should not be made too fast and the patient and relatives should be able to contact without delay if exacerbation of psychotic symptoms is suspected.

The author has not supplied his declaration of competing interest.