Remarks y Discontinuation of antipsychotics should always be done by gradually and slowly reducing the medicine dose. When medicines are discontinued, people living with schizophrenia and family members need to be educated to detect the re-emergence of symptoms early to allow for close clinical monitoring of relapse.

Implementation considerations y As individuals with a first psychotic episode usually respond well to antipsychotics, drug choice should be mainly based on side-effect profiles. y People living with schizophrenia should be involved in drug choice in a supported decision-making process. y Treatment with antipsychotic medicines should be combined with psychosocial interventions (see other PICO questions in this module). y Acquisition costs can differ substantially. Also, throughout the world, second-generation and other newer antipsychotics may have higher costs than older first-generation antipsychotics. y Interruptions in medicine availability (common in LMICs and in supply chain interruption such as during emergencies) may interfere with continuation of treatment. Reliability of supply should inform choice of medicine. y For the treatment of psychotic disorders, the WHO EML (13) includes:

• fluphenazine (therapeutic alternatives: haloperidol decanonate, zuclopenthixol decanonate);
• haloperidol (therapeutic alternative: chlorpromazine);
• haloperidol injection;
• olanzapine;
• paliperidone (therapeutic alternative: risperidone injection);
• risperidone (therapeutic alternatives: aripiprazole, olanzapine, paliperidone, quetiapine);
• complementary list: clozapine.