Objective: It is believed that first-generation antipsychotics may cause more extrapyramidal
side effects and second-generation antipsychotics also may cause more metabolic syndrome, cardiovascular disease, and type-2 diabetes. However, there are still a lot of controversial studies about this subject in the literature. In particular, recent studies have shown that there is no difference in terms of efficacy and drug tolerability between these two drug groups. The aim of our study is to monitor if extrapyramidal side effects and changes of metabolic parameters were developed in a 12-month follow-up study with Haloperidol Decanoate (HD).
Methods: Fifty-four patients who were diagnosed with schizophrenia and hospitalized in Bakırkoy Mental Health and Neurological Diseases Hospital consecutively were included in this naturalistic study. The first examination at the inpatient clinic was named as Assessment 0, the interview after HD applied was named as Assessment 1. The next four Assessments (Assessment 2–5) were conducted as weekly follow-up. In the next month, it was organized as twice a week (Assessment 6–7) and next assessments (8–18) once in a month. The following parameters except the clinical efficacy and plasma levels were evaluated:
(1) Assessment of clinical efficacy of haloperidol decanoate and functionality
(2) Plasma levels of haloperidol
(3) Extrapyramidal symptoms and metabolic side effect
(4) The compliance of long-term treatment
Results: Fifty-four patients with schizophrenia consisting of 41 women and 13 men were included in the study. There were no severe side effects like neuroleptic malignant syndrome and acute dystonia during our follow-up study. There were only significant correlations between the beginning high dose of haloperidol and EPS scores in the positive direction. There were no statistically significant differences between measurements in the weight variable, but there was a significant difference in waist circumference. The first measurement of waist circumference was significantly higher from both the mid- and final measurements. Among all of these blood measures, only prolactin levels increased significantly over time with the use of haloperidol. There were no statistically significant differences between values of other metabolic parameters (fasting blood glucose, triglyceride, HDL, iron, Hgb, PRL, and HbA1c). In our study, half of the patients still used haloperidol depot at the end of the year and the remaining half of these patients had the following percentages: 14.8% (n = 8) had an atypical
antipsychotic, 7.4% (n = 4) were treated with mood stabilizer and another antipsychotic, 7.4% (n = 4) had another depot antipsychotic, and 20.4% (n = 11) had left treatment completely. When the causes of dropout from follow-up study were evaluated, it was learnt that 37.14% of patients had changed their treatment after clinician changing, 37.14% of patients discontinued treatment since lack of social support, and 25.71% of patients left treatment with their own desire or side effects.
Conclusions: This study pointed out that the HD was still an effective and tolerable drug for
patients with schizophrenia. It is also important to replicate these results in a hospital where
severe patients with non-adherence story are treated. As a result, clinicians must choose the
best treatment to meet the needs of their patients, leaving the fears and prejudices about the
first-generation antipsychotics.