For how long should antipsychotic medication be continued after the first psychotic episode in schizophrenics?

Four patients, two women aged 24 and 62 years and two men aged 25 and 24, respectively, were admitted because of psychosis. A Dutch consensus paper advises treating patients with a first episode of schizophrenia or schizophreniform disorder with neuroleptics for two years as secondary prophylaxis. However, this advice should be tailored to the individual patient's characteristics. Thus, the first patient was given prophylactic medication for five years because she had many schizophrenic symptoms and a positive family history. In the second patient, the diagnosis was much less certain and, because of her advanced age, the risk of developing tardive dyskinesia was considerable. Prophylaxis was given for three months only. The third patient used drugs and did not really want to be treated. In the fourth patient the affective symptoms could not be interpreted for certain as part of a basic schizophrenic defect. In addition, he would be seriously handicapped professionally if he developed tardive dyskinesia. In his case, two years of secondary prophylaxis was advised.