To determine whether depot patients on typical antipsychotics may benefit from a treatment switch.

Outpatients with a reported diagnosis of schizophrenia attending a depot clinic in Dewsbury, UK, were given full psychiatric and physical reviews. Recommendation of patients' future treatment was based on findings. Treatment switches were made three months after baseline assessments.

Of 111 patients considered for review, 108 (63 men/45 women) were assessed; 94.4% had a diagnosis of schizophrenia. Before review, 98% received typical antipsychotic depot preparations and 2% the long-acting atypical antipsychotic, Risperdal Consta. Nearly two-thirds (63.0%) received flupentixol decanoate. Following review, 74.1% patients received long-acting injectable medication, 24.1% oral medication and two patients discontinued treatment. Of those on long-acting injectable antipsychotics, 85.0% received typical depots; 15.0% Risperdal Consta. Most (92.3%) oral medications were atypical antipsychotics. Nearly two-thirds of patients (62.0%) continued on the same medication. On review, hyperprolactinaemia was found in 28 (25.9%) patients, particularly women; treatment was changed for 17 patients, mainly to Risperdal Consta. Eleven (10.2%) patients had glucose abnormalities; treatment was changed for three to risperidone preparations. 41.7% patients had other biochemical abnormalities, mainly liver function tests and dyslipidaemia. Nearly 40% were hypertensive and around one-quarter had electrocardiogram abnormalities.

Data suggest that depot patients on typical antipsychotics may benefit from medication review to consider use of atypicals and other newer classes of antipsychotics, and that health monitoring of these patients may be prudent.