Factors that should shape the LT Rx approach:

• How the patient has been affected by the condition
• How the patient will be helped by the Rx

Summary of evidence based LT Rx approach:

• Antipsychotics are the mainstay of Rx but psychosocial interventions (including psychotherapy) augments clinical improvement
• Most Sz patient’s benefit from combined use of antipsychotic drugs & psychosocial Rx than from either Rx used alone.

LT effects of clozapine (Lindstrom – 1988)

• 96 hospitalised patients with previous non-response to pharmacotherapy:
• 36% patient’s discontinued (due to lack of efficacy, poor compliance, temporary withdrawal of drug in 1975)
• 2 patients: stopped due to agranulocytosis/leukopenia
• 4 patients died (non-drug related)
• 85% could be discharged from the hospital
• Of the 62 with clinical efficacy – after 2 years – 18% had full time jobs & 21% part time
• Global evaluation – significant improvement in 43% & moderate improvement in 38% of patients compared to previous neuroleptic treatments   

Intense family therapy Rx versus additional support therapy (Carra G 2006):

• Patients and family member compliance greater in more intense behavioural management group

Implantable devices to deliver drugs (non-compliance):

• To aid the problem of non-compliance being a factor in less than satisfactory outcome in the treatment of schizophrenia, it has been investigated (with good results) the implantation of a device that delivers the drugs to you.