Hi Sandra, Thanks again for a balanced and interesting approach on this blog from an actual clinician. I particularly agree with your point about treating each person individually. Serious short term risk often has to be balanced against the potential for negative long term consequences. There isn’t an algorithm and like you, I still believe that neuroleptics are helpful for some people and should be used in some situations. I wanted to point out something about the Wunderink study which I don’t think was apparent from your post. It is my understanding that the trial participants were treated with a neuroleptic for the first 6 months and once stable were then randomized to either drug reduction or maintenance arms. It is an important point because it means that the data only directly comment on this specific group. That is those with first episode psychosis who become stable for 6 months with neuroleptic treatment. I think the study is very interesting and valuable, but accurate understanding of the context in which the data directly apply is critical. It is certainly not by itself evidence that supports not using neuroleptics at all. In fact, one could argue it supports rapid stabilization on neurleptics followed by judicious attempts to reduce dosage or wean off completely. For a balanced editorial on the article see, http://archpsyc.jamanetwork.com/article.aspx?articleid=1707649. Unfortunately many will not be able to access it due to journal paywalls, but some may be able to read it. I understand that there are many types of data that people cite in regards to the negative consequences of neuroleptics. It isn’t my intention to get into that, just to point out that this article applies to a narrow spectrum of patients with first episode psychosis who were successfully treated with neuroleptics prior to being weaned off.