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Rh Budhi Muljanto
Epidemiology of Schizophrenia
Afflicts 1 in 100 adults; approximately 2.4 million US adults1 Series of relapses and remissions2 Patients generally do not return to baseline functioning Further erosion in functioning after each relapse Educational, employment and social difficulties3 Increased mortality rate 2 - 4 times higher than general population4 Up to 10 times mortality rate in untreated vs. treated patients5 20 to 40% attempt suicide at least once; ~10% die by suicide2 Enormous costs to society and healthcare resources
1. NIMH Fact Sheet, rev 2006, www.nimh.nih.gov/publicat/numbers.cfm; 2. Kaplan and Sadock, 8th Ed; 3. APA 2004 DSM-IV; 4. APA 2004 (practice guideline); 5. Tiihonen et al 2006
>40% of patients are poorly adherent1 Over a 4-year period, the majority will have some difficulties with adherence1 Many will cycle in and out of adherence Nonadherence tends to increase over time2 Nonadherence is not typically a conscious decision3 Clinicians and patients tend to overestimate adherence to the oral treatment regimen4
1. Valenstein M, et al. J Clin Psychiatry. 2006;67:1542; 2. Fleishhacker WW, et al. J Clin Psychiatry. 2003;64:1250; 3. Lacro JP et al. J Clin Psychiatry. 2002;63:892; 4. Byerly M et al. Psychiatry Res. 2005;133:129
Antipsychotics (Neuroleptics)
Typical Neuroleptics
High potency (Haldol) Medium potency (Stelazine) Low potency (Thorazine) Depot/Decanoate (Prolixin-D or Haldol-D/LA) Clozaril Risperidol Zyprexa Seroquel
Atypical Neuroleptics
Pigott-11/98
1. Davis et al. Drugs. 1994;47:741-773.; 2. Mentschel et al. 156th mtg of APA; San Francisco, May 17-22, 2003. Abstract book, page 71.; 3. Adams et al. Br J Psychiatry. 2001;179:290-299
The Five Ps
1st Generation Fluephenazine deconoate Haloperidol deconoate 2st generation Risperidone [Risperdal Consta] Paliperidone palmitate [monthly] Olanzapine pamoate [monthly]