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.