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May 21, 2014

Maintenance Treatment With Long-Acting Injectable Antipsychotics: Comparing Old With New

Author Affiliations
  • 1Nathan Kline Institute for Psychiatric Research
  • 2New York University School of Medicine
  • 3Associate Editor, JAMA
JAMA. 2014;311(19):1973-1974. doi:10.1001/jama.2014.4311

Prevention of relapse is a major challenge in the treatment of schizophrenia. The re-emergence of psychosis, characterized by delusions, hallucinations, and disorganization, can be dangerous, disruptive, and costly for patients and their families. The risk of relapse is increased by factors commonly encountered in this group of patients, such as poor adherence, substance use, and social stress. High rates of nonadherence with antipsychotics, estimated at 40%, reflect an unfavorable balance between adverse effects and perceived benefit. Cognitive deficits, combined with poor social supports and homelessness, also can complicate adherence with daily dosing of oral medication. Long-acting injectable formulations of antipsychotics, which maintain therapeutic blood levels during the 2- to 4-week interval between injections, were developed to counter the problem of nonadherence; studies conducted in the 1980s of long-acting injectable preparations of fluphenazine, a first-generation antipsychotic, generally found a reduction in relapse rates.1