Treating schizophrenia in the ‘real world’
Mr. F—with a history of severe motor effects and noncompliance—seems ‘damned’ to a life of delusional, violent behavior. After 17 years of treatment failures, can a more tolerable therapy be found?
How can we ensure that patients with schizophrenia keep taking their medications—regardless of whether symptoms are present?
Dr. Canive’s observations
Clinical trials measure a drug’s efficacy under highly controlled circumstances. In the “real world,” however, noncompliance due to intolerability can undermine a medication’s effectiveness.
Too often noncompliance—stemming from abatement of symptoms or the emergence of side effects—derails treatment of schizophrenia. Misdrahi et al found that medication noncompliance accounts for 40% of schizophrenia relapses occurring more than 1 year after patients’ first hospitalization.4
Given aripiprazole’s 75-hour half-life, one might not expect to see symptoms emerge so soon after discontinuation. It is possible that:
- Mr. F. abstained from aripiprazole longer than he realized—or admitted
- Unidentified stressful life events also exacerbated symptoms and precipitated hospitalization.
When Mr. F consistently followed his regimen, his positive symptoms abated and he could attempt to live a normal life.
Our patients must understand that schizophrenia is a lifelong illness and that continued adherence to medication—even when symptoms do not exist—is crucial. A strong therapeutic alliance,5 increased social support, adjunctive cognitive-behavioral therapy, psychosocial interventions,6 and medications with fewer and less-severe side effects may help patients embrace this message.
Related resources
- Tamminga CA. Partial dopamine agonists in the treatment of psychosis. J Neural Transm 2002;109:411-20.
Drug brand names
- Amitriptyline • Elavil
- Aripiprazole • Abilify
- Benztropine • Cogentin
- Chlorpromazine • Thorazine
- Clonazepam • Klonopin
- Diazepam • Valium
- Fluphenazine • Prolixin
- Haloperidol • Haldol
- Lorazepam • Ativan
- Loxapine • Loxitane
- Oxazepam • Serax
- Thiothixene • Navane
- Trazodone • Desyrel
Disclosure
The author receives research/grant support from and is a speaker for and consultant to Bristol-Myers Squibb Co. He also receives research/grant support from and/or is a speaker for AstraZeneca Pharmaceuticals, Janssen Pharmaceutica, and Eli Lilly and Co.
