A review of compliance, depot intramuscular antipsychotics and the new long-acting injectable atypical antipsychotic risperidone in schizophrenia.
BACKGROUND
Several oral atypical antipsychotics are available for schizophrenia management. Besides positive and negative symptom control, they may improve cognition. Due to their limited availability as oral agents only, benefits are limited by noncompliance.


METHODS
Using Medline and PsycINFO databases, literature was reviewed to address: (1) factors underlying medication noncompliance; (2) available evidence on efficacy of depot intramuscular (IM) typical antipsychotics; and (3) current knowledge of long-acting atypicals.


RESULTS
Noncompliance remains high due to illness-, treatment-, and clinician-related factors. Compared to oral typicals, atypicals may improve compliance, even though noncompliance remains high. Depot IM typicals are efficacious (reduced relapses and rehospitalizations), but extrapyramidal symptoms are problematic. Available data on long-acting atypical risperidone suggest that it is safe and efficacious.


CONCLUSIONS
Development of long-acting injectable atypical agents is warranted since noncompliance remains high. Future long-acting IM atypical trials should include outpatient functioning, and preferably be of longer duration to address cost-effectiveness.
Bhanji
Nadeem H
NH
Clinical Psychopharmacology Unit, Allan Memorial Institute, McGill University Health Centre, Montreal, QC, Canada. nadeem.bhanji@mail.mcgill.ca
Chouinard
Guy
G
Margolese
Howard C
HC
D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019992:Databases as Topic; D004334:Drug Administration Schedule; D006801:Humans; D007267:Injections; D007273:Injections, Intramuscular; D010349:Patient Compliance; D018967:Risperidone / Q000008:administration & dosage / Q000627:therapeutic use*; D012559:Schizophrenia / Q000188:drug therapy*; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D018967:Risperidone