Schanda Hans, Stompe Thomas
Justizanstalt Göllersdorf.
Neuropsychiatr. 2010;24(1):14-26.
OBJECTIVE, METHODS: Relapse prevention is one of the central issues in the treatment of schizophrenic psychoses. The paper gives an overview of the current literature on medication adherence with special regard to 2nd generation antipsychotics and long-acting agents and describes the practical consequences for clinical routine. Additionally, it examines whether or not everyday practice is consistent with our actual scientific knowledge.
Even in shortterm trials, medication adherence in patients with schizophrenia comes up to merely 50%. The negative consequences of medication non-adherence are substantial. This concerns the rates of relapse and readmission, morbidity and mortality, - in particular suicide -, as well as the economic burden of society. Consequent antipsychotic treatment is associated with significantly better outcomes in all dimensions. In this regard, longacting agents are unequivocally superior to oral antipsychotics - even to atypical ones. These facts conflict with clinical routine, where long-acting antipsychotic agents are scarcely used.
Based on current scientific knowledge, the major objections raised against the application of long-acting agents can be refuted: 1) 2nd generation antipsychotics do not improve medication adherence. 2) Concerns that long-acting agents conflict with the autonomy of a patient neglect the loss of autonomy and self-determination in case of a psychotic relapse. 3) The assertion that the patients do not accept depot injections is simply untrue. Rather, it is the psychiatrists who have their (maybe primarily emotionally-based) reservations. In summary, the use of depot antipsychotics has important advantages in facilitating relapse prevention and should be considered for every patient for whom long-term antipsychotic treatment is indicated.
目的、方法：预防复发是精神分裂症治疗的核心问题之一。本文概述了当前关于药物依从性的文献，特别关注第二代抗精神病药物和长效制剂，并描述了对临床常规的实际影响。此外，研究日常实践是否与我们实际的科学知识相符。
即使在短期试验中，精神分裂症患者的药物依从性也仅达到50%。不依从药物治疗的负面后果相当严重。这涉及复发率和再入院率、发病率和死亡率，尤其是自杀率，以及社会的经济负担。持续的抗精神病治疗在各个方面都与明显更好的结果相关。在这方面，长效制剂明显优于口服抗精神病药物，甚至优于非典型药物。这些事实与临床常规不符，在临床常规中长效抗精神病药物很少使用。
基于当前的科学知识，对长效制剂应用提出的主要反对意见可以被反驳：1）第二代抗精神病药物不能提高药物依从性。2）担心长效制剂与患者的自主性相冲突忽视了精神病复发时自主性和自我决定权的丧失。3）声称患者不接受长效注射根本不正确。相反，是精神科医生有（可能主要基于情感的）保留意见。总之，使用长效抗精神病药物在促进预防复发方面具有重要优势，对于每一位需要长期抗精神病治疗的患者都应考虑使用。
