Atypical antipsychotic and compliance in schizophrenia

Relapse of schizophrenia due to poor compliance is a major preventable source of psychiatric morbidity. One often stated reason for non-compliance is side effects from the conventional neuroleptics. Minimum effective doses are known from most drugs minimizing side-effects but low-dose maintenance regimes below these minimum doses lead to relapse. The advantages of depot medication in ensuring compliance are clearly understood, but the use of depots varies enormously in different countries. In the longer term, it is hoped that new atypical neuroleptics may have several intrinsic advantages which maximize patient compliance. Atypical neuroleptics fall roughly into five groups, the later substituted benzamides, mixed dopamine-serotonin receptor antagonists, specific dopamine compounds, serotonin receptor antagonists and sigma receptor antagonists. There are some early indications of improved compliance with an atypical neuroleptic, clozapine, but it is difficult to disentangle the potential massive effect of the monitoring system used in controlled studies. There is still no evidence that the new atypical neuroleptics could substantially improve the compliance in comparison with for example depot neuroleptics.