Schizophrenia Treatment Challenges
By Donna A. Wirshing, M.D., and Peter Buckley, M.D.
May 1, 2003
Dr. Wirshing is associate professor of psychiatry and biobehavioral sciences at the David Geffen School of Medicine and co-chief of the Schizophrenia Treatment Unit at the Greater Los Angeles Veterans Affairs Healthcare System in Los Angeles.
Dr. Buckley is professor and chair of the department of psychiatry and health behavior at the Medical College of Georgia. Within the field of schizophrenia, his research has focused on antipsychotic medications and brain imaging studies. Dr. Buckley has also written and edited numerous books and articles on the topic.
In the near future we may be able to dispense the first long-acting formulation of a second-generation medication--risperidone microspheres (Risperdal Consta). This drug has already been approved in several countries. Because relapse rates are less for risperidone(Drug information on risperidone) compared to conventional agents, as demonstrated in a well-designed study by Csernansky and colleagues (2002), we envision that a guaranteed delivery system will further boost these encouraging results. Long-acting formulations of several other second-generation medications may also be available in the near future and are under study. Many patients may benefit from the availability of long-acting formulations, since the need to take daily oral medication will be obviated by--in the case of risperidone--bimonthly injections. Other possible formulations of long-acting, surgically implanted antipsychotic medications, such as the formulation of haloperidol(Drug information on haloperidol) being developed with the support of the National Alliance for Research on Schizophrenia and Depression, are also promising (Siegel et al., 2002). A surgically implantable formulation would be much like the contraceptive levonorgestrel(Drug information on levonorgestrel) (Norplant), which is implanted in women for long-term prevention of pregnancy.
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