| Summary: | Abstract Antipsychotic medication forms a cornerstone in the treatment of schizophrenia and its effect on positive symptoms and relapse prevention after the first episode has been shown. After the first episode, the treatment guidelines for schizophrenia recommend the continuation of antipsychotic medication at a minimum from six months to five years. The long-term and life-span benefits and harmful side-effects are not fully known. The aim of this naturalistic study was to analyze long-term use of antipsychotic medication with a special interest in medication tapering and discontinuation in schizophrenia. Non-medicated subjects were more often males and in remission, less often on a disability pension, and had better clinical outcomes when compared to medicated subjects at age 34 years. No differences were found when comparing relapse rates during the 8.7 years of follow-up after 34 years between non-medicated and medicated subjects. Not having been hospitalized during the previous 5 years before the follow-up predicted long-term successful antipsychotic discontinuation without relapse. In the long-term, use of antipsychotic medication became steadier after the first five years. A favorable outcome was associated with low and steady antipsychotic medication, and unfavorable with high long-term cumulative use and antipsychotic polypharmacy. Subjects with antipsychotic medication had non-significantly lower total gray matter (TGM) volume compared with non-medicated subjects. Time without antipsychotic medication preceding magnetic resonance imaging was associated with increased TGM and with increased regional volume in the right precentral gyrus and right middle frontal gyrus. This study has a unique description of long-term use of antipsychotics. It provides new information on medication discontinuation and its effect in schizophrenia in the long-term in terms of relapses and brain morphometry. Tiivistelmä Psykoosilääkkeet muodostavat perustan skitsofrenian hoidolle, ja niiden on osoitettu tehoavan ...
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