When taken as prescribed, antipsychotic medications are effective in preventing psychotic relapse and re-hospitalization in persons with schizophrenia. Yet, ensuring adherence with treatment remains a significant problem: 42% of schizophrenic patients have been reported to be noncompliant, as measured by medication taking scores, compared with 35% of patients receiving treatment for depression and 24% of patients receiving treatment for non-psychiatric illnesses.

Patients may fail to take medications as prescribed for many reasons that include psychological/cognitive, psychosocial, and medication factors. In a study investigating risk factors for non-adherence, drug-induced Parkinsonism appeared to be the strongest predictor. Regardless of what causes or contributes to it, non-adherence with pharmacotherapy in schizophrenic patients leads to poor outcome associated with increased morbidity, family burden, and social cost.

The principal risk factor for relapse in schizophrenia is discontinuation of medication. Even first-episode schizophrenic patients who do not take medication as prescribed show a relapse rate as high as 80% within 5 years. While long-term treatment with typical antipsychotics is associated with a high incidence of adverse effects, newer atypical agents appear to afford better long-term safety and tolerability.

Optimal management strategies for reducing relapse rate in schizophrenia include psychosocial therapy. Other strategies use long-acting, depot medications and relatively well-tolerated atypical antipsychotics to promote adherence with treatment over the long term.

Some studies have reported lower relapse rates in patients receiving depot formulations than in patients receiving oral formulations. Moreover, a study examining outcomes in patients receiving oral and depot fluphenazine reported a lower relapse rate in patients who concomitantly received psychosocial therapy.

In contrast, intermittent treatment that allows patients to discontinue medication when they are in remission and to resume treatment when they begin to experience recurrent symptoms shows a relatively high rate of relapse.

While a combination of psychosocial therapies and continuous pharmacotherapy with depot or atypical antipsychotics remains the best available option, results are still far from satisfactory. More studies are needed to improve therapeutic strategies and reduce relapse rates.