Modern therapeutic forms
Long-acting drugs, received every 2-4 weeks, ensure a convenient form of therapy which facilitates patient's day-to-day functioning and the adherence to treatment regimen.
Not only research studies but also the patient's everyday life prove that the higher is the frequency of medication, the lower is the level of collaboration and the sooner the patients abandon the therapy.
The problem applies not only to schizophrenia but to all chronic diseases, such as diabetes, hypertension and even bronchial asthma. Thus the present pharmacology aims at designing medicinal formulations, which will be as long acting as possible. Both in the world and in Poland, anti-psychotic medicines with sustained release are available.
They combine the features of the above-mentioned depot drugs with the advantages of atypical antipsychotics.
Oil is no more used as solvent in these drugs (being replaced by water for injections), thus the pain at administration is much weaker than in the application of classic depot drugs. Injections are also applied intramuscularly but, in case of some drugs, the patient has a choice of the administration site: the buttock or the arm.
With the slowly released active substance, identical with that, used in the oral antipsychotic medicine, the serum drug concentration is maintained at a constant level. It is, at the same time, a lower concentration than the concentrations, obtained in case of oral drugs, what prevents adverse effects, which may occur with the use of this form of the drug (e.g., moderate extrapyramidal symptoms or symptoms of increased prolactin levels). Injections are made every 2–4 weeks, as the drug concentrations remains stable during such time intervals. Thus the patient needs not to remember about daily medication dosage.
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The use of anti-psychotic drugs with sustained release considerably facilitates therapy continuation, extends remission periods and substantially reduces the risk of relapse (versus the use of the same substance in daily regimen).
The main groups of patients who may benefit from the replacement of the so far used atypical drug by long-acting antipsychotic drugs include:
- patients with frequent relapses, caused by worse collaboration in the use of oral atypical antipsychotic drugs,
- poorly collaborating patients, receiving oral atypical antipsychotic drugs,
- stable patients, receiving classic antipsychotic drugs with long-lasting effects, stable but with extrapyramidal symptoms,
- patients, receiving oral, atypical, antipsychotic drugs, who demonstrate frequent psychosis relapses of unknown causes,
- stable patients on conventional, oral, antipsychotic drugs, however experiencing extrapyramidal symptoms.
Therapy with long-acting drugs
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All long-acting antipsychotic drugs are administered via intramuscular injections.
The buttock is the main injection site. In case of some drugs, the patient has a choice of the administration site: the buttock or the arm. Injections are given by medical personnel (usually nurses). Injection appointments should be arranged in compliance with the doctor's recommendations (every 2-4 weeks) and, leaving aside exceptions, the injection procedure does not require any prior preparation. The medical personnel will inform the patient about special procedures prior to administration of specific agents.
The comprehensive therapy in schizophrenia, provided within the coherent system of patient care, includes not only pharmacological treatment but also psychosocial therapy, with support, provided by the patient's family and caregivers on one side, and by social and medical professionals on the other.
This therapy concentrates not only on psychopathological symptoms and disorders of cognitive functions. An improvement in the psychosocial functioning of the patient and ensuring that he/she played a recognised role in social life. It is then of substantial importance that both the patient and his/her family to adopt a proper approach towards the disease.
In order to make this complex therapy feasible and effective, multiple participation of professionals is required, including physician, nurse, psychologist, social worker and others plus an unconstrained access to health care units plus other forms of support and care.
The patient's participation in pharmacotherapy
It often happens that a patient, facing remission of acute symptoms, feels healthy and wants to forget about the disease; it is then difficult for such patient to accept the proposals of medication or participation in psychotherapy because he/she would like to be treated as a normal, healthy person.
While the proposal of prophylactic therapy, aimed to prevent disease relapses, is not at all to further see that person as patient. The objective of such therapy, after the experienced episode of psychosis or depression, is to provide the affected person, as that who is susceptible to disease relapse, with measures to prevent that relapse, as well as with necessary knowledge how to use the measures.
A treatment, counteracting disease relapse, is not to become a barrier, but a support in normal life. However, it requires active involvement and collaboration of the patient.
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The patient, who has acquired the knowledge on his/her disease, will understand the need of therapy and be able to precisely communicate problems, associated with the disease, as well as report the adverse effects of received drugs.
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It is important that the patient, together with his/her therapist, draws the objectives of his/her therapy and the methods of their achievement. Establishing a proper patient – caregiver – therapist dialogue increases the chances of successful cooperation in therapy.