What is Relapse ?
Is Relapse Immune
Mediated?
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Treat psychosis
Reduce symptoms
Reduce symptoms below a threshold to
make a diagnosis : Symptom resolution
Maintain the patient with no more than
mild positive or negative symptoms for > 6
months : Remission
Recovery is the ultimate goal
Antipsychotics reduce relapse rates by 30-40%
Prophylactic effect in fully remitted patients
Maintain current functional status in partially remitted patients
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RLAI
Olanzapine
pamoate
Paliperidone
palmitate
Administered
intramuscularly every 2
weeks1
Once-monthly deltoid or
gluteal administration,
approved in several
countries including the
USA3 and EU4
Risk of PDSS*
No refrigeration
or reconstitution
Risk of re-hospitalization in
nationwide cohort of
consecutive patients with
schizophrenia hospitalized for
the first time in Finland
Data obtained from national
databases of hospitalization,
mortality and AP prescriptionsa
Perphenazine, oral
Quetiapine
No treatment
Haloperidol, oral
Zuclopenthixol, oral
0
hazard ratios were adjusted for effects of sociodemographic and clinical variables, temporal sequence of APs used, and the choice of
the initial AP for each patient; bPairwise comparison [adjusted hazard ratio=0.36, 95% CI=0.170.75)]
LAI, long-acting injectable; AP, antipsychotic; CI, confidence interval
Reproduced with permission
LAI/Depot
Risk ratio
MH, random, 95% CI
Oral
Events
Total
Events
Total
Arango 2005
Barnes 1983
Del Guidice 1975
Falloon 1978
Gaebel 2010
Hogarty 1979
Li 1996*
Potapov 2008
Rifkin 1977
Schooler 1979
Total (95% CI)
10
3
21
8
54
22
32
4
2
26
26
19
27
20
355
55
155
20
23
143
843
6
3
30
5
102
32
52
8
3
35
20
17
31
24
355
50
137
20
28
147
829
Total events
182
276
Weight
(%)
5.2
1.9
22.8
4.2
18.6
14.8
15.1
3.6
1.4
12.4
100.0
0.01
0.1
Favours depot
10
100
Favours oral
RLAI in FES
18
19
20
21
22
23
p<0.0001
p=0.0025
50
44%
40
30
20
20%
10
0
Paliperidone
palmitate
(n=70)
Placebo
(n=75)
48%
50
40
30
20
13%
10
0
Paliperidone
palmitate
(n=135)
Placebo
(n=128)
p<0.001
p=0.0031
Good adherence
profile
Consider
patients choice
Explain chronic
disease model
Relapse
(due to poor adherence)
Poor adherence
risk profile*
Prior exposure
to neuroleptic
Highly aroused
and agitated
Neuroleptic
naive
Proceed as per
local or
institutional
acute arousal
guidelines
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Guidelines Recommendation
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Thanks !
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