Discontinuation of antipsychotic medication or dose reduction may be considered if a patient with psychosis experiences positive symptom remission, implying minimal or no residual positive symptoms. Discontinuation may be appropriate for those rare individuals whose first psychotic episode was misdiagnosed as schizophrenia (eg, a patient who was initially diagnosed with schizophrenia but may actually have had a psychotic episode related to a condition other than schizophrenia, such as drug-induced psychosis). Suspicion that the diagnosis is not schizophrenia should only be considered in those patients with no positive, negative, or cognitive symptoms. The presence of any of those symptom clusters is a clue that this patient has schizophrenia and that they are likely to relapse without antipsychotic therapy. In addition to the absence of any core schizophrenia symptoms, candidates for medication discontinuation should also have excellent psychosocial support to help detect a relapse of psychotic symptoms. 

Although the number of patients who are accurately diagnosed with schizophrenia and who can successfully discontinue antipsychotic medication is extremely small, some modestly symptomatic individuals with schizophrenia who are stable may be appropriate candidates for antipsychotic dose reduction to lessen the burdens of treatment. This is particularly true for those who report adverse effects, most notably those related to dopamine D₂ antagonism. Under such circumstances, it is important to decrease the dose very slowly and in small increments (ie, 5% per month), thus allowing sufficient time to confirm that symptom severity remains at baseline prior to additional dose reductions. 

The need for caution in dose reduction or antipsychotic discontinuation cannot be overstated, as the repercussions of relapse may have long-term life consequences for the patient. In addition to psychiatric hospitalization, patients may lose their current housing situation and other social supports. Moreover, there may also be legal implications (eg, incarceration) if the patient becomes aggressive and/or violent when they relapse. As individuals with psychosis often lose insight into their condition, ensuring that they have appropriate psychosocial support during an attempt at antipsychotic dose reduction will, ideally, contribute to the quick and accurate identification of the emergence of relapse symptoms.