After a first episode in schizophrenia, maintenance treatment is recommended for at least 1 year. In addition to maintenance treatment or particularly in case of drug discontinuation prodrome based early intervention is a recommended (supplemental) long-term treatment strategy to prevent relapse. Drug discontinuation, although inferior to maintenance treatment in multiple-episode patients, showed comparable relapse preventing results in first-episode patients (Gaebel et al. 2002), However, more empirical data is strongly needed, to evaluate this treatment strategy in first-episode patients.

Accordingly, a 2-years long-term trial in first-episode schizophrenia was conducted within the GRNS. In the first treatment year, maintenance treatment with risperidone was compared to treatment with (low-dose) haloperidol (randomized double-blind design). In the second treatment year, continued neuroleptic treatment was compared with stepwise drug withdrawal (randomized design) both supplemented by prodrome-based early intervention.

From the 96 patients after 1-year maintenance treatment, about 50% were not eligible for both treatment strategies due to doctors concerns (particularly to discontinue drug treatment) or to patients decision. Likewise to the first treatment year, relapse rate is very low, and preliminary results seems to indicate a higher risk for relapse and deterioration after drug discontinuation. Early recognition of relapse based on prodromal symptoms and other early warning signs showed satisfactory results with the highest relapse predictive validity for a composite score of unspecific prodromes.

The results emphasizes the need to evaluate and provide various effective long-term treatment strategies to take patients conditions and circumstances into account.