Antipsychotic agents. Gradually improving treatment from the traditional oral neuroleptics to the first atypical depot

Abstract

Relapse is one of the key factors in the long-term outcome of schizophrenia. The consequences of relapse are diverse and often unpredictable, and the time to recovery and degree of recovery worsen with each successive relapse. There is now overwhelming evidence that advances in antipsychotic drug treatment have led to significant reductions in the rate of relapse. This review charts the developments that have taken place in antipsychotic therapy from the introduction of depot formulations, through atypical agents, to the development of the first long-acting atypical antipsychotic. Depot formulations of conventional antipsychotics were developed in the 1960s and led to fewer relapses and episodes of hospitalization, compared with oral equivalents. Meta-analysis has confirmed that patients receiving depot antipsychotics experience significantly greater global improvement than those receiving the respective oral agents. Conventional antipsychotics are, however, associated with a range of potentially serious adverse events. The atypical antipsychotics were introduced in the 1990s and have significant advantages over conventional agents with regard to positive and negative symptoms. There is also evidence that atypical agents can reduce the risk of relapse. Importantly, atypical antipsychotics have an improved safety profile compared with older agents, particularly with regard to extrapyramidal symptoms. One disadvantage of atypical agents has been that they are only available in an oral form. The recent development of a long-acting injectable formulation of risperidone means that a new treatment option is available to physicians.

The Endocannabinoid System as an Emerging Target of Pharmacotherapy

“…With disease progression, behavioral impairment can lead to complete social isolation. Although recent advances in the pharmacotherapy of schizophrenia produced great improvement in the clinical symptoms and the quality of life of patients, there is room for further improvements (Ban et al, 2004;Moller, 2005).…”

Psychosocial and socio-demographic correlates of medication compliance among people with schizophrenia

“…Psychoeducation, motivational interviewing, cognitive-behavioral modeling, family intervention, community-based intervention are the commonly adopted strategies to improve medication compliance (Dolder et al, 2003;Zygmunt et al, 2002). Moreover, the adoption of depot antipsychotics would be beneficial to improve the tolerability and compliance among patients (Moller, 2005). We believe that medication compliance among individuals with schizophrenia would be improved with these strategies.…”

“…Medication side effect is most well known (Blackwel, 1972;Corrigan, Liberman, & Engel, 1990;Perkins, 2002). Adverse side effects such as extrapyramidal symptoms are commonly found among users of conventional agents (Moller, 2005). Atypical antipsychotics are developed to address this problem by reducing uncomfortable side effects (Mortimer, Williams, & Meddis, 2003).…”

Barriers to, and Strategies for, Starting a Long Acting Injection Clinic in a Community Mental Health Center

“…Moreover, if the prescriber knows that medication is on board, time with the patient can be spent more productively with a focus on recovery goals rather than a focus on whether or not the individual is taking medication as prescribed. While depot medications are often suggested for use in those who repeatedly stop taking their medication, long-acting injectable antipsychotics may have utility for a larger group of patients whose wavering insight, poor understanding, cognitive deficits and unstructured lives make taking medications on a regular basis very difficult (Moller 2005;Velligan et al 2008).…”