47 - Relapse or acute exacerbation of schizophreni

Relapse or acute exacerbation of schizophrenia

Schizophrenia and related psychoses CHAPTER 1 Relapse or acute exacerbation of schizophrenia (adherence doubtful or known to be poor)

• Compliance aids (e.g. Medi-­Dose® system in the UK) are not a substitute for patient education. The ultimate aim should be to promote independent living, perhaps with patients filling their own compliance aid, having first been given support and training. Note that such compliance aids are of little use unless the patient is clearly motivated to adhere to prescribed treatment. Some medicines are not suitable for storage in compliance aids. ** Patients generally have positive views of depot medication.10,31 Investigate reasons for poor adherence Discuss with patient Switch to antipsychotic medication with a more favourable adverse-effect profile Use LAI if patient agrees Discuss with patient Consider depot/LAI antipsychotic medication** Simplify drug regimen Reduce any anticholinergic load Consider ‘compliance aids’* Consider depot/LAI** Forgetful or disorganised Treatment algorithm Lack of insight or support Poorly tolerated treatment