Choice of Maintenance Medication for Schizophrenia

Unmedicated schizophrenia patients relapse at a rate of approximately 10% per month. Maintenancetreatment with antipsychotic medications can reduce this rate dramatically. Ensuring compliancewith medication in the maintenance treatment of schizophrenia encompasses 3 areas of concern:(1) choice of antipsychotic medication, accounting for efficacy and side effects; (2) route of administrationof medications, considering the benefits and detriments of long-acting injectable and oralmedications; and (3) reducing “doctor noncompliance,” the failure of some physicians to perceive theneed for long-term treatment for patients with chronic schizophrenia. This article focuses on the selectionof the antipsychotic medication that will most likely lead to successful maintenance treatment ofschizophrenia. Data from acute trials must be relied upon to evaluate the comparative risks and benefitsof these agents as long-term treatments since few double-blind, random-assignment studies havecompared the newer-generation antipsychotics for maintenance treatment of schizophrenia. Studiesof acute treatment, as well as a small number of studies of maintenance treatment, have shown thenewer-generation antipsychotics risperidone and olanzapine to be more efficacious and to havea more favorable side effect profile than conventional-generation antipsychotics. Research on thenewer-generation antipsychotics, including ziprasidone, aripiprazole, and quetiapine, shows theseagents to be efficacious and safe, although the limited amount of data on these agents precludes a definitiveevaluation of their efficacy and safety.