[Is our clinical practice of antipsychotic relapse prevention in schizophrenia really evidence-based]

Abstract

OBJECTIVE, METHODS: Relapse prevention is one of the central issues in the treatment of schizophrenic psychoses. The paper gives an overview of the current literature on medication adherence with special regard to 2nd generation antipsychotics and long-acting agents and describes the practical consequences for clinical routine. Additionally, it examines whether or not everyday practice is consistent with our actual scientific knowledge.

Results: Even in shortterm trials, medication adherence in patients with schizophrenia comes up to merely 50%. The negative consequences of medication non-adherence are substantial. This concerns the rates of relapse and readmission, morbidity and mortality, - in particular suicide -, as well as the economic burden of society. Consequent antipsychotic treatment is associated with significantly better outcomes in all dimensions. In this regard, longacting agents are unequivocally superior to oral antipsychotics - even to atypical ones. These facts conflict with clinical routine, where long-acting antipsychotic agents are scarcely used.

Conclusions: Based on current scientific knowledge, the major objections raised against the application of long-acting agents can be refuted: 1) 2nd generation antipsychotics do not improve medication adherence. 2) Concerns that long-acting agents conflict with the autonomy of a patient neglect the loss of autonomy and self-determination in case of a psychotic relapse. 3) The assertion that the patients do not accept depot injections is simply untrue. Rather, it is the psychiatrists who have their (maybe primarily emotionally-based) reservations. In summary, the use of depot antipsychotics has important advantages in facilitating relapse prevention and should be considered for every patient for whom long-term antipsychotic treatment is indicated.