Review Question - QID 206934

This patient's clinical presentation is consistent with schizophrenia. Risperidone is available in a long-acting, injectable form, which is helpful for patients who have difficulty with medication adherence.

Antipsychotics are the cornerstone of treatment for schizophrenia. Unfortunately, frank psychosis often leads to medication non-adherence secondary to issues of disorganization, paranoia, or lack of insight into the illness. Three antipsychotics (risperidone, haloperidol, and fluphenazine) are available in a long-acting, injectable form, that can be given once every two weeks to one month. These medications may be appropriate for patients with proven issues with adherence.

Muench and Hamer discuss adverse effects of antipsychotics. They note that "depot" (i.e., injectable) antipsychotics should not be used in patients with epilepsy. Both typical and atypical antipsychotics have the potential to lower the seizure threshold, and depot antipsychotics cannot be quickly washed out of a patient's body.

Novick et al. performed a prospective cohort trial comparing oral vs. depot antipsychotics for treatment of medication non-adherent patients with schizophrenia. They found that treatment discontinuation, as well as hospital admissions, were significantly lower for the group treated with depot antipsychotics. They conclude that depot antipsychotics are more beneficial than oral antipsychotics in patients with adherence difficulty.

Incorrect Answers:
Answer 2: Quetiapine is an atypical antipsychotic that often causes sedation and orthostatic hypotension and is not available in depot form.
Answer 3: Chlorpromazine is a typical antipsychotic that is not available in depot form.
Answer 4: Sertraline is a selective serotonin uptake inhibitor, which is not a first-line agent for treatment of schizophrenia.
Answer 5: Clozapine is an atypical antipsychotic that can cause agranulocytosis and is not available in depot form.