A good therapeutic relationship seems to be the best predictor of proper adherence24; in this respect, the use of clozapine, which requires a period of appointments with blood tests, would bring about a better therapeutic relationship.25 Comorbidity with drug abuse increases noncompliance.26 The distinction established

between covert noncompliance (resulting from the side VX-680 purchase effects of neuroleptics) and open noncompliance (caused by the characteristics of the illness) is an interesting issue in the exploration of the various factors that can bring about poor adherence.15 Patients’ attitudes toward Inhibitors,research,lifescience,medical the side effects and potential risks of neuroleptics also have an effect on adherence.27 Patients taking classic neuroleptics frequently experience extrapyramidal symptoms, which are also unpleasant for family members. They can also cause weight gain (with increased risk of diabetes mellitus and hyperlipemia), which is poorly tolerated,28 sedation, hypcrprolactincmia, prolonging of the Q-T interval, Inhibitors,research,lifescience,medical and arrhythmia. Children and adolescents are more susceptible to the extrapyramidal symptoms, weight gain, and hyperprolactinemia caused by neuroleptics, due to a higher density

of dopamine D2 receptors in the striatum during this period of development.29 While atypical neuroleptics cause fewer side effects than conventional Inhibitors,research,lifescience,medical ones (particularly extrapyramidal symptoms)30 and have a moderately higher adherence rate than classic neuroleptics,31 the possibility of covert noncompliance should not be underestimated, and efforts to improve adherence should be focused on minimizing the side effects of future

neuroleptics. It is noteworthy that depot Inhibitors,research,lifescience,medical formulations are being developed for atypical neuroleptics with positive results, as in the case of risperidone.32 In addition, providing good social support and possibly administering depot neuroleptics may also be interesting treatment strategies. While the advantages of depot over oral neuroleptics have crotamiton been described Inhibitors,research,lifescience,medical in terms of a lower frequency of relapse,33 these drugs are used relatively infrequently. Valenstein et al found that 18% of 1307 veterans with schizophrenia or schizoaffective disorder used depot neuroleptics, despite the fact that the previous year 49% had been noncompliant with treatment; there were also differences according to where the patients went for appointments and their ethnic group.34 A direct correlation has been found between higher doses of depot neuroleptics and a lower percentage of annual relapses (63% with 25 mg haloperidol decanoate every 4 weeks versus 15% with 200 mg).35 The risk of suspending neuroleptics is higher in patients with positive symptoms or sedation, but the risk is also present in those with few symptoms.