Fast Five Quiz: Schizophrenia Management in Adults

Stephen Soreff, MD


August 11, 2020

Nonadherence to pharmacologic therapy is difficult to estimate but is known to be common, and it is one of the reasons for the use of intramuscular (IM) preparations of antipsychotic medications. A regular routine of IM medication, such as every 2-4 weeks, is preferred by some patients because it obviates the need to take medication every day. It also allows for easier monitoring of medication adherence by the clinician. For many patients, it is difficult to take medications daily, which can lead to nonadherence. Nonadherence can lead to relapse and reemergence of symptoms. By eliminating the need for daily dosing, patient adherence improves and clinicians can ensure that patients are receiving their medication.

Whether IM medication is superior to oral medication is unclear. A large trial that compared long-acting injectable risperidone with the psychiatrist's choice of oral antipsychotic agent found that injectable risperidone was not superior to the oral form and was associated with more side effects.

Both first- and second-generation drugs are available in a variety of vehicles. First-generation drugs are available as liquid, IM, and transdermal preparations. Some of these agents (haloperidol and fluphenazine) are also available as depot preparations, meaning that a person can be given an injection of a medication every 2-4 weeks. Of the second-generation agents, risperidone is available as a long-acting injection that uses biodegradable polymers; olanzapine, paliperidone, and aripiprazole are also now available in long-acting injectable forms.

Learn more about schizophrenia treatment and management.


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