How Long Should People With Schizophrenia Take Antipsychotic Drugs?
Antipsychotic medications reduce the risk of future psychotic episodes in patients
who have recovered from an acute episode. Even with continued drug treatment,
some people who have recovered will suffer relapses. Far higher relapse rates
are seen when medication is discontinued. In most cases, it would not be accurate
to say that continued drug treatment "prevents" relapses; rather,
it reduces their intensity and frequency. The treatment of severe psychotic
symptoms generally requires higher dosages than those used for maintenance treatment.
If symptoms reappear on a lower dosage, a temporary increase in dosage may prevent
a full-blown relapse.
Because relapse of illness is more likely when antipsychotic medications are
discontinued or taken irregularly, it is very important that people with schizophrenia
work with their doctors and family members to adhere to their treatment plan.
Adherence to treatment refers to the degree to which patients follow the treatment
plans recommended by their doctors. Good adherence involves aking prescribed
medication at the correct dose and proper times each day, attending clinic appointments,
and/or carefully following other treatment procedures. Treatment adherence is
often difficult for people with schizophrenia, but it can be made easier with
the help of several strategies and can lead to improved quality of life.
There are a variety of reasons why people with schizophrenia may not adhere
to treatment. Patients may not believe they are ill and may deny the need for
medication, or they may have such disorganized thinking that they cannot remember
to take their daily doses. Family members or friends may not understand schizophrenia
and may inappropriately advise the person with schizophrenia to stop treatment
when he or she is feeling better. Physicians, who play an important role in
helping their patients adhere to treatment, may neglect to ask patients how
often they are taking their medications, or may be unwilling to accommodate
a patient's request to change dosages or try a new treatment. Some patients
report that side effects of the medications seem worse than the illness itself.
Further, substance abuse can interfere with the effectiveness of treatment,
leading patients to discontinue medications. When a complicated treatment plan
is added to any of these factors, good adherence may become even more challenging.
Fortunately, there are many strategies that patients, doctors, and families
can use to improve adherence and prevent worsening of the illness. Some antipsychotic
medications, including haloperidol (Haldol®), fluphenazine (Prolixin®),
perphenazine (Trilafon®) and others, are available in long-acting injectable
forms that eliminate the need to take pills every day. A major goal of current
research on treatments for schizophrenia is to develop a wider variety of long-acting
antipsychotics, especially the newer agents with milder side effects, which
can be delivered through injection. Medication calendars or pill boxes labeled
with the days of the week can help patients and caregivers know when medications
have or have not been taken. Using electronic timers that beep when medications
should be taken, or pairing medication taking with routine daily events like
meals, can helppatients remember and adhere to their dosing schedule. Engaging
family members inobserving oral medication taking by patients can help ensure
adherence. In addition, through a variety of other methods of adherence monitoring,
doctors can identify when pill taking is a problem for their patients and can
work with them to make adherence easier. It is important to help motivate patients
to continue taking their medications properly.
In addition to any of these adherence strategies, patient and family education
about schizophrenia, its symptoms, and the medications being prescribed
to treat the disease is an important part of the treatment process
and helps support the rationale for good adherence.
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