Medication Nonadherence in Schizophrenia: Strategies to Optimize Patient Outcomes

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In this webcast, Dr. Ilan Melnick examines the differences among available long-acting injectable (LAI) antipsychotics in terms of tolerability, efficacy, and implications on patient adherence.
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[@marianm7468]

Why does he have to use forensic cases to make his position? Most people with schizophrenia would never kill someone. That woman who killed her boyfriend is an exception to the rule. How can we reduce the stigma if we employ the worst possible case scenarios?

[@Rajiin]

I wish I could go 5 years with a Skitz.

[@tomwright9904]

8:29 The loss of grey matter is actually due to antipsychotics.

[@shadrach6299]

Proof?

[@spartandrops1792]

@@shadrach6299 "Antipsychotics are currently the predominant treatment for individuals diagnosed with schizophrenia, but there is an accumulating body of research that links the use of these drugs to structural abnormalities in the brain. A recent meta-analysis suggests that gray matter loss in the brain may depend on the dose and class of the antipsychotic. New research, published in this month’s issue of Biological Psychiatry, reinforces the link between antipsychotic drug use in patients with schizophrenia and progressive structural brain abnormalities. Antipsychotic use has been associated, specifically, with a decrease in gray matter in the brain. Gray matter is mainly located on the brain’s surface and functions, generally, to aid in the processing of information. The loss of gray matter could represent either cell shrinkage, cell loss, or both. Past research has found that the dose of antipsychotic is associated with decreased volume of gray matter but has not compared the impact of first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs). The latest study, led by Antonio Vita, set out to do just that. Vita and his colleagues completed a meta-analysis of longitudinal MRI studies published between 2002 and 2014. Altogether, their study included the antipsychotic dose and class information as well as gray matter measurements for 1,155 patients and 911 healthy control subjects. After crunching all of the data, they found that the greater the exposure to antipsychotics, the greater the reduction in gray matter in the brain. Patients taking FGAs or a combined treatment of both FGAs and SGAs had a significant decrease in brain volume. For these patients, greater brain volume loss was associated with a higher mean daily dose of antipsychotics. In patients treated with just SGAs, a significant decrease in volume was not found. Previous studies have also found that SGAs have less of an effect on brain volume, yet even a smaller effect may have significant implications. The connection between antipsychotic drugs and decreased gray matter may be strengthened by their finding that illness severity, age, and substance abuse were not associated with the reductions in brain volume. The researchers conclude: “Although this is a clinically meaningful result, many issues remain to be clarified: for instance, we still do not know whether the effects on the brain of antipsychotics vary as a function of age and stage of illness, or whether they may occur only when a certain threshold of exposure (daily dose or cumulative dose) is reached”"

[@spartandrops1792]

over a long period of time (more than 5 years) patients who are treated WITHOUT medication have better outcomes. So if medication non-adherence with this knowledge is the right and reasonable thing and does not have to be a problem, how can it be that a strategy for optimizing patient outcomes is talked about but the treatment in comparison does not lead to optimal results at all and therefore cannot be considered the best choice for the patient's well-being and health? Medication adherence is not an optimization for the patient but an optimization of the sales of psychotropic drugs by the companies...