Jan Bogers
Schizophrenia spectrum and other psychotic disorders remain among the most severe and costly psychiatric conditions worldwide, both in terms of individual suffering and societal expenditure. These disorders are heterogeneous in both presentation and course: some patients recover after a single psychotic episode, while others require repeated or even continuous hospitalization. Schizophrenia, the prototypical psychotic disorder, is characterized by positive symptoms (hallucinations, delusions), negative symptoms (amotivation, social withdrawal), and associated cognitive impairments. Importantly, long-term prognosis is not determined solely by positive symptoms. Negative and cognitive symptoms strongly predict functional outcomes, such as independent living, employment, and social integration 1 . While antipsychotics effectively reduce positive symptoms, their efficacy for negative and cognitive symptoms is limited 2 . Moreover, side effects of prolonged antipsychotic treatment can hinder recovery, leading to patient ambivalence toward long-term use 3 . The clinical challenge is therefore twofold: it involves not only managing relapse risk, but also redefining what counts as “successful treatment”, with functional and social recovery at the forefront. This tension has fueled debate about if, when, and how dose reduction or discontinuation of antipsychotics might be feasible. In this light, the comprehensive review by Moncrieff and Horowitz is highly relevant, as it compels us to reconsider where the balance should lie 4 .