À la recherche d'un dosage minimal d'antipsychotiques : construire une décision partagée avec les personnes souffrant de psychose

The search for a minimal dosage of antipsychotics in psychosis remains controversial but feasible, scientifically sound and especially recommended for first-episode psychosis. It assumes that the doses needed for prevention of relapse are lower than in the treatment of an acute episode. Process should be considered with caution and at a slow pace, particularly when the desired dosage reaches 300 mg CPZ EQ or leads to a complete interruption of treatment. The counter-indications include non-stabilized symptoms, dangerousness, a history of severe social consequences or a lack of cooperation with the patient and relatives. The potential consequences of relapse must be carefully examined with the person and family. A short delay between the early signs and full psychotic episode is a relative contraindication, especially if previous episodes have significant risks for the person or to others or had serious social consequences. Further studies should determine more precisely who could benefit from such an approach beyond first psychotic episode, in order to offer other choices to individuals than stopping medication against their therapist's advice.