Relapse of schizophrenia due to poor compliance is a major preventable
source of psychiatric morbidity. One often stated reason for non-comp
liance is side effects from the conventional neuroleptics. Minimum eff
ective doses are known from most drugs minimizing side-effects but low
-dose maintenance regimes below these minimum doses lead to relapse. T
he advantages of depot medication in ensuring compliance are clearly u
nderstood, but the use of depots varies enormously in different countr
ies. In the longer term, it is hoped that new atypical neuroleptics ma
y have several intrinsic advantages which maximize patient compliance.
Atypical neuroleptics fall roughly into five groups, the later substi
tuted benzamides, mixed dopamine-serotonin receptor antagonists, speci
fic dopamine compounds, serotonin receptor antagonists and sigma recep
tor antagonists. There are some early indications of improved complian
ce with an atypical neuroleptic, clozapine, but it is difficult to dis
entangle 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.