Schizophrenia is an enormously complex mental health issue. Adequate treatment is difficult to achieve, especially in cases where individuals do not adhere to a medication schedule. Most people with schizophrenia benefit from a holistic approach that includes antipsychotic medication and cognitive behavioral therapy. With successful treatment, individuals can lead productive and rewarding lives despite their issues with mental health.
Schizophrenia’s origins, too, are puzzling. Genetic abnormalities and environmental factors both seem to be contributing factors in the development of schizophrenia. While it seems to run in families, there’s no clear-cut test to predict who will eventually develop schizophrenia. Early intervention has proven to lead to better health outcomes, but misdiagnosis is still very common, especially in adolescents. When schizophrenia remains untreated, the risk of substance abuse, homelessness, and early mortality all increase.
Even with early intervention, the dangers of medication nonadherence are very real. People with schizophrenia often mistrust their physicians or don’t comprehend the important of their prescriptions. For those with severe schizophrenia and psychotic episodes, antipsychotic medications delivered intravenously represent an alternative to daily medication schedules. Prolixin (fluphenazine), Haldol (haloperidol), and Risperdal (risperidone) are all available as long-acting injections. Depending on the drug, an injection is only necessary once every 2 to 4 weeks. The development of these medications was initiated partly in the hope that long-acting agents could offer a safeguard against medication nonadherence. A retrospective study of the California Medicaid database revealed some interesting but not-really-encouraging statistics about adherence rates for injectable antipsychotic medications.
According to the database, people given antipsychotic injections have a distinct history of neglecting their medications and responding poorly to treatment regimens. This situation did not improve with the administration of injected formulations of their medications. On average, people maintained their injection schedule for only seven to 10 weeks. Prolixin was shown to be the least effective of the three medications studied. It showed both a high rate of adverse effects and an extremely low rate of adherence.
However, researchers were quick to note that these results do not indicate ineffectiveness of the medications in question but rather the difficulty of achieving effective schizophrenia treatment. All antipsychotic medications entail harsh side effects, and the individuals who require them represent a uniquely treatment-resistant population.
Intravenous antipsychotic medications have a place in the maintenance of schizophrenia but only when adherence can be guaranteed. Within this community, however, adherence is often difficult to achieve. When therapy and social support become meaningful aspects of a complete treatment package, outcomes generally improve. Because of the ease of dosing and reduction in number of pills, intravenous medications like Prolixin still hold promise.
References:
- Olfson, M., Marcus, S.C., Ascher-Svanum, H. (2007). Treatment of schizophrenia with long-acting fluphenazine, haloperidol, or risperidone. Schizophrenia Bulletin, 33(6), 1379-1387.
- PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Fluphenazine. Retrieved May 1, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000603/
- PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Haloperidol. Retrieved May 1, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000604/
- PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Risperidone. Retrieved May 1, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000944/
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