Duration of antipsychotic therapy for a first episode of psychosis

After a first episode of psychosis, continue antipsychotic therapy to facilitate recovery, and prevent relapse and suicide—see Principles of recovery and relapse prevention for advice on long-term treatment.

The minimum duration of antipsychotic therapy for a first episode of psychosis depends on the duration of symptoms and how quickly the patient responds to treatment.

• If symptoms last for longer than 6 months (ie the patient has schizophrenia or schizoaffective disorder) or the patient has delusional disorder, continue antipsychotic therapy for at least 2 years after symptom resolution—a longer duration is often required.
• If symptoms resolve in less than 6 months and the patient does not have delusional disorder, continue antipsychotic therapy for at least 1 year after symptom resolution—a shorter duration may be adequate if the patient rapidly responds to treatment (eg symptoms resolve in a month). Consider the impact of the episode (eg risk of suicide or violence) and its context (eg comorbid substance use, family history of psychotic disorder).

For principles of stopping antipsychotic therapy, see here.