A depot injectable antipsychotic such as haloperidol or fluphenazine decanoate would be an appropriate pharmacotherapy in this situation. The patient is unlikely to cooperate with medication, and the depot form offers at least the hope that an extended period of medication usage could gradually improve the situation to the point where the patient may develop more insight or a better alliance.¹ It is most likely to be helpful during the period of transition from the hospital to the community, when non-compliance with oral medication is often immediate with this type of patient. However, the benefits may not last much longer than that unless other interventions (outreach, improved supervision) are put into place.²
A loading dose strategy is recommended to minimize chances of relapse occurring during the transition to oral to depot. For example, use 100 mg of haloperidol decanoate I.M. weekly for 4 weeks, then 100 mg every two weeks for four weeks, then 100 mg every four weeks.³
After 3-6 months of depot medication usage, reassess if the insight, alliance, or at least the level of supervision and support for oral medication usage has improved to the point where a trial on one of the newer, potentially more effective medications would be feasible. It may be worth the risk of another relapse, even though the patient is relatively stabilized compared to how the patient was before depot treatment, to see if the patient has potential to progress further toward less disability and more normalized activity.
Recommendation #08
