Improving Medication Adherence in Patients with Schizophrenia
Symptomatic relapse is common in schizophrenia and related psychotic disorders, and one of the most common contributors to relapse is poor medication adherence.1 Nonadherence is a complicated issue that is influenced by a host of interrelated factors, including the severity of the disease, the patient's level of insight into his or her illness, the relationship between the patient and clinician (therapeutic alliance), and the clinician's communication style.2
Long-acting injectable (depot) antipsychotic preparations are an alternative to oral medication in the treatment of patients with schizophrenia who have experienced recurrent relapse related to nonadherence.1 Rather than taking oral medication once or twice a day at home, patients on a depot regimen typically receive an injection once or twice a month in a physician's office, clinic, or other outpatient setting. By preventing covert nonadherence,2 this type of regimen helps to ensure that patients are getting the medication at the prescribed dosage and frequency. Furthermore, the regular visits required for medication administration can foster the therapeutic alliance, potentially improving treatment outcomes.
Long-acting injectable antipsychotics include the second-generation agents aripiprazole (Abilify Maintena, Aristada), paliperidone (Invega Sustenna, Invega Trinza), risperidone (Risperdal Consta), and olanzapine (Zyprexa Relprevv), and the first-generation antipsychotics fluphenazine and haloperidol.3 The various agents differ with respect to their dosage, frequency of administration, approved indications, injection site and volume, needle gauge, storage requirements, instructions for initiation and oral supplementation, and potential drug interactions and adverse effects.4