Relapse prevention in schizophrenia - new therapeutic challenges.
Schizophrenia is a chronic progressive illness characterized with frequent relapses and requiring long-term treatment. In spite of the fact that this disorder belongs among ten leading causes of disability worldwide, the consequences and difficulties associated with schizophrenia are frequently underestimated. The course of the illness is further characterized by a high percentage of suicides and attempted suicides, decline in cognitive functions and frequent relapses. The results of numerous studies indicate that early treatment with antipsychotics leads to better long-term outcomes compared with control groups. In the process of deciding about treatment we must bear in mind the importance of individual approach to schizophrenic patients because there are significant differences in the type of disorder, symptoms, co-morbidity, course of disorder (first episode or chronic course), as well as the differences in treatment response and treatment adherence. When choosing an antipsychotic agent we should try to find the drug capable of addressing all aspects of the illness that is safe and well tolerated in long-term treatment; we should start the treatment as early as possible, reduce the psychotic symptoms and avoid negative effects on functioning, whilst avoiding adverse effects and establishing a trusting and productive therapeutic alliance with the patient. Existing evidence strongly suggests the use of adequate doses of antipsychotics as early as in prodromal psychosis. Evidence shows that schizophrenic patients remain longer in treatment with atypical antipsychotics particularly when they are applied as depot injections, because the efficacy of treatment is higher, drug concentration stable and long-lasting, there are fewer adverse effects, and the co-operation with the service provider is better. In this way, the atypical antipsychotics provide us with the opportunity to establish long-term control of the psychotic symptoms, and reduce relapse rate and the number of hospitalizations while improving the quality of life of schizophrenic patients and establishing optimal therapeutic alliance.
Kucukalić
Abdulah
A
Department of Psychiatry, University of Sarajevo Clinical Center, Bolnicka 25, 71,000 Sarajevo, Bosnia & Herzegovina.
Dzubur-Kulenović
Alma
A
Mehmedika-Suljić
Enra
E
D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D015897:Comorbidity; D006801:Humans; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D055502:Secondary Prevention; D013405:Suicide / Q000523:psychology; D016896:Treatment Outcome; D000092864:Suicide Prevention
D014150:Antipsychotic Agents