DEVELOPING MEDICATION STRATEGIES FOR RELAPSE PREVENTION IN SCHIZOPHRENIA

DEVELOPING MEDICATION STRATEGIES FOR

RELAPSE PREVENTION IN SCHIZOPHRENIA

John Kane, Hillside Hospital

The prevention of psychotic relapse and rehospitalization is

a major challenge in the treatment of schizophrenia.  The fact that 10-20%

of patients will experience a clinically significant exacerbation during a

one-year period even when receiving depot antipsychotic treatment

suggests that for some patients dopamine receptor antagonism is insufficient to

prevent relapse.

The process and vulnerability factors leading to relapse are

not well understood particularly among patients relapsing on medication. 

The assumption that an effective, preventative or maintenance treatment for

patients in general is a continuation of treatment effective in alleviating or

reducing acute psychopathology has generally been born out, however, those

patients who remain vulnerable might require a different approach.  The

new-generation antipsychotics appear to be associated with a significant

reduction in relapse rates, not necessarily attributable to enhanced

compliance.  The mechanism(s) involved remain to be elucidated.

The systematic testing of adjunctive or alternative

treatments for this subpopulation remains a challenge.  In addition,

genetic approaches to identifying subgroups at varying degrees of risk could

prove useful.